Calcium and dairy products in the chemoprevention of colorectal adenomas: a systematic review and meta-analysis.

The risk of transition to colorectal cancer (CRC) in advanced colorectal adenomas (ACAs) is about 2.5 times higher than the non-advanced ones. This systematic review and meta-analysis was performed to determine the effect of calcium and dairy products on the incidence of CAs and ACAs. Six databases were systematically searched and 37 relevant clinical trials and observational studies involving over 10,964 cases were selected for inclusion. The results showed that calcium consumption reduced the risk of CAs incidence by 8% (RR: 0.92; 95% CI: 0.89-0.96), and calcium intake as a food and dairy product reduced it about 21% (RR: 0.79; 95% CI: 0.72-0.86), and 12% (RR: 0.88; 95% CI: 0.78-0.98), respectively. However, calcium supplementation did not show a significant effect on CAs incidence (RR: 0.97; 95% CI: 0.89-1.05). Results also revealed that total calcium intake markedly reduced the risk of ACAs (RR: 0.79; 95% CI: 0.73-0.85) and the risk of recurrence of adenomas about 12% (RR: 0.88; 95% CI: 0.84-0.93). Our results suggest that natural sources of calcium such as dairy products and foods may have more effective role than supplementary calcium in terms of reducing the risk of incidence and recurrence of colorectal adenomas and advanced adenomas.

Expression of cord blood cytochrome P450 1A1 gene according to the air pollution level of the maternal residence area.

BACKGROUND: This study aimed to compare the cytochrome P450 1A1 (CYP1A1) gene expression in the cord blood of infants born from mothers living in low- and high-air polluted areas. MATERIALS AND METHODS: The study was conducted in Spring 2012 in Isfahan, the second large and air-polluted city in Iran. The study comprised 60 neonates, consisting of 30 infants born from mothers residing in areas with high levels of air pollution and an equal number of infants born in areas with a lower air pollution level. The umbilical cord blood sample was taken immediately after birth. The relative gene expression levels of CYP1A1 were examined using real time-polymerase chain reaction method. RESULTS: CYP1A1 gene expression level was 3.3-fold higher in the group living in areas with higher pollution level than in the other group (P = 0.01). No significant difference existed in the mean values of maternal age, gestational age, the newborns' birth weight, and the gender distribution between the two groups. CONCLUSION: This study provides confirmatory evidence of prenatal health hazards of ambient air pollution and highlights the need for pollution prevention programs to protect women of childbearing age and their children. The clinical implications of this study finding should be confirmed in future longitudinal studies.

The promotion of healthy breakfast and snacks based on the social marketing model: a mixed-methods study.

BACKGROUND: Skipping breakfast and replacing it with non-nutritious snacks are progressively increasing among adolescents. This study aimed to develop an educational intervention based on the Social Marketing Model and evaluate its effects on healthy breakfast and snack consumption among female adolescent students. METHODS: This mixed-methods study was conducted in 2016-2019 in two phases. In the first phase, a qualitative study was conducted through directed content analysis in guidance schools in Khorramabad, Isfahan, and Tehran, Iran, to explore factors affecting breakfast consumption. The results of this phase were set in the benchmarks of the Social Marketing Model. In the second phase, a randomized controlled trial was conducted based on the benchmarks of the Social Marketing Model on 94 students randomly recruited from guidance schools in Khorramabad, Iran. RESULTS: The findings of the qualitative phase were categorized into the benchmarks of the Social Marketing Model, namely the social marketing mix, the intended behavior, internal and external competing factors for behavior modification, theoretical concepts related to the behavior, and the role of supporters. In the quantitative phase, the univariate analysis showed significant between-group differences concerning the product, price, promotion, and behavior (p < 0.05). CONCLUSION: Healthy breakfast and snack consumption can be promoted through making acceptable the tastes, costs, preparations, and consumption places of breakfast and snack. TRIAL REGISTRATION: The trial was registered in the Iranian Registry of Clinical Trials (code: IRCT20170201032347N1 ). The trial was registered in 11/07/2018 and is accessible on the Iranian Clinical Trial Registration website.

