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Abstract Sarcopenia, characterized by progressive and generalized loss of skeletal muscle (SkM) mass, strength, and physical performance, is a prevalent complication in type 2 diabetes (T2D). Nitric oxide (NO), a multifunctional gasotransmitter involved in whole-body glucose and insulin homeostasis, plays key roles in normal SkM physiology and function. Here, we highlight the role of NO in SkM mass maintenance and its potential contribution to the development of T2D-related sarcopenia. Physiologic NO level, primarily produced by sarcolemmal neuronal nitric oxide synthase (nNOSμ isoform), is involved in protein synthesis in muscle fibers and maintenance of SkM mass. The observed effect of nNOSμ on SkM mass is muscle-type specific and sex-dependent. Impaired NO homeostasis [due to a diminished nNOSμ-NO availability and excessive NO production through inducible NOS (iNOS) in response to atrophic stimuli, e.g., inflammatory cytokines] in SkM occurred during the development and progression of T2D, may cause sarcopenia. Theoretically, restoration of NO through nNOS overexpression, supplying NOS substrates (e.g., L-arginine and L-citrulline), phosphodiesterase (PDE) inhibition, and supplementation with NO donors (e.g., inorganic nitrate) may be potential therapeutic approaches to preserve SkM mass and prevents sarcopenia in T2D.

Abstract Time-restricted feeding (TRF), an intermittent fasting approach involving a shortened eating window within 24 h, has gained popularity as a weight management approach. This review addresses how TRF may favor fat redistribution and the function of the adipose organ. TRF trials (mainly 16:8 model, with a duration of 5–48 weeks) reported a significant weight loss (1.2–10.2%, ~ 1.4–9.4 kg), with a considerable decrease in total fat mass (1.6–21%, ~ 0.5–7 kg) and visceral adipose compartment (VAC, 11–27%) in overweight and obese subjects. Experimental TRF in normal-fed and obesogenic-diet-fed mice and rats (with a fasting duration ranging between 9 and 21 h within 1–17 weeks) reported a significant reduction in body weight (~ 7–40%), total fat mass (~ 17–71%), and intrahepatic fat (~ 25–72%). TRF also improves VAC and subcutaneous adipose compartment (SAC) function by decreasing adipocyte size, macrophage infiltration, M1-macrophage polarity, and downregulating inflammatory genes. In conclusion, beyond its effect on body weight loss, total fat mass, and intrahepatic fat accumulation, TRF favors adipose organ fat redistribution in overweight and obese subjects by decreasing VAC and improving the function of VAC and SAC.

Abstract This cross-sectional study investigated the associations between urinary sodium (UNa) to potassium (UK) ratio, different phenotypes of elevated blood pressure (BP), and microalbuminuria (MAU) in a cohort of the Tehran Lipid and Glucose Study (TLGS). Adult participants (n = 1782, mean age of 43.0 ± 13.7 years and 46.0% were men) were recruited (2015–2017) for measurements of spot urinary metabolites, i.e., Na, K, creatinine (Cr), microalbumin, and BP. Multinomial logistic regression was used to estimate the relative risk ratios (RRR) of elevated BP phenotypes [i.e., isolated systolic (ISH), diastolic (IDH), and systolic-diastolic (SDH) hypertension], and binary logistic regression was used to estimate odds ratios (ORs) of MAU across quintile categories and per each SD-increment of UNa-K ratio. Mean UNa, UK, and its ratio was 137 ± 57.4, 72.1 ± 36.6 mmol/L, and 2.31 ± 1.41, respectively. Subjects with UNa-K > 3.14 had higher prevalence of ISH (3.4 vs. 1.1%), SDH (11.0 vs. 6.2%), and MAU (14.1 vs. 6.2%) (P for all 3.14 vs.

Abstract Aim We assessed the impact of a 3-year change-percent in adiposity measures on regression and pre-diabetes (Pre-DM) progression among Iranian adults. Methods Three-year change-percent in body weight (BW), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and visceral adiposity index (VAI) were calculated for 1458 Pre-DM subjects (mean age of 53.0 ± 13.7, 46.8% men), participated in the third examination of the Tehran Lipid and Glucose Study (2006–2008). Multinomial logistic regression models were used to estimate relative risk ratios (RRRs) of the outcomes [i.e., regression to normal glucose regulation (NGR), persistence in Pre-DM, and progression to newly diagnosed type 2 diabetes (T2D)] across 3-year change categories of adiposity measures (i.e., ≥ 5% decrease, 0–5% decrease, increase). Results Over nine years of follow-up, 37.7 and 39.0% returned to NGR and progressed to T2D, respectively. Decreased BW (0–5 and ≥ 5%) was associated with regression to NGR (RRRs = 1.44, 95% CIs = 1.05–1.98, and 2.64, 1.63–4.28, respectively). Decreased BMI and WC ≥ 5% were also associated with regression to NGR (RRRs = 1.63, 95% CI = 1.01–2.64; 1.69, 1.20–2.37, respectively). Changes in WHR and VAI were not associated with Pre-DM regression or progression. Pre-DM subjects with ≥ 5% BW loss had a constant FSG level overtime and a lower overall mean of FSG (116 vs. 111 and 112 mg/dL, P = 0.023 and 0.009, respectively) and 2 h-SG (154 vs. 165 and 168 mg/dL) compared to those had 0–5% BW loss or BW gain. Conclusion Short-term management of adiposity measures increases the regression probability to NGR. Targeting BW loss seems a more potent predictor of Pre-DM reversion among the adiposity measures.

Abstract Background The association between macronutrient consumption and the risk of type 2 diabetes (T2D) remains equivocal. Here, we investigated whether the quantity and quality of macronutrient intake are associated with T2D incidence in a West Asian population. Methods T2D-free adults (n = 2457, mean age 38.5 ± 13.6 years, 54.2% women) who participated in the third examination cycle (2005–2008) of the Tehran Lipid and Glucose Study were followed for a median of 8.6 years. We estimated the macronutrient quality index (MQI), its individual sub-indices (carbohydrate quality index (CQI), fat quality index (FQI), and healthy plate protein quality index (HPPQI)), as well as the macronutrient quantity. The risk of T2D in relation to macronutrient quantity, quality, and their combined effects was examined using Cox proportional hazard models adjusted for known risk factors for T2D. Results During the study follow-up, 257 incident cases of T2D were documented. Individuals in the highest tertiles of MQI and CQI had a 27% (HR = 0.73, 95% CI = 0.54, 0.98) and 29% (HR = 0.71, 95% CI = 0.51–0.99) lower T2D risk than those in the lowest tertiles. The T2D incidence was 35% lower in the middle HPPQI tertile than in the lowest (HR = 0.65, 95% CI = 0.47, 0.89). The multivariable adjusted model showed that individuals in the middle and highest tertiles of carbohydrate intake had 32% (HR = 0.68, 95% CI = 0.49–0.95) and 26% (HR = 0.74, 95% CI = 0.55–1.00) lower risks of T2D than individuals in the lowest tertile. A high-quantity, high-quality carbohydrate diet (≥ 58.5% of energy from carbohydrate with a CQI ≥ 13) and a low-glycemic index (GI), high-fiber diet (GI

