A comparison of principal component analysis, reduced-rank regression, and partial least-squares in the identification of dietary patterns associated with cardiometabolic risk factors in Iranian overweight and obese women.

BACKGROUND: According to epidemiological studies, unhealthy dietary patterns and lifestyle lead to rising obesity and cardiometabolic diseases in Iran. Hybrid techniques were used to identify a dietary pattern characterized by fiber, folic acid, and carotenoid intake due to their association with cardiometabolic risk factors such as anthropometric measurements, blood pressure, lipid profile, C-Reactive Protein (CRP), Plasminogen Activator Inhibitor (PAI), Homeostatic Model Assessment Index (HOMA Index), cardiometabolic index (CMI), and monocyte chemoattractant protein (MCP-1). So, the objective of the recent study is to compare the reduced-rank regression (RRR) and partial least-squares (PLS) approaches to principal component analysis (PCA) for estimating diet-cardiometabolic risk factor correlations in Iranian obese women. METHODS: Data on dietary intake was gathered from 376 healthy overweight and obese females aged 18 to 65 years using a 147-item food frequency questionnaire (FFQ). In this cross-sectional study, participants were referred to health centers of Tehran. Dietary patterns were developed using PCA, PLS, and RRR, and their outputs were assessed to identify reasonable patterns connected to cardiometabolic risk factors. The response variables for PLS and RRR were fiber, folic acid, and carotenoid intake. RESULTS: In this study, 3 dietary patterns were identified by the PCA method, 2 dietary patterns by the PLS method, and one dietary pattern by the RRR method. High adherence to the plant-based dietary pattern identified by all methods were associated with higher fat free mass index (FFMI) (P < 0.05). Women in the highest tertile of the plant-based dietary pattern identified by PLS had 0.06 mmol/L (95% CI: 0.007,0.66, P = 0.02), 0.36 mmHg (95% CI: 0.14,0.88, P = 0.02), and 0.46 mg/l (95% CI: 0.25,0.82, P < 0.001), lower FBS, DBP, and CRP respectively than women in the first tertile. Also, PLS and RRR-derived patterns explained greater variance in the outcome (PCA: 1.05%; PLS: 11.62%; RRR: 25.28%), while the PCA dietary patterns explained greater variance in the food groups (PCA: 22.81%; PLS: 14.54%; RRR: 1.59%). CONCLUSION: PLS was found to be more appropriate in determining dietary patterns associated with cardiometabolic-related risk factors. Nevertheless, the advantage of PLS over PCA and RRR must be confirmed in future longitudinal studies with extended follow-up in different settings, population groups, and response variables.

A health promotion model-based intervention to enhance treatment adherence in patients with type 2 diabetes.

BACKGROUND: The present study aimed to determine the effect of an intervention based on Pender's health promotion model (HPM) on treatment adherence in patients with type 2 diabetes (T2D). METHODS: The present quasi-experimental study with a 3-month follow-up was conducted in Bandar Abbas, a city in the south of Iran in 2023. The intervention group (IG) with a total number of 95 T2D patients was selected from Hormuz diabetes clinic and the control group (CG) with 95 T2D patients was selected from comprehensive health centers through a clustering sampling method. The educational intervention was implemented in 10 sessions to improve patients' treatment adherence. The teaching methods in training sessions were lectures, joint discussions, Q&A, role-play and peer training. The participants were evaluated using a researcher-made questionnaire including the constructs of Pender's HPM about T2D treatment adherence, hemoglobin A1C (HbA1C), and BMI. Independent-samples t-test, paired-samples t-test, covariance analysis and stepwise regression analysis were used. Data analysis was done in SPSS 26. FINDINGS: Three months after the intervention, in comparison to the CG, the mean and standard deviation of treatment adherence benefits (p = 0.002), treatment adherence self-efficacy (p = 0.010), treatment adherence related affect (p = 0.001), interpersonal influences (p = 0.012), commitment to plan of action (p < 0.001), treatment adherence behavior (p = 0.022), treatment adherence experiences (p = 0.001) was higher in the IG. The mean and standard deviation of situational influences (p < 0.001), immediate competing demands and preferences (p = 0.018) were lower than the CG. The results obtained from the analysis of covariance proved the effectiveness of the intervention in the constructs of Pender's HPM and HbA1C in participants of the IG (p < 0.001). The regression analysis showed, after the intervention, for every 1 unit of change in commitment to behavior planning, action related affect and perceived self-efficacy, compared to before the intervention, there were 0.22 units, 0.16 units and 0.26 units of change in the behavior score in the IG. CONCLUSION: The findings proved the effectiveness of the educational intervention in improving the constructs in Pender's HPM and the blood sugar level of T2D patients. As the results of the educational intervention showed, the use of a suitable educational approach as well as the development of appropriate educational content for the target population can significantly improve the treatment adherence behavior. TRIAL REGISTRATION: This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1: https://www.irct.ir/trial/61741 ) and first release date of 17th March 2022.

The association between dietary patterns and metabolic syndrome among Iranian adults, a cross-sectional population-based study (findings from Bandare-Kong non-communicable disease cohort study).

