The relationship between the World Index for Sustainability and Health (WISH) score and mental health in women: A cross-sectional study.

Diet quality has been associated with mental health, and recently, there has been growing interest in the association between sustainability of diets and human health. The objective of this cross-sectional study was to explore the relationship between a newly developed dietary index for health and sustainability, and psychological disorders among Iranian women. Participants in this cross-sectional study included 479 women living in Tehran with no history of chronic disease. A validated 168-item food frequency questionnaire was used to assess dietary intake. The World Index for Sustainability and Health (WISH) was calculated, consisting of four sub-scores: less healthy, healthy, low environmental impact, and high environmental impact. Participants psychological status was assessed using the Depression Anxiety Stress Scale-21. Logistic regression models were used to examine the association between WISH and psychological disorders. Participant ages ranged from 20-50 years, with a mean age of 31.86 (SD:7.68) years. After adjusting for potential confounders (age, energy, BMI, marital status, education, family history of chronic disease, body satisfaction, socio-economic status, physical activity, smoking), women in the highest tertile of the healthy sub-score had significantly lower odds of experiencing depression (OR: 0.40; 95% CI: 0.24-0.67), anxiety (OR: 0.45; 95% CI: 0.23-0.87) and psychological distress (OR: 0.46; 95% CI: 0.28-0.77) compared to the reference group. Similarly, the less healthy sub-score was significantly associated with depression (OR: 0.51; 95% CI: 0.32-0.89), anxiety (OR: 0.44; 95% CI: 0.25-0.78), and psychological distress (OR: 0.57; 95% CI: 0.36-0.90). An inverse association was observed between the low environmental impact sub-score and depression (OR: 0.32; 95% CI: 0.19-0.54), anxiety (OR: 0.38; 95% CI: 0.18-0.76), and psychological distress (OR: 0.30; 95% CI: 0.17-0.51). However, no further significant associations were found with the high environmental impact sub-score, except with depression (OR: 0.57; 95% CI: 0.33-0.96). The healthy and low environmental impact sub-scores of the WISH were found to be inversely associated with depression, anxiety, and psychological distress. However, due to the cross-sectional study design, causality cannot be inferred. Further prospective studies are required to validate and expand upon these findings and explore potential mechanisms and alternative explanations, such as reverse causation. While this study suggests that choosing a diet that is both healthy for individuals and sustainable for the environment may be associated with lower risk of mental health issues among women, more research is needed.

Associations between empirically derived dietary patterns and cardiovascular risk factors among older adult men.

Cardiovascular disease (CVD) remains the leading cause of death globally, and epidemiological studies have suggested a link between diet and cardiometabolic risk. Currently, the prevalence of CVD is rapidly increasing with an aging population and continues to contribute to the growing economic and public health burden. However, there is limited evidence available regarding dietary patterns and cardiometabolic risk factors in older adults. We conducted a cross-sectional study to assess dietary patterns and cardiometabolic risk factors in males ≥60 years. Factor analysis identified a "healthy" diet and an "unhealthy" diet as the two primary dietary patterns. Multivariable logistic regression was used for estimating the associations of identified dietary patterns and cardiometabolic risk factors including anthropometric measures, blood pressure, glycemic biomarkers, lipid profile, and inflammatory biomarkers. A healthy dietary pattern was significantly associated with decreased odds of high serum fasting blood sugar (FBS) (OR: 0.32; 95% CI: 0.15-0.67; Ptrend=0.002), but increased odds of high serum low-density lipoprotein cholesterol (LDL-C) (OR: 1.82; 95% CI: 1.02-3.24; Ptrend=0.04). In comparison, an unhealthy diet was associated with increased odds of obesity (OR: 2.33; 95% CI: 1.31-4.15; Ptrend=0.004) and high LDL-C (OR: 2.00; 95% CI: 1.10-2.61; Ptrend=0.02). Thus, in older adults, adherence to an unhealthy dietary pattern has a significant impact on clinically relevant risk factors for cardiometabolic risk.

