The High-Dietary Insulin Load Score Is Associated With Elevated Level of Fasting Blood Sugar in Iranian Adult Men: Results From Fasa PERSIAN Cohort Study.

Aim: The potential of different foods to induce postprandial hyperinsulinemia may be involved in the development of metabolic syndrome (MetS). We aimed to evaluate the association between dietary insulin indices and MetS in a large population of adults in Iran. Methods: A total of 6356 adults aged 35-70 years were included in the present cross-sectional study. A validated block-format 125-item semiquantitative food frequency questionnaire (FFQ) was used to obtain usual food intakes, and MetS was defined according to the International Diabetes Federation (IDF) and American Heart Association (AHA)/National Heart, Lung, and Blood Institute (NHLBI) criteria. Results: MetS was prevalent in 13.8% of participants. Mean age of the study participants was 46.58 ± 8.82 years, and mean body mass index (BMI) was 25.02 ± 4.60 kg/m2. Mean dietary insulin index (DII) and dietary insulin load (DIL) were 63.15 ± 7.57 and 168.253 ± 52.09, respectively. In the crude model, men in the highest DIL quartile were more likely to have hyperglycemia than those in the lowest quartile (OR: 1.75, 95% CI: 1.12-2.73, p trend = 0.04). This association remained significant and was even stronger after adjusting for potential confounders in model I (OR: 3.64, 95% CI: 1.57-8.47, p trend = 0.005) and further adjustment for BMI in model II (OR: 3.61, 95% CI: 1.55-8.44, p trend = 0.006). Conclusions: In healthy men, adherence to a high-DIL diet may be associated with a greater likelihood of having hyperglycemia. No statistically significant association was observed between insulin indices and the odds of having MetS.

Improving Fertility in Non-obstructive Azoospermia: Results from an Autologous Bone Mar-row-Derived Mesenchymal Stromal/Stem Cell Phase I Clinical Trial.

BACKGROUND: In this phase I clinical trial, our primary objective was to develop an innovative therapeutic approach utilizing autologous bone marrow-derived mesenchymal stromal/stem cells (BM-MSCs) for the treatment of nonobstructive azoospermia (NOA). Additionally, we aimed to assess the feasibility and safety of this approach. MATERIALS AND METHODS: We recruited 80 participants in this non-randomized, open-label clinical trial, including patients undergoing NOA treatment using autologous BM-MSCs (n=40) and those receiving hormone therapy as a control group (n=40). Detailed participant characteristics, such as age, baseline hormonal profiles, etiology of NOA, and medical history, were thoroughly documented. Autotransplantation of BM-MSCs into the testicular network was achieved using microsurgical testicular sperm extraction (microTESE). Semen analysis and hormonal assessments were performed both before and six months after treatment. Additionally, we conducted an in-silico analysis to explore potential protein-protein interactions between exosomes secreted from BM-MSCs and receptors present in human seminiferous tubule cells. RESULTS: Our results revealed significant improvements following treatment, including increased testosterone and inhibin B levels, elevated sperm concentration, and reduced levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. Notably, in nine patients (22.5%) previously diagnosed with secondary infertility and exhibiting azoospermia before treatment, the proposed approach yielded successful outcomes, as indicated by hormonal profile changes over six months. Importantly, these improvements were achieved without complications. Additionally, our in-silico analysis identified potential binding interactions between the protein content of BM-MSC-derived exosomes and receptors integral to spermatogenesis. CONCLUSION: Autotransplantation of BM-MSCs into the testicular network using microTESE in NOA patients led to the regeneration of seminiferous tubules and the regulation of hormonal profiles governing spermatogenesis. Our findings support the safety and effectiveness of autologous BM-MSCs as a promising treatment modality for NOA, with a particular focus on the achieved outcomes in patients with secondary infertility (registration number: IRCT20190519043634N1).

Reply to Ghobadi and Jafari: diet quality in relation to the risk of hypertension among Iranian adults: cross-sectional analysis of Fasa PERSIAN cohort study.

