Burden of type 2 diabetes mellitus and its risk factors in North Africa and the Middle East, 1990-2019: findings from the Global Burden of Disease study 2019.

BACKGROUND: The prevalence of Type 2 Diabetes Mellitus (T2DM) in the North Africa and Middle East region is alarmingly high, prompting us to investigate the burden and factors contributing to it through the GBD study. Additionally, there is a lack of knowledge about the epidemiological status of T2DM in this region, so our aim is to provide a comprehensive overview of the burden of T2DM and its associated risk factors. METHODS: Using data from the 2019 Global Burden of Disease Study, we calculated the attributable burden of T2DM for each of the 21 countries in the region for the years 1990 and 2019. This included prevalence, mortality, disability-adjusted life years (DALYs), and risk factors. RESULTS: Between 1990 and 2019, there was a significant increase in the age-standardized incidence (79.6%; 95% Uncertainty Interval: 75.0 to 84.5) and prevalence (85.5%; [80.8 to 90.3]) rates of T2DM per 100,000 populations. The age-standardized mortality rate (1.7%; [-10.4 to 14.9]), DALYs (31.2%; [18.3 to 42.2]), and years lived with disability (YLDs) (82.6%; [77.2 to 88.1]) also increased during this period. Modifiable risk factors, such as high body mass index (56.4%; [42.8 to 69.8]), low physical activity (15.5%; [9.0 to 22.8]), and ambient particulate matter pollution (20.9%; [15.2 to 26.2]), were the main contributors to the number of deaths. CONCLUSION: The burden of T2DM, in terms of mortality, DALYs, and YLDs, continues to rise in the region. The incidence rate of T2DM has increased in many areas. The burden of T2DM attributed to modifiable risk factors continues to grow in most countries. Targeting these modifiable risk factors could effectively reduce the growth and disease burden of T2DM in the region.

The roles of quercetin in diabetes mellitus and related metabolic disorders; special focus on the modulation of gut microbiota: A comprehensive review.

Quercetin is a dietary flavonoid that can affect the balance between anti-oxidant defense system and oxidative stress. A number of studies showed the positive effects of quercetin on diabetes mellitus and related metabolic disorders through different pathways such as gut flora. However, findings are conflicting. In addition, it seems no studies have summarized all potential mechanisms of quercetin in diabetes mellitus, so far. Therefore, the aims of the present comprehensive review were to provide an overview on biological and biochemical characteristics of quercetin and investigate the effect of quercetin on diabetes mellitus and related metabolic disorders by focusing on its effects on the modulation of gut microbiota. For this purpose, findings of In vitro, animal studies, clinical trials, and review studies with the English language published until January 2021 were summarized. They were identified through electronic databases (PubMed, Scopus, and Cochrane Library) and Google Scholar. Findings showed that quercetin can be an effective component for improving glycemic status and other metabolic disorders related to diabetes mellitus based on In vitro and animal studies. However, environmental factors, food processing and using nanoformulations can affect its efficacy in human studies. Several potential mechanisms, including the modulation of gut flora are proposed for its actions. However, due to limited clinical trials and contradictory findings, more high-quality clinical trials are needed to make a decision on the efficacy of supplementation with quercetin as a complementary therapy for the management of diabetes mellitus, metabolic disorders, and modulating gut flora.

The effects of dietary supplements and natural products targeting glucose levels: an overview.

Identifying effective dietary supplements and medicinal herbs has attracted the attention of clinicians and researchers to complement the standard treatment in controlling diabetes mellitus. In the present overview, we aimed to collect studies with the highest level of evidence to shed light on detecting the most effective dietary supplements and medicinal herbs for controlling glycemic status. For the current overview, four electronic databases, including PubMed, Scopus, Web of Science, and Cochrane Library, were systematically searched from inception to 31 December 2020 and then updated until 1 October 2021 to obtain eligible meta-analyses on either dietary supplements or medicinal herbs and their effects on glycemic status. Fasting blood sugar (FBS) and Hemoglobin A1C (HbA1C) were considered as primary outcomes. Finally, ninety-one meta-analyses on dietary supplements (n = 55) and herbs (n = 36) were included. Evidence showed positive effects of chromium, zinc, propolis, aloe vera, milk thistle, fenugreek, cinnamon, ginger, and nettle on FBS and/or HbA1C. However, mostly the heterogeneity (I2) was high. Other supplements and herbs also showed no reduction in glucose levels or their effects were small. Although some dietary supplements and medicinal herbs showed a significant reduction in FBS and/or HbA1C, mostly their effects from the clinical point of view were not remarkable. In addition, due to high heterogeneity, publication bias, and a limited number of included studies in most cases further clinical trials are needed for making decision on anti-diabetic supplement efficacy.