Metabolic phenotypes and risk of colorectal cancer: a systematic review and meta-analysis of cohort studies.

BACKGROUND: The association of obesity with colorectal cancer (CRC) may vary depending on metabolic status. OBJECTIVE: This meta-analysis aimed to investigate the combined impacts of obesity and metabolic status on CRC risk. METHODS: The Scopus, PubMed, and web of sciences databases were systematically searched up to Jun 2021 to find all eligible publications examining CRC risk in individuals with metabolically unhealthy normal-weight (MUHNW), metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUHO) phenotypes. RESULTS: A total of 7 cohort studies with a total of 759,066 participants were included in this meta-analysis. Compared with healthy normal-weight people, MUHNW, MHO, and MUHO individuals indicated an increased risk for CRC with a pooled odds ratio of 1.19 (95% CI = 1.09-1.31) in MUHNW, 1.14 (95% CI = 1.06-1.22) in MHO, and 1.24 (95% CI = 1.19-1.29) in MUHO subjects. When analyses were stratified based on gender, associations remained significant for males. However, the elevated risk of CRC associated with MHO and MUHO was not significant in female participants. CONCLUSIONS: The individuals with metabolic abnormality, although at a normal weight, have an increased risk for CRC. Moreover, obesity is associated with CRC irrespective of metabolic status.

Association between overweight/obesity with depression, anxiety, low self-esteem, and body dissatisfaction in children and adolescents: a systematic review and meta-analysis of observational studies.

PURPOSE: Childhood and Adolescent overweight and obesity may be associated with psychological problems. We aimed to conduct a systematic review and summarize published articles on the association between overweight/obesity with risk of depression, anxiety, low self-esteem, and body dissatisfaction among children and adolescents. METHODS: PubMed and Scopus databases were used to conduct a comprehensive search and identify eligible literature published prior to July 2020. The random-effects models (DerSimonian-Laird method) were applied to pool the effect sizes. Subgroup analysis was performed to find potential sources of heterogeneity. RESULTS: 28 studies (3 prospective cohorts and 25 cross-sectional) were included in the current systematic review and meta-analysis. The total sample sizes ranged from 244 to 60252. A positive significant association was found between overweight (pooled risk estimate: 1.15, 95% CI: 1.00-1.31, P = 0.04) and obesity (pooled risk estimate: 1.53, 95% CI: 1.16-2.02, P = 0.003) with risk of low self-esteem, respectively. A significant positive association was found between obesity and risk of body dissatisfaction (pooled risk estimate: 4.05, 95% CI: 2.34-7.023, P = 0.0001). Moreover, no association was found between overweight and risk of body dissatisfaction among children and adolescents. Also, no association was observed between overweight/obesity and risk of depression and anxiety. CONCLUSIONS: Findings showed a positive association between obesity and the risk of body dissatisfaction and low self-esteem among children and adolescents. Moreover, there was a significant positive association between overweight and the risk of low self-esteem.

Is eating a mixed diet better for health and survival?: A systematic review and meta-analysis of longitudinal observational studies.

The role of dietary diversity in chronic disease or survival is controversial. This meta-analysis quantified the health impact of dietary diversity. Random-effects models pooled risk ratios (RRs) and 95% confidence intervals (CIs) of 20 longitudinal studies. Total dietary diversity was associated with a 22% lower risk of all-cause mortality (RR 0.78 [95%CI: 0.64, 0.96]), and was inversely associated with incident cancer- or CVD-specific mortality only in subgroup analyses (RR range: 0.53 to 0.90, p < 0.05). Similarly, diversity across healthy foods was inversely associated with all-cause mortality (RR 0.84 [95%CI: 0.73, 0.96]). An inverse association between total diet diversity and incident CVD was significant in non-European populations consuming diets with diverse food groups (RR: 0.93 [95% CI: 0.86-0.99]). Effects on cancer risk are unstudied. Diversity within fruits and/or vegetables showed null associations for all outcomes, except potentially for squamous cell-type carcinomas. More robust research is warranted. Findings indicated greater dietary diversity may benefit overall survival.

