Bovine Colostrum in Increased Intestinal Permeability in Healthy Athletes and Patients: A Meta-Analysis of Randomized Clinical Trials.

BACKGROUND: Increasing intestinal permeability causes chronic inflammation, which is one of the etiological factors of many diseases that presently constitute global challenges. AIMS: Considering the importance of developing therapies to eliminate the increased intestinal permeability, in this systematic review and meta-analysis, we analyze the impact of bovine colostrum (BC) on the gut barrier and its permeability. METHODS: Online databases, including PubMed, ISI Web of Science, and Scopus, were searched to find pertinent articles up to March 2022. Weighted mean difference (WMD) and 95% confidence intervals (CI) were considered as effect sizes. The random-effects model was used to pool the study results. RESULTS: A total of ten articles were included in the meta-analysis. The pooled effect revealed a significant reduction in the 5-h urinary lactulose/rhamnose ratio after BC consumption [mean difference (MD): -0.24; 95% CI -0.43 to -0.04; I2 = 99%] and urinary lactulose/mannitol ratio (MD: -0.01; 95% CI -0.02 to -0.001; I2 = 29.8%). No differences were observed in the plasma intestinal fatty acid-binding protein (I-FABP) between BC and control groups (MD: 2.30; 95% CI -293.9 to 298.5; I2 = 92%). CONCLUSIONS: BC supplementation significantly reduced intestinal permeability; however, to confirm the results, more randomized clinical trials considering different quality, dose, and duration are needed.

Burden of colorectal cancer and its risk factors in the North Africa and Middle East (NAME) region, 1990-2019: a systematic analysis of the global burden of disease study.

OBJECTIVE: The geographical differences in incidence rates of colorectal cancer (CRC) and its burden due to modifiable risk factors warrant investigating the CRC burden and its risk factors in different regions. In the current study, we aimed to estimate the burden of CRC and the share of its risk factors in the North Africa and Middle East (NAME), from 1990 to 2019. STUDY DESIGN: Systematic review. METHODS: The rates of incidence, prevalence, death, years of life lost (YLL), years lived with disability (YLD), and disability adjusted life years (DALYs) of CRC were estimated through the framework of the Global Burden of Diseases (GBD), Injuries and Risk Factors Study 2019 by age, sex, between 1990 and 2019. The CRC-related DALYs attributable to each lifestyle and metabolic risk factor was also estimated through a comparative risk assessment approach. RESULTS: In NAME region, the trends of incidence, prevalence, death, YLL, YLD, and DALYs of CRC were increasing, with higher rates in males than females over this period. High and high-middle socio-demographic index (SDI) countries had greater CRC DALYs rate compared with middle- and low-SDI countries in 2019, except for Palestine [434.66 (95% UI: 368.82, 503.88)]. In NAME region, like the global, dietary risk (33.18%), low whole grain intake (19.79%), and low intake of milk (15.77%) were the major contributing risk factors to DALYs due to CRC in 2019. CONCLUSIONS: Due to increasing trend of CRC burden and the considerable role of lifestyle and metabolic factors in its burden in NAME region, implementing fundamental strategies to minimize CRC burden and its risk factors is imperative.

Retrieving Rare Cases: A Protocol for Searching Complex Medical Cases.

This study sought to provide a protocol for searching complex medical cases of grand rounds. A clinical informationist was embedded in gastroenterology grand rounds to use comprehensive search strategies and summarize patients' information through concept mapping. Our proposed protocol classifies into three categories: (1) The general search strategy, (2) The protocol for searching for evidence about rare diseases, and (3) Identifying other resources more than routine medical databases. This approach represents a novel method beyond previous studies which were focused on usual ward rounds to facilitate evidence-based decision-making by providing and simplifying a comprehensive summary view of complex medical cases.

Post-discharge health assessment in survivors of coronavirus disease: a time-point analysis of a prospective cohort study.