Pro-inflammatory diet, cardio-metabolic risk factors and risk of type 2 diabetes: A cross-sectional analysis using data from RaNCD cohort study.

BACKGROUND: Inflammation and cardiometabolic risk factors can be involved in developing type 2 diabetes mellitus (T2DM). This study aimed to investigate and compare the association between a pro-inflammatory diet and cardiometabolic risk factors in patients with T2DM and non-T2DM cases. METHODS: In this cross-sectional population-based study, considering the baseline data of the Ravansar Non-Communicable Disease (RaNCD) cohort, patients with T2DM (n = 785) and non-T2DM cases (n = 8254) were included. The dietary inflammatory index (DII) was calculated using a food frequency questionnaire (FFQ) and was classified into four groups (quartiles) with lowest to highest scores. Logistic regression analysis was conducted to determine the association between DII and cardiometabolic risk factors in both groups. RESULTS: The participants were 9,039 (4140 men and 4889 women) with a mean age of 47.4 ± 8.2 years; the mean body mass index (BMI) and DII were 27.49 ± 4.63 kg/m2 and - 2.49 ± 1.59, respectively. After adjustment for confounding factors, we found that DII can increase the risk of T2DM by 61% (95% CI 1.27 to 2.05, P < 0.001). A comparison of two groups revealed that the association of DII, obesity/overweight and dyslipidemia were also significant in both diabetic (P < 0.05) and non-diabetic cases (P < 0.05). However, no significant association was found between DII, MetS, and hypertension in either of the groups. The association between DII and cardiovascular diseases (CVDs) was only significant in diabetic patients (1.65; 95%CI: 1.02 to 2.65, P = 0.04) and T2DM showed an interaction with the association between DII and CVDs. CONCLUSION: Inflammatory potential of diet may increase the risk of T2DM. Although it can increase the risk of some cardiometabolic risk factors in both diabetic and non-diabetic cases, its effects were greater among patients with T2DM. However, further prospective studies are required to confirm these associations.

Iranian Multi-center Osteoporosis Study (IMOS), 2021-2022: the study protocol.

BACKGROUND: This paper presents the protocol of the 4th round of Iranian Multi-center Osteoporosis Study (IMOS), a national survey with the primary objective of estimating the prevalence of osteoporosis and sarcopenia and their risk factors in a representative sample of urban and rural populations. METHODS: The target population of the survey is all individuals ≥ 50 years in Iran. A multi-stage random sampling method has been used in the study. We stratified the 31 provinces of the country into 5 strata based on the distribution of their potential risk factors for osteoporosis and randomly selected one or two provinces from each stratum. Then, we invited 2530 people aged ≥ 50 years recruited in the 8th National Survey of None Communicable Diseases (NCD) Risk Factors (STEPs-2021) in the selected provinces to participate in IMOS. Body composition measurements including bone mineral density, muscle mass, and fat mass are measured through Dual-energy X-ray Absorptiometry (DXA) method using HOLOGIC (Discovery and Horizon) devices; and Trabecular Bone Score (TBS) is measured on the DXA scans using iNsight software. Anthropometric measurement and physical examinations are made by a trained nurses and other required information are collected through face-to-face interviews made by trained nurses. Laboratory measurements are made in a central lab. The prevalence of osteoporosis and sarcopenia will be estimated after applying sampling design, non-response, and post-stratification weights to the data. DISCUSSION: IMOS will provide valuable information on the prevalence and determinants of osteoporosis and sarcopenia at the national level, and the results can be used in evaluating health system interventions and policymaking in the field of musculoskeletal diseases.

An Overview of Zebrafish Modeling Methods in Drug Discovery and Development.

