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Background/Objectives: Since the main characteristics of Rheumatoid Arthritis (RA) are joint dysfunction caused by inflammation and serious pain, anti-inflammatory agents may alleviate the clinical symptoms in RA. Pomegranate juice is rich in polyphenolic compounds that possess antioxidant and anti-inflammatory activities. This study aimed to determine the beneficial effects of pomegranate extract (POMx) in RA patients. Subjects/Methods: A total of 55 RA patients were enrolled and randomly allocated to an intervention group (n=30) or a control group (n=25). The intervention group received 2 capsules of 250 mg POMx and the control group 2 capsules of 250 mg cellulose per day for 8 weeks. At the beginning of the study and after 8 weeks, Health Assessment Questionnaire (HAQ) and Disease Activity Score (DAS) 28 were completed and serum concentrations of C-reactive protein (CRP), matrix metalloproteinases 3 (MMP3), malondialdehyde (MDA), glutathione peroxidase (GPx) and erythrocyte sedimentation rate (ESR) were analyzed using standard methods and compared between the two groups. Results: Compared with the placebo group, POMx supplement significantly reduced the score of DAS28 (P Conclusions: POMx alleviates disease activity and improves some blood biomarkers of inflammation and oxidative stress in RA patients., Author(s): M Ghavipour [sup.1] , G Sotoudeh [sup.2] , E Tavakoli [sup.3] , K Mowla [sup.4] , J Hasanzadeh [sup.5] , Z Mazloom [sup.3] Author Affiliations: (1) Department of Community [...]

Background: Metabolic syndrome (MetSx) is common among liver transplant recipients. It contributes to morbidity and mortality. Objective: To determine the prevalence of MetSx in patients undergoing liver transplantation (LTx) in Iran. Methods: 202 liver transplant recipients of both sexes completed this study. Relevant information including age, sex, the underlying disease, systolic and diastolic blood pressure, waist circumference, fasting serum levels of blood sugar (FBS), triglyceride (TG), and HDL-cholesterol were measured. The prevalence of MetSx was evaluated at 1, 3, 6, 9, and 12 months after LTx. Results: The prevalence of MetSx was 36.6% after 1 month that decreased to 28.2% after 12 months of follow-up. The lowest prevalence of MetSx (27.7%) was observed 9 months after LTx. Our data showed a decrease in TG and an increase in HDL-C level and no significant changes in blood pressure, waist circumference and FBS during the study period. Conclusion: The prevalence of MetSx after LTx is high when compared to the normal population. It seems that a change in diet after transplantation may affect the prevalence of MetSx. [ABSTRACT FROM AUTHOR]

AbstractBackground and Objectives: Low back pain is one of the most common complaints in pregnancy that interferes with work, daily activities and sleep. The aim of this study was to determine the effect of sitting pelvic tilt exercise on low back pain and sleep disorder during the third trimester in primigravidas.Methods: In this quasiexperimental study, 60 primigravidas who attended 3 prenatal clinics of Zanjan University of Medical Sciences, Zanjan, Iran, were selected by simple sampling, then they were randomly allocated into two groups, case and control. The case group did the sitting pelvic tilt exercise for 8 weeks during the third trimester. The control group just received usual prenatal care. Data collection was done by interview, using a Visual Analogue Scale (VAS) and a questionnaire which was carried out by the researcher on 0 and 56 days (pre and post intervention). T- Test and Chi Square were used for data analysis. Results: The intensity of low back pain in the case group after exercise was significantly decreased (P=0.0001), but in the control group, the intensity of low back pain increased as pregnancy advanced (P=0.0001). Also in the case group, sitting pelvic tilt exercise reduced the sleep disorders in comparison with pre treatment and control group (P

Background: Multiple sclerosis (MS) is accompanied by many health-related issues. This study aimed to evaluate the anthropometric indices, nutrient intakes and health-related characteristics of MS patients as well as their possible correlations., Methods: This cross-sectional study was performed on 283 MS patients in Shiraz, Iran, during 2018-2019. Body mass index (BMI) and body composition were measured for each participant. A food frequency questionnaire was used to determine the patients' nutrient intakes. The level of fatigue, disability and quality of life of the individuals were assessed by the modified fatigue impact scale (MFIS), the expanded disability status scale and the multiple sclerosis quality of life-54 questionnaires, respectively., Results: The results revealed that 43.11% of the patients were overweight or obese, and their %body fat (%BF) was 35.65 ± 7.63. Besides, intakes of vitamins A, E, D, folic acid, calcium, zinc and magnesium were significantly lower than recommendations in both genders, and sodium intake was significantly higher than the tolerable upper intake level in females. A significant positive linear correlation was observed between MFIS and BMI ( r  = 0.12, P  = 0.045). Significant positive correlations were also found between psychosocial subscale of MFIS and both of %BF ( r  = 0.12, P  = 0.049) and visceral fat area ( r  = 0.14, P  = 0.02). Unexpectedly, the patients' quality of life showed significant negative correlations with fat free mass and skeletal muscle mass., Conclusion: Being overweight, having a high %BF and poor nutrient intakes are common among MS patients. Improving the patients' lifestyle and dietary intake is recommended to reduce fatigue and increase their life quality.