PURPOSE:  The objective of this study was to quantitatively evaluate psychological and quality of life-related complications at three months following discharge in hospitalized coronavirus disease 2019 (COVID-19) patients during the pandemic in Iran. METHODS: In this time-point analysis of prospective cohort study data, adult patients hospitalized with symptoms suggestive of COVID-19 were enrolled. Patients were stratified in analyses based on severity. The primary outcomes consisted of psychological problems and pulmonary function tests (PFTs) in the three months following discharge, with Health-related quality of life (HRQoL) as the secondary outcome. Exploratory predictors were determined for both primary and secondary outcomes. RESULTS: 283 out of 900 (30%) eligible patients were accessible for the follow-up assessment and included in the study. The mean age was 53.65 ± 13.43 years, with 68% experiencing a severe disease course. At the time of the final follow-up, participants still reported persistent symptoms, among which fatigue, shortness of breath, and cough were the most common. Based on the regression-adjusted analysis, lower levels of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio was associated with higher levels of depression (standardized ß = - 0.161 (SE = 0.042), P = 0.017) and stress levels (standardized ß =- 0.110 (SE = 0.047), P = 0.015). Furthermore, higher levels of anti-SARS-CoV-2 immunoglobulin-M (IgM) were associated with significantly lower levels of depression (standardized ß = - 0.139 (SE = 0.135), P = 0.031). CONCLUSIONS: There is an association between lung damage during COVID-19 and the reduction of pulmonary function for up to three months from acute infection in hospitalized patients. Varying degrees of anxiety, depression, stress, and low HRQoL frequently occur in patients with COVID-19. More severe lung damage and lower COVID-19 antibodies were associated with lower levels of psychological health.

Costs and outcomes of colorectal cancer screening program in Isfahan, Iran.

BACKGROUND: Colorectal cancer is one of the most prevalent gastrointestinal cancers in Iran i.e., the fourth and the second prevalent cancer among Iranian males and females, respectively. A routine screening program is effective in the early detection of disease which can reduce the cancer burden both for individuals and society. In 2015, Iran's Package of Essential Non- communicable Diseases program had been piloted in Shahreza city in Isfahan province. Colorectal cancer screening for the population aged 50-70 was a part of this program. So far, there was no study about the cost and outcomes of that program. Thus, this study aimed to analyze the costs and outcomes of colorectal cancer screening done from 2016 to 2019 in Shahreza. METHODS: This cost-outcome description study used the data of 19,392 individuals who were 50-70 years old experienced a fecal immunochemical test (FIT) and had an electronic health record. All direct costs including personnel, building space, equipment, training, etc. were extracted from the financial documents existing in the Isfahan province Health Center. The outcome was defined as positive FIT, detection of adenoma or malignancy as recorded in the E-integrated health system. RESULTS: The results of this study indicated that the direct costs of the colorectal cancer screening program during the years 2016-2019 were 7,368,707,574 Rials (321,029 PPP$) in Shahreza, Isfahan province. These costs resulted in identifying 821 people with a positive FIT test, of those 367 individuals were undergone colonoscopy. Of whom 8 cases of colorectal cancer, and 151 cases with polyps were diagnosed. CONCLUSION: This study showed that by paying a small amount of 320 thousand international dollars we could prevent 151 cases of polyps to be progressed to colorectal cancer,resulting in a significant reduction in colorectal cancer incidence.

Re-investigation of functional gastrointestinal disorders utilizing a machine learning approach.