Ghobadi and Jafari have mentioned some points about our article titled "Diet quality in relation to the risk of hypertension among Iranian adults: cross-sectional analysis of Fasa PERSIAN cohort study" which was published in the Nutrition Journal. Thanks for their consideration, the following is provided as a response to their comments.

A cohort study on the predictive capability of body composition for diabetes mellitus using machine learning.

Purpose: We applied machine learning to study associations between regional body fat distribution and diabetes mellitus in a population of community adults in order to investigate the predictive capability. We retrospectively analyzed a subset of data from the published Fasa cohort study using individual standard classifiers as well as ensemble learning algorithms. Methods: We measured segmental body composition using the Tanita Analyzer BC-418 MA (Tanita Corp, Japan). The following features were input to our machine learning model: fat-free mass, fat percentage, basal metabolic rate, total body water, right arm fat-free mass, right leg fat-free mass, trunk fat-free mass, trunk fat percentage, sex, age, right leg fat percentage, and right arm fat percentage. We performed classification into diabetes vs. no diabetes classes using linear support vector machine, decision tree, stochastic gradient descent, logistic regression, Gaussian naïve Bayes, k-nearest neighbors (k = 3 and k = 4), and multi-layer perceptron, as well as ensemble learning using random forest, gradient boosting, adaptive boosting, XGBoost, and ensemble voting classifiers with Top3 and Top4 algorithms. 4661 subjects (mean age 47.64 ± 9.37 years, range 35 to 70 years; 2155 male, 2506 female) were analyzed and stratified into 571 and 4090 subjects with and without a self-declared history of diabetes, respectively. Results: Age, fat mass, and fat percentages in the legs, arms, and trunk were positively associated with diabetes; fat-free mass in the legs, arms, and trunk, were negatively associated. Using XGBoost, our model attained the best excellent accuracy, precision, recall, and F1-score of 89.96%, 90.20%, 89.65%, and 89.91%, respectively. Conclusions: Our machine learning model showed that regional body fat compositions were predictive of diabetes status.

The effects of aerobic and resistant exercises on the lipid profile in healthy women: a systematic review and meta-analysis.

Exercise can have a wide range of health benefits, including improving blood lipid profiles. For women to achieve optimal cardiovascular health, it is vital to determine the effect of exercise on their health and whether different exercise intensities can affect their blood lipid profile. A systematic review and meta-analysis were conducted to examine the effects of exercise on improving the lipid profile of healthy women. A database search was conducted using PubMed, Google Scholar, Embase, Scopus, and Web of Science from inception until July 2, 2021, for randomized controlled trials (RCTs) investigating exercise's effects on healthy women's blood lipid profiles. A total of 10 eligible articles (or 17 trials) with 576 participants were identified as eligible for the study. Overall, the meta-analysis shows that physical activity significantly improved total cholesterol (TC), triglycerides (TG), and high-density lipoprotein (HDL-C) levels: TC [WMD = -5.77 mg/dL, 95% CI: -10.41, -1.13, P < 0.01]; TG [WMD = -5.60 mg/dL, 95% CI: -8.96, -2.23, P < 0.01]; HDL [WMD = 4.49 mg/dL, 95% CI: 0.33, 8.65, P = 0.03]. Additionally, sub-group analyses indicated that combined exercise training improved TG and TC (p 0.05), and aerobic exercise significantly increased HDL. In this study, physical activity appears to be one of the most effective non-pharmacological means for improving HDL, TG, and TC in healthy women. In terms of TG and TC, CT was the most effective.

Comparison of atherosclerotic cardiovascular disease (ASCVD) and Framingham risk scores (FRS) in an Iranian population.