Introduction: Macro-algae products have been shown to ameliorate the metabolic disorders state. Thus, highlighting their function as supplementary therapeutic agents can be a novel strategy for clinical therapies. This systematic review and meta-analysis of clinical trials aimed to summarize the effect of macro-algae consumption on serum lipid profile, glycaemic control and anthropometric factors., Methods: In this systematic review and meta-analysis, a comprehensive search was performed for relevant studies published up to May 2023. The Cochran's Q test and I-square (I 2 ) tests were used to evaluate heterogeneity across the included studies. The meta-analysis was conducted using random-effects model (DerSimonian and Laird), and weighted mean difference (WMD) was considered as the pooled effect size., Results: Out of 8602 papers in the initial screening, eight clinical trials with a total of 438 participants were included into this meta-analysis. The results indicated that macro-algae supplementation significantly decreased serum levels of total cholesterol (TC) (WMD = -6.7 mg/dL; 95% CI: -12.59, -0.80; item = 0.026) and low-density lipoprotein cholesterol (LDL-c) (WMD = -8.25 mg/dL; 95% CI: -15.38, -1.12; p-value = .023). There was an increase in level of high-density lipoprotein cholesterol (HDL-c) (WMD = 0.48 mg/dL; 95% CI: -2.05, 3.01; p-value = .71) which was not statistically significant. Macro-algae supplementation reduced body mass index (BMI) (WMD = -0.28 kg/m 2 ; 95% CI: -0.96, 0.41; p-value = .426), weight (WMD = -0.39 kg; 95% CI: -3.6, 2.83; p-value = .81), waist circumference (WC) (WMD = -0.52 cm; 95% CI: -2.71, 1.66; p-value = .64), fasting blood sugar (FBS) (WMD = -1.95 mg/dL; 95% CI: -5.19, 1.28; p-value = .24) and HbA1c (WMD = -0.02%; 95% CI: -0.14, 0.09; p-value = .66) in intervention group., Conclusions: This meta-analysis indicated that macro-algae supplementation significantly decreased TC and LDL-c level. It can also increase HDL-c level and reduce anthropometric indices and glycaemic control factors., (© 2023 The Authors. Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd.)

Nutritional interventions can be valuable for the prevention of postmenopausal osteoporosis. This study aimed to investigate the effects of kefir fortified with omega-3 and vitamin C on the bone and uterus parameters of ovariectomized rats. Seventy-seven female Sprague-Dawley rats were ovariectomized or sham-operated. The ovariectomized rats were assigned to six groups and received 1 ml/day of distilled water (OVX group), milk, kefir, kefir fortified with omega-3 fatty acids (kefir+ω3), kefir fortified with vitamin C (kefir+vit-C) or kefir fortified with omega-3 and vitamin C (kefir+ω3+vit-C) for 12 weeks. The sham group also received 1ml/day of distilled water. Subsequently, bone mineral content (BMC) and bone mineral density (BMD) of various bones were assessed. Femurs and uteri were harvested for bone ash analysis and histopathological examinations, respectively. Sera were analyzed for carboxy-terminal cross-linked telopeptide of type 1 collagen, procollagen type 1 amino-terminal propeptide, calcium, phosphorous, tumor necrosis factor-α (TNF-α) and total antioxidant capacity levels. Ovariectomy resulted in significant reduction in bone density (P<0.05). Kefir+ω3+vit-C significantly improved BMC of lumbar spine (0.699±0.027 g compared with 0.580±0.018 in the OVX group), and kefir, kefir+vit-C and kefir+ω3+vit-C significantly increased BMD of tibia (0.118±0.003 g/cm 2 , 0.119±0.001 and 0.120±0.004 compared with 0.102±0.005 in the OVX group). Moreover, ovariectomy markedly elevated TNF-α level, which was significantly reversed by kefir+ω3+vit-C. Significant atrophy of the uterus was observed following ovariectomy, although the uterus parameters did not change by any of the interventions. In conclusion, kefir fortified with omega-3 fatty acids and vitamin C may have protective effects against bone loss through suppressing inflammation.

Background: The sarcopenia quality of life (SarQoL) ® questionnaire is a specific tool to measure QoL in sarcopenia. The aim of this study was to validate the SarQoL ® questionnaire for evaluation of sarcopenia-related quality of life in Iranian community-dwelling older adults., Methods: Validity (discriminative power, construct validity), reliability (internal consistency, test-retest reliability), and floor/ceiling effects of SarQoL ® questionnaire were evaluated in the current study. Moreover, the SarQoL ® questionnaire was compared with the Short-Form 36-item (SF-36) and the EuroQoL 5-Dimensions (EQ-5D) questionnaires., Results: Among 501 community-dwelling older adults, 128 elderly participants (including 88 sarcopenic individuals) were recruited for validation. Participants with sarcopenia had lower quality of life than non-sarcopenic individuals (Total Score: 39.37 ± 7.45 vs. 65.09 ± 7.85, p < 0.001). Also, the findings demonstrated a high internal consistency (Cronbach's alpha of 0.881), excellent test-retest reliability (ICC = 0.995, 95% CI 0.990-0.998), and no floor/ceiling effect of SarQoL ® questionnaire., Conclusion: This is the first study to confirm the reliability and validity of the Persian version of the SarQoL ® for the measurement of quality of life among Iranian sarcopenic older adults., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

This study aimed to evaluate the effects of licorice root supplementation on liver enzymes, hepatic steatosis, metabolic and oxidative stress parameters in women with nonalcoholic fatty liver disease (NAFLD). In this randomized double-blind, placebo-controlled trial, 60 women with NAFLD were selected and randomly assigned into 2 groups to take 1,000 mg/day powder of licorice root extract or placebo for 12 weeks. In addition, all the patients were advised to follow a weight loss diet and healthy lifestyle. The plasma levels of liver enzymes, glycemic indices, lipid profile, oxidative stress parameters, as well as hepatic steatosis were measured at the beginning and end of the study. Through the 12-weeks period of supplementation, women who received powder of licorice root experienced a statistically significant improvement in alanine aminotransferase (p < .001), insulin (p = .002), insulin resistance (p = .003), malondialdehyde (p < .001) serum levels, and ultrasonographic findings of liver steatosis (p < .001), compared to the placebo group. In conclusion, licorice root supplementation in addition to gradual weight loss and lifestyle modification is superior to lifestyle modification alone for the treatment of NAFLD., (© 2022 John Wiley & Sons Ltd.)