Dietary Inflammatory Index in relation to Type 2 Diabetes: A Meta-Analysis.

Background and Aims: Epidemiologic studies show a strong association between chronic inflammation and type 2 diabetes (T2D). Diet may also affect the risk of T2D by modulating inflammation. This meta-analysis aimed to assess the relation of dietary inflammatory index (DII) and risk of T2D. Methods: PubMed and Scopus were systematically searched from their inception to September 2020 to identify relevant studies. Relative risks, hazard ratios, or odds ratios (OR), with their corresponding 95% confidence intervals (95% CI), were calculated and pooled using a random-effects model. Results: A total of 48 different studies, with a total sample size of 1,687,424 participants, were eligible to be included in this meta-analysis. In the overall analysis, no significant association was observed between DII and risk of T2D (OR = 1.03, 95% CI: 0.91 to 1.15), with significant evidence for heterogeneity (I 2 = 96.5%, P < 0.001); however, higher DII was identified as being significantly related to increased risk of T2D in high quality studies (OR = 1.58, 95% CI: 1.15 to 2.17). In the stratified analysis by the dietary assessment tool, background disease, and sex of participants, DII showed no significant association with T2D. Conclusions: Higher DII might be associated with an increased risk of T2D. Additional well-designed studies are required to confirm this finding.

Letter to Editor: a cautionary note about "Dietary diversity score and cardio-metabolic risk factors: an updated systematic review and meta-analysis".

In the Journal's recent issue, Qorbani and colleagues conducted a systematic review and meta-analysis to determine if a dietary diversity score is associated with cardio-metabolic outcomes. Given the importance of evidence synthesis for nutrition policy and practice, robust review methodology is necessary to avoid spurious conclusions about the health impacts of a mixed diet. There are important conceptual and methodological issues unique to this nutrition topic that warrant consideration and attention and that raise concerns for internal validity of the review. We write to emphasise the need for readers' caution when interpreting this research evidence.

The negative impact of obesity on the occurrence and prognosis of the 2019 novel coronavirus (COVID-19) disease: a systematic review and meta-analysis.

PURPOSE: The 2019 novel coronavirus (COVID-19) is an emerging pandemic, with a disease course varying from asymptomatic infection to critical disease resulting to death. Recognition of prognostic factors is essential because of its growing prevalence and high clinical costs. This meta-analysis aimed to evaluate the global prevalence of obesity in COVID-19 patients and to investigate whether obesity is a risk factor for the COVID-19, COVID-19 severity, and its poor clinical outcomes including hospitalization, intensive care unit (ICU) admission, need for mechanical ventilation, and mortality. METHODS: The study protocol was registered in PROSPERO (CRD42020203386). A systematic search of Scopus, Medline, and Web of Sciences was conducted from 31 December 2019 to 1 June 2020 to find pertinent studies. After selection, 54 studies from 10 different countries were included in the quantitative analyses. Pooled odds ratios (OR) with 95% confidence intervals (CIs) were calculated to assess the associations. RESULTS: The prevalence of obesity was 33% (95% CI 30.0%-35.0%) among patients with COVID-19. Obesity was significantly associated with susceptibility to COVID-19 (OR = 2.42, 95% CI 1.58-3.70; moderate certainty) and COVID-19 severity (OR = 1.62, 95% CI 1.48-1.76; low certainty). Furthermore, obesity was a significant risk factor for hospitalization (OR = 1.75, 95% CI 1.47-2.09; very low certainty), mechanical ventilation (OR = 2.24, 95% CI 1.70-2.94; low certainty), intensive care unit (ICU) admission (OR = 1.75, 95% CI 1.38-2.22; low certainty), and death (OR = 1.23, 95% CI 1.06-1.41; low certainty) in COVID-19 patients. In the subgroup analyses, these associations were supported by the majority of subgroups. CONCLUSION: Obesity is associated with COVID-19, need for hospitalization, mechanical ventilation, ICU admission, and death due to COVID-19. LEVEL OF EVIDENCE: Level I, systematic reviews and meta-analyses.