Animal studies are recognized as a significant step forward in the bridging between drug discovery and clinical applications. Animal models, due to their relative genetic, molecular, physiological, and even anatomical similarities to humans, can provide a suitable platform for unraveling the mechanisms underlying human diseases and discovering new therapeutic approaches as well. Recently, zebrafish has attracted attention as a valuable experimental and pharmacological model in drug discovery and development studies due to its prominent characteristics such as the high degree of genetic similarity with humans, genetic manipulability, and prominent clinical features. Since advancing a theory to a valid and reliable observation requires the manipulation of animals, it is, therefore, essential to use efficient modeling methods appropriate to the different aspects of experimental conditions. In this context, applying several various approaches such as using chemicals, pathogens, and genetic manipulation approaches allows zebrafish development into a preferable model that mimics some human disease pathophysiology. Thus, such modeling approaches not only can provide a framework for a comprehensive understanding of the human disease mechanisms that have a counterpart in zebrafish but also can pave the way for discovering new drugs that are accompanied by higher amelioration effects on different human diseases.

The effects of Silymarin on the features of cardiometabolic syndrome in adults: A systematic review and meta-analysis.

Some medicinal herbs and their effective components showed positive effects on the features of the cardiometabolic syndrome (CMS). The aim of the present systematic review and meta-analysis is to examine the effects of silymarin on the components of CMS in adults. Four electronic databases including PubMed/Medline, Scopus, Web of Science, and Embase were systematically searched up to December 31, 2020 to identify all eligible clinical trials. A random-effect model using DerSimonian and Laird method was used to estimate the pooled weighted mean differences (WMDs) and the 95% confidence intervals (95%CIs). Finally, 11 clinical trials met the eligibility criteria. Our results demonstrated that silymarin significantly reduced the levels of fasting blood glucose (WMD: -17.96 mg/dL, 95% CI: -32.91, -3.02;I2 : 82.4%, p < 0.001), hemoglobin A1C (WMD: -1.25%, 95% CI: -2.34, 0.16; I2 : 92.9%, p Ë‚ 0.001), total cholesterol (WMD: -17.46 mg/dL, 95% CI: -30.98, -3.95; I2  = 62.9%, p = 0.006), triglyceride (WMD: -25.70 mg/dL, 95% CI: -47.23, -4.17; I2 :54.3%, p = 0.025), low-density lipoprotein-cholesterol (WMD: -10.53, 95% CI: -19.12, -1.94; I2: 37.5%, p = 0.119) and increased high-density lipoprotein- cholesterol (WMD: 3.36 mg/dL, 95% CI: 0.88, 5.84; I2 : 37.4%, p = 0.120) compared to placebo. However, its effects on BMI were not statistically significant. Silymarin can be an effective complementary therapy to improve most features of CMS. However, due to high heterogeneity and limited clinical trials in some parameters, further high-quality clinical trials are needed to confirm its efficacy.

Association of Vitamin D Concentrations with subjective health complaints in children and adolescents: the CASPIAN-V study.

BACKGROUND: Vitamin D deficiency (VDD) is recognized as a global pandemic. Identification, any association between VDD and subjective health complaints (SHC), can be helpful to realize critical mechanisms and improve psychological and somatic symptoms. Given few studies published on this issue and the importance of its clarification, the main objective of this study was to examine the association between VDD and the SHC in children and adolescents. METHODS: In this national cross-sectional study, 2596 Iranian children and adolescents aged 8-18 years were included. Data on SHC, anthropometric indices, physical activity, and serum levels of vitamin D were collected. Logistic regression models (crude, adjusted) were applied to examine the association between the VDD and the SHC. Statistical analysis was performed using STATA version 11. P-values< 0.05 were considered as statistically significant. RESULTS: Serum levels of vitamin D in approximately 70% of Iranian children and adolescents were lower than 30 ng/mL. Among the SHC, irritability (40.9%) and feeling anxiety (33.7%) were the most prevalent ones. Multiple complaints in students with the VDD was 2.5 times greater than those with sufficient vitamin D concentrations (p <  0.001). Compared to the reference group, the strongest association was found between vitamin D status and difficulties in getting to sleep (OR: 2.5, 95%CI: 1.18, 3.53, p <  0.001). CONCLUSION: VDD was observed in the considerable percentage of the study population. There were no significant differences between the two gender groups. In addition, there were significant associations between vitamin D status and most of the somatic and psychological symptoms, particularly for getting to sleep. It seems national interventional programs for vitamin D supplementation or food fortifications can be helpful.

