Effect of Cornus mas L. fruit extract on blood pressure, anthropometric and body composition indices in patients with non-alcoholic fatty liver disease: A double-blind randomized controlled trial.

BACKGROUND & AIMS: Obesity is linked to the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Patients with NAFLD are at increased risk for hypertension. Some investigations have hypothesized that Cornus mas L. fruit can improve obesity and hypertension. We investigated the effect of C. mas L. fruit extract on blood pressure, anthropometric and body composition indices in patients with NAFLD. METHODS: This 12-week double-blind randomized controlled trial was conducted on fifty patients with NAFLD. Patients received 20 cc/d C. mas L. fruit extract or placebo. We measured diastolic blood pressure (DBP), systolic blood pressure (SBP), weight, waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), body fat mass (BFM), body fat percent (BFP) and fat free mass (FFM) before and after intervention. RESULTS: Treatment group compared to control group showed a significant reduction in DBP (-8.62 ± 11.86 mmHg vs. 0.53 ± 8.53 mmHg; Pcrude = 0.003; Padjucted = 0.03) and SBP (-8.63 ± 14.37 mmHg vs. 0.0 ± 12.67 mmHg; Pcrude = 0.02; Padjucted = 0.02). We found no difference between groups in weight, WC, HC, WHR, BFM, BFP and FFM (P > 0.05). After adjusting for confounding factors, a significant reduction was observed in treatment group compared to control group in BFM (-0.2 ± 3.9 kg vs. 0.7 ± 2.4 kg; P = 0.01) and BFP (-0.2 ± 4.9% vs. 0.8 ± 2.8%; P = 0.02). CONCLUSIONS: C. mas L. fruit extract statistically reduced blood pressure and body fat. However, it had no effect on other anthropometric and body composition indices. Studies with larger sample sizes and higher dosages of extract are needed. TRIAL REGISTRATION: Registered on 30/9/2018 at Iranian Registry of Clinical Trials IRCT20180419039359N1 (https://www.irct.ir/trial/30707).

Effect of Cornus mas L. fruit extract on lipid accumulation product and cardiovascular indices in patients with non-alcoholic fatty liver disease: A double-blind randomized controlled trial.

BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is associated with high risk of cardiovascular diseases. The experimental studies have suggested that Cornus mas L. (cornelian cherry) fruit can improve cardiovascular risk factors. We designed a study to investigate the effect of cornelian cherry fruit extract on cardiovascular outcomes in patients with NAFLD. METHODS: We conducted a double-blind, randomized controlled trial. Fifty patients with NAFLD were randomly assigned into the treatment and the control groups. The treatment group received 20 cc/d cornelian cherry fruit extract as liquid form and the control group received 20 cc/d placebo for 12 weeks. The primary outcomes included lipid accumulation product (LAP), atherogenic index of plasma (AIP), Castelli risk index I (CRI-I), CRI-II and atherogenic coefficient (AC). RESULTS: At the baseline, there was no significant difference between two groups in values of LAP, AIP, CRI-I, CRI-II and AC. After the intervention, no significant change was found in the treatment group compared to the control group in LAP (-0.64 (-6.25 to 8.29) vs. 0.0 (-8.66 to 19.01); P = 0.91), AIP (0.0 ± 0.08 vs. 0.0 ± 0.1; P = 0.84), CRI-I (-0.18 ± 0.63 vs. -0.31 ± 0.49; P = 0.42), CRI-II (-0.23 ± 0.56 vs. -0.15 ± 0.32; P = 0.52) and AC (-0.18 ± 0.63 vs. -0.31 ± 0.49; P = 0.42). CONCLUSION: Cornelian cherry fruit extract has no effect on cardiovascular outcomes. Further studies with longer intervention durations are needed. TRIAL REGISTRATION: Registered on 30 September 2018 at Iranian Registry of Clinical Trials (IRCT20180419039359N1).

The effect of (Cornus mas L.) fruit extract on liver function among patients with nonalcoholic fatty liver: A double-blind randomized clinical trial.