An insufficient intake of magnesium may be associated with the development of chronic obstructive pulmonary disease (COPD). We aimed to determine the relationship between health related quality of life (QoL), anthropometric indices and nutritional status with dietary magnesium intake in COPD patients. Sixty-one COPD patients participated in this cross-sectional study. QoL and nutritional status were assessed. Furthermore, body composition, calf circumference, and muscle strength were measured; equations were used to calculate fat-free mass index, body mass index, and muscle mass value. Dietary magnesium intake was assessed by three 24-hours recalls and magnesium intake was categorized as ≤ 188.08 mg/day (A group) and > 188.08 mg/day (B group). The χ 2 , independent-sample t-test and Mann-Whitney test were used for statistical analysis. The p values less than 0.05 were considered significant. Of QoL assessments the total and impact mean scores of St. George's respiratory questionnaire in the B group were significantly lower than the means of the A group (p value = 0.007 and 0.005, respectively). The instrumental activity of daily living score was significantly improved in patients with higher consumption of dietary magnesium (p = 0.02). Participants had a significantly lower mean score of patient-generated subjective global assessment in the B group compared to the A group (p = 0.003). Higher intake of dietary magnesium can lead to improve QoL and nutrition status., Competing Interests: Conflict of Interest: The authors declare that they have no competing interests., (Copyright © 2022. The Korean Society of Clinical Nutrition.)

Introduction: Melon seeds, as an excellent source of protease inhibitors, may have a protective role against tumor progression and angiogenesis. However, their effects on angiogenesis and the mechanism of their action against cancer progression remain elusive. This study aimed to investigate the effect of bioactive compounds of melon seed on the expression of angiogenesis genes in BALB/c mice with breast cancer., Material and Methods: Trypsin inhibitor (TI) was purified from the seed powder of Cucumis melo . Half- maximal inhibitory concentration was determined for TI, extract of melon seed powder (EXT), and tamoxifen (TAM) by the (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test. Also, breast tumor was induced by subcutaneous injection of MC4-L2 cells in BALB/c inbred mice breast tissue. After tumor growth, mice were treated with TI, EXT, and TAM to examine their effects on the tumor characteristics and expression of angiogenesis-related genes including MMP-2, MMP-9, and vascular endothelial growth factor (VEGF) using the reverse transcription polymerase chain reaction method., Results: Trypsin inhibitor, EXT, TAM, and adjuvant treatment of TI + TAM resulted a reduction in expression of MMP-2, MMP-9, and VEGF. All treatments improved the breast tumor characteristics and the necrosis. The real-time polymerase chain reaction method verified the positive effects of the treatments on the breast cancer cell line and tumors., Conclusions: The results indicated that treatments with TI purified from Cucumis melo seeds and also combination therapy of TI and TAM can be considered as an alternative therapy in breast cancer patients. Further studies are warranted., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Termedia.)

Background/objectives: Patients with diabetes mellitus have a lower quality of life and sleep compared with healthy individuals. Nutrition therapy has an important role in the management of diabetes and can improve inflammation and quality of life in patients with diabetes. The present study aimed to evaluate the effect of high-protein versus high-carbohydrate intake during evening meal on quality of life, sleep quality, inflammation, and oxidative stress in subjects with type 2 diabetes., Subjects/methods: This is a 10-week randomized controlled trial. 96 adult patients with type 2 diabetes were assigned into one of the following three groups: standard evening meal (ST), high-carbohydrate evening meal (HC), and high-protein evening meal (HP). The effect of these diets was examined on high-sensitivity C-reactive protein, malondialdehyde, quality of life, and sleep quality., Results: Sleep quality improved significantly in all groups ( p  < .05). The quality of life and high-sensitivity C-reactive protein improved in all groups except for the HP group ( p  < .05). Serum malondialdehyde level did not change significantly throughout the study ( p  > .05)., Conclusions: Small manipulation of protein and carbohydrate distribution among the meals might not affect sleep quality. A diet with an even distribution of macronutrients among the meals or with a higher percentage of carbohydrates in the evenings can improve the quality of life and reduce inflammation in patients with type 2 diabetes, while a diet with a higher percentage of protein in the evenings may not improve it., Competing Interests: None., (© 2021 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Background: The role of dietary interventions in improving the symptoms of Multiple Sclerosis (MS) has always been considered, but few studies have been conducted in this area. This study aimed to investigate the effects of modified anti-inflammatory diet on fatigue, quality of life, and inflammatory markers among patients with Relapsing-Remitting Multiple Sclerosis (RRMS)., Methods: This randomized clinical trial was conducted on 100 patients with RRMS. The patients were randomly divided into the diet group (anti-inflammatory diet) or the control group (healthy diet recommendations) for 12 weeks. Fatigue and quality of life were assessed by Modified Fatigue Impact Scale (MFIS) and Multiple Sclerosis Quality of Life (MSQoL-54), respectively. Anthropometric measures and inflammatory biomarkers, including Interleukin 17 (IL-17), Interleukin 4 (IL-4), and high sensitivity C-Reactive Protein (hs-CRP), were assessed at baseline and end of the study., Results: The results showed a significant improvement in MFIS as well as in physical and mental components of MSQoL-54 ( p  = 0.001, p  = 0.015, and p  = 0.003, respectively) in the diet group compared to the control group. The results also showed a significant increase in IL-4 level ( p  = 0.022). However, no significant changes were detected in IL-17 and hs-CRP levels ( p  = 0.091, 0.418, respectively)., Conclusion: Modified anti-inflammatory diet could improve fatigue and quality of life and increase IL-4 level.