Background: Framingham risk score (FRS) and Atherosclerotic Cardiovascular Disease risk score (ASCVDrs) are widely used tools developed based on the American population. This study aimed to compare the ASCVDrs and FRS in an Iranian population. Method: The participants of the Fasa Adult Cohort Study and the patients of the cardiovascular database of Vali-Asr Hospital of Fasa, aged 40-80 years, were involved in the present cross-sectional study. After excluding non-eligible participants, the individuals with a history of myocardial infarction or admission to the cardiology ward due to heart failure were considered high-risk, and the others were considered low-risk. The discriminative ability of FRS and ASCVDrs was evaluated and compared using receiver operating characteristic curve analysis. The correlation and agreement of ASCVDrs and FRS were tested using Cohen Kappa and Spearman. Results: Finally, 8983 individuals (mean age:53.9 ± 9.5 y, 49.2 % male), including 1827 high-risk participants, entered the study. ASCVDrs detected a greater portion of participants as high-risk in comparison with FRS (28.7 % vs. 15.7 %). ASVD (AUC:0.794) had a higher discriminative ability than FRS (AUC:0.746), and both showed better discrimination in women. Optimal cut-off points for both ASCVDrs (4.36 %) and FRS (9.05 %) were lower than the original ones and in men. Compared to FRS, ASCVDrs had a higher sensitivity (79.3 % vs. 71.6 %) and lower specificity (64.5 % vs. 65.1 %). FRS and ASCVDrs had a moderate agreement (kappa:0.593,p-value<0.001) and were significantly correlated (Spearman:0.772,p-value<0.001). Conclusions: ASCVDrs had a more accurate prediction of cardiovascular events and identified a larger number of people as high-risk in the Iranian population.

Identifying Risk Indicators of Cardiovascular Disease in Fasa Cohort Study (FACS): An Application of Generalized Linear Mixed-Model Tree.

BACKGROUND: Today, cardiovascular disease (CVD) is the most important cause of death around the world. In this study, our main aim was to predict CVD using some of the most important indicators of this disease and present a tree-based statistical framework for detecting CVD patients according to these indicators. METHODS: We used data from the baseline phase of the Fasa Cohort Study (FACS). The outcome variable was the presence of CVD. The ordinary Tree and generalized linear mixed models (GLMM) were fitted to the data and their predictive power for detecting CVD was compared with the obtained results from the GLMM tree. Statistical analysis was performed using the RStudio software. RESULTS: Data of 9499 participants aged 35‒70 years were analyzed. The results of the multivariable mixed-effects logistic regression model revealed that participants' age, total cholesterol, marital status, smoking status, glucose, history of cardiac disease or myocardial infarction (MI) in first- and second-degree relatives, and presence of other diseases (like hypertension, depression, chronic headaches, and thyroid disease) were significantly related to the presence of CVD (P<0.05). Fitting the ordinary tree, GLMM, and GLMM tree resulted in area under the curve (AUC) values of 0.58 (0.56, 0.61), 0.81 (0.77, 0.84), and 0.80 (0.76, 0.83), respectively, among the study population. In addition, the tree model had the best specificity at 81% but the lowest sensitivity at 65% compared to the other models. CONCLUSION: Given the superior performance of the GLMM tree compared with the standard tree and the lack of significant difference with the GLMM, using this model is suggested due to its simpler interpretation and fewer assumptions. Using updated statistical models for more accurate CVD prediction can result in more precise frameworks to aid in proactive patient detection planning.

Reference Interval for Non-HDL-Cholesterol, Remnant Cholesterol and Other Lipid Parameters in the Southern Iranian Population; Findings From Bandare Kong and Fasa Cohort Studies.