The effects of magnesium supplementation on obesity measures in adults: a systematic review and dose-response meta-analysis of randomized controlled trials.

Previous studies reported inconsistent findings regarding the effects of magnesium supplementation on obesity measures. This study was done to quantify the effect of magnesium supplementation on body weight, Body Mass Index (BMI), Waist Circumference (WC), Body Fat (BF) percentage and Waist to Hip Ratio (WHR). Four online databases (Scopus, PubMed, Google Scholar and Cochrane library) were searched until March 2020 using relevant keywords. Random-effects model was used to pool effect sizes; Cochran's Q-test and I2 index assessed heterogeneity. Sensitivity analysis and Egger test were used to check the robustness of findings and the possibility of publication bias, respectively. Thirty-two RCTs including different dosage of magnesium (48-450 mg/d), and duration (6-24 weeks) were entered to this study. Magnesium supplementation resulted in a great reduction in BMI [Weighted Mean Difference (WMD): -0.21 kg/m2, 95% CI: -0.41, -0.001, P = 0.048, I2 = 89.5%, n = 22], which was mainly driven by the effect among those with magnesium deficiency, insulin resistance related disorders, and obesity at baseline. No significant change was observed in bodyweight, WC, BF percentage and WHR as compared to controls. However, the change in body weight, and WC was significant in subgroups of participants with insulin resistance related disorders, hypertension, obesity, magnesium deficiency at baseline, and females. We found a significant reduction in BMI following magnesium supplementation. The change in body weight and WC were evident in certain subgroups.

Associations between dietary intake of B-vitamins and psychological disorders among Iranian women: a cross-sectional study.

OBJECTIVE: B-vitamins affect brain function through multiple pathways. Given limited evidence on the relationship between dietary intake of these vitamins and psychological disorders, we examined dietary intake of vitamin B6-9-12 in relation to psychological disorders among Iranian women. DESIGN: Cross-sectional study. Dietary intake was assessed using a valid and reliable FFQ. To assess psychological disorders, we used a version of the Depression Anxiety Stress Scale-21 validated in Iran. SETTING: Ten public health centres in southern Tehran, Iran. PARTICIPANTS: A total of 447 female participants aged 20-50 years. RESULTS: The median values of vitamin B6 (pyridoxine), B9 (folate) and B12 (cobalamin) were 1·30 mg/d, 313·89 µg/d and 3·99 µg/d, respectively. After adjustment for potential confounders, dietary vitamin B6 intake was associated with lower odds of depression (OR: 0·54; 95 % CI: 0·31, 0·95; Ptrend: 0·03). However, there was a positive association between dietary vitamin B12 intake with the odds of depression (OR: 2·05; 95 % CI: 1·17, 3·60; Ptrend: 0·01) and psychological distress (OR: 2·00; 95 % CI: 1·17, 3·41; Ptrend: 0·01). No association was found between vitamin B9 with any psychological disorders. CONCLUSIONS: Women with higher dietary intakes of vitamin B6 had lower likelihood of depression. However, women with higher dietary intake of vitamin B12 had higher odds of depression and psychological distress. Future prospective studies in different populations are needed to clarify whether B-vitamin deficiency is a cause or consequence of psychological disorders.

Associations between dietary intake of B vitamins and cardiovascular risk factors in elderly men: A cross-sectional study.