Type 2 diabetes (T2D) significantly increases the risk of vascular complications (12-32 %), which are a major cause of death (over 50 %) in T2D patients. In T2D, both endothelial (ET) and vascular smooth muscle (VSM) cells are impaired, which act as independent risk factors for cardiovascular disease. Thus, the question of this systematic review and meta-analysis is: Do ET-dependent and -independent VSM relaxation impair in T2D? We systematically searched PubMed and Scopus databases until March 2024; 44 eligible clinical trial studies (68, 16, 30, and 50 study arms for acetylcholine (ACh), methacholine (MTH), sodium nitroprusside (SNP), and glyceryl trinitrate (GTN)) published were included. ET-dependent VSM relaxation in response to ACh (overall ES = -28.9 %, 95 % CI: -35.2, -22.7; p

Abstract Background We assessed the possible effect of usual dairy consumption on pre-diabetes (Pre-DM) remission or progression to type 2 diabetes (T2D). Methods Pre-DM adults (n = 334, mean age of 49.4 years, and 51.5% men) were assessed for dairy intakes (2006–2008) and followed up to 9 years for incidence of T2D or normal glycemia (NG). All biochemical measurements were done at baseline and all subsequent examinations with 3-y follow-up intervals. Multinomial regression models with adjustment of confounding variables were used to estimate odds ratios (OR) and 95% confidence intervals (CIs) of incident T2D and NG for each serving/d dairy consumption. Results The odds of NG was significantly elevated by 69% (OR = 1.69, 95% CI = 1.00–2.86, P = 0.05) per 200 g/d increased high-fat dairy intake, while the amount of total dairy or low-fat dairy was not related to the outcomes. Higher intakes of yogurt were more likely to be associated with an increased odds of NG (OR = 1.82, 95% CI = 1.20–2.74, P = 0.01). Usual intakes of milk, cheese, or cream-butter were not associated to Pre-DM remission or progression to T2D. Conclusion Regular dairy consumption may increase the chance of Pre-DM regression to NG.

Abstract Background Cardiovascular disease (CVD) is a major cause of death worldwide, although limited data are currently available regarding the impact of consuming ultra-processed food (UPF) on its incidence. Given the increased consumption of UPF in Iran, we aimed to investigate the association between UPF intake and CVD risk. Methods Individuals without CVD (n = 2050) aged ≥ 30 years old were recruited from the Tehran Lipid and Glucose Study (TLGS). Dietary data were collected using a validated food frequency questionnaire (FFQ) and UPF intakes were assessed based on the Nova food classification. Multivariable Cox proportional hazard models adjusted for potential confounders were used to estimate the hazard ratio (HR) and 95% confidence intervals (95% CI) for the risk of CVD across tertiles of UPF intake. Results A 10.1% incidence of CVD occurred over a median follow-up of 10.6 years, with a 22% increase in CVD risk per each 50 g/day UPF intake. Participants with the highest intake of UPF had a 68% greater incidence of CVD compared to those with the lowest intake (HR = 1.68, 95% CI=1.14–2.48) after controlling for potential confounders. Regarding sub-groups of UPF, participants in the 3rd tertile compared to the reference had a significantly increased risk of CVD (HR = 1.56, 95% CI=1.04–2.34). Nevertheless, intake of bread, fast food, sweetened beverages, sweets and desserts, high-fat dairy products, and other UPFs were not associated with greater CVD risk. Conclusion Our findings support the hypothesis that the incidence of CVD is enhanced with the higher consumption of UPF in a representative sample of the Iranian population.

Abstract Background The association of prediabetes (Pre-DM) regression and progression with visceral adiposity index (VAI) and adipose tissue dysfunction (ATD) remains to be investigated. Methods The present cohort study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) on 1458 Pre-DM cases (aged ≥ 21 years) who were followed for nine years. VAI was estimated based on waist circumference, body mass index, triglycerides, and high-density lipoprotein cholesterol. ATD status (i.e., absent, mild-moderate, and severe) was defined based on the age-stratified cutoff values of VAI. Multinomial logistic regression models with adjustment of potential confounders were used to estimate the chance of Pre-DM regression to normoglycemia or progression to T2D across ATD status. Results During the study follow-up, 39.0% of the participants developed T2D, and 37.7% returned to normoglycemia. Compared to mild-moderate ATD, Pre-DM subjects with severe ATD had a higher risk of developing T2D by 45% (OR = 1.45, 95% CI = 11.08–1.93). Severe ATD was also associated with a decreased chance of returning to normoglycemia by 26% (OR = 0.74, 95% CI = 0.55–0.99). Participants with severe ATD had significantly higher fasting (overall mean = 111, 95% CI = 109–112 vs. 106, 95% CI = 105–108 mg/dL) and 2h-serum glucose (overall mean = 165, 95% CI = 161–168 vs. 153, 95% CI = 149–156 mg/dL) concentrations over time. Conclusion Severe ATD was associated with an elevated risk of developing T2D and longitudinal poor-glycemic controls in Pre-DM subjects. ATD may be a simple and useful index for detecting subjects at a higher risk of Pre-DM progression to T2D, allowing for timely intervention strategies.

Abstract Vascular nitric oxide (NO•) resistance, manifested by an impaired vasodilator function of NO• in both the macro- and microvessels, is a common state in type 2 diabetes (T2D) associated with developing cardiovascular events and death. Here, we summarize experimental and human evidence of vascular NO• resistance in T2D and discuss its underlying mechanisms. Human studies indicate a ~ 13-94% decrease in the endothelium (ET)-dependent vascular smooth muscle (VSM) relaxation and a 6-42% reduced response to NO• donors, i.e., sodium nitroprusside (SNP) and glyceryl trinitrate (GTN), in patients with T2D. A decreased vascular NO• production, NO• inactivation, and impaired responsiveness of VSM to NO• [occurred due to quenching NO• activity, desensitization of its receptor soluble guanylate cyclase (sGC), and/or impairment of its downstream pathway, cyclic guanosine monophosphate (cGMP)-protein kinase G (PKG)] are the known mechanisms underlying the vascular NO• resistance in T2D. Hyperglycemia-induced overproduction of reactive oxygen species (ROS) and vascular insulin resistance are key players in this state. Therefore, upregulating vascular NO• availability, re-sensitizing or bypassing the non-responsive pathways to NO•, and targeting key vascular sources of ROS production may be clinically relevant pharmacological approaches to circumvent T2D-induced vascular NO• resistance.