This double-blind randomized clinical trial aimed to investigate impact of Cornus mas L. fruit extract (CMFE) on liver function in nonalcoholic fatty liver disease (NAFLD). Fifty patients were randomly assigned into the CMFE and placebo groups to receive 20 ml of the extract or placebo for 12 weeks, respectively. Serum alanine aminotransferase, aspartate aminotransferase, cytokeratin 18 (CK-18) levels, and steatosis and fibrosis scores were examined before and after the intervention. Although, a significant decrease was observed in CK-18 levels among the CMFE group (288.80 ± 85.40 vs. 235.66 ± 60.38; p = .001) after 12 weeks, no significant difference was found between the two groups. Moreover, a significant increase in fibrosis score in the placebo group (8.20 (6.35-9.40) vs. 8.40 (7.70-13.00); p = .03) as well as a significant difference in this marker (CMEF: 7.64 (6.30-8.25); placebo: 8.40 (7.70-13.00); p = .02) and its changes (CMEF: 0.60 (-1.00-1.07); placebo: 0.80 (-0.25-3.95); p = .02) were found between the groups after 12 weeks. No significant effect was noted on other variables. Therefore, consuming CMFE might have some beneficial effects on liver function markers in NAFLD. However, more studies are required in this area.

Association between empirically derived dietary patterns and liver function tests in adults: Shahedieh cohort study.

OBJECTIVES: Limited data exist on the association between dietary patterns (DPs) and enzymes mainly produced by the liver. This study aimed to examine the relationship between empirically derived DPs and serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma glutamyl transferase (GGT) levels in addition to the alanine/aspartate aminotransferase ratio. METHODS: This cross-sectional study was conducted on adults in the baseline phase of the Shahedieh cohort study in Yazd, Iran. Blood samples were taken from participants in a fasted state to provide data on dietary intake and other variables. Major DPs were derived using a principal component analysis. RESULTS: In total, 4973 participants (age 46.33 ± 9.08 y) were included in the study. Three DPs were derived: Traditional diet (high in vegetables, fruits, tomatoes, dairy, dried fruits, fruit juice, yogurt, olive and olive oil, sweet desserts, and high-fat dairy products), western diet (high in pizza, refined grains, soft drinks, high-fat dairy products, processed meats, mayonnaise, and snack foods), and hydrogenated fat and sugar diet (high in hydrogenated fat, potatoes, sugars, and legumes). After adjustment for all confounders, the western DP had a significant linear association with serum GGT (P < 0.001). This diet was also associated with higher odds for developing abnormal levels of serum GGT (Ptrend < 0.001). Although the other DPs had some linear associations with enzymes levels, they were not associated with the likelihood for developing abnormally high liver enzymes levels. CONCLUSIONS: A higher consumption of a western DP might adversely affect serum GGT levels. Prospective studies are recommended to confirm our results.

Prevalence of torque teno virus in healthy individuals and those infected with hepatitis C virus living in Yazd, Iran.

BACKGROUND: Torque teno virus (TTV) is a non-enveloped DNA virus that its role as a helper or causative agent in hepatitis is still unclear. TTV prevalence varies in different regions of the world. This study aimed to determine the prevalence of TTV in healthy individuals and those infected with hepatitis C virus (HCV) living in Yazd city, Iran. METHODS: In this case-control study, 50 healthy subjects and 68 HCV-positive individuals who referred to Yazd hospitals participated in this study. TTV DNA in serum samples were detected by nested polymerase chain reaction (PCR) using specific primers of 5΄-UTR and N22 regions. The genotypes of HCV and TTV were determined by sequencing method. RESULTS: TTV-DNA was detected in 2 out of 50 (4℅) healthy individuals and in 4 out of 68 (5.8℅) HCV-positive persons. There was not a significant correlation between the prevalence of TTV and HCV infection. The most common TTV genotypes among HCV-positive individuals were 3, 17 and 13, respectively. There was not a significant association obtained between HCV genotypes and TTV genotypes. CONCLUSION: The prevalence of TTV in Yazd province was low compared with the other areas of Iran. The prevalence of TTV in HCV infected people was not significantly higher than its rate in uninfected individuals.