The effect of Capsaicinoids or Capsinoids in red pepper on thermogenesis in healthy adults: A systematic review and meta-analysis.

The outcomes of the earlier trials are controversial concerning the effect of Capsaicinoids/Capsinoids on thermogenesis. We carried out this systematic review and meta-analysis to examine the effect of Capsaicinoids/Capsinoids on thermogenesis indices including resting metabolic rate (RMR) and respiratory quotient (RQ) in healthy adults. An electronic literature search was conducted between 1990 and 2019, using the following databases: PubMed, Web of Sciences, Scopus, Cochrane Central Register of Controlled Trials, and EMBASE. Placebo-controlled clinical trials were considered as eligible papers. Effect sizes were pooled using weighted mean difference (WMD), with a random-effects model. Of the 4,092 articles, 13 studies were included in the meta-analysis. Pooled effect sizes revealed that compared with placebo, Capsaicinoids/Capsinoids significantly increased RMR (WMD: 33.99 Kcal/day, 95% CI: 15.95, 52.03; I2 : 0%, p = .94), energy expenditure, and fat oxidation. It also significantly lessened RQ (WMD: -0.01, 95% CI: -0.02, -0.01; I2 : 5.4%, p = .39) and carbohydrate oxidation. Moreover, intervention in capsule form for longer duration had a more considerable influence on RMR than comparative groups. We observed moderate improvement in RMR, RQ, and fat oxidation following supplementation with Capsaicinoids/Capsinoids. However, further high-quality studies are required to clarify the thermogenic properties of Capsaicinoids/Capsinoids.

Association of dietary acid load with anthropometric indices in children and adolescents.

PURPOSE: High dietary acid load (DAL) may have an influence on anthropometric indices. Given that there was no study on the association between DAL and anthropometric indices children and adolescents, the current study was aimed to examine the association between DAL and anthropometric indices in Iranian children and adolescents. METHODS: Students aged 6-18 years were recruited using a multi-stage, cluster sampling method from 30 provinces of Iran. Dietary intake was assessed through a validated food frequency questionnaire. Height (Ht), weight (Wt), neck circumference (NC), waist circumference (WC), wrist circumference, and hip circumference (HC) were measured. WC-to-HC ratio (WHR), WC-to-Ht ratio (WHtR), body mass index (BMI) z-score, tri-ponderal mass index (TMI), and parental BMI were computed. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) were used to estimate DAL. The association between DAL and anthropometric indices was evaluated using linear regression models. RESULTS: In total, 5326 students (46.92% girls), with mean (standard deviations (SD)) age of 12.50 (3.14) years participated in the study (response rate: 98.13%). After adjusting for confounders, there was a significant association between NEAP and NC (P < 0.05). Also, an inverse association was observed between PRAL and NEAP with parental BMI (P < 0.05). CONCLUSION: Our findings showed a direct association between diet-induced acid load and NC and an inverse association between DAL indices and parental BMI. More well-designed clinical studies are warranted to confirm our results and the underlying mechanisms. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Prebiotic supplementation modulates advanced glycation end-products (AGEs), soluble receptor for AGEs (sRAGE), and cardiometabolic risk factors through improving metabolic endotoxemia: a randomized-controlled clinical trial.

