From adolescence to adulthood: Mediterranean diet adherence and cardiometabolic health in a prospective cohort study.

BACKGROUND AND AIMS: Recent investigations suggest that specific dietary patterns during adolescence may predict cardiometabolic complications later in life. In this study, we aimed to examine the association between Mediterranean diet score (MDS) during adolescence and cardiometabolic outcomes when participants reached adulthood. METHODS AND RESULTS: This cohort study was conducted on 668 subjects, aged 10-19 years, in framework of the Tehran Lipid and Glucose Study. The MDS was determined based on eight components using a validated food-frequency questionnaire. Anthropometric measurements, fasting blood glucose (FBG), and lipid profile data were measured both at baseline and after a 6.8 ± 2.9-year follow-up. Using multivariable linear regression, we explored the association between MDS and changes in cardiometabolic risk factors. Moreover, multivariable-adjusted cox proportional hazard regression was used to estimate hazard ratios (HR) and 95 % confidence intervals (CIs) for cardiometabolic complications across MDS tertiles. The mean ± SD age of participants (43.5 % men) was 15.8 ± 2.47 years. The mean ± SD of MDS was 4.03 ± 1.56, with a median of 4.00 among all participants. Higher MDS was inversely associated with 6.8-year changes in waist circumference (WC), FBG, total cholesterol (TC), and high-density lipoprotein-cholesterol (Ptrend<0.05). Based on the HR analysis, after controlling for potential confounders, individuals in the highest tertile of MDS had a significantly lower risk of high-TC(HR = 0.36,95%CI:0.18-0.74,Ptrend = 0.004) compared to those in the lowest tertile. However, no significant association was observed between MDS and other cardiometabolic risk factors. CONCLUSIONS: Greater adolescent adherence to a Mediterranean-type diet was associated with favorable cardiometabolic factors in adulthood, including improving the levels of WC, FBG, TC, as well as reduced risk of high-TC.

Dietary and lifestyle indices for hyperinsulinemia with the risk of obesity phenotypes: a prospective cohort study among Iranian adult population.

BACKGROUND: Previous studies have cited insulin-related disorders, including hyperinsulinemia, as one of the main causes of obesity risk and metabolic disorders. We aimed to investigate the association of the Empirical Dietary Index for Hyperinsulinemia (EDIH) and Empirical Lifestyle Index for Hyperinsulinemia (ELIH) with the risk of obesity phenotypes among Iranian adults. METHODS: Present study was conducted on 2705 subjects, including 1604 metabolically healthy normal weights (MHNW) and 1101 metabolically healthy obesity (MHO) individuals. Obesity phenotypes, including MHNW, MHO, metabolically unhealthy normal weights (MUNW), and metabolic unhealthy obesity (MUO), were determined using the criteria of the Joint International statement (JIS) for metabolic syndrome. Dietary intake data from the previous year was gathered using a food frequency questionnaire. Cox proportional hazard regression was used to estimate the hazard ratio and 95% confidence intervals (HRs and 95% CIs) of obesity phenotypes incident across tertiles of EDIH and ELIH scores. RESULTS: The mean ± SD of age and BMI of all participants were 33.5 ± 12.2 years and 24.3 ± 3.8 kg/m2, respectively. In the multivariable-adjusted model, a higher ELIH score was associated with a greater risk for incidence of MUO (HR: 3.47, 95%CI: 2.54-4.74; Ptrend = < 0.001) and MHO (HR: 3.61, 95%CI: 2.73-4.77; Ptrend = < 0.001). Also, a higher score of EDIH was related to an increased risk of MUO incidence (HR: 1.35, 95%CI: 1.02-1.79; P for trend = 0.046). However, there was no significant association between a higher score of EDIH and the risk of MHO. CONCLUSION: Our findings revealed that a high insulinemic potential of diet and lifestyle, determined by EDIH and ELIH indices, may be related to an increase in the simultaneous occurrence of obesity with metabolic disorders in Iranian adults.

Herbal Products as Complementary or Alternative Medicine for the Management of Hyperglycemia and Dyslipidemia in Patients with Type 2 Diabetes: Current Evidence Based on Findings of Interventional Studies.