Studies have revealed that the timing of macronutrient ingestion may influence body weight and glucose tolerance. We aimed to examine the effect of high protein v. high carbohydrate intake at the evening meal on metabolic parameters of patients with type 2 diabetes. This is a single-blinded, parallel, randomised controlled trial. Ninety-six patients with type 2 diabetes, aged 32-65 years with a mean BMI of 28·5 (sd 3·4) kg/m2, were randomly assigned into one of these three groups: standard evening meal (ST), high-carbohydrate evening meal (HC) and high-protein evening meal (HP). Then, the patients were followed for 10 weeks. HbA1c, fasting blood glucose, fasting insulin, insulin resistance, TAG, LDL-cholesterol, VLDL-cholesterol, diastolic blood pressure, body weight, body fat percentage and waist circumference decreased significantly in all three groups (P < 0·05). HbA1c showed more improvement in the ST compared with the HP group (-0·45 (sd 0·36) v. -0·26 (sd 0·36)). Reductions in BMI and body weight were significantly higher in the ST compared with the HP group (P < 0·05). Reductions in total cholesterol, non-HDL-cholesterol and systolic blood pressure were significant in all groups, except for the HP group. Non-HDL-cholesterol:HDL-cholesterol remained unchanged in all groups. The results of the present study revealed that even distribution of carbohydrates and protein among meals compared with reducing carbohydrates and increasing protein at dinner may have a more beneficial effect on glycaemic control of patients with type 2 diabetes.

Background: Chronic obstructive pulmonary disease (COPD), as an airway limitation condition, is accompanied by alteration of muscle mass and function. We aimed to determine the relationship between disease severity and body composition, muscle function, and nutritional status in COPD patients. Methods: This cross-sectional study was conducted on 129 COPD participants. Muscle strength, body composition, and calf circumference (CC) were measured using a hydraulic hand dynamometer, bioelectrical impedance analysis (BIA), and a tape measure, respectively. Furthermore, fat-free mass index (FFMI), body mass index (BMI) and muscle mass value were calculated by equations. Forced expiratory volume in one second (FEV1) was assessed as well. Nutritional status was also evaluated by subjective global assessment (SGA) questionnaire. SPSS software (version 21 ) was used, chi-square, fisher's exact test, univariate and multivariate linear regression models were used for statistical analysis. P-values less than 0.05 were considered significant. Results: Based on FEV1 classification, 52.7% of the patients had severe conditions. The reports indicated that the prevalence of low CC was 54.2%, low muscle mass 38.7%, low FFMI 34.8%, low right handgrip strength 61.2% and low left handgrip strength 64.3%. Furthermore, there was an increasing trend based on FEV1 in low CC (p=0.032), low muscle mass (p=0.005), low FFMI (p=0.002), low right handgrip strength (p=0.004) and low left handgrip strength (p=0.014). The results of univariate analysis showed muscle mass (p=0.036), total protein (p=0.043), FFM (p=0.047), FFMI (p=0.007), SGA (p=0.029), right handgrip strength (p=0.004) and left hand grip strength (p=0.023) were associated with FEV1. In addition, the results of multivariate analysis demonstrated low values of FFMI (p=0.005) and right handgrip strength (p=0.042) were the main detrimental factors for FEV1. The results of multivariate analysis were confirmed by stepwise model. Conclusion: Low values of muscle mass and function are prevalent among COPD patients. The present study revealed that low FFMI and handgrip strength were closely related to disease severity., Competing Interests: Conflicts of Interest: None declared, (© 2021 Iran University of Medical Sciences.)

Aim: This study aimed to compare the effects of synbiotic soymilk fortified with whey protein concentrate and zinc sulfate with lactulose on bile duct ligated-induced HE., Background: Hepatic encephalopathy (HE) is seriously associated with neuromuscular and cognitive alterations., Methods: Eighty-two Sprague Dawley rats were randomly assigned into seven groups (sham, bile duct ligation (BDL), BDL + lactulose, BDL + soymilk (SM), BDL + Synbiotic soymilk (SSM), BDL + SSM + whey protein concentrate (WPC), BDL + SSM + WPC + ZnSO4). Different SM products, lactulose, and normal saline were administered via oral gavage (2 mL/rat/day). The serum and liver markers as well as liver histopathology were assessed after 28 days., Results: The SM products significantly reduced the serum alanine aminotransferase, albumin, and ammonia ( P < 0.05). The levels of aspartate aminotransferase, endotoxin, and liver interleukin-6 improved significantly in all treatments, except for those receiving SM. SSM and SSM + WPC + ZnSO4 were the only effective products in reducing serum alkaline phosphatase ( P < 0.05). Furthermore, the liver total antioxidant capacity was greater ( P <0.05) in the SSM + WPC and SSM + WPC + ZnSO4 groups. The histopathological examinations confirmed the efficiency of all SM products in reducing liver fibrosis. Liver bile duct proliferation diminished only in the SSM + WPC and SSM + WPC+ ZnSO4 groups (P<0.05)., Conclusion: This study showed the positive effects of different SM products, especially SSM + WPC and SSM + WPC + ZnSO4, on HE. Further studies are required to confirm our findings., (©2020 RIGLD, Research Institute for Gastroenterology and Liver Diseases.)