BACKGROUND: Growing evidence shows the undisputable role of non-HDL-C and remnant cholesterol (remnant-C) in cardiovascular disease (CVD) risk assessment and treatment. However, the reference interval (RI) for these lipid parameters is not readily available. The aim of the present investigation was to determine the age and sex-specific RIs for non-HDL-C and remnant-C as well as other lipid parameters among a healthy population in southern Iran. We also report the RI of lipid parameters in rural and urban residents, smokers and post-menopausal women. METHODS: Among 14063 participants of Bandare Kong and Fasa cohort studies, 792 healthy subjects (205 men and 578 women) aged 35-70 years were selected. Fasting blood samples were used for determination of total cholesterol (TC), triglycerides (TG) and HDL-C using colorimetric methods. Non-HDL-C and remnant-C were calculated using the valid formula. The 2.5th and 97.5th percentiles were calculated and considered as RI. RESULTS: In the total population (n=792, age 35-70), RIs for non-HDL-C and remnant-C was 74.0-206.8 and 8.0-52.7 mg/dL, respectively. Age (35-44 and≥45 years) and gender-specific RIs for serum non-HDL-C and remnant-C were determined. Remnant-C and non-HDL-C level were different between sex and age categories. The mean value of all lipid parameters except HDL-C was higher in men, urban residents, subject with age≥45 years and smokers. CONCLUSION: This is the first study in which the RIs for non-HDL-C and remnant-C in southern Iran are reported. This may help physicians to conveniently use these lipid parameters for patient care and better cardiovascular risk assessment.

Role of gender in explaining metabolic syndrome risk factors in an Iranian rural population using structural equation modelling.

Many factors can lead to an increase in the prevalence of metabolic syndrome (MetS) in different populations. Using an advanced structural equation model (SEM), this study is aimed to determine the most important risk factors of MetS, as a continuous latent variable, using a large number of males and females. We also aimed to evaluate the interrelations among the associated factors involved in the development of MetS. This study used data derived from the Fasa PERSIAN cohort study, a branch of the PERSIAN cohort study, for participants aged 35 to 70 years with 10,138 males and females. SEM was used to evaluate the direct and indirect effects, as well as gender effects of influencing factors. Results from the SEM showed that in females most changes in MetS are described by waist circumference (WC), followed by hypertension (HP) and triglyceride (TG), while in males most changes in MetS are described by WC, followed by TG then fasting blood glucose (FBG). Results from the SEM confirmed the gender effects of social status on MetS, mediated by sleep and controlled by age, BMI, ethnicity and physical activity. This study also shows that the integration of TG and WC within genders could be useful as a screening criterion for MetS in our study population.

Dietary inflammatory index (DII) is correlated with the incidence of non-alcoholic fatty liver disease (NAFLD): Fasa PERSIAN cohort study.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver disease predisposing patients to life-threatening conditions, including cirrhosis. There is evidence that the incidence of NAFLD is related to the individuals' dietary patterns; however, it is still remaining unknown whether the inflammatory potential of various foods/dietary patterns can directly predict a higher incidence of NAFLD. METHODS: In this cross-sectional cohort study, we investigated the relationship between the inflammatory potential of various food items and the incidence/odds of NAFLD. We used data from Fasa PERSIAN Cohort Study comprising 10,035 individuals. To measure the inflammatory potential of diet, we used the dietary inflammatory index (DII®). Fatty liver index (FLI) was also calculated for each individual to identify the presence of NAFLD (cut-off = 60). RESULTS: Our findings showed that higher DII is significantly associated with increased incidence/odds of NAFLD (OR = 1.254, 95% CI: 1.178-1.334). Additionally, we found out that higher age, female gender, diabetes mellitus, hypertriglyceridemia, hypercholesterolemia, and hypertension are other predictors of developing NAFLD. CONCLUSIONS: It can be concluded that consuming foods with a higher inflammatory potential is associated with a greater risk of developing NAFLD. Additionally, metabolic diseases, including dyslipidemia, diabetes mellitus, and hypertension, can also predict the incidence of NAFLD.

The relationship between pregnancy count and duration of breast-feeding with metabolic syndrome (Fasa Persian cohort study).