Abstract Background The current prospective cohort study aimed to explore the potential associations between dietary sodium (Na), potassium (K), and sodium-to-potassium (Na-to-K) ratio with an incidence risk of cardiovascular disease (CVD) among Iranian adults. Methods The participants of the Tehran Lipid and Glucose Study (men and women aged 30–84 years, n = 2050), free of CVD at baseline (2006–2008) were included. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ), and incident CVD (i.e., coronary heart disease, stroke, and CVD mortality) were documented up to March 2018. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI) regarding the association between dietary Na, K, and Na-to-K ratio with CVD events. Results During a median follow-up of 10.6 years, 10.14% of participants experienced CVD outcomes. A 41% increased risk of CVD in relation to each increase in 1000 mg/d of Na intake. In the fully-adjusted model, higher Na intake (> 4143 versus

Abstract Background We aimed to assess potential associations of habitual dietary pattern scores in relation to the risk of pre-diabetes (Pre-DM) progression to type 2 diabetes mellitus (T2DM) or the chance of returning to normal glycemia. Methods This cohort study included 334 Pre-DM individuals (mean age of 49.4 years, and 51.5% men) who participated in the third phase of the Tehran Lipid and Glucose Study (2006–2008) and followed up for a median of 9 years. A validated food frequency questionnaire at baseline assessed usual intakes of the participants. Major dietary patterns were identified using principal component analysis. The DASH score and Mediterranean diet score (MDS) were also calculated. Multinomial logistic regression analysis was used to estimate the odds ratios (95% confidence intervals (CIs)) of developing T2DM and returning to normal glycemia in relation to dietary pattern scores. Results During the study follow-up, 39.8% progressed to T2DM, and 39.8% returned to normal glycemia. Three following major dietary patterns, including Western-style (with a higher load of red meats, hydrogenated fats, sodium, and total fat intakes), healthy pattern (with a higher load of whole grains, vegetables, and dairy products), and processed-foods pattern (with a higher load of processed-meats, fast-foods, salty snakes, and sweets and candies) were identified. The Western-style dietary pattern increased the risk of progressing to T2DM by 38% (OR = 1.38; 95% CI = 1.00 to 1.89, P = 0.050). Other dietary pattern scores were not related to regression or progression from Pre-DM. Conclusion The Western-style dietary pattern (characterized by higher load of red meats, hydrogenated fats, sodium intake, and high-GI foods) may accelerate the progression of Pre-DM to T2DM.

Abstract Background The potential effects of dietary oxalate (Ox) intake on cardio-renal function have remained unestablished. We evaluated the effect of usual Ox intake and its interaction with dietary calcium (Ca) on incident hypertension (HTN) and chronic kidney disease (CKD). Methods Adult men and women, free of HTN and CKD at baseline (2006–2008), were recruited. Dietary intakes were assessed using a validated food frequency questionnaire, and the outcomes were documented up to 2014–2017. Multivariate Cox proportional hazard regression models were used to estimate the development of HTN and CKD in relation to Ox intakes. Repeated-measures generalized estimating equation (GEE) linear regression models were used to assess possible effect of Ox-intake on the estimated glomerular filtration rate (eGFR) and blood pressure levels over eight years. Results Dietary Ox intakes were positively associated with incident CKD (HR = 2.59, 95% CI = 1.46–4.64) and HTN (HR = 1.79, 95% CI = 1.05–3.04). Compared to high-Ca consumers, subjects who had lower Ca intakes ( 220 vs.

The possible association of habitual physical activity (PA) and the risk of pre-diabetes (Pre-DM) progression to type 2 diabetes (T2D) or the chance of returning to normoglycemia was investigated. This cohort study included 1167 Pre-DM individuals (mean age of 53.5 years, and 45.3% men) who participated in the third phase of the Tehran Lipid and Glucose Study (2006–2008) and followed up to a median of 9 years. PA, including leisure time and job activities, was measured using a reliable and validated Iranian version of the Modifiable Activity Questionnaire and reported as metabolic equivalent (MET)-minutes per week. The odds ratios (ORs) and 95% confidence intervals (CIs) of incident T2D and returning to normoglycemia were estimated in relation to PA levels (i.e., per every 500 MET-minutes/week, or across categories of PA levels 1500 MET-minutes/week). During the study follow-up, 39.0 % progressed to T2D, and 37.8% returned to normoglycemia. Compared to subjects with a PA 1500 MET-minutes/week. We further noted that each 500 MET-min/week activity corresponded to an elevated chance of returning to normoglycemia by 5% (OR = 1.05, 95% CI = 1.01–1.11). The study’s findings provided evidence that higher daily PA levels may facilitate Pre-DM regression to normoglycemia. The beneficial effect of PA in Pre-DM subjects needs to exceed the recommended levels (i.e., 600 MET-minutes/week).

Introduction: Nutrition Clinical Trials (NCTs) are pivotal in establishing causal links between nutritional interventions and chronic diseases. This review comprehensively examines prevalent clinical trial designs, emphasizing their strengths and limitations. The goal is to provide insights into the selection and optimization of these designs for dietary intervention studies. Methods: Various study designs in NCTs are explored, including quasi-experimental designs, double-blind randomized placebo-controlled trials for nutrient/functional foods supplementation, community-based lifestyle interventions, pragmatic nutrition interventions, and field trial projects. The characteristics, advantages, and challenges of each design are discussed. Real examples are presented to illustrate how these designs can be tailored and optimized for dietary intervention studies. Results: Parallel randomized clinical trials are acknowledged as the gold standard, despite requiring substantial sample sizes and having inherent limitations. Cross-over NCTs emerge as valuable for assessing temporary treatment effects while mitigating potential confounders and interpatient variability. However, they may not be suitable for acute diseases and progressive disorders, and attrition rates can be higher. Multi-arm randomized designs offer increased study power with a lower sample size but necessitate more intricate design, analysis, and result reporting. Conclusion: In conclusion, each study design in NCTs comes with its set of strengths and limitations. The selection of an appropriate design should consider determinants and common considerations to provide robust evidence for establishing cause-and-effect associations or assessing the safety and efficacy of food products in nutrition research. This comprehensive understanding aids researchers in making informed choices when planning and conducting nutrition clinical trials.

Abstract Aim This study aimed to determine the association of urinary microalbumin concentrations with type 2 diabetes mellitus (T2DM), metabolic syndrome (MetS), and its phenotypes. The optimum cut-off values of urinary microalbumin and microalbumin-to-creatinine ratio (MCR) for predicting the chance of having T2DM and MetS were also defined. Methods Adult men and women (n = 1192) participated in the sixth phase (2014-2017) of the Tehran Lipid and Glucose Study (TLGS), with completed data, were included in the analyses. Odds ratios (ORs) (and 95% confidence intervals (CIs)) of T2DM, MetS, and its components across tertile categories of urinary microalbumin concentrations were estimated using multivariable logistic regressions. The optimal cut-off points of urinary microalbumin and MCR were determined using the receiver operator characteristic (ROC) curve analysis. Results Participants’ mean (±SD) age was 44.9 (±14.0) years, and 44.6% of the participants were men. The prevalence of microalbuminuria was 14.4%. Chance of having T2DM was significantly higher in the highest tertile of urinary microalbumin concentration (OR = 2.29, 95% CI = 1.43-3.67) and MCR (OR = 1.82, 95% CI = 1.15-2.89). Subjects with the highest urinary microalbumin concentration were more likely to have MetS (OR = 1.66, 95% CI = 1.17-2.35), hypertension (OR = 1.63, 95% CI = 1.16-2.30) and hyperglycemia (OR = 1.78, 95% CI = 1.24-2.56). No significant association was observed between urinary microalbumin concentrations and other components of MetS. The optimal cut-off points of urinary microalbumin for predicting the chance of having T2DM and MetS were 14.0 and 13.6 mg/L, respectively. Conclusions Elevated spot urinary microalbumin, below the values defined as microalbuminuria, was associated with the chance of having T2DM and MetS.