Type 2 diabetes (T2D) is known as a major public health problem with a noticeable adverse impact on quality of life and health expenditures worldwide. Despite using routine multiple pharmacological and nonpharmacological interventions, including diet therapy and increasing physical activity, controlling this chronic disease remains a challenging issue, and therapeutic goals are often not achieved. Therefore, recently, other therapeutic procedures, such as using herbal products and functional foods as complementary or alternative medicine (CAM), have received great attention as a new approach to managing T2D complications, according to the literature. We reviewed the existing evidence that supports using various fundamental medicinal herbs, including cinnamon, saffron, ginger, jujube, turmeric, and barberry, as CAM adjunctive therapeutic strategies for T2D patients. The current review addressed different aspects of the potential impact of the abovementioned herbal products in improving glycemic indices and lipid profiles, including the effect size reported in the studies, their effective dose, possible side effects, herbs-drug interactions, and their potential action mechanisms.

Changes in Physiological Levels of Cortisol and Adrenocorticotropic Hormone upon Hospitalization Can Predict SARS-CoV-2 Mortality: A Cohort Study.

There is some indication that coronavirus disease 2019 (COVID-19) causes hypothalamic-pituitary-adrenal axis insufficiency. However, being on glucocorticoids makes it difficult to fully investigate this axis, especially in patients with severe COVID-19. We aimed to discover if there was a connection between blood total cortisol and adrenocorticotropic hormone (ACTH) levels and mortality in patients with COVID-19. In Iran, 154 hospitalized patients with COVID-19 were studied in a prospective cohort study. ACTH and cortisol levels in the blood were measured on the first or second day of hospitalization. Most patients (52.6 vs. 47.4%) were men over 50 years old (55.8%), and 44.4% had an underlying illness. Serum cortisol and plasma ACTH medians were 15.6 (µg/dl) and 11.4 (pg/ml), respectively. 9.09% of the patients died. Cortisol levels were substantially lower in those who died (11.3 µg/dl) than in patients who were discharged (16.7 µg/dl, P < 0.01), while ACTH levels were unaffected. The most important factors determining mortality, according to the logistic model, were blood cortisol levels, the existence of an underlying disease, and the use of a mechanical ventilator. Cortisol levels that rose by one-unit correlated with a 26% lower risk of mortality. Comorbidities and mechanical ventilation increased the risk of death by 260 and 92 times, respectively. It can be concluded that in patients with COVID-19, a low cortisol level is linked to a high risk of mortality. Patients may sometimes have relative primary adrenal insufficiency. To judge and decide on therapeutic interventions, more reliable and long-term follow-up studies are required.

Association Between Serum Lipid Levels and Estimated Glomerular Filtration Rate in Type 2 Diabetic Patients.

INTRODUCTION: Dyslipidemia is a common metabolic abnormality in Type 2 diabetic Mellitus (T2DM) patients with kidney dysfunction. Therefore, the current study was conducted to assess the association between serum lipid levels and estimated glomerular filtration rate (eGFR) in T2DM patients. METHODS: This cross-sectional study was performed on 802 participants, aged 40 years or more who had referred to the Abu Reyhan Clinic of Shahid Mohammadi Hospital in Bandar Abbas, Hormozgan province, Iran. Biochemical variables including FBS, triglycerides, total cholestrol, LDL-C, and HDL-C levels were measured using the enzymatic method. The association between serum lipid profile and eGFR was assessed using the Spearman correlation coefficient test and linear regression model. RESULTS: Mean ± SD age of the subjects (72.3% females) was 53.55 ± 5.56 years old. Mean ± SD of eGFR-EPI and eGFR-MDRD was 86.30 ± 17.48 and 86.80 ± 23.29, respectively for all the subjects. In the current study, a negative association was observed between eGFR-EPI and FBS (r = -0.123, ß = -0.172) and TGs (r = -0.080, ß = -0.096) (P < .01). Also, there was an inverse association between the eGFR-MDRD and FBS (r = -0.123, ß = -0.172) and TGs levels (r = -0.074, ß = -0.086) (P < .05). However, the concentration of other lipid profiles was not associated with the eGFR level (estimated by EPI and MDRD methods). CONCLUSION: Our findings suggested that the patients with reduced eGFR level are more likely to have greater TG serum level. Therefore, high TG levels can be considered as a potential biomarker for predicting renal complications in the patients with T2DM.