Background: Obesity is a major public health problem and its occurrence is markedly increasing in developed and developing countries. However, few studies have investigated the use of natural products to treat obesity. The effects of taking a combination of oxymel and Zataria multiflora Boiss. (ZM), herein referred to as Zataria oxymel (ZO), on obesity, lipid profile and insulin resistance have not yet been studied., Objective: This study evaluates the effects of oxymel and ZO on obesity, lipid profile and insulin resistance., Design, Setting, Participants and Interventions: In this randomized, controlled, triple-blind trial, overweight patients were randomly divided into three groups and received doses of study compounds twice per day for twelve weeks. Group A received 0.75 g ZM in 10 mL oxymel in each treatment; group B received 1.5 g ZM in 10 mL of oxymel in each treatment and group C (control) only received 10 mL of oxymel in each treatment., Main Outcome Measures: Anthropometric parameters, including body mass index (BMI), waist circumference and hip circumference, were measured at the time of registration. Blood tests were carried out at the beginning and once again at end of the study. Blood parameters included fasting blood sugar (FBS), insulin levels, serum lipid profile (total cholesterol, triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol) and liver enzymes (aspartate transaminase and alanine transaminase). Serum creatinine was also measured at the beginning of the project and in monthly intervals for three months. The homeostasis model assessment index was calculated as fasting insulin (μIU/mL) × FBS (mg/dL)/405., Results: The results showed that patients receiving ZO experienced significant reduction in waist circumference in groups A, B and C, respectively (P < 0.001) but no significant change in BMI. Group A also experienced reduction in hip circumference (P = 0.01). Groups B and C had reduction in the homeostatic model assessment of insulin resistance (P = 0.05 and P = 0.01, respectively), with no significant reduction in FBS. No effect on lipid profile, liver enzymes or serum creatinine was observed in the three groups., Conclusion: In this study, treatment with ZO and oxymel reduced insulin resistance, and waist and hip circumferences in overweight patients. Nonetheless, the traditional Persian use of ZO as a beverage to improve the anthropometric indices in overweight individuals still requires further research with a larger sample size., Trial Registration: Iranian Registry of Clinical Trials Code IRCT20171220037976N1., (Copyright © 2020. Published by Elsevier B.V.)

Background: The development of effective nutritional supports for patients with chronic obstructive pulmonary diseases (COPD) is still challenging. This study was conducted to investigate the efficacy of daily consumption of fortified whey on inflammation, muscle mass, functionality, and quality of life in patients with moderate-to-severe COPD., Methods: A single-blind, randomized trial study was performed on patients with COPD (n = 46). Participants in the intervention group (n = 23) daily received 250 ml of whey beverage fortified with magnesium and vitamin C for 8 weeks. Any changes in inflammatory cytokines (including interleukin- 6 (IL-6) and tumor necrosis factor (TNFα)) were the primary outcomes and the secondary outcomes were fat-free mass, handgrip strength, malnutrition, glutathione and malondialdehyde serum concentrations, and health-related quality of life (HRQoL). Body composition and muscle strength were measured by Bioelectrical Impedance Analysis (BIA) and hydraulic hand dynamometer, respectively. Fat-free mass index (FFMI) was also calculated., Results: At the end of the study, 44 patients were analyzed. There were significant decreases in IL-6 concentrations in the intervention group compared to the control group. Also, FFMI, body protein, and handgrip strength increased significantly in the intervention group with significant changes between two groups. Moreover, improvement in health-related quality of life was observed in the intervention group compared to the control group. There were no significant changes in other study variables., Conclusions: This novel nutritional intervention decreased inflammatory cytokines levels, improved indices of skeletal muscle mass and muscle strength, and ultimately, increased HRQoL in patients with moderate-to-severe COPD. Thus, it is suggested to do further studies to assess the effects of nutrition intervention on COPD progression., Trial Registration: IR.SUMS.REC.1396.85 ( https://www.irct.ir/ ).

Background: Recent studies have reported that herbal extracts may have some protective effect against the complications of diabetes mellitus. This study aimed to investigate the effects of Achillea millefolium hydroalcoholic extract in comparison to metformin on liver damage, lipid abnormality, and glycemic control in diabetic rats., Methods: Rats were randomly assigned to 7 groups of 10 animals. Diabetes was induced by injection of streptozotocin (STZ) to 4 groups of rats. Three groups of diabetic rats were given 250 mg/kg/day metformin, 25 mg/kg/day Achillea millefolium hydroalcoholic extract, or 100 mg/kg/day of this extract. Two non-diabetic groups were also given either 25 mg/kg/day or 100 mg/kg/day Achillea millefolium extract. Normal control and diabetic control rats received 1 mL/day of normal saline. Treatments were administered through oral gavage for 28 days. At the end, rats were anesthetized with ether and their serum samples were separated in order to measure blood glucose, serum total protein, lipids, and liver enzymes., Results: There was a significant reduction in blood glucose, serum liver enzymes, triglycerides, and total- and LDL-cholesterol levels of the Achillea millefolium extract-treated groups compared to the other groups. In addition, there was a significant increment in body weight and HDL-cholesterol serum level in the Achillea millefolium-treated groups., Conclusion: Achillea millefolium extract compared to metformin reduces lipid abnormality, blood glucose and liver enzymes in STZ-induced diabetic rats. Future clinical studies are warranted to confirm our experimental findings in humans.

Background: Ulcerative colitis is an inflammatory disease with indefinite treatment. The present study aimed to assess the anti-inflammatory and antioxidant effects of Carum copticum L. (CC) extract on induced colitis in rats., Methods: Sixty male rats were randomly divided into six groups (n=10 per group). Acetic acid-induced colitis rats were orally administered with doses of 100, 200, and 400 mg/kg CC extract, and 100 mg/kg sulfasalazine for seven consecutive days, respectively. Colonic biopsies were taken to measure histopathological parameters as well as the tumor necrosis factor (TNF-α), interleukin-6 (IL-6), myeloperoxidase (MPO), malondialdehyde (MDA), and glutathione (GSH). Data analysis was performed using the one-way ANOVA and Tukey's test for normally distributed data. Kruskal-Wallis test followed by Dunn's test was used for non-normally distributed data. The analysis was performed at P≤0.05 using SigmaStat software (version 10.0)., Results: The control colitis group had a significantly higher total colitis index (P=0.01), TNF-α (P=0.01), IL-6 (P=0.01), MPO (P=0.01), and MDA (P=0.01); and lower GSH (P=0.01) than those of the sham group. The colitis group receiving a dose of 200 mg/kg/day CC extract had a significantly lower total colitis index (P=0.01), TNF-α (P=0.01), IL-6 (P=0.01), MPO (P=0.01), and MDA (P=0.01); and higher GSH (P=0.01) than those of the control colitis group. The colitis group receiving a dose of 200 mg/kg/day CC extract had a significantly lower total colitis index (P=0.04), TNF-α (P=0.03), IL-6 (P=0.04), MPO (P=0.03), and MDA (P=0.03); and higher GSH (P=0.01) than those of the colitis group receiving sulfasalazine., Conclusion: The present study revealed that CC extract had healing effects on colitis, possibly due to its antioxidant and anti-inflammatory properties., (Copyright: © Shiraz University of Medical Sciences.)

