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Abstract Background Although adherence to a healthy dietary pattern is one of the primary recommendations for the prevention of polycystic ovary syndrome (PCOS), there is still no conclusive evidence of which specific dietary pattern is best. The Lifelines diet score (LLDS) is a new, evidence-based scoring system to determine diet quality, and its association with PCOS has not been investigated. The present study aimed to assess the association between LLDS and PCOS in Iranian women. Materials and methods This frequency-matched case-control study was carried out on 108 women with PCOS and 108 women without PCOS as a control group in Yazd, Iran. Healthy controls were matched to PCOS women based on age and BMI. The validated 178-item food frequency questionnaire was used to assess the usual dietary intake. Logistic regression was used to estimate the association between LLDS and PCOS. Results The findings of the present study showed women in the highest tertile of LLDS compared with the participants in the lowest tertile had 90% lower odds of PCOS (Odds Ratio (OR): 0.10; 95% Confidence Interval (CI): 0.04 to 0.21, p for trend:

Abstract Background Type 2 diabetes mellitus (T2DM) is often linked to chronic inflammation, which can be influenced by both lifestyle and dietary choices. However, the relationship between the inflammatory potential of diet and lifestyle factors and the risk of developing T2DM remains unclear. The present study aimed to investigate the associations of the empirical dietary inflammatory index (EDII), dietary inflammatory score (DIS), and lifestyle inflammatory score (LIS) with the risk of T2DM among Iranian adults. Methods The current study was conducted on 5714 individuals from Yazd Health Study (YaHS) who were followed up for a mean period of six years. YaHS is a prospective cohort study which has been conducted since 2014. Dietary intakes were collected at baseline using the food frequency questionnaire. The relative risk (RR) of T2DM was calculated by Cox regression analysis across tertiles of EDII, DIS, and LIS, adjusted for potential confounders. Results The mean ± SD for the age and body mass index of the study population were 47.0 ± 9.2 years and 26.7 ± 5.1 Kg.m2, respectively. A significant association between LIS and the risk of T2DM was observed (RR: 4.05, 95% CI: 2.61–6.27 P-trend

Abstract Background Polycystic ovary syndrome (PCOS) is the most common ovarian dysfunction. Recent studies showed the effectiveness of licorice on metabolic profiles with inconsistent findings. So, we investigated the effect of licorice on obesity indices, glycemic indices, and lipid profiles in women with PCOS. Methods This randomized, double-blind, placebo-controlled trial was performed on 66 overweight/obese women with PCOS. The participants were randomly assigned to receive either 1.5 gr/day licorice extract plus a low-calorie diet (n = 33) or placebo plus a low-calorie diet (n = 33) for 8 weeks. Participants’ anthropometric indices and body composition were assessed using standard protocols. Fasting blood sugar (FBS), insulin levels, low-density lipoprotein-cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), and high-density lipoprotein-cholesterol (HDL-C) were measured using enzymatic kits. The homeostasis model assessment-insulin resistance (HOMA-IR) and HOMA of β-cell function (HOMA-B) were calculated using valid formulas. Results Between-group comparisons demonstrated significant differences between the groups in terms of obesity indices (body weight, BMI, and body fat), lipid profiles (TG, TC, LDL-C, and HDL-C), FBS and insulin levels, HOMA-IR, and HOMA-B at the end of the study (P

Abstract Background Metabolic syndrome (MetS) as a multifactorial disorder is associated with non-communicable diseases. The dietary approaches to stop hypertension (DASH) diet is a healthy dietary pattern. We investigated the effect of the DASH diet on fatty liver and cardiovascular risk factors in subjects with MetS. Methods 60 Subjects with MetS were assigned into the intervention group (DASH diet) or the control group (a healthy diet). Fatty liver index (FLI), hepatic steatosis index (HSI), waist circumference (WC), weight, body mass index (BMI), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) were evaluated at the beginning and after intervention. Equations of fatty liver indices such as FLI and HSI are based on liver enzymes, anthropometric variables, sex and having diabetes. Results 30 subjects in the intervention group and 29 subjects in the control group completed the study. We found a significant reduction in the intervention group compared to the control group in FLI (-13.06 ± 10.03 vs. -2.90 ± 6.82;P

Abstract Background Polycystic ovary syndrome (PCOS) is the most prevalent cause of ovulatory infertility and endocrine abnormalities in reproductive-age women. Although the MIND diet has been introduced to improve brain function, evidence shows that the MIND diet is rich in beneficial food groups that can have a preventive effect on other metabolic disorders. The present study was conducted to investigate the association between adherence to the MIND diet and PCOS. Methods This age and BMI frequency-matched case-control study was conducted on 216 women between January 2018 and March 2019 in Yazd, Iran. PCOS was diagnosed based on Rotterdam criteria. Participants were selected by convenience sampling method. The validated 178-item food frequency questionnaire was used to assess the usual dietary intake. Logistic regression was used to estimate the association between the MIND diet and PCOS. Results The findings of the present study showed a significant inverse association between adherence to the MIND diet and PCOS in the crude model (OR for T3 vs. T1: 0.12 (95% CI: 0.05–0.25), P-value

Abstract Recent evidence shows the beneficial effects of Baltic Sea diet score (BSDS) and healthy Nordic diet index (HNDI) on chronic diseases, however, there is no evidence to investigate them on the risk of non-alcoholic fatty liver disease (NAFLD). The purpose of this study was to investigate the associations between BSDS and HNDI with the risk of NAFLD. In this case–control study, 552 people in good health and 340 people with NAFLD over the age of 18 took part. The evaluation of BSDS and HNDI employed a validated 168-item semi-quantitative food frequency questionnaire (FFQ). Binary logistic regression was used to determine how OBS and NAFLD are related. The mean BSDS and HNDI were 16.00 ± 2.49 and 11.99 ± 2.61, respectively. The final model's confounder adjustment revealed that greater HNDI adherence scores gave protection against the occurrence of NAFLD (odds ratio [OR]: 0.42; 95% confidence interval [CI] 0.18–0.98; P for trend = 0.043). In addition, those with the highest BSDS scores had significantly lower risks of developing NAFLD compared to subjects with the lowest scores (OR = 0.48, 95% CI 0.32–0.89; p for trend = 0.003). Our findings showed that following a healthy Nordic diet can significantly prevent the risk of developing NAFLD, and suggest that the highly nutritious components of the Nordic diet are beneficial for the prevention of NAFLD.

Abstract Background Metabolic syndrome (MetS) is a cluster of metabolic abnormalities (including obesity, insulin resistance, hypertension, and dyslipidemia), which can be used to identify at-risk populations for diabetes and cardiovascular diseases, the main causes of morbidity and mortality worldwide. The achievement of a simple approach for diagnosing MetS without needing biochemical tests is so valuable. The present study aimed to predict MetS using non-invasive features based on a successful random forest learning algorithm. Also, to deal with the problem of data imbalance that naturally exists in this type of data, the effect of two different data balancing approaches, including the Synthetic Minority Over-sampling Technique (SMOTE) and Random Splitting data balancing (SplitBal), on model performance is investigated. Results The most important determinant for MetS prediction was waist circumference. Applying a random forest learning algorithm to imbalanced data, the trained models reach 86.9% and 79.4% accuracies and 37.1% and 38.2% sensitivities in men and women, respectively. However, by applying the SplitBal data balancing technique, the best results were obtained, and despite that the accuracy of the trained models decreased by 7.8% and 11.3%, but their sensitivity improved significantly to 82.3% and 73.7% in men and women, respectively. Conclusions The random forest learning method, along with data balancing techniques, especially SplitBal, could create MetS prediction models with promising results that can be applied as a useful prognostic tool in health screening programs.