BACKGROUND: Metabolic syndrome is a cluster of metabolic disorders increasing the risk of cardiovascular disease and diabetes. Dietary patterns are supposed to be important and controllable factors in developing metabolic syndrome. The purpose of this study was to investigate the association of dietary patterns with metabolic syndrome and its components. SUBJECTS/METHODS: Cross-sectional data were extracted from the Bandare-Kong cohort study conducted on 4063 people aged 35 to 70. Dietary patterns were extracted using principal component analysis based on thirty-eight pre-defined food groups. Multivariable logistic regression was conducted to investigate the association between metabolic syndrome and its components with quintiles of dietary patterns in crude and adjusted models. RESULTS: Three major dietary patterns were identified (healthy, western, and traditional) in the final analysis of 2823 eligible individuals. After adjusting for covariates, the odds of metabolic syndrome were significantly decreased by 46% in subjects with the highest adherence to the healthy dietary pattern compared to those with the lowest adherence quintile. Results from fully adjusted models on individual metabolic syndrome components showed an inverse association between higher adherence to the healthy dietary pattern and the odds of increased blood glucose, high waist circumference, and elevated blood pressure. However, in fully adjusted models, no significant association was observed between the western and traditional dietary patterns with odds of metabolic syndrome and its components. CONCLUSIONS: Adherence to a healthy dietary pattern containing high amounts of fruits, vegetables, nuts, low-fat dairy products, and legumes, could be recommended to prevent and control metabolic syndrome.

Interactions Between Genetic Risk Score and Healthy Plant Diet Index on Cardiometabolic Risk Factors Among Obese and Overweight Women.

People with higher genetic predisposition to obesity are more susceptible to cardiovascular diseases (CVDs) and healthy plant-based foods may be associated with reduced risks of obesity and other metabolic markers. We investigated whether healthy plant-foods-rich dietary patterns might have inverse associations with cardiometabolic risk factors in participants at genetically elevated risk of obesity. For this cross-sectional study, 377 obese and overweight women were chosen from health centers in Tehran, Iran. We calculated a healthy plant-based diet index (h-PDI) in which healthy plant foods received positive scores, and unhealthy plant and animal foods received reversed scores. A genetic risk score (GRS) was developed based on 3 polymorphisms. The interaction between GRS and h-PDI on cardiometabolic traits was analyzed using a generalized linear model (GLM). We found significant interactions between GRS and h-PDI on body mass index (BMI) (p = 0.02), body fat mass (p = 0.04), and waist circumference (p = 0.056). There were significant gene-diet interactions for healthful plant-derived diets and BMI-GRS on high-sensitivity C-reactive protein (p = 0.03), aspartate aminotransferase (p = 0.04), alanine transaminase (p = 0.05), insulin (p = 0.04), and plasminogen activator inhibitor 1 (p = 0.002). Adherence to h-PDI was more strongly related to decreased levels of the aforementioned markers among participants in the second or top tertile of GRS than those with low GRS. These results highlight that following a plant-based dietary pattern considering genetics appears to be a protective factor against the risks of cardiometabolic abnormalities.

The association between dietary pattern and visceral adiposity index, triglyceride-glucose index, inflammation, and body composition among Iranian overweight and obese women.

The aim of the present study was to investigate the association between dietary patterns, derived through latent class analysis (LCA), with visceral adiposity index (VAI), Triglyceride-Glucose Index (TyG), inflammation biomarkers, and body composition in overweight and obese Iranian women. For this cross-sectional study, dietary exposure was assessed using a validated 147-item semi-quantitative food frequency questionnaire (FFQ). Dietary patterns were derived through LCA. Binary logistic was performed to test the associations of dietary patterns with VAI, TyG, inflammation biomarkers, and body composition. Health centers in Tehran, Iran. 376 obese and overweight women, aged > 18 years. Two dietary patterns were identified using LCA modeling: healthy and unhealthy. Women in the unhealthy class were characterized by higher consumption of fast food, sweetened beverages, grains, unhealthy oils, butter and margarine, and snacks. Compared with the healthy class, the unhealthy class was associated with an increased risk of higher fasting blood sugar (FBS) (OR = 6.07; 95% CI: 1.33-27.74, P value = 0.02), c-reactive protein (CRP) (OR = 1.72; 95% CI: 1.05-2.80; P value = 0.02), and lower fat free mass index (FFMI) (OR = 0.56; 95% CI: 0.35-0.88, P value = 0.01), after adjusting for confounders. We found that adherence to an unhealthy dietary pattern was associated with decreased FFMI and increased FBS and CRP using LCA, but not with the rest of the variables. Further studies should be conducted to confirm the veracity of these findings.

Concentration of mineral and heavy metals in raw mare (horse) milk consumed in Yazd, Iran: A risk assessment study.