OBJECTIVE: Low intake of B vitamins can lead to hyperhomocysteinaemia, which is reported as a risk factor for cardiovascular disease (CVD). However, little is known about this relationship. Therefore, we decided to examine the association between dietary intake of B vitamins and cardiovascular risk factors in elderly men. METHODS: The present cross-sectional study consisted of 357 elderly men. Dietary intake was assessed using a validated and reliable food frequency questionnaire. All biochemical factors [fasting blood sugar (FBS), triglyceride (TG), high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6) and tumour necrosis factor-α (TNF-α)], waist circumference (WC) and blood pressure (BP) were assessed using standard methods. RESULTS: A significant inverse association was observed between high dietary intake of total B vitamins (ORTotal B vitamins : 0.30; 95% CI: 0.10, 0.86; P = .01) and vitamin B9 (ORvitamin B9 : 0.20; 95% CI: 0.02, 0.52; P = .002) with high WC. Furthermore, an inverse association was observed between high dietary intake of vitamin B6 (ORvitamin B6 : 0.28; 95% CI: 0.08, 1.00; P = .05) and vitamin B9 (ORvitamin B9 : 0.20; 95% CI: 0.06, 0.70; P = .01) with hs-CRP level. CONCLUSIONS: In elderly men, a high dietary intake of total B vitamins and vitamin B9 was associated with lower odds of having a high WC. Similarly, high dietary intake of vitamin B6 and B9 was associated with lower odds of having a high hs-CRP level.

Effects of garlic supplementation on oxidative stress and antioxidative capacity biomarkers: A systematic review and meta-analysis of randomized controlled trials.

Evidence suggests that garlic supplementation may have an effect on oxidative stress by augmenting the rate of enzymatic and non-enzymatic antioxidants and diminishing pro-oxidant enzymes. Given inconsistencies across studies, we aimed to systematically review the current literature and quantify the effects of garlic supplementation on oxidative stress. We conducted a systematic search with multiple databases (Scopus, PubMed, and Web of Science) to find relevant articles published prior to October 2020. Results were reported as bias-corrected standardized mean difference (Hedges' g) with 95% confidence intervals (CI) using random-effects models. Cochrane's Q and I squared (I2 ) tests were used to determine heterogeneity among the studies included. Twelve randomized controlled trials (RCTs) were included. Garlic doses ranged from 80 to 4,000 mg/day, and intervention duration varied between 2 and 24 weeks. Garlic supplementation increased serum level of total antioxidant capacity (TAC) (Hedges' g: 2.77, 95% CI: 1.37 to 4.17, p < 0.001) and superoxide dismutase (SOD) (Hedges' g: 13.76, 95% CI: 4.24 to 23.29, p = 0.004), while it reduced the malondialdehyde serum level (MDA) (Hedges' g: -1.94, 95% CI: -3.17 to -0.70, p = 0.002). Due to limited data available, glutathione (GSH) was not considered for the current meta-analysis. The nonlinear dose-response effect of garlic supplementation was not observed with regard to serum TAC and MDA levels (TAC: p-nonlinearity = 0.398; MDA: p-nonlinearity = 0.488). Garlic supplementation appears to improve serum levels of TAC, MDA, and SOD. Garlic supplementation may be useful to reduce oxidative stress and related diseases. Future studies with large sample sizes and longer duration are required to confirm these findings.

The association between Healthy Beverage Index and anthropometric measures among children: a cross-sectional study.

PURPOSE: Several studies evaluated the associations between specific beverages and cardio-metabolic risks among children. However, the evidence on the association between patterns of the beverage consumption and children's anthropometric indices is rare. Therefore, this study was conducted to examine the association between Healthy Beverage Index (HBI) and anthropometric measures among 6-year-old girl children. METHODS: In this cross-sectional study, 788 children selected from health centers in Tehran, Iran. Data on beverage intake, socio-demographic, physical activity, and anthropometric characteristics were evaluated using reliable and validated standard protocols. The predefined HBI was calculated based on the previous research. RESULTS: After controlling for several confounders [mother age, mother body mass index, mother physical activity, socioeconomic status, children physical activity and energy intake, total oils (all kinds of oils like animal and plant oils), and total sweet foods (sweet foods except sweetened beverages)], being in the third compared to the first tertile of HBI among children was associated with increased odds of wasting (OR: 5.16; 95% CI 1.5-17.79) and underweight/wasting (OR: 1.81; 95% CI 1.07-3.07). Among the HBI components, just being in the third compared to the first tertile of high-fat milk was inversely associated with decreased odds of wasting (OR: 0.18; 95% CI 0.04-0.73). CONCLUSIONS: The HBI among children was associated with higher odds of wasting and underweight/wasting. In addition, high-fat milk consumption decreased the odds of wasting among children. Further prospective studies need to confirm these results. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

The effects of N-Acetylcysteine on serum level of inflammatory biomarkers in adults. Findings from a systematic review and meta-analysis of randomized clinical trials.