Abstract Background Intake of plant foods and phytochemicals can decrease the odds of mental health. Aim The aim of study is to investigate the association between Dietary Phytochemical Index (DPI) with symptoms of depression, anxiety and stress in a large sample of Iranian adults. Methods In this cross-sectional study, a total of 7385 adults aged 20–50 years old were provided from the recruitment phase of Yazd Health Study, a population-based cohort research on Iranian adults. Food intakes were assessed via a validated and reliable food frequency questionnaire. Symptoms of depression, anxiety and stress were assessed using a validated Depression, Anxiety and Stress Scales questionnaire with 21-items. DPI was calculated by the percent of daily energy intake taken from phytochemical-rich foods. Results After adjustment for potential confounders, normal weight subjects in the highest tertile of DPI had lower odds of depression (OR 0.65; 95% CI 0.44–0.97) and anxiety symptoms (OR 0.65; 95% CI 0.45–0.93) compared with those in the lowest tertile. However, the apparent association was not found between depression, anxiety and stress in overweight and obese subjects. Conclusion We found a significant association between DPI and mental health in normal weight adults. Prospective studies are required to approve these conclusions.

Introduction: Genetic and environmental factors are involved in the pathogenesis of cardiovascular diseases (CVDs). The aim of the study was to investigate between the genotype of the NFKB1 gene and the cardiometabolic risk factor in patients undergoing coronary angiography. Methods: This cross-sectional study was conducted on 462 adults (male and women) aged between 35 and 75 years who referred to Afshar Hospital for coronary angiography in 2021- 2022. The polymerase chain reaction restriction fragment length polymorphism method was used to detect the genotype of rs28362491. Biochemical parameters were measured using commercial kits. Gensini and Syntax scores were calculated using the angiography result to assess the extent of coronary artery stenosis. We used multivariate logistic regression analysis to examine the relationship between genotype variants and cardiometabolic risk factors. Results: There was no association between variant genotypes and abnormally levels of serum alanine aminotransferase (ALT) (P value=0.51), aspartate aminotransferase (AST) (P value=0.99), triglyceride (TG) (P value=0.48), total cholesterol (P value=0.79), low density lipoprotein-cholestero (LDL-C) (P value=0.31), high-density lipoprotein-cholesterol (HDL-C) (P value=0.53), fast blood sugar (FBS) (P value=0.39), systolic blood pressure (P value=0.14), diastolic blood pressure (P value=0.64), Gensini score (P value=0.48) and syntax score (P value=0.74) in the crude model even after adjustment for confounding factors. Conclusion: We found no association between the ATTG polymorphism and cardiometabolic risk factors in patients who had coronary angiography. Further investigations are needed to assess the association between variants of 28362491 and cardiometabolic markers.

Abstract Background Dietary fatty acids can affect brain health by modifying neuronal membrane fluidity. Dietary lipophilic index (LI) and load (LL) may be related to cell membrane fluidity. This study aimed to determine the relationship between dietary LI and LL with symptoms of depression, anxiety and stress. Methods In this cross-sectional study, taken from the YaHS (Yazd Health Study) population-based cohort, the data of 2,982 individuals was extracted. Several questionnaires- a 178-item Food Frequency Questionnaire (FFQ), Depression, Anxiety and Stress Scale 21 (DASS 21), and International Physical Activity Questionnaire (IPAQ)- were used to obtain information on dietary intake, mental status, and physical activity, respectively. LI and LL were calculated using dietary intake and the melting point of each fatty acid. Results The analysis was performed on 2982 individuals. The odds ratio of depression in the second tertile of dietary LI compared to the first tertile was 0.815 (95% CI 0.66–1.00, P = 0.051, Ptrend = 0.017) and after adjusting confounders was 0.793 (95% CI 0.63–0.99, P = 0.043, Ptrend = 0.011). Also, LL was related inversely with anxiety (0.771, 95% CI 0.63–0.93, P = 0.003) that after multiple regression, OR of anxiety was 0.762 (95% CI 0.53–1.07, P = 0.045). The odds of stress in the third tertile of LL was 1.064 but not statistically significant (95% CI 0.88–1.28, P = 0.729). Conclusion This study showed an inverse association between dietary LI and depression symptoms. Anxiety and stress did not show a significant relationship with LI or LL.

Abstract Background Previous studies examined the effects of obesity on sperm parameters and reported inconsistent results. Thus, the present study aimed to evaluate the association between obesity and the quality of sperm parameters in infertile men. Material and methods The present cross-sectional study evaluated 218 infertile men aged 20–50. To this end, the 168-item food frequency questionnaire (FFQ) was utilized to evaluate dietary intake. The anthropometric and biochemical variables were examined using standard methods. Further, the association between obesity and the quality of sperm parameters was evaluated using the controlled linear regression for potential confounders. Results The normal sperm morphology had a significant inverse association with BMI [adjusted β − 0.074, CI (− 0.141 to − 0.008), P = 0.029] and WC [adjusted β − 0.026, CI (− 0.051 to − 0.001), P = 0.038]. Additionally, visceral fat had a marginal inverse association with normal sperm morphology [adjusted β − 0.065, CI (− 0.138 to 0.008), P = 0.079] and non-progressive sperm motility [adjusted β − 0.241, CI (− 0.495 to 0.014), P = 0.063]. Conclusion Even though the present results indicated that obesity, abdominal obesity, and visceral fat had inverse associations with normal sperm morphology, more mechanism-based studies should be conducted to confirm these findings.

Abstract Coronary artery disease (CAD) is one of the most important cardiovascular diseases. Lifestyle and genetic factors play important roles in the development of CAD. The aim of the study is to examine the interaction of dietary patterns and genes on the likelihood of abnormal lipid profile and coronary artery stenosis in Iranians undergoing coronary angiography. This cross-sectional study was performed on 440 patients who underwent coronary angiography. The factor analysis method was used to extract dietary patterns. Commercial kits have been used to assess biochemical parameters. The detection of the rs28362491 genotype was carried out by the method of restriction fragment length polymorphism. Traditional (TDP) and western dietary pattern (WDP) were extracted. We observed an interaction of adherence to TDP and rs28362491 on the odds of having a high Gensini score. These interactions indicated that higher adherence to TDP was associated with higher odds of having a high Gensini score for patients with DD genotype than for those with II genotype. (OR 2.33, 95%CI 1.00–5.44; P = 0.05). These interactions remained statistically significant even after confounder variables. We observed an interaction between higher adherence to TDP and rs28362491 variants on the odds of high low-density lipoprotein cholesterol levels (P = 0.04) in the unadjusted model. We found a significant interaction of this polymorphism and higher adherence to WDP on the odds of having a high Gensini score in the unadjusted model (P = 0.04). This study provides a basis for future research on NF-KB1 gene and diet interaction. More large-scale longitudinal studies are needed to validate these findings.

Abstract Background Previous studies have shown that insulin directly affects the risk of type 2 diabetes mellitus (T2DM) but the relationship between insulinaemic potential of diet and lifestyle and the T2DM risk is still unknown. Accordingly, we aimed to investigate the relationship between the insulinaemic potential of diet and lifestyle based on indices including empirical dietary index for hyperinsulinaemia (EDIH), empirical lifestyle index for hyperinsulinaemia (ELIH), empirical dietary index for insulin resistance (EDIR) and empirical lifestyle index for insulin resistance (ELIR) and the T2DM risk in the Iranian adults. Methods This study was performed on data of enrollment phase of the Yazd Health Study (YaHS) and TAghzieh Mardom-e-Yazd (Yazd Nutrition Study) (TaMYZ) on 5714 adults aged 20–70 years (mean: 36.29 years). A validated food frequency questionnaire and clinical tests were used to assess food intake and T2DM ascertainment, respectively. We used the Cox regression analysis for determining the relationship between the indices and T2DM risk. Results After adjusting for confounding variables, our findings showed that diet with higher ELIH score is 2.28 times more likely for T2DM risk (RR 2.28 [95% CI 1.69–2.56]), but there was no significant relationship between the EDIH, ELIR and EDIR scores and T2DM risk in adults, in the entire study population. Conclusions Our findings suggest that diets with higher ELIH score increases the T2DM risk, but there was no significant relationship between the EDIH, ELIR and EDIR scores and T2DM risk. Further epidemiological studies are needed to confirm our findings.