PURPOSE: The oxidative stress plays a key role in the initiation, propagation, and development of the complications of type 2 diabetes mellitus (T2DM). This trial aimed to evaluate the effects of resistant dextrin as a prebiotic on the cardiometabolic risk factors and the status of oxidative stress in patients with T2DM. METHODS: Sixty-five female subjects with T2DM were assigned to either the intervention (n = 33) or control (n = 32) groups receiving 10 g/day of resistant dextrin or placebo, respectively, for 8 weeks. Fasting blood samples were collected at baseline and post-intervention to determine the serum levels of glycemic indices, lipid profile, atherogenic indices, and soluble receptor for AGEs (sRAGE), carboxymethyl lysine (CML), pentosidine, malondialdehyde (MDA), 8-iso-prostaglandin F2α (8-iso-PGF2α), total antioxidant capacity (TAC), antioxidant enzymes activity, and uric acid. Data were analyzed using SPSS software 17. Paired, unpaired Student's t tests, and analysis of covariance were used to compare the quantitative variables. RESULTS: Resistant dextrin caused a significant decrease in FPG (- 17.43 mg/dl, 9.80%), TG (- 40.25 mg/dl, 23.01%), TC/HDL (- 0.80, 21.87%), LDL-c/HDL-c (- 0.80, 17.85%), Atherogenic index (- 0.40, 15.80%), LPS (- 6.5 EU/ml, 23.40%) and hs-CRP (- 8.02 ng/ml, 54.00%), MDA (- 1.21 nmol/mL, 25.58%), CML (- 93.40 ng/ml, 26.30%), 8-iso-PGF2α (- 4.65 pg/ml, 15.00%), and a significant increase in TAC (0.33 mmol/L, 36.25%) and s-RAGE (2.10 ng/ml, 28.90%) in the intervention group compared with the control group. No significant changes were observed in glycosylated hemoglobin, total cholesterol, LDL-c, HDL-c, superoxide dismutase, glutathione peroxidase and catalase, pentosidine, and uric acid in the intervention group compared with the control group. CONCLUSIONS: Supplementation with resistant dextrin may improve the advanced glycation end-products, sRAGE, and cardiometabolic risk factors in women with type 2 diabetes mellitus.

Comparison common equations for LDL-C calculation with direct assay and developing a novel formula in Iranian children and adolescents: the CASPIAN V study.

BACKGROUND: Hypercholesterolemia is a common dyslipidemia that leads to atherosclerosis. It is proved that early stages of atherosclerosis begins in early stages of life. In several studies, widespread prevalence of dyslipidemia in children is reported. So, assessment of lipid profile in children and adolescence is necessary for early diagnosis of dyslipidemia. Laboratory methods for measuring LDL are not available and economical. So, in some laboratories Friedwald method is used to determine LDL level. But, the preciseness of this method is not acceptable. Further, the preciseness of this method was not assayed in children and adolescence. So, it seems that assaying the preciseness of different methods is necessary. METHODS: The methodology of this work is on the basis of findings of the Caspian V study. This study was conducted in 30 provinces of Iran during 2015. The population of this work was rural and urban students aged 7-18 years old. The level of total cholesterol (TC), HDL, LDL, and TG were measured using laboratory methods. The average and variances values were determined for each group of data using SPSS. Further, LDL values were calculated with a new formula introduced in this work. A comparison was made between the new formula and the other methods. RESULTS: In the present study, we found that compare to four common formulas, Friedwald was the best equation to estimate LDL-C concentrations in Iranian children and adolescents and the new formula was the next accurate equation. The strongest correlation between Friedwald and the new equation was found for those with 15-18 years old. CONCLUSION: Considering the cut-off points of TG (100 mg/dL), we observed the strongest correlation between Friedwald equation and direct assay and the weakest one was for Ahmadi formula in subjects with either greater or lower TG concentrations. Furthermore, we found that Anandraja equation had the most sensitivity (89.5%), while the most specificity was dedicated to the new formula (98.9%).

Association of wrist circumference with cardio-metabolic risk factors: a systematic review and meta-analysis.

BACKGROUND AND AIMS: The association of Wrist Circumference (WrC) with cardio-metabolic risk factors is still contradictory. We aimed to systematically review the association of WrC with cardio-metabolic diseases among the general populations. METHODS: We systematically searched electronic databases such as PubMed/Medline, Web of Sciences, and Scopus without language restriction until March 2017. Observational studies that examined the association of WrC with any cardio-metabolic risk factors were included. Pooled association of WrC with metabolic syndrome (MetS) was estimated using a random-effect model, and heterogeneity among studies was assessed by I2 index and Q test. RESULTS: A total of 14 papers including cohort study (n = 9), cross-sectional study (n = 4), and case-control study (n = 1) met the criteria and included. The eligible papers have been examined the association of WrC with any cardiovascular disorders (n = 8), metabolic syndrome (n = 4), insulin resistance (IR) (n = 5), diabetes mellitus (n = 2), impaired glucose tolerance (n = 1), cardio-metabolic risk factors (n = 2) and obesity/overweight (n = 1). In the whole population (both adults and pediatric population), high WrC increased the risk of MetS by 33% (Pooled OR = 1.33; 95% CI 1.20, 1.48; I2 = 60.2%, p = 0.04), while the pooled OR in adult populations was 1.27 (95% CI 1.15-1.41; I2: 32.8%, p = 0.21). Qualitative synthesis showed that associations of WrC with other cardio-metabolic risk factors are conflicting. CONCLUSION: High WrC increased the risk of MetS and other cardio-metabolic risk factors. However, due to limited studies, particularly in children, results should be declared with great caution. Further cohort studies are needed to clarify whether WrC is a suitable anthropometric index to predict cardio-metabolic disorders in adult and children populations in different societies. LEVEL OF EVIDENCE: Level 1, systematic review and meta-analysis.