BACKGROUND: Functional gastrointestinal disorders (FGIDs), as a group of syndromes with no identified structural or pathophysiological biomarkers, are currently classified by Rome criteria based on gastrointestinal symptoms (GI). However, the high overlap among FGIDs in patients makes treatment and identifying underlying mechanisms challenging. Furthermore, disregarding psychological factors in the current classification, despite their approved relationship with GI symptoms, underlines the necessity of more investigation into grouping FGID patients. We aimed to provide more homogenous and well-separated clusters based on both GI and psychological characteristics for patients with FGIDs using an unsupervised machine learning algorithm. METHODS: Based on a cross-sectional study, 3765 (79%) patients with at least one FGID were included in the current study. In the first step, the clustering utilizing a machine learning algorithm was merely executed based on GI symptoms. In the second step, considering the previous step's results and focusing on the clusters with a diverse combination of GI symptoms, the clustering was re-conducted based on both GI symptoms and psychological factors. RESULTS: The first phase clustering of all participants based on GI symptoms resulted in the formation of pure and non-pure clusters. Pure clusters exactly illustrated the properties of most pure Rome syndromes. Re-clustering the members of the non-pure clusters based on GI and psychological factors (i.e., the second clustering step) resulted in eight new clusters, indicating the dominance of multiple factors but well-discriminated from other clusters. The results of the second step especially highlight the impact of psychological factors in grouping FGIDs. CONCLUSIONS: In the current study, the existence of Rome disorders, which were previously defined by expert opinion-based consensus, was approved, and, eight new clusters with multiple dominant symptoms based on GI and psychological factors were also introduced. The more homogeneous clusters of patients could lead to the design of more precise clinical experiments and further targeted patient care.

Dietary methyl donor micronutrients intake in relation to psychological disorders in adults.

Previous investigations have mostly studied an individual methyl donor nutrient in relation to psychological disorders and the findings were inconsistent. We investigated the association of methyl donor micronutrients (folate, B6, B12, choline, betaine and methionine) with psychological disorders in Iranian adults. In this cross-sectional study, dietary intakes of 3299 adults were collected using a validated food frequency questionnaire. Methyl donor micronutrient score (MDMS) was calculated based on energy-adjusted deciles of each nutrient. Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ), validated for Iranians, have been applied to assess depression, anxiety and psychological distress. Participants had a mean age of 36·3 ± 7·9 years, of whom 58·5 % were women. After considering potential confounders, adults in the top quartile of MDMS, compared to the bottom one, had decreased odds of anxiety (OR: 0·53, 95 % CI: 0·37, 0·75), depression (OR: 0·75, 95 % CI: 0·58, 0·97) and psychological distress (OR: 0·61, 95 % CI: 0·46, 0·80). Among women, the top quartile of MDMS was protectively associated with anxiety (OR: 0·60, 95 % CI: 0·40, 0·90), depression (OR: 0·68, 95 % CI: 0·50, 0·93) and psychological distress (OR: 0·53, 95 % CI: 0·38, 0·74). Overweight and obese subjects in the highest quartile of MDMS had a 67 %, 35 % and 53 % lower odds of anxiety (95 % CI: 0·20, 0·56), depression (95 % CI: 0·44, 0·94) and psychological distress (95 % CI: 0·31, 0·70), respectively. We found that high consumption of methyl donor micronutrients was related to a reduced odds of psychological disorders, especially in women and overweight or obese individuals.

The association between dietary total antioxidant capacity and odds and severity of irritable bowel syndrome among Iranian adults: a cross-sectional study.

BACKGROUND: Little evidence is available in terms of the role of dietary antioxidants in the management of irritable bowel syndrome (IBS) disease. This study aimed to examine the association between dietary total antioxidant capacity (dTAC) and odds of IBS and its severity. METHODS: This cross-sectional study was conducted on 3,362 Iranian adults who were referred to health centers in Isfahan province, Iran. Participants' dietary intakes were collected using a semi-quantitative validated food frequency questionnaire (DS-FFQ). The dTAC was measured by the ferric-reducing antioxidant power (FRAP) method. Multivariable binary or ordinal logistic regression analyses were performed to estimate any associations between dTAC and odds of IBS, IBS severity, and IBS subtypes. RESULTS: The average age and BMI of the participants and dTAC score were 36.3 ± 7.87 year, 24.9 ± 3.82 kg/m2. The prevalence of IBS, IBS with constipation (IBS-C), IBS with diarrhoea (IBS-D), mixed IBS (IBS-M), and un-subtyped IBS (IBS-U) were 22.2, 7.5, 4.6, 3.8, and 6.2%, respectively. In crude and adjusted models, the results did not show any significant association between dTAC and odds of IBS among whole and gender-age stratified populations. Being in the third compared with the first tertile of dTAC was not also significantly associated with odds of IBS severity. Besides, there were no significant associations between dTAC and odds of IBS-C, IBS-D, IBS-M, and IBS-U. CONCLUSION: This study indicates that dTAC may not be associated with the odds of IBS and its severity even after stratification for gender and body mass index.