Abstract Background Postpartum Depression (PPD) is a major depressive disorder that mainly begins within one month after delivery. The present study aimed to determine the relationship between dietary patterns and the occurrence of high PPD symptoms in women participating in the initial phase of the Maternal and Child Health cohort study, Yazd, Iran. Methods This cross-sectional study was carried out in the years 2017–2019 included 1028 women after childbirth The Food Frequency Questionnaire (FFQ) and the Edinburgh Postnatal Depression Scale (EPDS) were study tools. The EPDS questionnaire was used to measure postpartum depression symptoms and a cut-off score of 13 was considered to indicate high PPD symptoms. The baseline data related to dietary intake was collected at the beginning of the study at the first visit after pregnancy diagnosis and the data related to depression, were collected in the second month after delivery. Dietary patterns were extracted by exploratory factor analysis (EFA). Frequency (percentage) and mean (SD) were used for description. Chi-square test, Fisher’s exact test, independent sample t-test, and multiple logistic regression (MLR) were used for data analysis. Results The incidence of high PPD symptoms was 24%. Four posterior patterns were extracted including prudent pattern, sweet and dessert pattern, junk food pattern and western pattern. A high adherence to the western pattern was associated with a higher risk of high PPD symptoms than a low adherence (ORT3/T1: 2.67; p 0.05). Conclusion High adherence to prudent patterns was characterized by high intake of vegetables, fruit and juice, nuts and beans, low-fat dairy products, liquid oil, olive, eggs, fish, whole grains had a protective effect against high PPD symptoms, but the effect of western pattern was characterized by high intake of red and processed meats and organs was reverse. Therefore, it is suggested that health care providers have a particular emphasis on the healthy food patterns such as the prudent pattern.

Abstract Evidence has also shown that oxidative stress and systemic inflammation, or in other words, disruption of the oxidant and antioxidant balance, can play an important role in the initiation or progression of NAFLD. The purpose of this study was to investigate the associations between the oxidative balance scores (OBS) and the risk of NAFLD. 552 healthy and 340 patients adult over the age of 18 with NAFLD participated in this case–control research. A validated 168-item quantitative food frequency questionnaire (FFQ) and indicators of physical activity, obesity, and smoking status were used to assess OBS score. The connection between OBS and NAFLD was discovered using binary logistic regression. The mean (± SD) age and (body mass index) BMI of the study population was 40.22 ± 9.79 years and 29.06 ± 3.92 kg/m2, respectively. The mean ± SD of OBS was 41.48 ± 5.23. After adjustment for potential confounders, higher scores of adherence to the OBS conferred a protection for the presence of NAFLD (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.15–0.49; P for trend

AimNon-alcoholic fatty liver disease (NAFLD) is a condition characterized by the accumulation of fat in the liver without excessive alcohol consumption. Lifestyle modifications, such as adopting a healthy diet, represent the standard treatment for NAFLD. However, the impact of the Dietary Approaches to Stop Hypertension (DASH) diet on oxidative stress biomarkers in patients with NAFLD remains unclear. Therefore, this study aimed to determine the effect of the DASH diet on total antioxidant capacity (TAC), catalase (CAT), superoxide dismutase (SOD) levels, and body composition in overweight and obese patients with NAFLD.MethodsA total of 70 overweight and obese patients aged 1870 years were randomly assigned to either the intervention (DASH diet, n = 35) or the control group (control diet, n = 35) for 12 weeks, with both groups following a calorie-restricted diet.ResultsThe mean age of participants was 43.1 ± 8.1 years in the DASH group and 45.1 ± 8.6 years in the control group. At the end of the study, a significant difference was observed in the mean TAC and SOD levels between the two groups (p = 0.02). After adjusting for potential confounding factors, such as age, sex, diabetes, smoking, physical activity, and baseline values, the DASH diet maintained its significant effects on TAC and SOD compared to the control diet (p = 0.03). However, there were no significant differences in CAT levels between the two groups. Moreover, a significant reduction in visceral fat (p = 0.01) and a marginally significant decrease in BMI (p = 0.06) were observed in the DASH group compared to the control group after adjusting for potential confounders.ConclusionIn conclusion, our study showed that following the DASH diet for 12 weeks in overweight and obese patients with NAFLD has beneficial effects on TAC, SOD, and visceral fat. These findings support the use of the DASH diet as a potential therapeutic intervention for the improvement of oxidative biomarkers in patients with NAFLD.Clinical trial registrationwww.irct.ir/, identifier IRCT20170117032026N3.

Abstract Background and Aims Anthocyanins (ACNs) are water‐soluble plant pigments belong to flavonoids with beneficial effects on health and disease prevention. Some studies have examined the effect of ACNs on anthropometric and body composition indices, but the findings were inconsistent. This systematic review and meta‐analysis aimed to investigate the effect of ACNs and sources rich in anthocyanins on body mass index (BMI), body weight (BW), waist circumference (WC), hip circumference (HC), waist‐hip ratio (WHR), percentage of fat mass (PFM) and fat free mass (FFM). Methods PubMed, Web of Science, Scopus, and Google Scholar were searched with no limitation until May 2021 to find relevant randomized controlled clinical trials (RCT). The risk of bias was assessed utilizing Cochrane collaboration's tool. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were obtained using a random effects model. Results A total of 31 RCTs (with 0.77–640 mg/day of ACNs supplementation for 28–90 days) with 1438 participants were included. No significant effect was found in BMI, WC, HC, WHR, PFM and FFM after ACNs consumption. Conclusions The results showed that ACNs did not significantly affect anthropometric and body composition parameters. Further high‐quality RCTs are required to validate these findings.

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is defined as the excessive accumulation of fat in the liver cells of people who do not drink alcohol. The aim of study is investigated the association between low carbohydrate diets (LCDs) and NAFLD. Methods This age and gender-matched case–control study was conducted on 120 patients newly diagnosed with NAFLD and 120 adults without NAFLD. Diagnosis of NAFLD based on laboratory tests and abdominal ultrasound. Low carbohydrate diets score calculated on the percentage of energy as carbohydrate, fat, and protein. Participants in the highest rank intake of fat and protein and lowest intake of carbohydrate received 10 points. Multivariable logistic odds ratio was used for examine the relation between LCDs and NAFLD. Results This study showed subjects in the highest tertile of LCD has more intake of zinc and vitamin B12 compare to lowest. Also, intake of protein (p = 0.02) carbohydrate (p

Background: Quercetin is one of the main flavonoids, overall distributed in plants. The antioxidant capacity of quercetin is several times vitamin E and glutathione. This systematic review and meta‐analysis of randomized controlled trials were performed to determine the effect of quercetin on oxidative stress (OS) markers. Methods: A literature search was conducted in PubMed, ISI Web of Science, Scopus, and Google Scholar to February of 2021. Meta-analysis was conducted on 8 eligible RCTs containing a total of 668 participants. The weighted mean difference (WMD) with 95% confidence intervals (CIs) was calculated for a pool effect size of Malondialdehyde (MDA), Total Antioxidant Capacity (TAC), and Ferric Reducing Ability of Plasma (FRAP). Subgroup analyses were performed based on intervention duration and dosage. The heterogeneity of studies was examined by Cochran's Q test and I-squared (I2) statistic. Results: Effect sizes from 668 participants based on the random effect model showed that quercetin supplementation had no significant effect on TAC and MDA compared to the control group. The analysis illustrated that quercetin supplementation significantly increased FRAP in adults (WMD = -0.159 mmol/l, 95% confidence interval (CI):-0.178, -0.141, P ≤ 0.001). Conclusions: The finding of the current study showed that quercetin supplementation had no significant effect on TAC levels, although it significantly increased FRAP levels in adults. Also, MDA level did not markedly change. It has needed to conduct clinical trials with more quality and bigger sample sizes to verify the positive impact of quercetin on stress oxidative marker.