The effect of vitamin D supplementation on oxidative stress parameters: A systematic review and meta-analysis of clinical trials.

Recent studies have shown that vitamin D supplementation beneficially decreases oxidative stress (OS) parameters; however, there is no consensus on this subject. In this systematic review and meta-analysis we aimed to investigate the effect of vitamin D supplementation on OS parameters. We searched electronic databases including Medline, Embase, Scopus, Web of Science and Cochrane Library up to July 2018 without any language restriction. Trials were reviewed using preferred reporting items for systematic reviews and meta-analyses (PRISMA) and Cochrane handbook. To compare the effects of vitamin D with placebo, standardized mean difference (SMD) with 95% confidence intervals (CI) were pooled using random effects model. Across thirteen clinical trials, we found that vitamin D supplementation increased serum levels of total antioxidant capacity (TAC) (SMD: 0.54 mmol/L, 95% CI: 0.29 to 0.79; I2 = 65.4%, P = 0.001) and glutathione (GSH) (SMD: 0.33; 95% CI: 0.11 to 0.54, P = 0.003; I2 = 61.2%, P = 0.001). Besides, malondialdehyde (MDA) concentration decreased significantly (SMD: -0.40 mmol/L, 95% CI: -0.60 to -0.21, P < 0.001) following vitamin D supplementation compared to placebo. However, its effects on nitric oxide (NO) was not significant (0.17, 95% CI: -0.10 to 0.45, I2 = 71.1%, P = 0.21). Finally, we showed that vitamin D supplementation can improve OS parameters; however, this finding may not be clinically significant. Further large prospective clinical trials are needed to confirm the effect of vitamin D supplement on other OS parameters.

The effects of supplementation with conjugated linoleic acid on anthropometric indices and body composition in overweight and obese subjects: A systematic review and meta-analysis.

Clinical trials have indicated conflicting results on the effects of conjugated linoleic acid (CLA) on obesity. The present study aimed to systematically review controlled clinical trials examining the effects of CLA on anthropometric indices and body composition in overweight and obese subjects. Pubmed, Scopus, Web of science, and Cochrane databases were searched between 2000 and December 2017 with no language restriction. Placebo-controlled clinical trials that reported anthropometric indices and body composition in overweight and obese subjects were included. Random-effect model was used to pool the effect estimates. Of 4032 publications, 13 trials were included for the meta-analysis. Pooled effect sizes indicated that CLA significantly reduced body weight (WMD: -0.52 kg, 95% CI: -0.83, -0.21; I2: 48.0%, p = 0.01), BMI (WMD: -0.23 kg/m2, 95% CI: -0.39, - 0.06; I2: 64.7%, p = 0.0001), FM (WMD: -0.61 kg, 95% CI: -0.98, -0.24; I2: 53.8%, p = 0.01) and increased LBM (WMD: 0.19 kg, 95% CI: 0.04, 0.34; I2: 81.4%, p = 0.0001) compared to the placebo group. However, the effects of CLA on WC (WMD: 0.05 cm, 95% CI: -0.01, 0.1; I2: 0%, p = 0.93) was not significant. Additionally, its impact on body weight in subjects older than 44 year (WMD: -1.05 kg, 95% CI: -1.75, -0.35; I2: 57.0%, p = 0.01), with longer duration (more than 12 weeks) (WMD: -1.29 kg, 95% CI: -2.29, -0.29; I2: 70.3%, p = 0.003) and dosage more than 3.4 g/day (WMD: -0.77 kg, 95% CI: -1.28, -0.25; I2: 62.7%, p = 0.004) were greater than comparative groups. Supplementation with CLA can slightly reduce body weight and FM and increase LBM in overweight and obese subjects. However, its efficacy was not clinically considerable. Further studies with high methodological quality are needed to shed light on the effects of CLA on anthropometric indices in overweight and obese subjects.