The Association between Adherence to the MIND Diet and Irritable Bowel Syndrome.

BACKGROUND AND AIMS: No earlier study examined the association between adherence to the MIND (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay) diet and odds of irritable bowel syndrome (IBS). This study was conducted to examine the relationship between adherence to the MIND diet and odds of IBS among Iranian adults. METHODS: In this cross-sectional study, dietary intakes of 3,362 adults were examined using a validated Dish-Based 106-item Semi-Quantitative Food Frequency Questionnaire (DS-FFQ). The MIND diet score was constructed based on participants' dietary intakes obtained from DS-FFQ. IBS was evaluated using a modified Persian version of the Rome III questionnaire. RESULTS: Overall, 22.2% of the study population were affected by IBS (n = 748). We observed no significant relationship between adherence to the MIND diet and odds of IBS in the whole population (OR: 0.97; 95% CI: 0.71-1.31). By gender and BMI status, no significant association between adherence to the MIND diet and odds of IBS was seen. Also, no significant association was found between adherence to the MIND diet and IBS subtypes. CONCLUSION: No significant association was found between adherence to the MIND diet and odds of IBS. Further studies are needed to examine the association between dietary patterns and IBS.

Coffee and caffeine intake in relation to symptoms of psychological disorders among adults.

OBJECTIVE: Given that there is an inconsistency in the findings related to the relationship between coffee and caffeine consumption and symptoms of psychological disorders, we performed a cross-sectional analysis to examine the association between coffee and caffeine intake and symptoms of psychological disorders among adults. DESIGN: In this cross-sectional study, 3362 participants were included. We assessed the coffee and caffeine intakes using a self-completed food frequency questionnaire (FFQ). Symptoms of depression, anxiety, and psychological distress were assessed using HADS and GHQ screening tools. RESULTS: The mean age of participants in this study was 36.2±7.8 years. After controlling for potential confounders, individuals who consumed coffee weekly or more had a significantly lower odds of symptoms of depression (OR: 0.67; 95% CI: 0.46-0.96) and symptoms of anxiety (OR: 0.57; 95% CI: 0.34-0.95) compared with those who did not consume coffee. However, no significant association was found between coffee intake and symptoms of psychological distress (OR: 0.98; 95%CI: 0.68-1.42). No significant relationship was found between caffeine intake and odds of symptoms of depression (OR: 0.94; 95% CI: 0.75-1.16), symptoms of anxiety (OR: 0.90; 95% CI: 0.67-1.20), and symptoms of psychological distress (OR: 1.13; 95% CI: 0.89-1.42). CONCLUSION: Compared with lack of coffee intake, weekly or more coffee consumption might be correlated with symptoms of depression and anxiety.

Dietary Inflammatory Potential in relation to General and Abdominal Obesity.

Background/Aims: Limited data are available on the association of Dietary Inflammatory Potential (DIP) with general and abdominal obesity in developing countries. The aim of this study was to examine the association between DIP score with general and abdominal obesity among Iranian adults. Methods. This cross-sectional study was conducted among adults in Isfahan, Iran. Dietary intakes were assessed by using a validated, self-administrated, dish-based, semiquantitative food frequency questionnaire. DIP was calculated based on standard method. Data regarding height, weight, and waist circumference (WC) were collected using a self-reported questionnaire. Overweight or obesity was defined as body mass index (BMI) ≥25 kg/m2, and abdominal obesity was defined as WC ≥ 80 cm for women and ≥94 cm for men. Results. Mean age of study participants was 36.8 ± 8.08 years. The prevalence of general and abdominal obesity was 46.5% and 52.9%, respectively. We observed that higher DIP scores were significantly associated with a lower odds of general obesity (OR: 0.66; 95% CI: 0.58-0.74). Stratified by sex, this significant association was seen only for women (OR: 0.58; 95% CI: 0.46-0.72). In addition, no significant association was found between DIP scores and abdominal obesity. Conclusions. We found a significant inverse association between consumption of a proinflammatory diet and general obesity. In the gender-stratified analysis, this was seen in women, but not in men. There was no significant association between the DIP scores and abdominal obesity.