Background: This systematic review and meta‐analysis of randomized controlled trials (RCTs) was conducted to determine the effect of dark chocolate on C-Reactive Protein (CRP) levels as one of the inflammatory factors. Methods: A literature search was conducted in PubMed, ISI Web of Science, Scopus, and Google Scholar up to April of 2020. The registration number of study in PROSPERO was CRD4202020072, which was conducted over 5 eligible RCTs containing a total of 330 participants. The weighted mean difference (WMD) with 95% confidence intervals was calculated for the pool effect size of CRP. The heterogeneity of studies was examined by Cochran's Q test and I-squared (I2) statistic. Results: Effect sizes from 330 participants based on random effect model showed no effect between consumption of dark chocolate on CRP levels compared to the control group (WMD: 0.01 mg/dl; 95% CI: −0.19, 0.22 mg/dl; P = 0.89; Cochran's Q test, Q statistic = 21.97; P < 0.001; I2 = 81.80%). The results of subgroup analysis based on intervention duration and dosage showed no significant effect on CRP levels (WMD = 0.05 mg/dl, 95% CI: −0.30, 0.42 mg/dl; P = 0.76). Meta-regression for the intervention duration (slope: −0.0033, 95% CI: −0.0089, 0.0022; P = 0.24) and dosage (slope: 0.00006, 95% CI: −0.0036, 0.0037; P = 0.97) indicated no significant relationship with the mean difference of CRP. Conclusion: The results of the present meta-analysis showed that consuming dark chocolate had no significant effect on the CRP level. More clinical trials are required with higher quality and bigger sample sizes to verify the positive impact of dark chocolate on the reduction CRP level.

Abstract Background Attention deficit/hyperactivity disorder (ADHD) is the most common chronic mental and behavioral disorder among children. Some studies showed the lower levels of vitamin D in patients with ADHD compared with the healthy people. Few clinical trials were conducted in this field. The present study will be performed to examine the effect of vitamin D supplementation in children with ADHD. Methods We will conduct a double-blind, randomized controlled clinical trial to investigate the effect of vitamin D supplementation on brain waves, behavioral performance, serum nitric oxide, malondialdehyde, and high-sensitivity C-reactive protein in 50 patients with ADHD. The intervention group will receive one capsule 50,000 IU vitamin D every week, for 8 weeks. The control group will receive one placebo capsule containing 1000 mg olive oil every week. Electroencephalography will be performed for 10 min using Brain Master Discovery from 19 scalp sites both before the first intervention and the 10 sessions of the therapy. The artifact-free periods of 1-min electroencephalography data will be analyzed for quantitative electroencephalography measures. Discussion For the first time, this clinical trial will evaluate the effect of vitamin D supplementation on brain waves, serum nitric oxide, malondialdehyde, and high-sensitivity C-reactive protein in patients with ADHD. The results of the present clinical trial will provide a better vision about the vitamin D efficacy in patients with ADHD. Trial registration Registered on 5 November 2020 at Iranian Registry of Clinical Trials with code number IRCT20200922048802N1 ( https://www.irct.ir/trial/51410 ).

Abstract Background Osteoarthritis is associated with obesity, dyslipidemia and cardiovascular diseases. It has been hypothesized that L-carnitine can improve cardiovascular risk factors. We aimed to investigate the effect of L-carnitine supplementation on lipid accumulation product (LAP) and atherogenic indices in women with overweight/obesity who have knee osteoarthritis. Methods In this double-blind randomized controlled trial, seventy-six women with overweight/obesity who had knee osteoarthritis were assigned into the intervention group and control group for 12 weeks. The intervention group received 1000 mg/day L-carnitine as capsule, and the control group received placebo. The primary outcomes were LAP, atherogenic index of plasma (AIP), atherogenic coefficient (AC) and Castelli risk index II (CRI-II). Results We found no significant difference between the groups in baseline values of LAP, AIP, AC and CRI-II. After the intervention, a significant reduction in LAP was observed in intervention group compared to the control group (− 11.05 (− 28.24 to 0.40) vs. − 5.82 (− 24.44 to 2.68); P = 0.03). However, there was no significant difference between two groups in AIP (− 0.05 ± 0.16 vs. − 0.01 ± 0.13; P = 0.19), AC (− 0.40 ± 0.81 vs. − 0.30 ± 0.67; P = 0.67) and CRI-II (− 0.20 ± 0.76 vs. − 0.21 ± 0.47; P = 0.11). Conclusions L-carnitine supplementation for 12 weeks can improve LAP, but it has no effect on cardiovascular outcomes. To reach a definitive conclusion, further clinical trials with larger sample sizes and higher dosages of L-carnitine are needed. Trial registration Registered on 27/4/2017 at Iranian Registry of Clinical Trials IRCT2017011932026N2.

Abstract Background Given the role of dietary antioxidants in relieving depression, anxiety, and stress, as well as studies on the beneficial effects of the Mediterranean and Dash diets separately on these problems, in this study, we examine the relationship between the MIND index (Mediterranean- DASH diet Intervention for Neurodegenerative Delay) as a combined indicator of the Mediterranean and DASH diet with psychological disorders such as depression, anxiety, and psychological stress among a large sample of the Iranian adult population. Methods This cross-sectional study was performed on 7165 participants of the enrollment phase of Yazd Health Study (YaHS) and Yazd Nutrition Study (TAMYZ) a valid 178-item semi-quantitative food frequency questionnaire (FFQ) was used to assess participants’ food intake. The MIND diet score was calculated based on participants’ dietary intakes obtained from FFQ. Also, the valid Iranian version of the Depression, Anxiety, and Stress Scale (DASS 21) was used to assess psychological disorders and stress. In addition, the association between the MIND diet and psychological disorders and stress was assessed through logistic regression. Results The mean ± SD score was 3.33 ± 3.79 for depression, 2.99 ± 3.65 for anxiety, and 5.93 ± 4.70 for psychological stress. The mean score of MIND in this study was 7.56. After adjustment for after adjusting for age, gender, intake of energy, BMI, history of chronic disease, marital status, education level, smoking history, physical activity level, pregnancy or lactation, intakes of dietary EPA, DHA, and fiber, individuals in highest compared to the lowest quartile of MIND diet score had significantly lower odds of depression (OR = 0.62, 95% CI 0.40 – 0.96; P-trend = 0.02) and anxiety (OR = 0.61, 95% CI 0.41 – 0.91; P-trend = 0.01). However, no significant association was observed for psychological stress (OR = 0.57, 95% CI 0.28 – 1.14; P-trend = 0.83). Conclusion Therefore, it seems that following the MIND diet can prevent the possibility of these psychological problems. However, there is a need to design studies with more robust methodologies such as clinical trial studies.

Background: Attention to children's nutrition is important; since they are the most sensitive and vulnerable group in the community against malnutrition and food shortages. Therefore, this study aims to design, implement, and evaluate the effect of educational programs based on (philosophy for children) on thinking skills about healthy breakfast consumption of sixth-grade elementary school students in Yazd. Methods: The present clinical trial study was performed on 120 sixth-grade students of public schools in Yazd. Data were collected using a researcher-made questionnaire in control and experimental groups before and after the educational program. Results: The results showed that the mean score of critical thinking after the intervention (38.7 ± 81.1) in the experimental group (EG) increased compared to before the intervention (29.2 ± 96.4), which was statistically significant (P < 0.001). Based on the results, the difference observed in the mean score of critical thinking, caring, and creative thinking of sixth-grade students before and after the intervention in the two groups was significant (P < 0.001). On the other hand, the mean score of students' critical, caring, and creative thinking in the EG increased. In other words, the designed educational program improved all three skills in the EG. The mean scores of critical, caring, and creative thinking of sixth-grade students in the control group (CG) before and after the educational program in two stages were not significant (P > 0.05). Conclusion: According to the obtained results, the implementation of philosophy education programs for children raises the level of critical thinking, caring, and creative skills in students to eat a healthy breakfast. Therefore, increasing philosophical thinking in students and improving the studied skills through education, even virtually, can be very valuable and effective.