BACKGROUND: Changes that occur during pregnancy and after that during breastfeeding induce some symptoms similar to metabolic syndrome (MetS) risk factors. This study aims to determine the relationship between pregnancy, as well as the duration of breastfeeding and MetS controlling the effect of other risk factors like hypertension, glucose intolerance, triglyceride, central obesity, and reduction of high-density lipoprotein in women of Fasa Persian Cohort Study. MATERIALS AND METHODS: In this cross-sectional study, 5015 women aged 35-70 years were investigated in the Sheshdeh region from 2016 to 2021, and the information related to the disease symptoms was collected through questionnaires, examinations, and laboratory tests. MetS was calculated based on two guidelines according to adult treatment panel III (ATP III) and international diabetes federation (IDF) methods. For reporting the data, the odds ratio with its 95% confidence interval was used. In order to eliminate the effect of confounders, logistic regression was used. RESULTS: Prevalence of MetS showed a descending trend in women with up to two pregnancies and it reached 22.6% and 22.4% using ATPIII and IDF methods respectively, while with an increase in the number of pregnancies of more than two, MetS prevalence was ascending. The prevalence of MetS did not have any specific trend across various breastfeeding duration groups. Multivariate analysis approved that the odds ratio of developing MetS in comparison with women who had two pregnancies was significantly increasing trend when the pregnancy counts increased. CONCLUSION: The chance of developing MetS based on both IDF and ATP III methods after adjustment for confounding effects would grow with an increase in the number of pregnancies to more than two and breast-feeding of more than seven years. It is recommended that women with more than two pregnancies or the long duration of breast-feeding women undergo a specialized examination to investigate and control MetS problems so that future diseases could be prevented.

Evaluation of the topical gel and oral administration of Punica Granatum Var Pleniflora on oral mucositis induced by 5-Fluorouracil in golden hamsters.

BACKGROUND: Oral mucositis (OM), an acute inflammation of the oral cavity, is a common complication in patients undergoing invasive myeloblastic chemotherapy or radiation therapy. 5-fluorouracil (5-FU) is one of the most effective therapeutic drugs, but one of the common side effects of 5-FU administration is OM. Unfortunately, no suitable treatment has been found, so far to control its side effects. Studies showed that herbal medicine like Punica granatum var pleniflora (PGP) has medicinal properties such as anti-inflammatory and antibacterial and can be an alternative for the treatment of fungal infection. Accordingly, we decided to investigate the therapeutic effect of PGP in the treatment of OM caused by 5-FU in golden hamsters. METHODS: Sixty male golden hamsters were divided into six main group. Chemotherapy with 5-FU at dose of 60 mg/kg was performed at a ten-day duration. Then, cheek pouches of the hamsters were scratched with an 18-gauge sterile needle to induce oral mucositis in animals. On the twelfth day, as a day of intensification of OM, treatment with PGP including topical gel with concentrations of 5% and 10% and oral administration of hydro-alcoholic extract with doses of 125 mg/kg and 250 mg/kg for three- and five-day therapeutic duration were separately started. Finally, samples of cheek pouches in hamsters were collected on 14th and 17th days and histopathologic score (HPS), malondialdehyde (MDA), and myeloperoxidase (MPO) levels were assayed. RESULTS: A significant (p < 0.05) decrease in histopathologic score was observed in G10%-, P125-treated groups in comparison to the Ctrl group. Our data showed that treatment with G10% is more potent than P125-treated group. In contrast, histopathologic score in G10%, P125, and P250 treated groups demonstrated almost similar values On the 17th day. However, the levels of MDA and MPO in the treatment groups were enhanced compared with control group (p < 0.05). CONCLUSIONS: It is possible that PGP can play protective role in the healing of tissue damage caused by chemotherapy with 5-FU due to the presence of its natural compounds and antioxidant properties.

The association between nonalcoholic fatty liver disease and corrected QT interval prolongation among generally healthy Iranian population: Fasa Cohort Study (FACS).