Abstract Background and aim The potential cardiovascular impact of usual intakes of oxalate (Ox) is uninvestigated. We evaluated the effect of dietary Ox and its interaction with dietary calcium (Ca) on incident cardiovascular disease (CVD). Methods We included 2966 adult men and women aged 19–84 y without known CVD during baseline enrollment (2006–2008) of the Tehran Lipid and Glucose Study. Dietary intakes were assessed using a validated FFQ, and incident CVD (i.e., coronary heart disease, stroke, and CVD mortality) were documented through March 2018. Results A 7.1% incident of CVD occurred during a median follow-up of 10.6 y. After multivariable adjustment for traditional risk factors and key dietary nutrients, including total fat and fiber, Ox intakes ≥220 mg/d increased incident CVD (HR T3 vs. T1 = 1.47, 95% CI = 1.02–2.12). This association was potentiated (HR T3 vs. T1 = 2.42, 95% CI = 1.19–4.89) in subjects who had a lower intake of Ca (

Abstract Background and aim Hydrogen sulfide (H2S), a signaling gasotransmitter, is involved in carbohydrate metabolism. Here, we aimed to assess the potential association between serum H2S and dysglycemia in the framework of a population-based study. Methods Adults men and women with completed data (n = 798), who participated in the Tehran Lipid and Glucose Study (2014–2017) were included in the study. Medians of fasting serum H2S concentration were compared across the glycemic status of the participants, defined as type 2 diabetes mellitus (T2DM), isolated impaired fasting glucose (IIFG), isolated impaired glucose tolerance (IIGT), combined IFG-IGT, and normal glycemia [i.e., those with both normal fasting glucose (NFG) and normal glucose tolerance (NGT)]. Multinomial logistic regression was used to assess potential associations between serum H2S and the defined glycemic status. Results Mean age of the participants was 45.1 ± 14.0 y, and 48.1% were men. Prevalence of T2DM, IIFG, IIGT, and combined IFG-IGT was 13.9, 9.1, 8.1, and 4.8% respectively. No significant difference was observed in serum H2S concentrations between the groups. Lower serum H2S (

Abstract Background We aimed to estimate salt intake among an Iranian population using spot urine-based equations and a dietary-based method. Methods Adult men and women (n = 2069) were recruited from the Tehran Lipid and Glucose Study (2014–2017). Urinary sodium (Na), potassium (K), and creatinine (Cr) concentrations were measured in the morning spot urine samples. The 24-h urinary Na excretion and predicted salt intake was estimated using five equations, i.e., Kawasaki, Tanaka, Intersalt, Toft, and Whitton. A validated food frequency questionnaire (FFQ) was used to obtain dietary intake of salt. The agreement of each urinary- and FFQ-based salt estimation with the overall mean of the methods, considered as the gold standard, was assessed using the Bland–Altman method. Results Mean age of the participants was 45.6 ± 14.8 y, and 45.4% were men. Mean (SD) estimated salt intake, derived from the overall mean of the methods, was 9.0 ± 2.2 g/d (10.2 ± 2.1 and 7.9 ± 1.7 g/d in men and women, respectively). Mean bias of the estimations from the overall mean ranged from − 0.2.42 to 2.75 g/d, with the Tanaka equation having the least bias (mean bias = 0.13 ± 1.10, 95% CI − 2.37, 2.30 g/d). Tanaka estimated a mean salt intake of 8.9 g/d (range 2.1 to 18.7 g/d); accordingly, only 5.1% of participants adhered to the recommendation (

Abstract Background The association between dietary fats and the risk of cardiovascular disease (CVD) is under debate. We aimed to determine the potential effects of dietary saturated fats (SFA), mono-unsaturated (MUFA) and poly-unsaturated (PUFA) fatty acids on the occurrence of CVD in an adult Asian population. Methods This study was conducted within the framework of the Tehran Lipid and Glucose Study on 2809 CVD-free adults, aged ≥ 19 years. Dietary intakes of fats were estimated using a validated 168-items semi-quantitative food frequency questionnaire, at baseline. Adjusted hazard ratios and 95% confidence intervals of CVD were calculated in tertile categories of dietary fats. The risk of CVD was estimated with multivariable Cox regression for the substitution of total fat or SFA with other macronutrients. Results During 10.6 years of follow up, the incidence rate of CVD events was 7.1%. Mean (± SD) age of the participants was 39 (± 14) years and 43.9% were men. Total fat, animal and plant sources of fats were not associated with risk of CVD events. No significant associations were found between total SFA, lauric acid, myristic acid, stearic acid, palmitic acid as well as MUFA and PUFA and CVD incidence. Substitutions of total fats or SFA with other macronutrients were not associated with CVD risk. Conclusions In this study, no significant associations were found between dietary fats and CVD risk. Considering the emerging body of literature that suggests no association between fats and CVD risk, reconsideration of dietary recommendations regarding low fat diets to prevent CVD, seems to be essential.

Abstract Background and aim Considering the inconsistencies in the cardiovascular effects of dietary acid load and the impact of dietary acidity on the acid–base homeostasis within the body, we aimed to assess the association of dietary acid load and the risk of cardiovascular disease (CVD) in a prospective community-based study. Materials and methods Participants (n = 2369) free of CVD at baseline (2006–2008) were included from the Tehran Lipid and Glucose Study (TLGS) and followed up for a mean of 6.7 ± 1.4 years. Dietary intakes of the participants were assessed using a semi-quantitative food frequency questionnaire (FFQ). The dietary acid load was evaluated by Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP) scores. Both scores have used the macronutrient and micronutrient data of the Food Frequency Questionnaires. Multivariate Cox proportional hazard regression models were used to estimate the 6-years incident risk of CVDs across tertiles of PRAL and NEAP scores. Results Mean age and body mass index of participants were 38.5 ± 13.3 years and 26.6 ± 4.8 kg/m2 at baseline. Within 6.7 ± 1.4 years of follow-up, 79 cases of cardiovascular events were reported. NEAP was significantly associated with the incidence of CVDs (HRs = 0.50, CI 0.32–0.96; P for trend = 0.032); however, after adjusting for potential confounders, no significant associations were observed between PRAL and NEAP scores and the risk of CVDs. Conclusions This study failed to obtain independent associations between dietary acid load and the incidence of CVDs among an Asian population.

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

Abstract Background Current evidence regarding the prognostic relevance of urinary sodium-to-potassium ratio (Na-to-K ratio), as an indicator of diet quality is limited. This study was conducted to investigate whether urinary Na-to-K ratio could be related to habitual dietary patterns, in a general population. Methods This study was conducted in the framework of the Tehran Lipid and Glucose Study (2014–2017) on 1864 adult men and women. Urinary Na and K concentrations were measured in the morning spot urine samples. Dietary intakes of the participants were assessed using a validated 147-item Food Frequency Questionnaire (FFQ) and major dietary patterns were obtained using principal component analysis. Mediterranean dietary pattern and Dietary Approaches to Stop Hypertension (DASH) score, were also calculated. Multivariable-adjusted linear regression was used to indicate association of dietary patterns and urinary Na-to-K ratio. Results Mean (± SD) age of participants was 43.7 ± 13.9 years and 47% were men. Mean (± SD) urinary Na, K and the ratio was 139 ± 41.0 and 57.9 ± 18.6 mmol/L, 2.40 ± 0.07, respectively. Higher urinary Na-to-K ratio (> 2.37 vs.