Correlation between interleukin-28 gene polymorphism with interleukin-28 cytokine levels and viral genotypes among HCV patients in Yazd, Iran.

OBJECTIVES: Recent studies using genome-wide association studies (GWAS) have shown the strong association between polymorphisms near the interleukin-28B (IL-28B) gene and spontaneous clearance of hepatitis C virus (HCV). The present study was designed to evaluate the association of interleukin-28 gene polymorphism with interleukin-28 cytokine levels in different viral genotypes among HCV patients in Yazd, Iran. RESULT: The most prevalent genotype in chronic cases was genotype 3a, and the lowest one was 2/3a. There were statistically significant differences in genotype frequency between the two studied groups for IL-28B rs12979860C/T. The frequency of CC genotype of IL-28B at rs12979860 SNP was higher in spontaneously cleared patients in comparison with chronic HCV patients. Significant association was found when serum levels of IL28B were compared to various IL-28 genotypes. There was a significant difference between IL-28 polymorphism and HCV genotypes (p = 0.003).

The effect of total anthocyanin-base standardized (Cornus mas L.) fruit extract on liver function, tumor necrosis factor α, malondealdehyde, and adiponectin in patients with non-alcoholic fatty liver: a study protocol for a double-blind randomized clinical trial.

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

Five-year Survival Rate for Gastric Cancer in Yazd Province, Central Iran, from 2001 to 2008.

BACKGROUND The number of patients with gastric cancer is growing worldwide. In Iran (in 2009) of 74067 new cases of cancer, 6886 were diagnosed as having gastric cancer. This study was conducted to investigate 5-year survival rate for gastric cancer in Yazd province, central Iran. METHODS In this descriptive study, the medical records of patients with gastric cancer were collected from the archives of Yazd hospitals from 2001 to 2008. The data gathered included age, sex, type of histopathology, site of involvement, cancer staging, and mode of treatment, which were analyzed using SPSS software version 11.5. To investigate the survival and the factors influencing the survival time of patients, which are the main objectives of this study, Kaplan-Meier method was used and Cox proportional hazards model was fitted to the data. To compare survival function in different subgroups, the log rank test or generalized Wilcoxon test was used. RESULTS 295 cases of gastric cancer were enrolled in the study. The mean age of the subjects was 59.3 ± 9 years. 5-year survival rate of the patients was calculated as 18% where the highest rate was 39% for the age group of 50-60 years and the lowest was 3% for the age group of above 80 years. 5-year survival rates in different groups were as follows: 32% in women, 13% in men; 16% in adenocarcinoma, 46% in other pathologies; 16% in gastric cardia involvement, 17% in antrum; 59% in stage 1, 31% in stage 2, 13% in stage 3, and 3% in stage 4. CONCLUSION The results of this study showed that age, stage of the cancer, mode of therapy, and type of histopathology affected the survival rate of gastric cancer. No significant association was found between the site of involvement and survival rate. In general, the survival rate for gastric cancer was low, which might be due to slow but steady progress of the disease and delayed referral of the patients.

Quality of life in patients with colorectal cancer in Iran.