BACKGROUND: There are limited studies about the association between nonalcoholic fatty liver disease (NAFLD) and corrected QT interval (QTc) prolongation worldwide. HYPOTHESIS: Therefore, we designed the current study to determine this association in a large cohort of a generally healthy population. METHODS: We analyzed the data of 4603 individuals aged 35-70 who participated in the Fasa Cohort Study (FACS). Based on 12-lead electrocardiograms, QT intervals were calculated and corrected by Bazzet's formula. A QTc interval of more than 430 ms in men and 450 ms in women was considered prolonged. The Fatty Liver Index was used to identify the participants with NAFLD. RESULTS: Of all participants, 1550 (33.6%) met the NAFLD criteria. In subjects of both genders with NAFLD, the mean values of the QTc interval were considerably higher than in those without NAFLD (p < .001). After adjusting for a wide range of confounders, including age, gender, smoking status, physical activity, total cholesterol, high-density lipoprotein-cholesterol levels, diabetes, and hypertension status, in linear regression analysis, the standardized ß coefficient of QTc interval among participants with NAFLD was 2.56 ms (95% confidence interval [CI]: 0.49-4.64). After controlling the same confounders, the odds ratio of NAFLD for a prolonged QTc interval in men was 1.47 (95% CI: 1.18-1.84; p < .001) and in women was 1.39 (95% CI: 1.15-1.68; p < .001) using logistic regression analysis. CONCLUSIONS: NAFLD was a risk factor for QTc interval prolongation. Awareness about the risk of NAFLD in increasing the potential cardiac arrhythmias should be raised to lower cardiac mortality.

Diet quality and dietary acid load in relation to cardiovascular disease mortality: Results from Fasa PERSIAN cohort study.

Dietary intake is a determining factor in the morbidity and mortality of chronic disorders. However, not many documents have investigated this relationship. The aim of this study was to evaluate the associations of the Mediterranean dietary score (MDS), Alternative Healthy Eating Index (AHEI), Dietary Inflammatory Index (DII), DASH score, and dietary acid load with cardiovascular disease (CVD) mortality. A total of 2158 CVD patients (mean age of 54.73 ± 8.62 years) from the Fasa cohort study, Iran, participated in the current study. Diet quality indices including DII, AHEI, MDS, DASH, and dietary acid load (NEAP score) were computed using a validated 125-item Food Frequency Questionnaire (FFQ). Cox regression analyses were used to determine HRs and 95% CIs. During a follow-up of 3 years, we documented 59 CVD deaths. After adjusting for relevant confounders (age, gender, family history of CVD, smoking, physical activity, alcohol intake, and HTN) in the final model, we found that higher DII scores and dietary acid load were significantly related to increased mortality due to CVD (HR = 1.11; 95% CI = 1.01-1.24; and HR = 1.02; 95% CI = 1.01-1.03). However, the DASH score was insignificantly associated with decreased CVD mortality by 20.4% (HR = 0.79; 95% CI = 0.57-1.09). There was no significant relationship among AHEI score, MDS, and CVD mortality. This study showed that increasing dietary acidity and the use of inflammatory food compounds could contribute to CVD mortality. Also, adherence to the DASH diet may be associated with reduced CVD mortality.

Translation and psychometric assessment of a Persian version of medication safety competence scale (MSCS) for clinical nurses.

Nurses play a key role in medication safety and, by extension, patient safety. Evaluation of medication safety competence in nurses requires valid, specific, and comprehensive instruments. The present study was conducted to translate and psychometric assessment a Persian version of medication safety competence scale (MSCS) for clinical nurses in Iran. This is a cross-sectional and multi-centric work of research with a methodological design. A total of 1080 clinical nurses were selected from 5 cities located in Iran. The original version of the MSCS was translated into Persian and the psychometric properties of MSCS were assessed using COSMIN criteria. The exploratory factor analysis (EFA) showed that the factor loading of the 36 items was between 0.72-0.87, all of which were significant. The confirmatory factor analysis (CFA) fitted the data well (χ2/df = 7, RMSEA = 0.01, CFI = 0.96, NFI = 0.95, and TLI = 0.97). The reliability of the instrument was assessed in terms of its internal homogeneity where the Cronbach's alpha of the whole instrument was found to be 0.96. The Persian version of MSCS for nurses possesses satisfactory validity and reliability. Thus, nurse managers can use this instrument to measure medication safety competence in nurses.