Dietary intake of branched-chain amino acids in relation to general and abdominal obesity.

PURPOSE: Despite the huge evidence on the link between dietary protein intake and obesity, limited studies have examined the role of individual amino acids in this regard. This study aimed to investigate the association between dietary total and individual BCAAs intake and odds of general and abdominal obesity in a large group of adults. METHODS: This cross-sectional study was conducted among 8691 adults aged 18-55 years in Isfahan, Iran. Dietary BCAAs were assessed using a validated dish-based 106-item semi-quantitative food frequency questionnaire (DS-FFQ). Information about weight and waist circumference was collected through a self-reported validated questionnaire. General obesity was defined as body mass index (BMI) ≥ 30 kg/m2, and abdominal obesity was defined as waist circumference (WC) ≥ 88 cm for women and ≥ 102 cm for men. RESULTS: Mean age of study participants was 36.8 ± 8.1 years. Prevalence of general obesity was 9.2% in men and 9.7% in women and that of abdominal obesity was 13.3% and 36.2% in men and women, respectively. We found that participants in the top tertile of total BCAAs intake had higher odds of general obesity compared with those in the bottom tertile (OR: 1.42; 95% CI: 1.09-1.84). Such significant association was seen in men (OR: 1.57; 95% CI: 1.05-2.34), but not in women (OR: 1.33; 95% CI: 0.94-1.89) in our stratified analysis. We found no significant association between total BCAAs intake and odds of abdominal obesity. Stratified by sex, no significant association was observed between total BCAAs intake and odds of abdominal obesity [for men: (OR: 1.10; 95% CI: 0.74-1.65) and for women: (OR: 1.08; 95% CI: 0.84-1.38)]. Assessing the association with individual BCAAs, a significant positive association was observed between dietary intake of valine (OR: 1.42; 95% CI: 1.10-1.84), leucine (OR: 1.43; 95% CI: 1.10-1.86), and isoleucine (OR: 1.42; 95% CI: 1.09-1.84) with general obesity. We observed no significant association between dietary intake of individual BCAAs intake and odds of abdominal obesity. CONCLUSION: Dietary BCAAs intake was associated with an increased odds of general obesity, in particular among men. No significant association was observed between dietary BCAAs and abdominal obesity. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Gastrointestinal manifestations in patients with coronavirus disease-2019 (COVID-19): Impact on clinical outcomes.

Background: In this study, we summarized the data on gastrointestinal (GI) involvement and the potential association with clinical outcomes among the patients admitted to Khorshid Hospital. Materials and Methods: We investigated 1113 inpatients (≥18 years old) diagnosed with coronavirus disease-2019 (COVID-19) from March to June 2020 in Khorshid Hospital. We collected demographic details, clinical information, vital signs, laboratory data, treatment type, and clinical outcomes from patients' medical records. The data of patients with GI symptoms were compared with those without GI symptoms. Results: A total of 1113 patients were recruited (male = 648). GI symptoms were observed in 612 (56.8%) patients (male = 329), the most common of which were nausea 387 (34.7%), followed by diarrhea 286 (25.7%), vomiting 260 (23.4%), and abdominal pain 168 (15.0%). The most prominent non-GI symptoms were cough 796 (71.5%), fever 792 (71.2%), shortness of breath 653 (58.7%), and body pain 591 (53.1%). The number of patients who were discharged, died, and were admitted to intensive care unit was significantly different in groups on the basis of GI and non-GI symptoms (P = 0.002, 0.009, 0.003). Conclusion: While COVID-19 was predominantly diagnosed in males, GI symptoms were more commonly reported by females. The results indicated that GI symptoms in COVID-19 patients are common, and the symptoms are not correlated with the severity of the disease. Moreover, the presence of GI symptoms was positively related to milder disease. Among COVID-19 positive patients, the clinical outcomes of the GI group were promising, compared to those of non-GI group.