PURPOSE: Randomized Clinical Trials (RCTs) have provided varied and conflicting findings regarding the effect of N-acetylcysteine (NAC) on inflammatory biomarkers. This study was conducted to review existing literature to determine whether NAC supplementation can affect inflammatory biomarkers in adults. METHODS: Bibliographic databases of Scopus, and PubMed were used for relevant papers published until October 2019. Results were reported as weighted mean differences (WMD) with 95% confidence intervals (CI) using multi-level models. Cochrane's Q and I-squared (I2) tests were used to determine heterogeneity among studies. RESULTS: Twenty-four RCTs which include 1057 sample size were entered to analysis. NAC doses and intervention duration ranged from 400 to 2000 mg/d, and 1 to 80 weeks, respectively. Oral supplementation of NAC reduced serum level of C-reactive protein (CRP) [WMD: -0.61 mg/L, 95% CI: -1.18 to -0.03, P = 0.039, I2 = 79.6%], and interleukin-6 (IL-6) [WMD: -0.43 pg/mL, 95% CI: -0.69 to -0.17, P = 0.001, I2 = 89.3%]. However, the effect of oral NAC supplementation on other inflammatory biomarkers was nonsignificant. Dose-response investigation showed a non-linear association between oral NAC supplementation with CRP. CONCLUSION: Oral NAC supplementation reduced serum level of CRP and IL-6, but did not affect other inflammatory biomarkers. Nevertheless, more RCTs seems to be required to explore how NAC in different dosage and different routes of administration can affect inflammatory biomarkers.

The effects of psyllium supplementation on body weight, body mass index and waist circumference in adults: A systematic review and dose-response meta-analysis of randomized controlled trials.

Background: Previous studies reported inconsistent findings regarding the effects of psyllium supplementation on obesity measures. This systematic review and meta-analysis was performed to summarize data from available randomized clinical trials (RCTs) on the effect of psyllium supplementation on body weight, body mass index (BMI), and waist circumference (WC) in adults.Methods: PubMed, SCOPUS, Cochrane Library, and Google Scholar were searched to identify relevant articles up to August 2018. The effect sizes were presented as weighted mean difference (WMD) and 95% confidence intervals (CI) by using random effects model. To detect dose-response relationships, we used fractional polynomial modeling.Results: A total of 22 RCTs were included. Meta-analysis did not find any significant effect of psyllium supplementation on body weight (MD: -0.28 kg, 95% CI: -0.78, 0.21, p = 0.268), BMI (MD: -0.19 kg/m2, 95% CI: -0.55, 0.15, p = 0.27) and WC (MD: -1.2 cm, 95% CI: -2.6, 0.2, p = 0.09). Subgroup analysis showed that psyllium dosage, kind of psyllium administration, duration of trial, study design, sample size, and gender were potential sources of heterogeneity. Moreover, there was nonlinear association between duration of psyllium consumption, BMI and WC.Conclusion: Psyllium supplementation does not reduce body weight, BMI, and WC significantly.

Dietary intake of fish, n-3 polyunsaturated fatty acids, and risk of inflammatory bowel disease: a systematic review and meta-analysis of observational studies.