Background: Acne vulgaris is a dermatological disorder that is related to inflammation and oxidative stress. Recent studies have also suggested diet as a potential reason for acne. Considering the inconsistency of the few previous reports, the present study aimed to determine the levels of vitamin D, adiponectin, oxidative stress, lipid profile and nutrient intakes in females with acne., Materials and Methods: Forty females with acne vulgaris and 40 age-matched healthy females were included in this study in Shiraz, Iran. Data on their sociodemographic status, acne history, and anthropometric indices were collected. Blood samples were taken to determine the levels of 25-hydroxyvitamin D, adiponectin, malondialdehyde, total antioxidant capacity, and lipid profile. Three 24-hour dietary recalls were also obtained from each of the individuals to evaluate nutrient intakes. Data were analyzed using the Chi-square test, Independent-samples t-test or Mann-Whitney U-test, and Logistic Regression., Results: Patients with acne had a significantly higher family history of acne compared to controls (P=0.006). Serum level of malondialdehyde was significantly higher in cases (P=0.01), while high-density lipoprotein cholesterol was significantly lower (P=0.02). Moreover, significantly lower fiber intake was observed in cases compared with controls (P=0.007). In the multivariate analysis, a family history of acne and increased malondialdehyde levels were risk factors for acne, whereas a higher fiber intake was protective., Conclusion: Family history of acne, oxidative stress, dyslipidemia, and lower dietary fiber intakes may play a role in acne pathogenesis. An early assessment of these parameters may be useful for planning treatment procedures., (Copyright© 2019, Galen Medical Journal.)

Background & Aims: Melatonin supplementation may be associated with blood lipids improvement; however, the current evidence from randomized controlled trials (RCTs) is inconsistent. The present study aimed to systematically review and analyze RCTs assessing the effects of melatonin supplementation on blood lipids., Methods: A comprehensive literature search in several database was performed up to January 2017. Quantitative data synthesis was performed using a fixed or random-effects model, with weight mean difference (WMD) and 95% confidence intervals (CI). Standard methods were used for assessment of heterogeneity, meta-regression, sensitivity analysis and publication bias., Results: A total of 8 RCTs were eligible. Meta-analysis suggested a significant association between melatonin supplementation and a reduction in triglycerides (WMD: -31.54 mg/dL, 95% CI: -50.71, -12.38, p = 0.001), and total cholesterol levels (WMD: -18.48 mg/dL, 95% CI: -35.33, -1.63, p = 0.032), while no significant effect on LDL-C (WMD: -2.37 mg/dL, 95% CI: -11.61, -6.86, p = 0.615) and HDL-C (WMD: 1.28 mg/dL, 95% CI: -0.66, 3.23, p = 0.197) was found. In sub-group analysis, a significant decrease in triglycerides was found at doses ≥8 mg/d and when trials last ≥8 weeks. In addition, a significant decrease of total cholesterol was found at doses ≥8 mg/d and when total cholesterol baseline levels were ≥200 mg/dL., Conclusions: Melatonin supplementation has significant effects on triglycerides and total cholesterol levels, which was more evident in higher dose and longer duration and also in a higher concentration of cholesterol levels. Further studies are required to determine the benefits of melatonin on lipid profile., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Bachground and Aims: Endothelial dysfunction can promote atherosclerosis pathogenesis. The aim of the present meta-analysis was to determine the effects of walnut consumption on peripheral endothelial function (EF) in adults., Methods: PUBMED, MEDLINE and EMBASE were searched to identify studies up to August 2017. Eligible studies conducted randomized controlled trials (RCTs) on the effects of walnut consumption compared with a control on EF. Standard mean difference (SMD) and 95% confidence intervals (CI) were reported as summary statistics. Standard methods were used for assessment of heterogeneity, meta-regression, sensitivity analysis and publication bias., Results: Five studies comprising a total of 323 subjects were included in the meta-analysis. The results showed a significant increase in EF after walnut consumption (SMD: 0.40%; 95% CI: 0.20 to 0.62; p < 0.001) with no evidence of heterogeneity across studies. Sensitivity analysis showed that the effect size was robust and not sensitive to any single study. Meta-regression did not indicate any significant association for an increase in EF after walnut consumption with dose of treatment, duration of treatment, or baseline EF., Conclusion: The available evidence from RCTs suggests there may be a clinically relevant effect of walnut consumption on EF., (Copyright © 2018. Published by Elsevier Ltd.)