Absolute mortality risk assessment of COVID-19 patients: the Khorshid COVID Cohort (KCC) study.

BACKGROUND: Already at hospital admission, clinicians require simple tools to identify hospitalized COVID-19 patients at high risk of mortality. Such tools can significantly improve resource allocation and patient management within hospitals. From the statistical point of view, extended time-to-event models are required to account for competing risks (discharge from hospital) and censoring so that active cases can also contribute to the analysis. METHODS: We used the hospital-based open Khorshid COVID Cohort (KCC) study with 630 COVID-19 patients from Isfahan, Iran. Competing risk methods are used to develop a death risk chart based on the following variables, which can simply be measured at hospital admission: sex, age, hypertension, oxygen saturation, and Charlson Comorbidity Index. The area under the receiver operator curve was used to assess accuracy concerning discrimination between patients discharged alive and dead. RESULTS: Cause-specific hazard regression models show that these baseline variables are associated with both death, and discharge hazards. The risk chart reflects the combined results of the two cause-specific hazard regression models. The proposed risk assessment method had a very good accuracy (AUC = 0.872 [CI 95%: 0.835-0.910]). CONCLUSIONS: This study aims to improve and validate a personalized mortality risk calculator based on hospitalized COVID-19 patients. The risk assessment of patient mortality provides physicians with additional guidance for making tough decisions.

Combined Healthy Lifestyle Is Inversely Associated with Upper Gastrointestinal Disorders among Iranian Adults.

OBJECTIVE: Although lifestyle-related factors have separately been examined in relation to functional gastrointestinal disorders (FGIDs), there is no epidemiological data on the combined association of lifestyle factors with these conditions. We aimed to examine how combinations of several lifestyle factors were associated with functional dyspepsia (FD), its symptoms, and gastroesophageal reflux disease (GERD) in a large group of Iranian adults. DESIGN, SETTING, AND SUBJECTS: In a cross-sectional study on 3,363 Iranian adults, we calculated the "healthy lifestyle score" for each participant by summing up the binary score given for 5 lifestyle factors, including dietary habits, dietary intakes, psychological distress, smoking, and physical activity. A dish-based 106-item semi-quantitative validated food frequency questionnaire, General Practice Physical Activity Questionnaire, General Health Questionnaire, and other pre-tested questionnaires were used to assess the components of healthy lifestyle score. To assess FGIDs, a validated Persian version of ROME III questionnaire was used. RESULTS: After adjustment for potential confounders, we found that individuals with the highest score of healthy lifestyle had 79 and 74% lower odds of FD (OR: 0.21; 95% CI: 0.05-0.92) and GERD (OR: 0.26; 95% CI: 0.09-0.69), respectively, compared with those with the lowest score. They were also less likely to have early satiation (OR: 0.28; 95% CI: 0.11-0.73), postprandial fullness (OR: 0.22; 95% CI: 0.09-0.50), and epigastric pain (OR: 0.44; 95% CI: 0.21-0.92). In addition to the combined healthy lifestyle score, low levels of psychological distress, a healthy diet, healthy dietary habits, and nonsmoking were separately and protectively associated with FGIDs. CONCLUSION: We found that adherence to a healthy lifestyle was associated with lower odds of GERD, FD, and its symptoms in this group of Iranian adults, in a dose-response manner. Individual lifestyle-related factors were also associated with these conditions.

Nutritional challenges of gastric cancer patients from the perspectives of patients, family caregivers, and health professionals: a qualitative study.