Abstract Background The prevalence of non-alcoholic fatty liver disease (NAFLD) is rising at an exponential rate throughout the world. Given the confirmed association between nutritional status and NAFLD, this study aimed to investigate the relationship of dietary patterns with NAFLD in overweight and obese adults. Methods In this age- and gender-matched case–control study, 115 newly diagnosed cases and 102 control individuals participated. A validated 178-item semi-quantitative food frequency questionnaire was administered to assess the participants' dietary data. Dietary patterns were extracted from 24 predefined food groups by factor analysis. Multivariate logistic regression was run to evaluate the relationship between dietary patterns and NAFLD. Results Factor analysis resulted in: “western”, “traditional”, and “snack and sweets” dietary patterns. The NAFLD odds were greater in participants at the highest quintile of the “western” dietary pattern than the lowest quintile (OR: 3.52; 95% CI: 1.64, 8.61). A significant increasing trend was observed in NAFLD odds across increasing quintiles of the “western” dietary pattern (P-trend = 0.01). After adjusting for the potential confounders, this relationship remained significant (OR: 3.30; 95% CI: 1.06–10.27). After full adjustments, NAFLD had no association with “traditional” or “snack and sweets” dietary patterns. Conclusion The “western” dietary pattern containing fast food, refined grains, liquid oil, pickles, high-fat dairy, sweet desserts, red meat, tea, and coffee was associated with increased odds of NAFLD. However, further prospective studies are required to establish these results.

Polycystic ovary syndrome (PCOS) is a common endocrine abnormality among reproductive-aged women. This study aimed to investigate the relevance of major nutrient patterns and PCOS. Methods: This age-body mass index (BMI) matched case-control study was conducted among 216 women with and without PCOS. The validated 178-items food frequency questionnaire (FFQ) was used for driving nutrient patterns. Logistic regression was used to assess the relationship between nutrient patterns and odds of PCOS. Results: Four major nutrient patterns were identified (65% of the variances of nutrient intake), including factor 1) high in carbohydrate, saturated fatty acids (SFA), total fat, and low in Eicosapentaenoic acid (EPA), Docosahexaenoic acid (DHA), factor 2) high loadings of SFA, cholesterol, vitamin D, total fat, and total fiber, factor 3) high in total fiber, EPA, DHA, chrome, vitamin C, vitamin D, and polyunsaturated fatty acids (PUFA), and factor 4) high loaded by fat, sodium, SFA, and low in vitamin D. Factor 1 and factor 4 nutrient patterns significantly increased the odds of PCOS (OR = 7.42; 95% CI 2.86, 18.1; Ptrend < 0.001) and (OR = 11.32; 95% CI 4.3, 29.97; Ptrend < 0.001), respectively. Also, the moderate adherence to factor 3 nutrient pattern had a protective effect on odds of PCOS (OR = 0.77; 95% CI 0.39, 0.98; Ptrend = 0.04). Conclusion: It was found that factor 1 nutrient pattern increased the odds of PCOS and factor 3 nutrient pattern decreased the risk of PCOS. More prospective studies are required to confirm the study findings.

Abstract Background The association between the Mediterranean diet (MED) or dietary approach to stop hypertension (DASH) and cardiovascular disease (CVD) risk factors is well-documented. Nevertheless, a consistent relationship with the Middle East population has yet to be known. Thus, we aimed to investigate the association between DASH/MED and blood lipids in Iranian adults. Methods Four thousand seven hundred forty participants, aged 35–70 years (mean: 50.0) participated in the Shahedieh cohort study in Yazd, Iran, were followed from 2016 until now. Participants provided dietary and blood lipid data through a validated semi-quantitative food frequency questionnaire, and blood samples were taken after a fasted state. We used binary logistic regression to examine the association between DASH/MED scores and blood lipids. Results In the participants who ingested a DASH-like diet the third vs. the first tertile of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) levels, and LDL/HDL (high-density lipoprotein) ratio reduced significantly (P

Abstract Background Despite the protective effects of foods being rich in phytochemicals against chronic diseases, this issue is still poorly understood. The aim of this study was to investigate the association between Dietary Phytochemical Index (DPI) and metabolic syndrome (MetS) and its components. Methods This cross-sectional study focused on adults aged between 20 and 70years. The dietary intake was assessed using a validated and reliable food frequency questionnaire. DPI was calculated based on dietary energy, derived from phytochemical-rich food sources (kcal) per total daily energy intake (kcal). The odds ratio of MetS and its components were assessed across DPI quartiles by logistic regression models. Results After adjustment for all potential confounders, the risk of MetS (OR: 0.63, 95% CI = 0.41–0.96) and elevated blood pressure (OR: 0.62, 95% CI = 0.40–0.96) in the second category of DPI decreased significantly as compared to that in the first category. Subjects in the second and fourth quartiles of DPI with adjusting for age, sex and total energy intake revealed 30 and 25% lower risk of abdominal obesity, respectively. After full adjustment for confounders, the analysis stratified by sex showed women in the highest quartile of DPI had 59% lower risk of MetS (OR: 0.41, 95% CI = 0.22–0.76) as compared to those in the lowest quartile of DPI. Conclusions Greater adherence to phytochemical-rich diet could reduce odds of MetS and some components, especially in women. Further studies with intervention approaches are recommended.

Abstract Background The literature showed that Grape Products Containing Polyphenols (GPCP) had anti-oxidant activity. However, the effects of GPCP on different biomarkers of oxidative stress are still controversial. In this regard, this systematic review and meta-analysis aimed to evaluate the effect of Grape Products Containing Polyphenols (GPCP) intake on oxidative stress markers. Methods PubMed, Scopus, Web of Science, and Google Scholar data bases were searched up to August 20, 2020. A random-effects model, weighted mean difference (WMD), and 95% confidence interval (CI) were applied for data analysis. Meta-analysis was conducted over 17 eligible RCTs with a total of 633 participants. The study registration number is CRD42019116696. Results A significant increase was observed in Total Antioxidant Capacity (TAC) (weighted mean difference (WMD) = 1.524 mmol/L, 95% confidence interval (CI): 0.83, 2.21). Intake of GPCP enhanced Superoxide Dismutase (SOD) (WMD = 0.450 mmol/L, 95% CI: 0.23, 0.66), TAC (WMD = 2.829 mmol/L, 95% CI: 0.13, 5.52), and Oxygen Radical Absorbance Capacity (ORAC) (WMD = 0.524 μmol/L, 95% CI: 0.42, 0.62) among healthy participants. Higher GPCP doses increased SOD (WMD = 0.539 U/mgHb, 95% CI: 0.24, 0.82) and ORAC (WMD = 0.377 μmol/L, 95% CI: 0.08, 0.67), whereas longer intervention periods enhanced ORAC (WMD = 0.543 μmol/L, 95% CI: 0.43, 0.64). Conclusion GPCP intake may partly improve status of oxidative stress, but further well-designed trials are required to confirm these results.

Abstract Backgrounds L-carnitine decreases oxidation and inflammation by reducing the fatty acid in plasma and using oxygen in ATP synthesis. As such, knee osteoarthritis (KOA) can be improved by reducing apoptotic chondrocytes. This study was designed to compare the effect of L-carnitine supplementation and low-calorie diet on improving KOA among obese women. We further investigated the effect of L- carnitine on improvement of KOA in obese women on low calorie diet. Methods To conduct the study, 76 obese women with KOA were randomly assigned into two low-calorie diet groups: the first received 1000 mg of LCG and the second took the placebo (PLG) (n = 38). Anthropometry indices, body composition, lipid profile, C-reactive Protein (CRP), Malondialdehyde (MDA), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were assessed at the baseline condition and after 12 weeks. Results The mean change of body mass index (BMI) (− 1.21 ± 0.84 vs. -0.79 ± 0.70; P = 0.02) and weight (− 2.76 ± 1.69 vs. -1.95 ± 1.73; P = 0.05) were significant in the LCG compared with the PLG. Likewise, LCG compared to the PLG showed insignificant improvement in waist circumference (WC) (− 5.65 ± 5.85 vs. -3.64 ± 3.37; P = 0.08). Total cholesterol (P = 0.02), MDA (P = 0.03), fat mass (P = 0.03) and visceral fat (P = 0.001) only showed decreased levels in LCG in comparison to the baseline condition. There was no significant difference between LCG and PLG, in the mean changes of hip circumference, visceral fat, free fat mass, fat mass, lipid profiles, CRP, MDA as well as stiffness, physical function, decrease of pain and total scores (P > 0.05). Conclusion The 12-week L-carnitine supplementation could improve BMI, but had no significant effect on other anthropometric and body composition measures as well as clinical symptoms, CRP, MDA, and lipid profile in women with KOA. Further trials with higher doses and longer durations are required. IRCT registration number: IRCT2017011932026N2. Registration date: 2017-04-27.