Background: Critical illness is associated with oxidative stress and insulin resistance. These conditions affect the clinical outcomes in intensive care unit (ICU). The aim of this study was to determine whether intervention with α-lipoic acid (ALA) influences the oxidative stress, insulin resistance, and clinical outcomes in critically ill patients., Method: In this randomized double-blind placebo-controlled trial, 80 critically ill patients who were expected to stay at least seven days in the ICU and required enteral feeding were randomly allocated to two equal groups to receive either ALA (900 mg) or placebo daily for 10 days. Serum levels of total antioxidant capacity (TAC), malondialdehyde (MDA), insulin, glucose (GLC), C-reactive protein (CRP), albumin (Alb), prealbumin (preAlb), total protein (total-pr) and total lymphocyte count (TLC) as well as homeostasis model assessment-estimated insulin resistance (HOMA-IR) were measured at baseline and at the end of ALA supplement phase. Clinical outcomes (length of ICU/hospital stay, ICU/hospital mortality, and 28-day mortality and ventilator free days) were also recorded., Results: TAC increased significantly in the ALA supplemented group compared to the placebo group (p < 0.001). Moreover, serum levels of GLC decreased significantly in the ALA group compared to lack of changes in the placebo group (p = 0.011). ALA supplementation also hindered an increase in HOMA-IR (p = 0.015). There were no significant differences in other biochemical markers and clinical outcomes between the two groups., Conclusion: ALA may be an effective supplement to improve antioxidant defense and insulin resistance in critically ill patients., Competing Interests: None declared.

Context: The results of human clinical trials investigating the effects of flaxseed on glucose control and insulin sensitivity are inconsistent., Objective: The present study aimed to systematically review and analyze randomized controlled trials assessing the effects of flaxseed consumption on glycemic control., Data Sources: PubMed, Medline via Ovid, SCOPUS, EMBASE, and ISI Web of Sciences databases were searched up to November 2016., Study Selection: Clinical trials in which flaxseed or its products were administered as an intervention were included., Data Extraction: The outcomes were fasting blood glucose, insulin concentration, insulin resistance (HOMA-IR), insulin sensitivity (QUIKI), and hemoglobin A1c (HbA1c)., Results: A total of 25 randomized clinical trials (30 treatment arms) were included. Meta-analysis suggested a significant association between flaxseed supplementation and a reduction in blood glucose (weighted mean difference [WMD], -2.94 mg/dL; 95%CI,  -5.31 to - 0.56; P = 0.015), insulin levels (WMD,  -7.32 pmol/L; 95%CI, -11.66 to -2.97; P = 0.001), and HOMA-IR index (WMD, -0.49; 95%CI,: -0.78 to - 0.20; P = 0.001) and an increase in QUIKI index (WMD, 0.019; 95%CI, 0.008-0.031; P = 0.001). No significant effect on HbA1c (WMD, -0.045%; 95%CI, -0.16 to - 0.07; P = 0.468) was found. In subgroup analysis, a significant reduction in blood glucose, insulin, and HOMA-IR and a significant increase in QUIKI were found only in studies using whole flaxseed but not flaxseed oil and lignan extract. Furthermore, a significant reduction was observed in insulin levels and insulin sensitivity indexes only in the subset of trials lasting ≥12 weeks., Conclusions: Whole flaxseed, but not flaxseed oil and lignan extract, has significant effects on improving glycemic control. Further studies are needed to determine the benefits of flaxseed on glycemic parameters., (© The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

The results of human clinical trials have revealed that the effects of resveratrol on adipokines are inconsistent. Our objective was to elucidate the role of resveratrol supplementation on adipokines through a systematic review and a meta-analysis of available randomized placebo-controlled trials (RCTs). 1 The search included PubMed-MEDLINE, SCOPUS and ISI web of sciences database till up to 6th November 2016. Weight mean differences (WMD) 2 were calculated for net changes in adipokines using fixed-effects or random-effects models; meta-regression analysis and publication bias were conducted in accordance with standard methods. Nine RCTs with 11 treatment arms were eligible for inclusion in this systematic review and meta-analysis. Meta-analysis of data from 10 treatment arms showed a significant change in plasma adiponectin concentrations following resveratrol supplementation (WMD: 1.10μg/ml, 95%CI: 0.88, 1.33, p<0.001); Q=11.43, I 2 =21.29%, p=0.247). There was a significant greater adiponectin-reducing effect in trials with higher than or equal to 100mg/day (WMD: 1.11μg/ml, 95%CI: 0.88, 1.34, p<0.001), versus those with less than 100 mg/day dosage (WMD: 0.84μg/ml, 95%CI: -0.62, 2.31, p=0.260). Meta-analysis of data from 5 treatment arms did not find any significant change in plasma leptin concentrations following resveratrol supplementation (WMD: 3.77ng/ml, 95% CI: -2.28, 9.83, p=0.222; Q=8.00, I 2 =50.01%). Resveratrol significantly improves adiponectin but does not affect leptin concentrations. Additional studies are required to further evaluate the potential benefits of resveratrol on adipokines in humans., (Copyright © 2017. Published by Elsevier Ltd.)

Background: Malnutrition is an important factor in the survival of critically ill patients. The purpose of the present study was to assess the nutritional status of patients in the intensive care unit (ICU) on the days of admission and discharge via a detailed nutritional assessment., Methods: Totally, 125 patients were followed up from admission to discharge at 8ICUs in Shiraz, Iran. The patients' nutritional status was assessed using subjective global assessment (SGA), anthropometric measurements, biochemical indices, and body composition indicators. Diet prescription and intake was also evaluated., Results: Malnutrition prevalence significantly increased on the day of discharge (58.62%) compared to the day of admission (28.8%) according to SGA (P<0.001). The patients' weight, mid-upper-arm circumference, mid-arm muscle circumference, triceps skinfold thickness, and calf circumference decreased significantly as well (P<0.001). Lean mass weight and body cell mass also decreased significantly (P<0.001). Biochemical indices showed no notable changes except for magnesium, which decreased significantly (P=0.013). A negative significant correlation was observed between malnutrition on discharge day and anthropometric measurements. Positive and significant correlations were observed between the number of days without enteral feeding, days delayed from ICU admission to the commencement of enteral feeding, and the length of ICU stay and malnutrition on discharge day. Energy and protein intakes were significantly less than the prescribed diet (26.26% and 26.48%, respectively)., Conclusion: Malnutrition on discharge day increased in the patients in the ICU according to SGA. Anthropometric measurements were better predictors of the nutritional outcome of our critically ill patients than were biochemical tests.