Abstract Background Considering the inconsistent available findings regarding the cardioprotective effect of dietary fatty acid composition, we prospectively examined the feasible association between the dietary fatty acids and the cardiovascular disease (CVD) incidence in framework of the population-based Tehran Lipid and Glucose Study. Methods A total of 2369 participants (19–70 years, 43.5% men) without CVD at baseline (2006–2008) were included and followed-up for 6.7 years. Fatty acids’ dietary intake was estimated using a 168-item semi-quantitative food frequency questionnaire. The CVD incidence risk across tertiles of dietary fatty acids was predicted via Cox proportional hazards regression models. Results The average age and body mass index of the included population were 38.5 ± 13.3 years and 26.6 ± 4.8 kg/m2 at baseline. Over 6.7 years of follow-up, 79 cases of CVD were detected. The risk of CVD was lower in upper tertile of monounsaturated fatty acids, oleic acid, and docosahexaenoic acid + eicosapentaenoic acid among the tertiles. No significant associations were found between total fat, saturated and polyunsaturated fatty acids’ intake, and CVD. Conclusions Our results suggest that the dietary fatty acid composition might affect the incidence risk of CVD within the Iranian population.

Background and purpose: Obesity is one of the major health problems that is highly prevalent in the world. There is controversial evidence about the association between dietary nitrate and nitrite and obesity. The aim of this study was to investigate the association between dietary nitrate and nitrite intake and incidence of obesity phenotypes. Materials and methods: A prospective approach was used in this research that was conducted in participants of the Tehran Lipid and Glucose Study. The study included 1756 males and females and their nutritional, anthropometry, and biochemical information were recorded every three years and followed for six years. Food Frequency Questionnaire (FFQ) was administered to collect the data. General obesity phenotype, abdominal obesity phenotype, Hypertriglyceridemic-Waist Phenotype (HTW), and body adiposity index phenotype were determined. Then, the incidence of obesity phenotypes across tertiles and intakes of nitrate/nitrite was assessed using regression logistic test. Results: The cumulative incidence of HTW phenotypes was 25% after 6 years. The risk of HTW in highest tertiles compared to the lowest tertiles of total nitrate intake and intake of nitrate and nitrite through fruits decreased insignificantly by 6% (OR = 0.94, 95% CI = 0.72 - 1.17), 5% (OR = 0.95, 95% CI = 0.73 - 1.24), and 10% (OR = 0.90, 95% CI = 0.69 - 1.17), respectively. Conclusion: Dietary nitrate and nitrite had no effect on the occurrence of HTW, BMI, and general and abdominal obesity phenotypes.

Abstract Red beetroot (Beta vulgaris), as a naturally occurring root vegetable and a rich source of phytochemicals and bioactive compounds, is known for its beneficial roles in the improvement of several clinical and pathologic outcome. Chronic and acute beetroot juice supplementation, as a cost-effective strategy, is proposed to hold promises in controlling diabetes and insulin hemostasis, blood pressure and vascular function, renal health and the possible effect on microbiome abundance. The secondary outcome and physiological response of microbiome abundance modulation included the non- significant fluctuation of systolic and diastolic blood pressures. Also, some studies have suggested a reno-protective property of beetroot juice that is associated with the reduction of mortality rate and favorable changes in kidney’s functional parameters among patients with renal disorders. Similarly, it is shown that the persistent consumption of beetroot juice effectively postpones the postprandial glycemic response and decreases the blood glucose peak. The significant blood pressure lowering effect has been seen among normotensive subjects, which tend to be more considerable among hypertensive individuals and progressive among overweight adults. Within this context, this review aims to provide a comprehensive overview on the therapeutic applications of beetroot juice in metabolic disorders and theirs underlying mechanisms. Despite the inconsistencies in the set of results from the reviewed studies, there is no doubt that further contributing factors must be investigated more deeply in future studies.

Abstract Background Abnormal levels of liver enzymes, particularly aminotransferases, are prognostic features of non-alcoholic fatty liver disease (NAFLD). Considering the important role of dietary intakes in development of NAFLD, we aimed to determine possible association of unhealthy foods (fast foods, soft drinks, sweet and salty snacks) consumption with elevated levels of aminotransferases. Methods This cross-sectional study was conducted within the framework of sixth phase of the Tehran Lipid and Glucose Study (2014–2017), on 187 adult men and 249 adult women (19–70 y). Usual intakes of unhealthy foods (kcal/week) were measured using a validated semi-quantitative 147-items food frequency questionnaire. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) were measured. Multivariable logistic regression models were used to estimate the odds of elevated aminotransferases in each tertile of energy-dense unhealthy foods. Results Mean age of participants was 44.44 ± 15.09 years, 43% of participants were men. Higher consumption of fast foods (> 11.39% kcal/week) was associated with elevated ALT to AST ratio (OR: 3.27; 95% CI: 1.90–5.63) and elevated ALT (OR: 2.74; 95% CI: 1.57–4.76). Also, each 1 SD increased energy intakes from fast foods was related to increased chance of having elevated ALT and ALT to AST ratio by 35% (OR: 1.35; 95% CI: 1.08–1.68, OR: 1.35; 95% CI: 1.10–1.66, respectively). There was no significant association between consumption of soft drinks, sweet or salty snacks and elevated aminotransferases. Conclusions Higher intakes of energy from fast foods seems to be associated with an elevated serum levels of ALT and ALT to AST ratio, as indicators of development of NAFLD.

Abstract Background This study aimed to assess the potential effects of long-term intake of caffeine and habitual consumption of coffee and tea on the occurrence of cardio-renal events among an Iranian population with low coffee and high tea consumption. Methods Adult participants of the Tehran Lipid and Glucose Study (2006–2008 to 2012–2014) who met the study inclusion criteria, were recruited. Habitual dietary intakes were assessed using a validated food frequency questionnaire. Demographics, anthropometrics, blood pressure, and biochemical variables were evaluated at baseline and during follow-up examinations. Multivariate Cox proportional hazard and logistic regression models adjusted for potential confounders were used to estimate the risk of cardiovascular disease (CVD), hypertension (HTN) and chronic kidney disease (CKD). Results During median 6 years of follow-up, the incidence rate of CVD outcomes, HTN, and CKD were 3.3%, 15.5%, and 17.9%, respectively. The risk of CVD was increased more than two-fold in the highest tertile of tea consumption (HR = 2.44, 95% confidence interval, CI = 1.40–4.27; P for trend = 0.001), and caffeine intakes (HR = 2.22, 95% CI = 1.23–4.01; P for trend = 0.005). A 42% lower incidence of CVD was observed in coffee drinkers, compared to non-drinkers (HR = 0.58, 95% CI = 0.36–0.93; P for trend = 0.023). No significant association was observed between tea, coffee or caffeine intakes and the risk of HTN or CKD. Conclusions Findings of our study support previous data regarding the protective effects of coffee on CVD. Contrary to the previous studies, we found that higher intakes of tea and caffeine, mainly originated from tea in our population, may increase risk of CVD events. It may be related to the type of tea and its preparation methods, additives or artificial colors in tea consumed in Iran, and sweets or sugar that mostly consumed accompanied by tea. Also, genetic variants of the liver enzymes may modify the association of dietary caffeine sources and incidence of CVD. Further prospective studies with incorporation of different population with different dietary habits and genetic backgrounds are needed to clarify the contradictions.