BACKGROUND: In recent years, the mare's milk has been introduced as a rich source of nutrients with hypoallergic characteristics which is widely used for Iranian infants. OBJECTIVES: The present study aimed to investigate the heavy metal concentration of mare's milk and its consumption risk assessment. METHODS: About 88 mare's milk was collected from Yazd, the centre of Iran, during the summer of 2020. The raw mare's milk was digested and analysed for mineral and heavy metal content (As, Ca, Cd, Co, Cu, Fe, Mg, Mn, Ni, P, Pb and Zn) by ICP-OES. To estimate the health hazard for consumers the Estimated Daily Intake (EDI), Hazard Quotient (HQ) and Hazard Index (HI) of heavy metals were determined. RESULTS: The Ca ranged from 260.52 to 201.43 mg/L, which was the highest mineral in mare's milk followed by P and Mg. By increasing the age, P and Ca content was increased. The obtained ranges of Cu, Co, Fe, Mn and Zn were 72.12-75.11, 1.12-9.3, 180.69-230.21, 31.24-47.13 and 1060-1200 µg/L, respectively. The Cd and Arsenic content of mares' 8-11 years of age had higher concentrations. The highest Pb content was reported in mares 4-7 years old (10 µg/L). Although, Pb, Cd and As content of the mare's milk was evaluated lower than the permissible limit. Also, the HQ value was As > Cd > Pb > Zn > Ni > Cu for infants, toddlers and adults. The HI of mare's milk was 0.16, 0.15 and 0.022 for infants, toddlers and adults, respectively. CONCLUSIONS: Mare's milk could be an effective nutrition source for infants and children suffering from milk protein allergies.

The relationship of genetic risk score with cardiometabolic risk factors: a cross-sectional study.

BACKGROUND & AIMS: For more than eight decades, cardiovascular disease (CVD) has remained the leading cause of death in the world. CVD risk factors are multifaceted, with genetics and lifestyle both playing a role. The aim of this study was to investigate the association between a genetic profile risk score for obesity GRS and cardio-metabolic risk factors in overweight and obese women. METHODS: The current cross-sectional study was conducted on 391 overweight and obese women. The genetic risk score was created by combining three single nucleotide polymorphisms [MC4R (rs17782313), CAV-1 (rs3807992), and Cry-1 (rs2287161)]. Anthropometric measurements, blood pressure, and some blood parameters were measured by standard protocols. RESULTS: A significant association between the GRS and some of cardiometabolic risk factors variables such as body mass index (ß = 0. 49, 95%CI = 0.22 to 0.76, p < 0.001), waist circumference (ß = 0. 86, 95%CI = 0.18 to 1.54, p = 0.01), body fat mass (ß = 0. 82, 95%CI = 0.25 to 1.39, p = 0.005), %body fat (ß = 0. 44, 95%CI = 0.06 to 0.82, p = 0.02), and hs-CRP (ß = 0.46, 95% CI = 0.14 to 0.78, p = 0.005) was observed in crude model. After adjustment for confounding factors (age, BMI, and physical activity), a significant positive association was observed between BMI (p = 0.004), WC (p = 0.02), body fat mass (p = 0.01), %BF (p = 0.01), hs-CRP (p = 0.009), and GRS. In addition, we discovered a significant negative association between the GRS and BMC (= -0.02, 95%CI = -0.05 to -0.001, p = 0.04). But other variables did not show any significant association with GRS among obese and overweight women. CONCLUSION: We found a significant positive association between GRS, including MC4R (rs17782313), CAV-1 (rs3807992), and Cry-1 (rs2287161) and cardiometabolic risk factors among overweight and obese Iranian women.

Occurrence and ecological risk assessment of antibiotic residues in urban wastewater discharged into the coastal environment of the Persian Gulf (the case of Bandar Abbas).

This is the first attempt to detect antibiotic residues released into the Persian Gulf marine environment. In particular, this study quantifies and assesses the ecological risks of amoxicillin (AMX) and azithromycin (AZM) residues in wastewater outfalls from Bandar Abbas, one of the major coastal cities in southern Iran. The wastewater effluent samples were collected from two main wastewater discharging stations, Gursuzan and Suru, between December 2020 and February 2021. High-performance liquid chromatography (HPLC) analysis revealed the average concentration (± 95% CL) of AMX were 460 ± 230.0 µg L-1 and 280 ± 100.6 µg L-1 in Gursuzan and Suru stations. Mean AZM concentrations were also 264 ± 10.59 µg L-1 and 295 ± 89.75 µg L-1 in these stations, respectively. Pooled data indicated that there are 335.17 ± 105.11 and 288.17 ± 37.94 µg of AMX and AZM residues in the wastewater per liter. The values of potential ecological risk, hazard quotient (HQ), were extensively above 10 (AMX: 90,586.5 and AZM: 5541.7) which suggest that these substances have a high health risk for the ecosystem and public. Given that Bandar Abbas wastewater treatment plant (WWTP) outlets are discharged at about 500 to 700 L s-1, the daily maximum potential AMX and AZM released were estimated to be 19.05 (± 0.283) × 103 and 14.74 (± 0.113) × 103 g day-1, respectively (α = 0.05). Our findings show that there is a concerning volume of antibiotic residues released into the northern Persian Gulf, and hence urgent policies and actions are necessary to reduce this pollution.