Abstract Background Since evidence regarding to low carbohydrate diet (LCD) and psychiatric disorders is little and controversial, this study aimed to assess relation between LCD score and psychological disorders including depression, anxiety, and stress among a large representative sample of Iranian adult population in Yazd city, Iran. Methods This cross-sectional analysis was conducted on data of 7165 persons who participated in the recruitment phase of Yazd Health Study (YaHS) and Taghzieh Mardom-e-Yazd (TAMIZ) study. Dietary intakes were evaluated by a validated semi-quantitative food frequency questionnaire. LCD score was calculated for each person according to summing up assigned scores to deciles of percentages of energy from macronutrients. Assessment of psychological disorders was also conducted by the validated Iranian version of depression, anxiety and stress scale questionnaire (DASS 21). Eventually, association between adherence to LCD and psychological disorders was evaluated via logistic regression. Results After adjusting the confounders, women in the third quartile of LCD score might had 38% lower chance of depression versus those in the first quartile (odds ratio (OR) = 0.62, confidence interval (CI) = 0.42–0.93). However, no significant relationship was observed for other psychological disorders. Conclusions More adherences to LCD might be associated with lower chance of depression only among women. Further studies special prospective studies are required to validate these results.

Introduction: We know mothers with gestational diabetes mellitus (GDM) are in the higher postpartum risk of spare weight gain and type 2 diabetes. Excessive postpartum weight gains also lead to low maternal vitamin D levels. So, we decided to evaluate the result of a single mega dose of injectable vitamin D in postpartum weight gain and other anthropometric measurements in the new cases of GDM. Methods: This is a randomized clinical trial study with the follow-up time of 3 months. Totally 45 people were randomly allocated into control and intervention groups. The intervention group got only one IM injection of 300,000 IU of vitamin D whereas controls did not. The body mass index (BMI), waist circumference, hip circumference and waist to hip ratio were quantitated. Results: 24 mothers with an average age of 30.7±6.2 in the intervention group and 21 mothers with an average age of 29.5±4.0 in the control group took part in the study. Waist circumference and hip circumference reduced in the intervention group in compared to the control group (P value= 0.006), significantly. Changes of BMI were not significant after intervention (P value= 0.9). Conclusions: Only one single 300,000 IU dose of vitamin D decreased waist and hip circumference in postpartum of GDM women, but it did not find any significant effect on BMI. Further prospective studies with longer follow up period are necessary.

Summary: Background & aims: Vitamin D is being increasingly recognized for its important non-skeletal functions including endocrine actions. This study investigated if a single, large, intramuscular postpartum injection of vitamin D improve adiponectin levels among women with gestational diabetes mellitus (GDM). Methods: A total of 45 pregnant women with GDM participated in this randomized clinical trial. They were randomly divided into intervention and control group. The intervention group received an intramuscular injection of 300,000 IU of vitamin D during 3–10 days after their child delivery, but controls did not. Serum 25-hydroxyvitamin D, fasting plasma glucose (FPG), hemoglobin A1c (HbA1c) and serum adiponectin were measured at baseline and after 3 months of intervention. Results: Serum 25 OH vitamin D increase significantly in the intervention but not in the control group from 24.25 to 62.10 (nmol/L) (p-value

Background: Polycystic ovarian syndrome (PCOS), one of the most common causes of endocrine disorders with irregular menstruation, is accompanied by an increase in androgen and polycystic ovarian. The aim of this study was to evaluate the effect of weight loss regimen with and without supplementation. L-carnitine affects lipid profile, insulin, and hormone resistance indices. Methods: This double-blind randomized clinical trial was conducted over women within the age range of 18 to 45 years, who referred to Yazd Diabetes Center in 2019. The participants were divided into the experimental and control groups. The intervention group received 1000 mg L-carnitine (LG = 28) and the placebo group (PG = 28) received the placebo daily. All people followed a low celery diet for 12 weeks. Anthropometric indices and body composition (weight, body mass index, waist circumference, hip circumference, fat mass, and free fat mass) were measured prior to and after the intervention. Data analysis was performed using SPSS software version 22. The independent sample t-test was used to compare the mean changes between the LG and PG. Results: At the end of the study period, patients treated with L-carnitine showed a significant decrease in waist circumference compared to the PG (change: -1 ± 3.15, P = 0.001) and no significant difference was observed between the two groups in terms of other anthropometrics indices and body composition including fat mass, body mass index, and hip circumference (P > 0.05). Conclusion: The present study showed that 1000 mg oral L-carnitine had no significant effect on body weight, body mass index, body composition, and hip circumference, but had a significant effect on waist circumference size

Abstract Background Depression is a major contributor to disability-adjusted life years (DALY) lost in the world. Dietary patterns are widely used to investigate diet–disease relations. In the current study, the relationship between dietary patterns and depression was investigated. Besides, the role of serum vitamin D, zinc, magnesium, and total antioxidant capacity as potential mediatory variables was studied. Methods It was an individually matched case–control study in which 330 depressed and healthy subjects were recruited for the extraction of dietary patterns; psychiatrists diagnosed major depressive disorder, using the criteria of the Diagnostic and Statistical Manual of Mental Disorders. Serum vitamin D and aforementioned biomarkers were measured for a number of randomly selected depressed and healthy individuals. We conducted mediatory analysis by regression models. Results Healthy and unhealthy dietary patterns were associated with the lower and higher odds of depression (OR 0.39, CI 0.17–0.92 and OR 2.6, CI 1.04–6.08), respectively. A significant relationship between serum vitamin D with depression after adjusting for potential confounders was observed as well (OR 0.93, CI 0.87–0.99). According to the mediatory analysis the unhealthy dietary patterns were related to depression via altering the serum vitamin D concentration. Conclusion This study showed that vitamin D deficiency mediates the relationship between unhealthy dietary patterns and depression. However, to get a clearer result further prospective studies are required.

Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children. Children with ADHD usually have low blood pressure and weight disorders. Therefore, the present randomized clinical trial was conducted to evaluate the effect of Dietary Approaches to Stop Hypertension (DASH) on weight and blood pressure of children with ADHD. Methods: In this research, 86 children aged 6 to 12 years with diagnosed ADHD according to Conner’s Teacher's Questionnaire and DSM-4 criteria were investigated. Participants were randomly assigned into two groups to receive a DASH diet and a control diet for 12 weeks. Participants' anthropometric indices, blood pressure, physical activity, and dietary compliance were evaluated each month. Adherence to the diet was studied using a three-day food report completed by the participants' parents. Results: A total of 80 children completed the study (40 in each group). No significant difference was observed in any of the weight composition indices measured before and after the intervention between the study groups (P > 0.05). No significant difference was reported in the systolic and diastolic blood pressure between the study groups at the baseline. However, diastolic blood pressure increased in the DASH group significantly compared to the control group (P = 0.02). Conclusion: The DASH diet might increase the diastolic blood pressure in children with ADHD. Further studies with a longer follow-up period are necessary to confirm these results.

Abstract Background Previous studies showed an association between dietary intakes and psychological disorders. This study aimed to assess the association between dietary intakes and psychiatric disorders in Iran. Methods In this cross sectional research, the data on 9965 adults were extracted from enrollment phase of Yazd Health Study (YaHS); a population-based cohort study on Iranian adults which was conducted during 2014 to 2016. Data on socio-demographic characteristics, tobacco use, history of chronic disease, and dietary assessment were collected using a validated researcher-made questionnaire. Moreover, anthropometric measurement was conducted. Psychological and physical activity assessments were also performed by depression, anxiety and stress scale questionnaire (DASS 21 items) and the short form of the International Physical Activity Questionnaire (IPAQ) respectively. Finally, multiple logistic regression analysis was used to evaluate relation between dietary intakes and psychological disorders. Results After adjusting for the confounders, egg (depression: OR = 0.72, 95% CI: 0.52–0.98; anxiety: OR = 0.72, CI: 0.55–0.94), fruits (depression: OR = 0.60, 95% CI: 0.43–0.82; anxiety: OR = 0.70, 95% CI: 0.53–0.91), milk (depression: OR = 0.72, CI: 0.58–0.89; anxiety: OR = 0.73, CI: 0.61–0.87), and yogurt (depression: OR = 0.67, CI: 0.47–0.97; anxiety: OR = 0.54, CI: 0.4–0.73) were found to have protective effects on depression and anxiety. Higher fish consumption was associated with greater depression odds (OR = 1.54, CI: 1.18–2.04). Vegetables’ intake had an inverse relationship with anxiety (OR = 0.74, CI = 0.58–0.93) and stress (OR = 0.59, CI: 0.42–0.82). Fruits (OR = 0.6, CI: 0.43–0.85) and milk consumption (OR: 0.61, CI: 0.47–0.77) were found to have protective effects on stress. Conclusions Egg, fruits, milk, yogurt, and vegetables’ consumption had an inverse relationship with psychiatric disorders; whereas, higher fish intake was associated with higher depression chance. Further prospective studies are needed to confirm these findings.