Clinical and Epidemiological Characteristics of Hospitalized COVID-19 Patients in Hormozgan, Iran: A Retrospective, Multicenter Study.

BACKGROUND: To better manage the COVID-19 pandemic, it is necessary to carefully study information about patients with COVID-19. Objective: To report clinical and epidemiological characteristics of COVID-19 patients in southern Iran. METHODS: This cross-sectional retrospective study was conducted based on data extracted from the COVID-19 registry of Hormozgan. Data from patients with confirmed COVID-19 based on CT-scan results or real-time reverse transcriptase-polymerase chain reaction (RT-PCR) results until September 25, 2020, were analyzed for this study (2351 inpatients). We reported demographics, signs and symptoms on admission, comorbidities, and treatments, as well as clinical outcomes, hospital stay, and intensive care unit (ICU) admission. RESULTS: Most of patients were men (1235/2351; 52.5%) and the most common signs and symptoms included cough (1343/2351; 57.1%), shortness of breath (1224/2351; 52.1%) and fever. The most common comorbidities included hypertension (410/2351 (17.4%), diabetes (343/2351; 14.6%) and chronic cardiac disease (282/2351; 12%). Also, 228 patients (9.7%) were hospitalized in the ICU. The mortality rate was 12.5% (295/2351) among all patients and 64.5% (147/228) in ICU wards, respectively. The number of cases with comorbidities including hypertension, chronic cardiac disease, diabetes, chronic neurological disorders, chronic kidney disease, chronic hematologic disease, malignant neoplasm, moderate or severe liver disease, dementia and fauvism in the ICU was significantly higher than the general wards. CONCLUSION: Most characteristics of our patients were similar to those reported in other studies; however, our patients were younger and suffered from a less severe disease. The mortality rate in the ICU was higher than other studies.

Bilateral Adrenal Myelolipoma, A Case Presentation and Brief Literature Review.

As a rare and normally-benign and functionless tumor, primary adrenal myelolipoma comprises adipose tissue and myeloid cells, and its diagnosis is usually difficult owing to its asymptomatic nature. Imaging techniques can detect these masses in over 90% of the cases. CT scan is the most sensitive imaging technique, which can display the tissue nature of this tumor with a high resolution. The present case report involves a 45-year-old woman with bilateral adrenal myelolipoma diagnosed with imaging methods.

Prevalence of peripheral arterial disease in hemodialysis patients.

INTRODUCTION: The ankle-brachial index (ABI), measurement of carotid artery intima-media thickness (CIMT), and assessment of the thickness of interventricular septum (IVS), are noninvasive methods used to predict subclinical atherosclerosis in hemodialysis patients. This study aimed to determine the prevalence of peripheral arterial disease and to assess the correlations between ABI, CIMT, the thickness of IVS, and blood parameters in hemodialysis patients. MATERIALS AND METHODS: The ABI, CIMT, and the thickness of IVS were measured in 50 patients on hemodialysis. Data were collected regarding the levels of calcium, urine nitrogen, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, cholesterol, creatinine, albumin in serum, as well as erythrocyte sedimentation rate. Results. Ten percent of the patients showed a reduced ABI (< 0.9). The mean values for ABI, CIMT, and IVS were 1.09 ± 0.13, 0.68 ± 0.11 mm, and 9.83 ± 1.65 mm, respectively. The levels of calcium, cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride in the serum of the patients with normal ABI were significantly higher than in patients with reduced ABI. There was a negative correlation between ABI and levels of serum LDLC (r = -0.29, P = .04) and triglyceride (r = -0.32, P = .02). Conclusions. The prevalence of peripheral arterial disease in the patients with CRF was 10% and it was correlated with several classical risk factors for atherosclerosis, including elevated LDL and cholesterol levels. CIMT and the thickness of IVS showed no apparent association with ABI.