Prediction of dyslipidemia using gene mutations, family history of diseases and anthropometric indicators in children and adolescents: The CASPIAN-III study.

Dyslipidemia, the disorder of lipoprotein metabolism resulting in high lipid profile, is an important modifiable risk factor for coronary heart diseases. It is associated with more than four million worldwide deaths per year. Half of the children with dyslipidemia have hyperlipidemia during adulthood, and its prediction and screening are thus critical. We designed a new dyslipidemia diagnosis system. The sample size of 725 subjects (age 14.66 ±â€¯2.61 years; 48% male; dyslipidemia prevalence of 42%) was selected by multistage random cluster sampling in Iran. Single nucleotide polymorphisms (rs1801177, rs708272, rs320, rs328, rs2066718, rs2230808, rs5880, rs5128, rs2893157, rs662799, and Apolipoprotein-E2/E3/E4), and anthropometric, life-style attributes, and family history of diseases were analyzed. A framework for classifying mixed-type data in imbalanced datasets was proposed. It included internal feature mapping and selection, re-sampling, optimized group method of data handling using convex and stochastic optimizations, a new cost function for imbalanced data and an internal validation. Its performance was assessed using hold-out and 4-foldcross-validation. Four other classifiers namely as supported vector machines, decision tree, and multilayer perceptron neural network and multiple logistic regression were also used. The average sensitivity, specificity, precision and accuracy of the proposed system were 93%, 94%, 94% and 92%, respectively in cross validation. It significantly outperformed the other classifiers and also showed excellent agreement and high correlation with the gold standard. A non-invasive economical version of the algorithm was also implemented suitable for low- and middle-income countries. It is thus a promising new tool for the prediction of dyslipidemia.

Association of glycaemic index and glycaemic load with metabolic syndrome in an Iranian adult population: Isfahan Healthy Heart Program.

AIM: There is controversy around the clinical effects of the dietary glycaemic index (GI) and glycaemic load (GL) on cardiovascular diseases risk factors such as metabolic syndrome (MetS). So, the present study was performed to evaluate the relationship between GI or GL and metabolic syndrome in an Iranian adult population in 2007. METHODS: The study was based on data from a sub-sample of the Isfahan Healthy Heart Program (IHHP), collected across three cities in central Iran, in the year 2007. This was a cross-sectional survey of 1618 randomly selected adults aged ≥19 years. Nutritional assessment was conducted by a single 24-hour recall questionnaire. Fasting serum lipids, anthropometric indicators and blood pressure were measured by standard methods. Analysis of covariance was used to compare metabolic syndrome components according to energy-adjusted GI and GL levels. To expose the effect of potential confounders, hierarchical logistic regression models were utilised to determine adjusted odds ratios (OR) and 95% CI. RESULTS: After adjustment for age, gender, body mass index and energy intake, high GI was found to be significantly associated with MetS (OR 95% CI) (1.46 (1.01-2.12)). This was attenuated marginally by excluding the confounding effects of dietary fibre intake (1.29 (1.01-1.74)). All hierarchical models illustrated no significant association between energy-adjusted GL and the risk of MetS adjusted for confounders. CONCLUSIONS: There is a positive relationship between dietary GI, but not GL, and the presence of MetS after adjustment for potential confounders. However, studies with long duration of follow up and experimental studies are still required to confirm this relationship.

Relationship of the intake of different food groups by pregnant mothers with the birth weight and gestational age: Need for public and individual educational programs.