PURPOSE: This study aims to explore the perceptions of gastric cancer patients, their family caregivers, physicians, and nurses of nutritional challenges. METHODS: Using a descriptive qualitative method, this study was conducted in 2019-2020. Twenty participants (6 patients, 6 family caregivers, 3 physicians, and 5 nurses) were selected through purposive sampling. Data was collected through in-depth semi-structured interviews and examined using qualitative content analysis. RESULTS: Data analysis revealed three categories, each with two subcategories: eating, an unpleasant experience that contains "a feeling like hyperemesis gravidarum" and "childish food excuses"; flexibility while adhering to a proper diet, which consists of "dietary dos and don'ts" and "nutritional leniency"; and nutrition with distress that contains "patient's sense of being an extra burden" and "provision of nutrition with suffering in caregivers." CONCLUSION: Because of the significant physical and psychological impact of nutritional problems on patients and their caregivers, the need to provide care and education to these patients and their families using a multidisciplinary team is becoming more important.

Empirically derived food-based dietary inflammatory index is associated with increased risk of psychological disorders in women.

Purpose/introduction: There is no study on the association of empirically derived food-based dietary inflammatory index (FDII) and risk of psychological disorders. We investigated the association between FDII and odds of psychological disorders in Iranian adults.Methods and materials: In this cross-sectional study, data on dietary intakes of 3363 Iranian adult participants were collected using a validated dish-based 106-item semi-quantitative food frequency questionnaire. FDII score was constructed based on participants' dietary intakes of 28 pre-defined food groups. The Iranian validated version of Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ) was used to assess psychological disorders. Depression, anxiety and psychological distress were defined based on standard criteria.Results: After controlling for potential confounders, participants in the top quintile of FDII score had a greater odds of depression (OR: 1.49; 95% CI: 1.08-2.06), anxiety (OR: 1.92; 95% CI: 1.24-2.96), and psychological distress (OR: 1.55; 95% CI: 1.10-2.19) compared with those in the bottom quintile. When we did the analyses stratified by gender, we found a significant positive association between FDII score and depression (OR: 1.57; 95% CI: 1.04-2.35), anxiety (OR: 1.99; 95% CI: 1.19-3.34), and psychological distress (OR: 1.68; 95% CI: 1.10-2.56) among women comparing the highest and the lowest quintiles. We found no significant association between FDII score and psychological disorders in men.Conclusion: We found that greater FDII score was positively associated with psychological disorders. In the gender-stratified analysis, this was seen in women but not in men.

Adherence to Mediterranean dietary pattern is inversely associated with depression, anxiety and psychological distress.

Background: Few studies have assessed adherence to the Mediterranean diet in relation to psychological health, in particular in the Middle East.Objective: To examine the association between adherence to Mediterranean dietary pattern and prevalence of psychological disorders among a large population of Iranian adults.Design: In this cross-sectional study on 3172 Iranian adults aged 18-55 years, we used a validated food frequency questionnaire for the assessment of dietary intakes. Adherence to the Mediterranean dietary pattern was examined using the Trichopoulou et al. method. To assess psychological health, the Iranian validated version of the Hospital Anxiety and Depression Scale (HADS) was used. Psychological distress was assessed through the use of General Health Questionnaire (GHQ).Results: Mean age of study participants was 36.54 ± 4.97 years. After controlling for potential confounders, participants with the greatest adherence to the Mediterranean diet had lower odds for depression (OR: 0.60, 95% CI: 0.46-0.78), anxiety (OR: 0.61, 95% CI: 0.42-0.86) and psychological distress (OR: 0.60, 95% CI: 0.45-0.79) compared with those with the lowest adherence. When the association with components of Mediterranean diet was examined, we found that high intake of fruits and vegetables was associated with a lower odds of depression, anxiety and psychological distress. In contrast, high intake of grains was positively associated with depression, anxiety and psychological distress.Conclusion: We found evidence indicating an inverse association between adherence to Mediterranean dietary pattern and odds of psychological disorders including depression, anxiety and psychological distress.

Psychosomatic symptoms questionnaire (PSQ-39): a psychometric study among general population of Iranian adults.