Background: Attention deficit hyperactivity disorder (ADHD) is the most common chronic mental disorder among children. Children with ADHD may be at risk for a variety of nutrients' deficiencies. We aimed to assess the nutrients' intakes among ADHD children and compare them with the healthy ones. Methods: This was a hospital-based case-control survey over 120 ADHD as the cases and 240 non-ADHD children as the control participants aged 6-13 years. Usual dietary intakes were assessed using a validated semi quantitative food-frequency questionnaire (FFQ). The P-values were considered significant if they were < 0·05. Results: Energy: 2812.2 ± 1029.9 kcal/day vs. 3136.4 ± 1360.3 kcal/day, P = 0.001), fat: 78.3 ± 28.8 g/day vs. 87.2 ± 44.9 g/day, P > 0.001), and carbohydrate: 436.8 ± 192.6 g/day vs. 479.9 ± 244.2 g/day, P = 0.009) intakes were significantly lower in ADHD than healthy children. Similarly, consumption of calcium: 968.5 ± 358.3 mg/day vs. 1055.7 ± 453.4 mg/day, P = 0.03) and magnesium: 363.1 ± 173.9 mg/day vs. 411.9 ± 220.8 mg/day, P = 0.01) were significantly lower in the cases than control group. However, intakes of thiamin: 34.4±18.8 mg/day vs. 40.4 ± 25.6 mg/day, P = 0.002), riboflavin: 1.99 ± 0.76 mg/day vs. 2.21 ± 0.95 mg/day, P = 0.01), niacin: 24.9 ± 10.6 mg/day vs. 27.5 ± 13.2 mg/day, P = 0.01), and vitamin B5: 6.85 ± 3.35 mg/day vs. 7.49 ± 3.84 mg/day, P = 0.02) were significantly lower in the case than control group. Conclusion: Children with ADHD consumed significantly lower quantities of energy, macronutrients, calcium, magnesium, B vitamins (B1, B2, B3, B5), and vitamin C compared with the healthy children.

Abstract Background The dramatic increase in the prevalence of type 2 diabetes mellitus (T2DM) is a global major challenge to health. Circulating microRNAs have been suggested as promising biomarkers for different disorders such as diabetes. Imbalances in the gut microbiome have been revealed to contribute to the progression of multiple diseases including T2DM. Recently, the consumption of probiotics and synbiotics in the treatment of various diseases has shown a substantial growth. The anti-diabetes and anti-inflammatory effects of synbiotics have been indicated, which may be due to their beneficial effects on the gut microbiome. However, further research is needed to assess the effects of synbiotics on the microbiota and their impacts on expression of microRNAs relating to T2DM. Thus, we will aim to assess the effects of synbiotics on microbiota, serum level of tumor necrosis factor-α (TNF-α), and expression of microRNA-126 and microRNA-146a in patients with T2DM. Methods Seventy-two patients with T2DM will be recruited in this double-blind randomized parallel placebo-controlled clinical trial. After block matching based on age and sex, participants will be randomly assigned to receive 1000 mg/day synbiotic (Familact) or placebo for 12 weeks. The microRNA-126 and microRNA-146a expression levels will be measured by real-time polymerase chain reaction and serum TNF-α level will be assessed by enzyme-linked immunosorbent assay kit at the beginning and at the end of the study. Determination of the gut microbiota will be done by quantitative polymerase chain reaction methods at baseline and at the end of the trial. Biochemical assessments (glycemic and lipid profiles) will also be conducted at onset and end of the study. Discussion This is the first randomized controlled trial that will determine the effect of synbiotic supplementation on the gut microbiota and its probable impacts on serum levels of TNF-α and expression of related microRNAs in patients with T2DM. Trial registration Iranian Registry of Clinical Trials: IRCT20180624040228N2. Registered on 27 March 2019. http://www.irct.ir/trial/38371 .

Abstract Background Major depressive disorder is among main worldwide causes of disability. The low medication compliance rates in depressed patients as well as the high recurrence rate of the disease can bring up the nutrition-related factors as a potential preventive or treatment agent for depression. The aim of this study was to investigate the association between dietary patterns and depression via the intermediary role of the serum folate and vitamin B12, total homocysteine, tryptophan, and tryptophan/competing amino acids ratio. Methods This was an individually matched case-control study in which 110 patients with depression and 220 healthy individuals, who completed a semi-quantitative food frequency questionnaire were recruited. We selected the depressed patients from three districts in Tehran through non-probable convenience sampling from which healthy individuals were selected, as well. The samples selection and data collection were performed during October 2012 to June 2013. In addition, to measure the serum biomarkers 43 patients with depression and 43 healthy people were randomly selected from the study population. To diagnose depression the criteria of Diagnostic and Statistical Manual of Mental Disorders, fourth edition, were utilized. Results The findings suggest that the healthy dietary pattern was significantly associated with a reduced odds of depression (OR: 0.75; 95% CI: 0.61–0.93) whereas the unhealthy dietary pattern increased it (OR: 1.382, CI: 1.116–1.71). The mediation analysis showed that the healthy dietary pattern was associated with a reduced risk of depression via increased serum levels of the folate and vitamin B12; however, the unhealthy dietary pattern was associated with increased risk of depression via decreased serum levels of folate and vitamin B12, based on tree adjusted logistic regression models. Conclusion Dietary patterns may be associated with depression by changing the serum levels of folate and vitamin B12. Further studies are required to confirm the mechanism.

Abstract Background Since an association has been found between diet and psychological problems, this study aimed to evaluate the relationship between dietary habits and psychological problems among Iranian adults. Methods Data on dietary habits and psychological problems among 9965 adults were provided from the recruitment phase of Yazd Health Study, a population-based cohort research on Iranian adults. The association between dietary habits and psychological problems was assessed by multiple logistic regression analysis. Results After the adjustment for confounders, fast food and fried food consumptions were associated with increased depressive [odds ratio (OR) = 1.61, 95% confidence interval (CI) 1.18–2.20] and stress symptoms (OR = 2.47, 95% CI 1.46–4.18), respectively. Eating breakfast had a protective role on stress features (OR = 0.60, 95% CI 0.39–0.92), while snack intake was related to higher odds of depressive (OR = 1.36, 95% CI 1.01–1.84), anxiety (OR = 1.99, 95% CI 1.55–2.56) and stress symptoms (OR = 1.73, 95% CI 1.23–2.54). There was also an inverse association between sweetened drink consumption and depressive (OR = 0.76, 95% CI 0.59–0.96), anxiety (OR = 0.76, 95% CI 0.62–0.93), and stress features (OR = 0.73, 95% CI 0.55–0.97; OR = 0.63, 95% CI 0.48–0.82). Conclusions Even though an inverse relationship was found between sweetened drinks intake and psychological problems, snack consumption was associated with higher chances of them. Eating breakfast had a protective effect on stress symptoms, while fast food and fried food intakes were related to increased depressive and stress features chances, respectively.