BACKGROUND AND STUDY AIMS: Colorectal cancer is a major health problem primarily affecting the quality of life (QoL) of both patient and family. With the advances in surgery and novel chemotherapeutic drugs and modalities, survival has increased and the QoL has improved. The aim of this study was to assess QoL in patients with colorectal cancer taking the situation in the Iranian city Yazd from 2006 to 2011 as an example. PATIENTS AND METHODS: This study was conducted on 120 patients who were diagnosed with colorectal cancer within the 5-year period of the study. Different aspects of the patients' lives were assessed using the EORTC Quality of Life Questionnaire (QLQ)-C30 questionnaire, and the results were reported in average aligned score compared with the maximum score of 100. RESULT: The mean age of the patients was 60.31±15.71years (range 14-88years). Sixty-three patients were male and 57 female. Further, 85 patients (70.8%) suffered from colon cancer and 34 (28.3%) had rectal cancer. All patients had undergone partial or total colectomies as treatment followed by chemotherapy. The average QoL score was 77.37±8.7 in women and 76.64±8.7 in men. No significant relationship was found between the average QoL score and gender. The average QoL score was 77.28±8.86 for colon cancer and 76.5±8.47 for rectal cancer, which was not statistically significant. The maximum average QoL score was 77.89±8.79 for stage 2 of the disease and the minimum score for stage 3 (75.81±7.66), indicating no significant relationship between the average QoL score and stage of cancer (p=0.89). CONCLUSION: The results of the present study revealed that despite clinical efforts in the city of Yazd, the QoL of patients with colorectal cancer is still very poor in physical, social, clinical, and financial aspects.

The role of diet in the management of non-ulcer dyspepsia.

BACKGROUND Dyspepsia is a common symptom with an extensive differential diagnosis and a heterogeneous pathophysiology. Many studies have reported that dyspeptic symptoms are associated with ingestion of some foods. Current treatments for functional dyspepsia have generally ignored the potential role of diet. METHODS This cross-sectional study was done at the Gastroenterology Department of Shahid Sadoughi Hospital, Yazd, Iran from September 2008 to March 2009. Based on the diagnostic criteria for functional dyspepsia symptoms presented to outpatient gastroenterology clinics, adult patients were invited to participate in this study. Upper GI endoscopy was performed in all the patients so as to rule out any gross pathology. The patients were asked about a list of nutrients including 114 foods which is commonly used in our area. Then, the effects of specific foods were identified on the relief or aggravation of the symptoms with four degrees: low, medium, high, and very high. RESULTS Of 384 patients, 152 were men and 231 were women with a mean ± SD age of 39.16±14 years (range: 13-80 years). The foods that caused the highest aggravation of symptoms were sausage and bolognas, pickles vinegar, soft drinks, grain, tea, salt, pizza, watermelon, red pepper, and macaroni. However, the most frequent foods that led to the alleviation of symptoms were apples, rice, rock candy, bread, caraway seed, dates, honey, yogurt, quince, and walnut. CONCLUSION This study shows that some foods, especially spicy, pickled, and high-fat foods, strongly induced dyspepsia and aggravated the symptoms in dyspeptic patients.

Relative Expression of Toll-Like Receptors 2 and 7 mRNA in Peripheral Blood of Patients With Hepatitis C.

BACKGROUND: Hepatitis C virus (HCV) is an important human pathogen affecting an estimated 120 - 170 million individuals in the world. Toll-Like receptors (TLRs) are pattern-recognition receptors that recognize pathogen-associated molecular patterns, and stimulate immune responses. OBJECTIVES: The aim of this study was to determine the mRNA expression level of TLR2 and TLR7 in HCV-infected patients in comparison with normal controls. PATIENTS AND METHODS: Nineteen consecutive patients with HCV infection and nineteen sex and age-matched healthy controls were studied in a case-controlled research. RESULTS: Our results showed that the expressions of TLR7 in HCV infected samples were significantly increased in comparison those of the controls (P = 0.02), while the expression of TLR2 was similar between the case and the control group (P = 0.8). There were no associations between the expression levels of TLR2 and TLR7 with HCV viral load and HCV genotypes. Also, there was no association between viral load and genotypes of the virus. CONCLUSIONS: Our findings showed that HCV infection could lead to increased expression level of TLR7 mRNA in peripheral blood cells of HCV infected samples. The viral load and genotypes of HCV did not affect the mRNA expression levels of TLR2 and TLR7.

Hepatitis C virus genotypes and association with viral load in yazd, central province of iran.