Background: Recently, the potential of L-arginine supplementation as a novel and effective strategy for weight loss and improving biochemical parameters in obese patients has been under consideration., Objectives: To evaluate the influence of 8-week oral L-arginine supplementation on body mass index (BMI), waist circumference (WC), triceps skinfold (TS), subscapular skinfold (SS), systolic blood pressure (SBP), diastolic blood pressure (DBP), plasma fasting blood sugar (FBS), glycated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and malondialdehyde (MDA) in patients with BMI values > 29.9 or visceral obesity (WC > 102 cm in men or > 88 cm in women)., Patients and Methods: Ninety obese patients were included in a single-blind randomized controlled trial. Patients were randomized to receive either L-arginine (3 or 6 g thrice daily) or placebo for 8 weeks. Anthropometric and biochemical indices, dietary intake, and blood pressure values were measured at the baseline and after the 8-week intervention., Results: Significant decreases in anthropometric parameters, blood pressure (SBP, DBP), FBS, HbA1c, LDL, MDA (P < 0.001), TG (P = 0.02), and TC (P = 0.002) and a significant increase in HDL (P < 0.001) were observed in the intervention group, compared to the control group. In the control group, no significant differences were found between the baseline and end-of-intervention measurements., Conclusions: In conclusion, oral L-Arginine supplementation appears to improve anthropometric parameters, blood pressure values, and some blood biochemical indices associated with cardiovascular disease prevention.

Background: Metabolic syndrome (MetS) continues to be highly prevalent and contributes to a rapidly growing problem worldwide. The most important therapeutic intervention for metabolic syndrome is diet modification, an intervention whose efficacy has been proven for metabolic syndrome., Objectives: The aim of the present study was to compare the effects of low glycemic index diet versus metformin on MetS components in adults with MetS., Patients and Methods: Fifty-one adults with MetS participated in this randomized controlled clinical trial. Patients were randomly allocated to two groups of metformin and low glycemic index diet. The intervention period was eight weeks. The studied participants were compared at baseline and the end of the trial, regarding the following factors: weight, blood pressure, waist circumference, fasting blood sugar, hemoglobin A1c and lipid profiles (Triglyceride (TG), Total Cholesterol (TC), Low-Density Lipoprotein (LDL) cholesterol, and High-Density Lipoprotein (HDL) cholesterol)., Results: The anthropometric measurements, Fasting Blood Sugar (FBS), Hemoglobin A1c, serum lipid profiles (TG, TC, LDL-C, HDL-C) and lipoprotein ratio (LDL/HDL) showed a significant decrease after the intervention in both groups (P < 0.05). Comparison of the difference between the two groups was not significant, except for the mean reduction in FBS, which was more in the metformin group although this was not clinically significant., Conclusions: This study supports the assumption that low glycemic index diet as well as metformin can positively affect metabolic syndrome components.

Objective: Depression is considered as the most common psychological problem in hemodialysis (HD) patients. As there is little evidence regarding the association of depression with serum selenium level as an antioxidant in these patients, the current survey investigates the possible relationship between depression and nutritional status including serum selenium levels., Design: Cross-sectional study., Setting and Subjects: A total of 110 HD patients and 40 healthy controls were enrolled in the study. The patients were in the age range of 18 to 85 years, who had been on hemodialysis for at least 3 months without any acute illness., Main Outcome Measure: Beck Depression Inventory was used for assessing the severity of depression. Malnutrition was evaluated through subjective global assessment (SGA) and malnutrition inflammation score (MIS). Serum selenium levels and routine laboratory markers were measured from fasting samples., Results: Sixty-two percent of the patients had some degree of depression based on Beck Depression Inventory score. HD patients were considered to be selenium deficient after comparing the mean value of serum selenium between the patients and controls (P < .001). No significant difference was found in serum selenium levels between depressed HD patients and the rest of patients without depression. The mean level of SGA and MIS in the depressed patients was significantly higher than the rest of patients (P = .03 and P = .04, respectively). Also lower levels of hemoglobin and serum albumin were significantly seen in depressed patients compared with nondepressed ones (P = .004 and P = .04, respectively)., Conclusions: Although the HD patients in this study were selenium deficient, no significant association was found between depression and selenium. In addition, depression was more prevalent in malnourished HD patients with higher SGA and MIS scores and lower serum albumin and hemoglobin levels., (Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the effects of Coenzyme Q10 supplementation on glycaemic control, oxidative stress and adiponectin levels in people with type 2 diabetes., Methods: The randomised, single-blind, placebo-controlled study was conducted in the city of Shiraz, Iran, in 2012 and comprised type 2 diabetes subjects recruited from various health facilities. Subjects and controls received 100mg Coenzyme Q10 or placebo twice a day for eight weeks respectively. A variety of measurements were made at baseline and at the end of the intervention. These included measuring markers of glycaemic control (fasting blood glucose and glycated haemoglobin); a marker of oxidative stress (malondialdehyde); and an anti-inflammatory marker (adiponectin). SPSS 15 was used for statistical analysis., Results: Of the 52 patients, 28(54%) were male and 24(46%) were female, with an overall mean age of 51.73±7.34 years. There were 16(62% male and 10(39%) females in the intervention group, and 12(46%) male and 14(54%) female subjects in the control group. Among the cases, Coenzyme Q10 resulted in a significant reduction in malondialdehyde levels (p=0.04). However, the difference within the controls for this factor was not significant (p>-0.05). Moreover, fasting blood glucose, glycated haemoglobin and adiponectin levels showed no significant differences within or between the groups (p>0.05 each)., Conclusions: Coenzyme supplementation may reduce oxidative stress in type 2 diabetics. However, it may not have any effects on glycaemic control and adiponectin levels.