Background: Metabolic syndrome (MetS) is a collection of metabolic disorders including abdominal obesity, dyslipidemia, high glucose levels, and high blood pressure. The macronutrients such as carbohydrates, proteins, and fats are the effective factors in the occurrence of MetS. This study aimed to determine the association between the macronutrients intake and MetS in 20-69 year-old adult population of Yazd Greater Area, Iran. Methods: This study used Yazd Health Study (YaHS) recruitment phase data. The YaHS was a prospective cohort conducted on a random sample of 10,000 Yazdian adults aged 20-69 years. To conduct this study data from TaMeZ (Taghzieh Mardom-e-Yazd) or Yazd Nutrition Study, which was a nutrition study associated with YaHS were also used. MetS was defined according to the ATP III criteria. Dietary intake was evaluated using Food Frequency Questionnaire (FFQ). To evaluate the relationship between macronutrients and MetS, multivariate logistic regression analysis was used. Results: The odds ratio for the incidence of MetS was significantly higher in individuals who consumed higher amounts of carbohydrates. However, fat and protein intake did not have any significant relationship with odds of the developing MetS. Individuals with higher intake of carbohydrates had significantly higher odds of abdominal obesity (OR: 1.89, CI: 1.06-3.34); whereas, the probability of abdominal obesity decreased significantly in the highest quintile of protein intake (OR: 0.45, CI: 0.25-0.79). Conclusion: High intakes of carbohydrate increased the odds of getting to MetS and abdominal obesity. However, high levels of protein reduced the odds of abdominal obesity. No association was found between fat intake and the odds of the MetS. More prospective studies are needed to determine the role of macronutrients in MetS.

Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection that was first reported on December 31, 2019 in China . This disease behaves variously: from asymptomatic infection to influenza-like symptoms and severe acute respiratory distress syndrome (ARDS) . In the recent months, COVID-19 has infected millions and killed hundreds of thousands of patients worldwide . Human-to-human transmission of this disease happens mainly via direct contact or via droplets spread from an infected person’s cough or sneeze . The mortality rate and severity of COVID-19 are higher in elderly people and those with diabetes, cardiovascular disease, hypertension, respiratory dysfunctions, and other underlying diseases . In the crisis caused by COVID-19, the probability of publication of invalid data has increased. So, we tried to provide scientific evidences regarding the association between obesity and COVID-19. Furthermore, we aimed to investigate multiple mechanisms through which obesity may worsen the outcomes of COVID-19 using the published scientific literature

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide. Evidence showed that anthocyanins might have effects on NAFLD. Protective effects of Cornelian cherry (Cornus mas L.) extract, as an anthocyanins-rich source, on liver were reported in animal studies. However, very few clinical trials were conducted in this regard. Thus, the aim of this research will be to evaluate the effect of supplementation with total anthocyanin-base standardized cornelian cherry fruit extract on liver function (Serum levels of Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), cytokeratin-18 fragment M30 (CK-18 M30), as well as steatosis and fibrosis of liver), tumor necrosis factor α (TNF-α), malondealdehyde (MDA), and adiponectin in patients with NAFLD. Methods In a double-blind randomized clinical trial, 80 NAFLD patients will be studied. The patients will be randomly assigned into two groups. The intervention group will receive the cornelian cherry extract, containing 320 mg.d− 1 anthocyanins, per day for 12 weeks. The control group will also take the placebo daily for 12 weeks. Liver function (Serum levels of AST, ALT and CK-18 M30; steatosis and fibrosis of liver), serum levels of TNF-α, MDA, and adiponectin will be measured at the baseline and the end of trial for both groups and their results will be compared. Discussion Considering evidences about the useful impacts of anthocyanins on NAFLD, the effects of supplementation with cornelian cherry extract will be investigated on the important variables related to NAFLD. Trial registration Iranian Registry of Clinical Trials (IRCT20180419039359N1).

Abstract Objectives This descriptive-correlational study was conducted on 122 Iranian people living with HIV (PWHIV), who referred to a behavioral diseases counseling center in 2018. The AIDS Clinical Trial Group (ACTG) questionnaire was used to collect the required data. The study aimed to determine the level of medication adherence and its determinants in PWHIV. Results About 75.4% (confidence interval 67.2%–82.8%) of the samples had a good combined antiretroviral therapy (cART) adherence and 74.6% (n = 91) of them were sure about the positive effects of medications on their health. Patients reported that most important reasons for medication non-adherence included forgetfulness, high drug dosage, lack of knowledge about ART value, and transportation problems.

Background: Polycystic Ovary Syndrome (PCOs) is one of the most common metabolic and endocrine abnormalities among women in reproductive age. In the case of not comprehensive treatment, PCOs can lead to hormonal, metabolic, and fertility disorders. The exact cause of PCOs is still unclear. This disease seems to have a genetic background caused by the interference of several key genes with the environmental factors such as dietary habit and food intake, which play an important role in prevention and treatment of this syndrome. Methods: We searched Scopus, PubMed, SID, and Magiran data bases to find the studies conducted in Iran on dietary patterns, dietary intake, food intake, and PCOs published in English. Results: The findings showed that decrease of weight and fat intake from total calorie (especially saturated fat and cholesterol), increase of physical activity and intake of dietary fibers can improve this syndrome. Furthermore, DASH diet, increase of the protein/carbohydrate ratio in the diet, the low-calorie diets, or iso-caloric diets with a low glycemic index can also be useful in this regard. Discussion: In recent studies, the effects of some healthy diets were studied on PCOs women. A few of these studies were about finding appropriate dietary patterns for PCOs patients, but their number was limited. So, further studies are needed in this regard.

The Mediterranean (MED) diet was associated with a reduced risk of chronic disease, but the epidemiological studies reported inconsistent findings related to the MED diet and non-alcoholic fatty liver disease (NAFLD) risk. This age and the gender-matched case-control study were conducted among 247 adult patients. The MED diet score was obtained based on the Trichopoulou model. Multivariate logistic regression was used to examine the association between the MED diet and NAFLD risk. NAFLD prevalence in people with low, moderate and high adherence to the MED diet was 33, 13⋅1 and 4⋅6 %, respectively. The increasing intake of the MED diet was significantly related to the increment intake of nuts and fruits, vegetables, monounsaturated fatty acid/polyunsaturated fatty acid ratio, legumes, cereals and fish. However, total energy consumption, low-fat dairy and meats intake were reduced (P for all < 0⋅05). Following control for age, the person in the highest of the MED diet tertile compared with the lowest, the odds of NAFLD decreased (OR: 0⋅40, 95 % CI: 0⋅17–0⋅95). This relation became a little stronger after further adjusting for sex, diabetes, physical activity and supplement intake (OR: 0⋅36, 95 % CI: 0⋅15–0⋅89). However, this association disappeared after adjusting for body mass index, waist and hip circumference (OR: 0⋅70, 95 % CI: 0⋅25–1⋅97). High adherence to the MED diet was associated with a 64 % reduction in NAFLD odds before some anthropometric variable adjustments. However, further prospective studies are required, particularly in BMI-stratified models.

The prevalence of type 2 diabetes mellitus (T2DM) is increasing dramatically worldwide. Dysregulation of microRNA (miRNA) as key regulators of gene expression, has been reported in numerous diseases including diabetes. The aim of this study was to investigate the expression levels of miRNA-122, miRNA-126-3p and miRNA-146a in diabetic and pre-diabetic patients and in healthy individuals, and to determine whether the changes in the level of these miRNAs are reliable biomarkers in diagnosis, prognosis, and pathogenesis of T2DM. Additionally, we examined the relationship between miRNA levels and plasma concentrations of inflammatory factors including tumor necrosis factor alpha (TNF-α) and interleukin 6 (Il-6) as well as insulin resistance. In this case-control study, participants (n = 90) were allocated to three groups (n = 30/group): T2DM, pre-diabetes and healthy individuals as control (males and females, age: 25-65, body mass index: 25-35). Expression of miRNA was determined by real-time polymerase chain reaction (RT-PCR). Furthermore, plasma concentrations of TNF-α, IL-6 and fasting insulin were measured by enzyme-linked immunosorbent assay. Homeostatic model assessment for insulin resistance (HOMA-IR) was calculated as an indicator of insulin resistance. MiRNA-122 levels were higher while miRNA-126-3p and miRNA-146a levels were lower in T2DM and pre-diabetic patients compared to control (p