Objective: There is an interaction between dietary sodium/potassium intake in the pathogenesis of hypertension (HTN) and cardiovascular disease (CVD). The aim of this study was to investigate the association of dietary sodium to potassium (Na/K) ratio and the risk of HTN and CVD in a general population of Iranian adults. Methods: In this prospective cohort study, adults men and women with complete baseline data were selected from among participants of the Tehran Lipid and Glucose Study and were followed up for 6.3 years for incidence of HTN and CVD outcomes. Dietary sodium and potassium were assessed using a valid and reliable 168-item food frequency questionnaire. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between dietary sodium, potassium and their ratio and risk of outcomes. Results: During the study follow-up, 291 (15.1%) and 79 (5.0%) new cases of HTN and CVD were identified, respectively. No significant association was observed between usual intakes of sodium, potassium and dietary Na/K ratio with the incidence of HTN. There was no significant association between dietary intakes of sodium and potassium per se and the risk of CVD, whereas when dietary sodium to potassium ratio was considered as exposure in the fully-adjusted Cox regression model, and participants in the highest compared to lowest tertile had a significantly increased risk of CVD (HR = 2.19, 95% CI = 1.16–4.14). Conclusions: Our findings suggest that high dietary Na/K ratio could contribute to increased risk of CVD events.

Background and Aim: Decreased bioavailability of nitric oxide (NO) in type 2 diabetes contributes to disrupted pathways of glucose/insulin homeostasis and progression of long-term complications. Due to its ability to convert to NO, inorganic nitrate (NO3) has been recently highlighted as a potential therapeutic agent in type 2 diabetes. Materials and Methods: This research entails a double-blind, randomized, placebo-controlled, phase II clinical trial that will be conducted on 62 type 2 diabetic patients. The patients will be randomized to receive a 6-month daily dose of NO3-rich beetroot powder (5 g/d, contains ~250 mg NO3) or placebo (5 g/d, contains

Abstract Background Considering the lack of data on the association between habitual dietary intakes of nitrate (NO3 −) and nitrite (NO2 −) and cardiovascular events, we assessed possible effects of dietary NO3 − and NO2 −, in the context of total antioxidant capacity (TAC) of the diet, with the risk of cardiovascular (CVD) outcomes. Methods Adult men and women without CVD (n = 2369) were recruited from the Tehran Lipid and Glucose Study and were followed for a mean of 6.7 years. Dietary NO3 − and NO2 − intakes, as well as dietary TAC and nitric oxide (NO) index were assessed at baseline (2006–2008). Multivariable-adjusted Cox proportional hazards regression models were used to estimate risk of CVD above and below median of dietary intakes of NO3 −/NO2 − and dietary TAC and NO index. Due to a significant interaction between NO3 −/NO2 − intake and TAC, stratified analyses were done for < and ≥ median dietary TAC. Results Daily mean (SD) dietary NO3 − and NO2 − intakes were 460 (195) and 9.5 (3.9) mg; mean (SD) dietary TAC and NO index was 1406 (740) and 338 (197) μmol trolox equivalent (TE)/100 g. In subjects with lower dietary TAC, higher intake of NO3 − (≥ 430 mg/d) was accompanied with an increased risk of CVD (HR = 3.28, 95% CI = 1.54–6.99). There were no significant associations between dietary intakes of NO2 −, TAC of the diet and NO index with the occurrence of CVD events during the study follow-up. Conclusion High habitual intake of NO3 −, in the context of low TAC of the food, may be associated with the risk of CVD outcomes.

Pathological over production of nitric oxide (NO), induced by Helicobacter pylori, has been known as a risk factor for development of gastritis and gastric cancer. The current study investigated the effect of high-sulforaphane (SFN) broccoli sprouts powder on serum NO metabolites in H. pylori infected patients. Eighty-six patients with positive H. pylori stool antigen test (HpSAg) were randomized to receive one of the three following regimens: Standard triple therapy (STT) for 14 days, 6 g/d broccoli sprouts powder (BSP) for 28 days, and combination of these as STT (for 14 days) + BSP (for 28 days). Fasting serum NO metabolites were assessed at baseline and again after treatment. There was a significant decrease in serum NOx levels in BSP (25.2 vs. 51.6 μmol/L, P

Background: The aim of this study was calibration of a nitrate (NO3)/nitrite (NO2) database for estimated its dietary intakes. Methods: Overall, 250 healthy Tehranian adults were assessed in 2015 for dietary intakes of NO3 and NO2 and its serum and urine concentration. Food composition values for NO3 and NO2 were derived from a recent survey conducted on frequently consumed food items among Iranians. The correlation of dietary intakes of NO3/NO2 and its urinary and serum values was evaluated. Results: Mean (±SD) intakes of dietary NO3 and NO2 were 505±160 and 7.7±2.2 mg/d, respectively. The correlation coefficient of intake and urinary NO3 was 0.83 (95% CI=0.56-0.91) and 0.57 (95% CI=0.49-0.67) in men and women, respectively. A moderate agreement was also observed between NO2 intake and its urinary levels (r=0.27, 95% CI=0.13-0.37, and 0.29, 95% CI=0.17-0.41, in men and women, respectively). Conclusion: Using a national database of NO3 and NO2 content of food items along with a valid food frequency questionnaire could provide a valid estimation of dietary intakes of NO3 in the target population.

Background: There are growing concern globally regarding the alarming trend of fast food consump­tion and its related cardiometabolic outcomes including overweight and obesity. This study aimed to review the current evidences available in relation to adverse effects of fast food pattern on cardiometa­bolic risk factors. Methods: Relevant articles including epidemiological and clinical studies with appropriate design and good quality were obtained through searches of the Medline, PubMed, Scopus databases and Google scholar with related key words including "fast foods", "processed foods", "obesity", "overweight", "insulin resistance", "diabetes", "cardiovascular disease", "metabolic syndrome", "dyslipidemia" and "hypertension". Results: Fast food consumption and out-of-home eating behavior is a main risk factor for lower diet quality, higher calorie and fat intake and lower micronutrients density of diet. Frequent consumption of fast foods was accompanied with overweight and abdominal fat gain, impaired insulin and glucose homeostasis, lipid and lipoprotein disorders, induction of systemic inflammation and oxidative stress. Higher fast food consumption also increases the risk of developmental diabetes, metabolic syndrome and cardiovascular disease. Conclusion: This review provides further evidence warning us against the irreparable effects of fast food consumption on public health especially the increasing global burden of obesity and cardiovascu­lar diseases.