Associations between dietary insulin load with cardiovascular risk factors and inflammatory parameters in elderly men: a cross-sectional study.

Given the limited research on dietary insulin load (DIL), we examined DIL in relation to cardiovascular risk factors and inflammatory biomarkers in elderly men. For the present cross-sectional study, we recruited 357 elderly men. Dietary intake was assessed using FFQ. DIL was estimated by multiplying the insulin index of each food by its energy content and frequency of consumption and then summing the final value of all food items. After adjustment for covariates, a significant positive association was observed between high DIL with fasting blood sugar (FBS) levels (OR: 7·52; 95 % CI 3·38, 16·75; P=0·0001) and high-sensitive C-reactive protein (hs-CRP) (OR: 3·03; 95 % CI 1·54, 5·94; P=0·001). However, there was no association between high DIL and BMI (OR: 1·43; 95 % CI 0·75, 2·75; P=0·27), serum TAG level (OR: 0·82; 95 % CI 0·26, 2·59; P=0·73), HDL-cholesterol (OR: 2·03; 95 % CI 0·79, 5·23; P=0·13) and fibrinogen (OR: 1·57; 95 % CI 0·80, 3·06; P=0·18). Overall, elderly men with high DIL had higher FBS and hs-CRP levels than those with low DIL. Future studies are needed to clarify the association between DIL and other cardiovascular risk factors in both men and women.

The Association of Dietary Quality Indices and Cancer Mortality: A Systematic Review and Meta-analysis of Cohort Studies.

This study aimed to systematically review and do a meta-analysis on available evidence on the association of diet quality indices with cancer mortality. We searched for relevant papers published up to August 2017 through Web of science, PubMed/Medline, Scopus, and Google Scholar. Prospective cohort studies examined the association of any dietary quality indices with cancer mortality were included. Overall, 27 publications were included. There was significant inverse associations between the Dietary Approaches to Stop Hypertension (DASH) diet (HR: 0.85; 95% CI: 0.79, 0.91; I2 = 81.8%), the Alternative Healthy Eating Index (AHEI) (HR: 0.90; 95% CI: 0.85, 0.95; I2: 61.5), the healthy eating index (HEI) (RR: 0.82; 95% CI: 0.75, 0.89; I2: 89.5%) and cancer mortality. Significant associations with the lowest heterogeneity between Diet Quality Index (DQI) (HR: 0.91; 95% CI: 0.89-0.93, I2 = 0.0%), alternative Mediterranean Diet (aMED) (RR: 0.81; 95% CI: 0.78-0.83, I2 = 1.7%), and HEI-2010 (HR: 0.82; 95% CI: 0.69-0.98, I2 = 0.0%) and death due to cancer were also found. However, the Recommended Food Score, Dietary Diversity Score (DDS), and HEI-2005 were not related with cancer mortality. Adherence to DASH diet, AHEI, HEI, DQI, aMED, and HEI-2010 decreased the risk of cancer mortality.

Dietary Inflammatory Index and its Association with the Risk of Cardiovascular Diseases, Metabolic Syndrome, and Mortality: A Systematic Review and Meta-Analysis.