BACKGROUND: Psychosomatic symptoms, characterized by physical-bodily complaints not fully explained by organic reasons, are highly prevalent. The present study aimed to culturally adapt and evaluate the psychometric properties of Psychosomatic Symptoms Questionnaire 39-item version (PSQ-39) among Iranian general adult population. METHODS: This study included 996 Persian-speaking people, living in Isfahan, Iran. The translation of the PSQ-39 was performed using the forward-backward method. Test-retest reliability was evaluated through Intraclass correlation (ICC) coefficient and internal consistency by using Cronbach's α. Construct validity was investigated by using both exploratory (EFA) and confirmatory (CFA) factor analysis. Short Form Health Survey (SF-36) was used to assess divergent validity. Known-group validity was also assessed. RESULTS: The Persian version of the PSQ-39 showed excellent test-retest reliability in all domains (ICCs: 0.95-0.99). The computed Cronbach's alpha coefficients for domains of PSQ-39 were in the range good to excellent. The PSQ-39 showed good known-group validity and differentiated patients from the general population (Area under the curve [AUC] of 0.78 (95% CI: 0.73, 0.84). Construct validity evaluated by EFA led to extraction of seven factors (Cardiorespiratory, musculoskeletal, psychological, gastrointestinal, general, body balance and Globus), and the CFA confirmed the adequacy of extracted factors by EFA (CFI = 0.91, TLI = 0.90, PCFI = 0.77, PNFI = 0.71, CMIN = 1413.18 (df = 654), CMIN/DF = 2.16, and RMSEA = 0.06). Significant negative correlations between all domains of PSQ and SF-36 revealed an acceptable divergent Validity. CONCLUSIONS: The Persian version of the PSQ-39 is a reliable and valid questionnaire with applicability in a broad range of Persian language populations for assessing common psychosomatic symptoms in research as well as in clinical practice.

Dietary intake of branched-chain amino acids in relation to depression, anxiety and psychological distress.

BACKGROUND: There is no previous study that examined the association between branched-chain amino acids (BCAAs) intake and odds of psychological disorders. The aim of this study was to investigate the association between dietary BCAAs and odds of psychological disorders including depression, anxiety, and psychological distress in a large sample of Iranian adults. METHODS: In this cross-sectional study on 3175 Iranian adults aged 18-55 years, a validated food frequency questionnaire was used to assess dietary intakes. BCAAs intake was computed by summing up the amount of valine, leucine, and isoleucine intake from all food items in the questionnaire. Psychological health was examined through the use of Iranian validated version of the Hospital Anxiety and Depression Scale (HADS). Psychological distress was assessed using General Health Questionnaire (GHQ). For depression and anxiety, scores of 8 or more on either subscale were considered as psychological disorders and scores of 0-7 were defined as "normal". In terms of psychological distress, the score of 4 or more was defined as psychological distress. RESULTS: Mean age of study participants was 36.2 ± 7.8 years. Overall, 26.4% (n = 837) of study subjects had depression, 11.9% (n = 378) had anxiety and 20.9% (n = 665) were affected by psychological distress. After controlling for potential confounders, participants in the highest tertile of total BCAAs intake had lower odds of depression (OR: 0.76; 95% CI: 0.60-0.96) and anxiety (OR: 0.66; 95% CI: 0.47-0.91) compared with those in the lowest tertile. Participants in the top tertile of valine intake had a lower odds of depression (OR: 0.76; 95% CI: 0.60-0.96) and anxiety (OR: 0.65; 95% CI: 0.47-0.90) compared with those in the bottom tertile. A significant inverse association was also seen between leucine intake and depression (OR: 0.77; 95% CI: 0.61-0.98) and anxiety (OR: 0.66; 95% CI: 0.47-0.91). In addition, a significant inverse association was observed between isoleucine intake and odds of depression (OR: 0.75; 95% CI: 0.59-0.95) and anxiety (OR: 0.62; 95% CI: 0.45-0.86). There was no significant association between isoleucine intake and odds of psychological distress. CONCLUSION: Evidence indicating an inverse association between dietary intake of BCAAs and odds of depression and anxiety was found. Prospective studies are required to confirm these findings.