OBJECTIVE: This study was conducted to investigate the relationship between the intake of different food groups by pregnant mothers and neonatal low birth weight and premature births. MATERIALS AND METHODS: In this cohort, the target population was 225 pregnant women, randomly selected from different geographical areas of the city of Isfahan, Iran (from April to September, 2012). The main variables in the study were weight and gestational age of the neonates and the type and amount of different food groups used by the mothers. All nutritional variables were compared according to different groups of infants (normal, premature, and low birth weight). In the multivariate analysis, multiple linear and logistic regression models were used to identify those different food frequency questionnaire (FFQ) variables independently associated with the newborn's weight and gestational age, adjusted by maternal consumption of calcium supplementation, folic acid, and omega-3, during pregnancy. RESULTS: A total of 214 (47.7% boys) infants with complete information were included. They had a mean gestational age of 38.72 ± 1.2 weeks. The mean birth weight was 3.11 ± 0.384 kg. The percentages of premature and low birth weight (LBW) infants were 7 and 5%, respectively. At multiple logistic regression controlling for potentially confounding factors that were significantly associated with prematurity and LBW at univariate analysis (maternal consumption of calcium supplementation, folic acid, and omega-3, during pregnancy), type of nutritional groups containing dairy products, proteins, fish, and shrimp group, as well as fruits and vegetables, had a significant positive association with increasing the gestational age (P < 0.05). The group that consumed proteins, fish, and shrimp, as well as fruits and vegetables had a significant positive association with the newborn's weight (P < 0.05). CONCLUSION: This study indicated the importance of proper nutrition on reducing the rates of LBW and premature births. Comprehensive educational programs at individual and public levels are warranted in this regard.

Seasonality and Physician-related Factors Associated with Antibiotic Prescribing: A Cross-sectional Study in Isfahan, Iran.

BACKGROUND: Irrational antibiotic prescribing as a global health problem has a major influence on medical care quality and healthcare expenditure. This study was aimed to determine the pattern of antibiotic use and to assess the seasonality and physician-related factors associated with variability in antibiotic prescribing in Isfahan province of Iran. METHODS: This cross-sectional survey was conducted on all prescriptions issued by general physicians from rural and urban areas in 2011. Associations between season of prescribing and physician-related variables including gender, practice location and time since graduation with antibiotic prescriptions and also the pattern of antibiotic prescribing were assessed using Chi-square tests and multiple logistic regression models. RESULTS: Of the 7439709 prescriptions issued by 3772 general practitioners, 51% contained at least one antibiotic. Penicillins were the most frequently prescribed antibiotics, followed by cephalosporins and macrolides. Over-prescription of penicillins was associated with female gender (odds ratio [OR], 2.61; 95% confidence interval [CI] 2.13-3.19) and with moderate duration of time in practice (10-20 years) (OR, 1.42; 95% CI 1.14-1.76). Higher rates of cephalosporins prescription were observed in urban areas than rural areas and by male physicians. Seasonal peak was detected for penicillins and cephalosporins prescriptions in autumn. CONCLUSIONS: These findings showed the widespread use of antibiotics by general practitioners that was associated with the physicians' gender, time since graduation and practice location and also season of prescribing. More researches are needed on other factors related to the overprescribing of antibiotics and they could be used to project educational programs for improvement of antibiotic prescribing quality in our country.

The effects of cardiac tertiary prevention program after coronary artery bypass graft surgery on health and quality of life.

OBJECTIVES: Cardiac tertiary prevention programs intend to support the recovery course following coronary artery bypass grafting (CABG). We investigated the effects of attendance at cardiac rehabilitation (CR) programs following CABG on patients' mortality, morbidity and health related quality of life. METHODS: Eighty patients who underwent CABG were selected in a way that half of them had attended a cardiac rehabilitation program and the other half had not. Health related quality of life (HRQoL) was measured using the Short Form 36 (SF-36) questionnaire at a mean of 23.4 months postoperatively. Severity of cardiac symptoms on the basis of the New York Health Association (NYHA), the occurrence of any neurological symptoms, hospitalization and restoration of patients to their previous level of performance in social activities were assessed after CABG surgery. RESULTS: There were no deaths. There were no differences in postoperative NYHA scores, neurological symptoms, and hospitalization. Three of the eight health domains measured by SF-36, namely general health (P = 0.010), physical function (P = 0.002), and mental health (P < 0.001), showed significantly better values for attendants than non-attendants. Rehabilitation participants returned to their previous level of performance in social activities more than their control counterparts. CONCLUSIONS: Higher general health scores (SF-36) were associated with attendance at CR programs. The findings of this study provide rationale to consider a broader scope of physiological and psychosocial parameters to predict outcomes of CABG surgery.