Findings from previous studies on the association between the Dietary Inflammatory Index (DII) and the risk of chronic diseases and mortality have been inconsistent. We aimed to summarize studies on the association of the DII and the risk for cardiovascular disease (CVD), metabolic syndrome (MetS), and mortality in a systematic review and meta-analysis. We performed a systematic search in PubMed/Medline, Web of Knowledge, and Scopus databases for relevant studies written in English and published until 31 December 2017. Studies that reported the relative risk (RR), odd ratio (OR) or hazard ratio (HR) for the most pro-inflammatory versus the most anti-inflammatory diets were included. Finally, 17 studies [CVD (n=6), MetS (n=5), mortality (n=6)] were included for systematic review and meta-analysis. Findings indicated a trend toward a positive relationship between the DII and the risk for CVD (pooled RR: 1.35; 95% CI: 1.13, 1.60; I2: 28.6%, p=0.21), all-cause mortality (pooled HR: 1.21; 95% CI: 1.09, 1.35; I2: 72.6%, p=0.003), CVD mortality (pooled HR: 1.30, 95% CI: 1.07, 1.57; I2: 74.0%, p=0.009) and cancer mortality (pooled HR: 1.28; 95% CI: 1.07, 1.53; I2: 62.5%, p=0.03). However, no significant association was found between the DII and the risk for MetS (pooled RR: 1.01; 95% CI: 0.82, 1.24; I2: 32.6%, p=0.20). Although in the current meta-analysis the most pro-inflammatory diet versus the most anti-inflammatory diet was not associated with the risk of MetS, we observed a substantial association between the DII and the risk for CVD and all types of mortality. However, further cohort studies in different populations are needed to clarify this association.

The Association of Dietary and Urinary Sodium With Bone Mineral Density and Risk of Osteoporosis: A Systematic Review and Meta-Analysis.

OBJECTIVE: Although some earlier studies have indicated an association between dietary/urinary sodium and bone mass density (BMD), bone mass content (BMC), and the risk of osteoporosis (OS), findings are still conflicting. The aim of this study was to summarize the relation of dietary/urinary sodium with BMD, BMC, and the risk of OS. METHODS: We conducted a systematic search up to April 2017 in PubMed/MEDLINE, SCOPUS, and Web of Science to find relevant studies. Articles with cross-sectional and cohort designs in which odds ratios (ORs), correlations (r), or beta coefficients were reported for the association between dietary/urinary sodium and OS, BMD, or BMC were included. RESULTS: Pooling 11 effect sizes with a total of 39,065 people showed that higher sodium consumption significantly increased the risk of OS (OR = 1.20; 95% confidence interval [CI], 1.02-1.41; p = 0.026), with high heterogeneity among studies (I2 = 68.0%; p = 0.001). Subgroup analyses showed significantly higher risk of OS in premenopausal women (OR = 1.31; 95% CI, 1.01-1.69; p = 0.036), in participants with a mean age older than 50 years (OR = 1.15; 95% CI, 1.04-1.28; p = 0.005), in dietary sodium intake subgroup (OR = 1.45; 95% CI, 1.19-1.77; p < 0.001), and in individuals with adjustment for energy (OR = 1.77; 95% CI, 1.38-2.27; p < 0.001). The correlation coefficients showed no significant association between urinary sodium and BMD (r = -0.46; 95% CI, -0.74 to -0.18; p = 0.02). CONCLUSIONS: We found a positive association between sodium intake and the risk of OS, while no association was found with urinary sodium. Furthermore, there was no significant correlation between sodium intake and BMD. Due to high heterogeneity in this research, more studies are suggested.

Low-Carbohydrate-Diet Score and its Association with the Risk of Diabetes: A Systematic Review and Meta-Analysis of Cohort Studies.

The association between a low-carbohydrate diet (LCD) score and the risk of diabetes mellitus (DM) is contradictory. This study is a systemic review of cohort studies that have focused on the association between the LCD score and DM. We searched PubMed/Medline, Scopus, Embase, ISI Web of Science, and Google Scholar for papers published through January 2017 with no language restrictions. Cohort studies that reported relative risks (RRs) with 95% confidence intervals (CI) for DM were included. Finally, 4 studies were considered for our meta-analysis. The total number of participants ranged from 479 to 85 059. Among 4 cohort studies, 8 081 cases with DM were observed over follow-up durations ranging from 3.6 to 20 years. A marginal significant association was observed between the highest LCD score and the risk of DM (RR=1.17; 95% CI: 0.9, 1.51). Moreover, the RRs for studies with energy adjustments showed a significant association (RR: 1.32; 95% CI: 1.17, 1.49; I2: 0%). Based on our findings, study qualities score of less or equal to 7 had a significant influence on the pooled effect size (RR=1.31, 95%CI: 1.15, 1.49; I2: 0%), whereas the overall RR in the studies with quality score more than 7 was 1.09 (95% CI: 0.73, 1.63). In conclusion, we have found that the highest LCD score was marginally associated with the risk of DM. However, more prospective cohort studies are needed to clarify the effects of the LCD score on the risk of DM.