BACKGROUND: Hepatitis C virus (HCV) is a major cause of liver disease. Infection with HCV is a global public health problem. The virus is classified into 6 genotypes and more than 80 subtypes named as a, b, c, etc. HCV genotyping has been an important parameter for the treatment of HCV infection. OBJECTIVES: The main aim of this study was to estimate the prevalence of HCV genotypes in Yazd, central province of Iran. In addition, the study investigated whether there was any association between HCV load and genotypes. PATIENTS AND METHODS: This descriptive cross-sectional study was performed on samples suspicious of HCV infection from March 2010 to June 2013. Peripheral blood sample was obtained and screened for anti-HCV antibodies using Enzyme-Linked Immunosorbent Assay (ELISA). Then sera of anti-HCV positive samples were analyzed using quantitative polymerase chain reaction method. Plasma samples were used to determine the HCV genotypes of 1a, 1b, 2, 3, and 4 in 191 infected patients. RESULTS: One hundred fifty-two out of 191 (79.6%) samples were from male patients. The mean of the patients' age was 40.7 ± 11.9 years (range 21-75 years old). Sixty- three (33%) patients were included in 31-40 years group. The mean number of HCV in infected patients was 2.92 × 10(6) ± 1.85 × 10(6) copies/mL (Min: 508; Max: 2.75 × 10(8) copies/mL). HCV genotype 3 was the predominant genotype (50.3%) followed by subtypes 1a (38.7%) and 1b (6.8%). The distribution of other HCV genotypes showed genotype 2 in 1.6% and mixed genotypes in 2.6% of positive samples. Genotype 3 was predominant in all age groups except 21-30 years of age group. We were unable to find any significant difference between mean viral load of the patients infected with genotype 3 and those infected with genotype 1 (1a and 1b). CONCLUSIONS: Findings of the present study showed that HCV genotype 3 was the predominant genotype followed by the subtypes 1a and 1b in Yazd, central province of Iran. In addition, there was no difference between HCV load and genotypes 1 and 3. HCV genotyping is recommended in other provinces of Iran.

Incidence and risk factors for non-alcoholic steatohepatitis in females treated with tamoxifen for breast cancer.

BACKGROUND AND STUDY AIMS: Tamoxifen used in the treatment of breast cancer is reported to cause hepatic steatosis. This study aimed to assess the incidence and risk factors of the development of fatty liver disease, resulting from tamoxifen use, in females with breast cancer. PATIENTS AND METHODS: Seventy females aged between 28 and 80years with breast cancer were recruited from Shahid Sadoughi Clinic, Yazd, Iran in 2006-2008. The patients underwent chemotherapy followed by 20mg tamoxifen daily as postoperative endocrine treatment. Only in patients with normal baseline liver function, negative test for hepatitis C virus (HCV) and hepatitis B surface antigen (HbsAg) and normal liver ultrasonography were included. The development of fatty changes over a 6-months period of treatment was the main outcome measurement assessed by ultrasonography. RESULTS: Thirty-five of 70 patients developed fatty change during follow-up, in which nine were in grade one, 20 in grade two and six patients in grade three. Risk factors associated with the development of fatty change were elevation of triglycerides (2.4, 1.2-4.8), elevation of fasting blood sugar (FBS) and low high-density lipoprotein (HDL) (3.4, 1.4-7.8). No relation was found between the development of fatty change and age (1.3, 0.87-2.00), menopause (1.13, 0.69-1.9), previous history of diabetes (2.4, 0.7-8.4), previous chemotherapy regimen and receptors type (c-erbB2, P53, progesterone receptor (PR), oestrogen receptor (ER)) and stage of breast cancer. Further, there was no relation between the development of fatty change and hypercholesterolemia, low-density lipoprotein (LDL), arterial hypertension and body mass index (BMI). CONCLUSION: Tamoxifen was associated with a high risk of development of non-alcoholic steatohepatitis in patients with higher triglycerides and FBS and lower HDL. However, no relationship was found with the level of BMI, LDL, hypertension, overweight and obesity.