Background: The present study aimed to determine the effect of lentil sprouts [LS] on lipid profiles in overweight and obese patients with type 2 diabetes. Methods: Forty- eight overweight and obese type 2 diabetic patients, September and November2013, 30-65 years, participated in this clinical trial and randomly divided into two groups; LS group and con­trols. Patients in control group received conventional drug therapy, while patients in LS group received 60 g LS daily during 8 weeks along with routine medication. Significant differences among and between the groups were determined by independent t-test and paired sample t-test using SPSS software. The patients were blinded for the treatment. In this trial the effect of LS on serum lipid profiles were investigated. Results: Thirty-nine patients completed the study. After 8 weeks, serum levels of HDL-C was higher in the LS group compared to control group (48.3 ±1.9 vs. 42.8±1.7, P

BackgroundHelicobacter pylori infection and subsequent gastric inflammation have been proposed as risk factors for the development of insulin resistance and cardiovascular disease. In this study we assessed the possible association of H. pylori bacterial load, and serum biomarker of gastric inflammation with cardiometabolic risk factors in diabetic patients.MethodsIn this cross-sectional study, 84 H. pylori-infected type 2 diabetic patients were assessed for anthropometrics, biochemical and clinical measurements. Pearson correlation test, linear, and logarithmic regression curve estimation models were used to assess the association of H. pylori stool antigen (HpSAg) levels, and pepsinogen I (PGI) to pepsinogen II (PGII) ratio with fasting serum glucose, insulin, serum lipid and lipoprotein parameters, malondialdehyde, high-sensitive C-reactive protein (hs-CRP), systolic and diastolic blood pressure, body weight, waist circumference and lipid accumulation product (LAP) index.ResultsThe mean age of participants was 54±10 years, and 44% were men. Mean HpSAg levels and PGI/PGII ratio were 0.24±0.23 µg/mL and 9.9±9.0, respectively. Higher HpSAg as well as lower PGI/PGII was correlated with higher anthropometric measures and LAP. A significant negative correlation between PGI/PGII ratio and blood pressure (r=-0.21 and r=-0.22, systolic and diastolic, respectively, P

BackgroundMetabolic syndrome (MetS), a cluster of multiple metabolic abnormalities, is one of the major public health challenges worldwide. The current study was conducted to evaluate the association between sugar-sweetened beverage (SSB) consumption and MetS and its components in Iranian adults.MethodsThis cross-sectional study was conducted among 5,852 men and women, aged 19 to 70 years, who participated in the fourth phase (2009 to 2011) of the Tehran Lipid and Glucose Study. Demographics, anthropometrics, biochemical measurements, and blood pressure (BP) were assessed and MetS was defined by National Cholesterol Education Program Adult Treatment Panel III definition. Frequency and quantity of SSB intakes including carbonated drinks and synthetic fruit juices were collected using a validated semiquantitative food frequency questionnaire.ResultsMean age of participants (43%, men) was 40.6±12.9 years. Significant positive associations between SSBs and waist circumference, triglyceride level, systolic and diastolic BP in the third and fourth quartile of SSBs were observed, after adjustment for all potential confounding variables. The odds of MetS in the third and fourth quartiles compared to the first quartile category of SSBs was 1.21 (95% confidence interval [CI], 1.01 to 1.45) and 1.30 (95% CI, 1.06 to 1.58), respectively (P for trend=0.03). The odds of MetS, abdominal obesity, low high density lipoprotein cholesterol and elevated BP had increasing trends across increasing of SSB consumption (P for trend

BackgroundIn this study we investigated the associations of dietary acid-base load, identified by potential renal acid load (PRAL) and protein to potassium (Pro:K) ratio, with cardiometabolic risk factors in Tehranian adults.MethodsA cross-sectional study was conducted within the framework of the fourth phase of the Tehran Lipid and Glucose Study (2009 to 2011) on 5,620 men and women aged 19 to 70 years. Dietary data were collected by a trained dietitian using a validated, 147-food item, semi-quantitative food frequency questionnaire, and dietary PRAL and Pro:K ratio were calculated. Multiple linear regression models with adjustment for potential confounding variables were used to evaluate the associations of dietary acid-base load with anthropometric measures, blood pressure, serum triglycerides, high density lipoprotein cholesterol (HDL-C), serum creatinine, and fasting blood glucose.ResultsThe mean±SD age of the participants was 39.8±12.8 years and 54% of participants were women. Mean±SD PRAL was -22.0±29.1; mean PRAL was -15.6 in men and -26.8 in women. Dietary PRAL was associated with weight (β=0.098, P

Background: Diet plays a key role in the development of non-alcoholic fatty liver disease (NAFLD). The aim of this study was to review systematically observational studies available regarding the relationship between food intakes and NAFLD. Methods: We searched Scopus, PubMed, and Cochrane Library databases to identify English observational studies on food groups, dietary patterns, and NAFLD. Cross-sectional, case-control and cohort studies were selected and then duplication, topic, type of study, study population, variables examined and quality of data reporting of the articles were evaluated. Results: We identified 2128 studies in the initial search, of which 33 were reviewed in full text and 7 articles were included in this systematic review. Intakes of red meat, fats, and sweets were high whereas consumption of whole grains, fruits and vegetables were less in NAFLD patients. Moreover, there was a positive association between the Western dietary pattern and the risk of NAFLD, while adherence to the Mediterranean diet was significantly associated with the severity of hepatic steatosis. Conclusion: Generally, different food group intakes and dietary patterns are associated with the progression of NAFLD and its risk factors. Because of the many limitations of available studies reviewed on this topic, more prospective studies are suggested.

BackgroundLipid accumulation product (LAP) is a novel biomarker of central lipid accumulation related to risk of diabetes and cardiovascular disease. In this study, we assessed the association of LAP with glucose homeostasis, lipid and lipid peroxidation, and subclinical systemic inflammation in diabetic patients.MethodsThirty-nine male and 47 female type 2 diabetic patients were assessed for anthropometrics and biochemical measurements. LAP was calculated as [waist circumference (cm)-65]×[triglycerides (mmol/L)] in men, and [waist circumference (cm)-58]×[triglycerides (mmol/L)] in women. Associations of LAP with fasting glucose, insulin, insulin resistance index, lipid and lipoprotein levels, malondialdehyde, and high-sensitive C-reactive protein (hs-CRP) were assessed.ResultsMean age and LAP index were 53.6±9.6 and 51.9±31.2 years, respectively. After adjustments for age, sex and body mass index status, a significant positive correlation was observed between LAP index and fasting glucose (r=0.39, P

BACKGROUND: High intakes of phytochemical-rich foods have beneficial effects on lipid profiles and cardiovascular disease (CVD). In this study, we assessed the association between the dietary phytochemical index (PI) and changes in lipid profile after 3-year follow-up among Iranian adults. METHODS: This longitudinal study was conducted in 1983 subjects, aged 19-70 years, selected among participants of the Tehran Lipid and Glucose Study. Dietary data were collected by using a validated semi-quantitative food frequency questionnaire with 168 food items at baseline. PI was calculated based on daily energy derived from [(phytochemical-rich foods kcal/total daily energy intake kcal) × 100]. Lipid profile was measured at baseline and after 3 years and changes in serum lipid profiles were assessed during 3-year follow-up. RESULTS: The mean age of participants was 40.4 ± 13.0 years; participants in the highest PI quartile category were more likely to be older. After 3 years of follow-up, total cholesterol was significantly lower in the highest quartile compared with lower quartile of PI in men (181 ± 3 vs. 189 ± 3, P for trend CONCLUSION: Higher dietary PI is associated with 3 years improvement of total cholesterol, triglycerides, and non-HDL-C. Higher consumption of phytochemical-rich foods is recommended to prevent CVD. Keywords: Phytochemical, Triglyceride, Cholesterol, Fruit and vegetables, Whole Grains