Nano-scaled emulsion and nanogel containing Mentha pulegium essential oil: cytotoxicity on human melanoma cells and effects on apoptosis regulator genes.

BACKGROUND: Topical drug delivery using nanoemulsions and nanogels is a promising approach to treating skin disorders such as melanoma. METHODS: In this study, the chemical composition of Mentha pulegium essential oil with five major compounds, including pulegone (68.11%), l-menthone (8.83%), limonene (2.90%), iso-pulegone (2.69%), and iso-menthone (1.48%) was first identified using GC-MS (Gas chromatography-Mass Spectrometry) analysis. Afterward, a nano-scaled emulsion containing the essential oil with a droplet size of 7.70 ± 1 nm was prepared. Nanogel containing the essential oil was then prepared by adding (2% w/v) carboxymethyl cellulose to the nano-scaled emulsion. Moreover, the successful loading of M. pulegium essential oil in the nano-scaled emulsion and nanogel was confirmed using ATR-FTIR (Attenuated total reflectance-Fourier Transform InfraRed) analysis. Then, human A375 melanoma cells were treated with different concentrations of samples, the MTT assay evaluated cell viability, and cell apoptosis was confirmed by flow cytometry. In addition, the expression of apoptotic and anti-apoptotic genes, including Bax and Bcl-2, was evaluated using the qPCR (quantitative Polymerase Chain Reaction) technique. RESULTS: The results showed that cell viability was reduced by 90 and 45% after treatment with 300 µg/mL of the nanogel and nano-scaled emulsion. As confirmed by flow cytometry, this effect was mediated by apoptosis. Furthermore, gene expression analysis showed up-regulation of Bax and down-regulation of Bcl-2 genes. Therefore, the prepared nanogel, with high efficacy, could be considered a potent anticancer agent for supplementary medicine and in vivo research.

Association of Dietary Acid Load With Metabolic Syndrome and Its Components in Iranian Adults: A Cross-Sectional Study.

Introduction Metabolic syndrome (MetS) remains one of the leading health challenges worldwide. A combination of genetic and environmental factors has been implicated in the etiology of MetS. Diet is a changeable environmental risk factor, and dietary modifications could significantly reduce the incidence and mortality of numerous diseases, including MetS. Certain dietary factors may contribute to MetS by affecting the acid-base balance within the body. This study examined the association of dietary acid load (DAL) with MetS and its components in Iranian adults. Materials and methods This cross-sectional study was conducted in 2022 on 6356 Iranian adults aged 35-70 years. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) as two indicators of DAL were calculated based on nutrient intake data from validated food frequency questionnaires. MetS and its components were defined according to the Adult Treatment Panel III criteria. Logistic regression analysis was used to explore the associations between DAL and MetS and its components. Age, energy intake, physical activity, education, marital status, home ownership, socioeconomic status, history of obesity-related disease, and calcium supplements were included in model I. Further adjustment in model II was made for body mass index. Results Higher NEAP scores were associated with increased odds of low high-density lipoprotein cholesterol (HDL-C) in the crude model (OR: 1.26, 95% CI: 1.01-2.56, p trend = 0.06) in women, which was confirmed in the adjusted models. In model I, women in the last quintile of NEAP had 54% greater odds of having hypertriglyceridemia compared to the first quintile (OR: 1.54, 95% CI: 1.007-2.36, p trend = 0.02). This association was still significant and even stronger after further adjustment for BMI (OR: 1.55, 95% CI: 1.01-2.40, p trend = 0.01). In addition, in model I, men in the fourth quintile of NEAP had 5.68-fold greater odds of hyperglycemia compared to the first quintile (OR: 5.68, 95% CI: 1.18-27.25, p trend = 0.11). Similar results were found in the fully adjusted model (OR: 5.89, 95% CI: 1.19-28.99, p trend = 0.54). Conclusion There was no significant association between DAL and MetS. DAL was positively associated with the odds of low HDL-C and hypertriglyceridemia in women. Moreover, moderate DAL (NEAP) was associated with an increased odds of hyperglycemia in men.