The effectiveness of high-sulforaphane broccoli sprouts powder, as both complementary and alternative treatment, was compared to the standard triple therapy on Helicobacter pylori eradication in type 2 diabetic patients. Eighty-six type 2 diabetic patients with positive H. pylori stool antigen test (HpSAg) were randomized to receive one of the three following regimens: (STT) standard triple therapy, (BSP) 6 g/d broccoli sprouts powder for 28 days, and combination of these as STT + BSP. H. pylori eradication rates were assessed both by HpSAg and the urea breath test (UBT). Fasting serum glucose, insulin, insulin resistance, pepsinogen (PG) I and II levels and PGI/II ratio were also assessed. The H. pylori eradication rates, as assessed by UBT and HpSAg, were 85.3% and 89.3% in STT, 36.0% and 56.0% in BSP, and 83.3% and 91.7% in STT + BSP groups, respectively. There were no significant differences in serum pepsinogen I, pepsinogen II and PGI/PGII ratio and glucose homeostasis parameters between the three groups. BSP regimen despite a considerable effect on H. pylori eradication could not compete with the standard triple therapy.

Background & Aims: Unhealthy snacks contain high amounts of calories, simple sugars, fat, cholesterol, salt, additives, and conservatives. Increased consumption of these unhealthy snacks is one of the underlying factors for the prevalence of overweight, obesity, and metabolic disorders. In this study, we investigated the effects of unhealthy snacks on diet and the risk of metabolic syndrome after 3-years of follow-up in Tehranian adults. Methods: This longitudinal study was conducted within the framework of the Tehran Lipid and Glucose Study, between 2006-2008 and 2009-2011, on men and women in Tehran, Iran. Dietary intakes of participants were measured using a validated semi-quantitative food frequency questionnaire at baseline. Biochemical and anthropometric measurements were assessed at baseline and 3 years later. Multiple logistic regression models with adjustment for confounding factors were used to estimate the occurrence of metabolic syndrome (MetS) in each quartile of unhealthy snacks. Results: The mean age of participants was 37.8 ± 12.3 years, and the mean of body mass index was 26.0 ± 4.5 kg/m2 . Moreover, 39% of the participants were male. Daily energy intake, dietary energy density, and total fat and sodium intake were higher in the fourth quartile of unhealthy snacks consumption. There was a significant decreasing trend in dietary intake of carbohydrate, calcium, zinc, selenium, and fiber parallel to increase in consumption of energy-dense snacks. Participants who were in the highest quartile of energy intake from unhealthy snacks consumed less whole grains, vegetables, and dairy products. After adjustment for potential confounders, the risk of metabolic syndrome had a significant positive association with salty snacks consumption, and a non-significant positive association with consumption of candies, chocolate, and soft drinks. Conclusion:Increased daily energy intake from unhealthy snacks could be a risk factor for the occurrence of metabolic syndrome.

Anti-inflammatory therapeutic approaches are considered to be important in management of type 2 diabetes and prevention of its complication. This trial was conducted to evaluate the effects of broccoli sprouts powder (BSP) with high sulforaphane concentration, on inflammatory markers. Eighty-one patients with type 2 diabetes were randomly assigned to three treatment groups for 4 weeks. The groups received either 10 g/d BSP (n = 27), 5 g/d BSP (n = 29), or placebo (n = 25). Serum high-sensitive C reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis α (TNF-α) were measured at baseline and 4 weeks after treatment. Sixty-three patients were included in the analysis: 10 g/d BSP (n = 21), 5 g/d (n = 22), placebo (n = 20). After 4 weeks, in the BSP treatment groups there was a significant decrease in serum hs-CRP concentration (−20.5% and −16.4%), and also non-significant decrease in serum IL-6 (−3.6% and −0.7%), and TNF-α concentration (−1.6% and −10.9%), in group A and B, respectively. Serum hs-CRP and IL-6 were lower in group A as compared to the controls after intervention. High-sulforaphane BSP had favorable effects on inflammatory markers in type 2 diabetic patients.

Background: General and abdominal obesity are major global health problems. This cross-sectional study was conducted to evaluate the association between consumption of sugar-sweetened beverages (SSBs) and body mass index and waist circumference status in 5852 Iranian adults within the framework of the Tehran Lipid and Glucose Study (TLGS). Methods: Intakes of SSBs including carbonated drinks and synthetic fruit juices were measured using a validated food frequency questionnaire. The association between body mass index, waist circumference and body adiposity index in each quartile category of SSB consumption were determined using the multivariable linear regression models. The odds ratio (OR) of general and abdominal obesity in each quartile of SSB consumption was also determined using the multivariable logistic regression models. Results: Mean dietary intake of SSBs was 48.9 g/d or 0.25 servings/d. After adjustment for all potential confounding variables, significant associations were observed between SSB consumption and BMI (β: 0.49, 95% CI: 0.13-0.86), and waist circumference (β: 1.28, 95% CI: 0.40-2.16) in the fourth quartile. There was no significant association between SSB consumption and body adiposity index. Participants who consumed > 57.1 g/d of SSBs had 22% higher risk of general obesity (OR: 1.22, 95% CI: 1.00-1.48) and 35% higher risk of abdominal obesity (OR: 1.35, 95% CI: 1.12-1.61), compared with those in the lowest quartile of SSB consumption. Conclusion: Higher intakes of SSBs were associated with the higher risk of general and abdominal obesity in adults suggesting that limiting the consumption of SSBs may be a practical approach to prevent and manage obesity. Keywords: Sugar-sweetened beverages, Obesity, Abdominal obesity, Iran

Letter to the Editor

Data regarding the effects of dietary protein on modifying serum lipid and lipoprotein levels are controversial. In this study we have investigated the hypothesis whether dietary protein and protein to carbohydrate ratio could be related to subsequent changes in lipid profile in adults.This 3-yaers follow-up_longitudinal study was conducted on a sample of participants (845 men and 1043 women, aged 19-70 years) of the Tehran Lipid and Glucose Study. Dietary intakes were assessed using a validated semi-quantitative food frequency questionnaire. Anthropometric and serum lipid and lipoprotein levels were measured both at baseline (2006-2008) and after 3 years.After adjustment for potential confounding variables and dietary factors, the highest quartile energy intakes from protein was inversely associated with changes in total cholesterol (β= -6.5; 95% CI= -11.5, -1.5) and HDL-C levels (β= -6.7; 95% CI= -12.2, -1.4) in men during the follow-up. Increased proportion of energy intake from protein, compared to that of carbohydrate also had favorable effect on 3-years changes in triglycerides (β= -18.2; 95% CI= -36.7, -0.1) and total cholesterol (β= -8.4; 95% CI= -15.1, -1.8) in men. Higher dietary P/C ratio (median ≥ 0.23) was associated with a significant decrease in serum total cholesterol at 3-years follow-up in men with the higher intake of protein (median ≥ 13.4 % of energy).Higher intakes of dietary protein and more importantly, higher proportion of energy intakes from protein, compared to carbohydrate, had favorable effects on modifying lipid levels during a 3-year follow-up.