PURPOSE: Fish consumption and dietary intake of n-3 polyunsaturated acids (PUFAs) may be associated with inflammatory bowel disease (IBD). We aimed to conduct a systematic review and summarize published articles on the association between fish consumption and dietary intake of n-3 PUFAs with the risk of IBD. METHODS: PubMed, Scopus, and Web of Science databases were used to conduct a comprehensive search and identify eligible literature published prior to January 2019. Fixed-effects model or random-effects models (DerSimonian-Laird method) were applied to pool the effect sizes. Cochrane Q test was used to trace the potential source of heterogeneity across studies. RESULTS: 12 studies (5 prospective and 7 case-control) were included in the systematic review, which ten of them were eligible for inclusion in the meta-analysis. Studies were included a total sample size of 282610 participants which 2002 of them were cases of IBD [1061 Crohn's disease (CD) and 937 ulcerative colitis (UC)]. A negative association was found between fish consumption and the incidence of CD (pooled effect size: 0.54, 95%CI: 0.31-0.96, P = 0.03). There was no relationship between total dietary n-3 PUFAs intake and IBD (pooled effect size: 1.17, 95%CI: 0.80-1.72, P = 0.41). A significant inverse association was observed between dietary long-chain n-3 PUFAs and the risk of UC (pooled effect size: 0.75, 95%CI: 0.57-0.98, P = 0.03). Moreover, no association was found between α-Linolenic acid (ALA) and IBD (pooled effect size: 1.17, 95%CI: 0.63-2.17, P = 0.62). CONCLUSIONS: Findings showed a negative association between fish consumption and the risk of CD. Moreover, there was a significant inverse association between dietary long-chain n-3 PUFAs and the risk of UC.

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.

Dietary total antioxidant capacity is inversely associated with depression, anxiety and some oxidative stress biomarkers in postmenopausal women: a cross-sectional study.

BACKGROUND: Postmenopausal women are at higher risk of mental disorders. Oxidative stress has implication in the development of these disorders. Dietary total antioxidant capacity (DTAC) has been proposed as a tool for assessing dietary antioxidants intake. The relationship between DTAC with depression, anxiety and stress has not been investigated in postmenopausal women. Thus, we aimed to assess the association between DTAC and depression, stress and anxiety as well as oxidative stress biomarkers. METHODS: This cross-sectional study was carried out on 175 postmenopausal women. Data on dietary intake and mental health were collected by 147-item semi-quantitative food frequency questionnaires (FFQ) and Depression Anxiety Stress Scales (DASS-42), respectively. Dietary and serum total antioxidant capacity (TAC), malondialdehyde (MDA), oxidized-LDL, and superoxide dismutase (SOD) were measured. ANOVA test was applied to compare the mean of variables across the tertiles of DTAC. The relationship between DTAC and oxidative stress biomarkers was determined through ANCOVA method. Simple and multivariate linear regression tests were performed to measure the relationship between DTAC and mental health. RESULTS: Serum MDA level was significantly lower in the subjects at the highest tertiles of DTAC (P-value < 0.001). In addition, serum TAC level was significantly higher in subjects at the second tertile of DTAC (P-value = 0.04). DTAC was inversely and independently related to depression (ß = - 0.16, P-value = 0.03) and anxiety scores (ß = - 0.21, P-value = 0.007). There was no significant association between DTAC and stress score (ß = - 0.10, P-value = 0.1). CONCLUSION: An inverse relationship was found between DTAC with depression, anxiety scores and some oxidative stress biomarkers in postmenopausal women. These findings indicate DTAC may be used for developing effective dietary measures for reducing depression and anxiety in these women.

Dietary Total Antioxidant Capacity and Cardiovascular Disease Risk Factors: A Systematic Review of Observational Studies.

OBJECTIVE: Measurement of dietary total antioxidant capacity (DTAC) is considered a new holistic dietary approach and assesses total antioxidants present in the overall diet. Our aim was to perform a comprehensive review of the literature on the association between DTAC and cardiovascular disease (CVD) risk factors. METHODS: PubMed, Web of Science, and Scopus were used to conduct a comprehensive search for articles published on this topic through September 2017. There was no limit on earliest year of publication. The search was based on the following keywords: dietary total antioxidant capacity, nonenzymatic antioxidant capacity, total radical-trapping antioxidant parameter, ferric reducing ability of plasma, oxygen radical absorbance capacity, Trolox equivalent antioxidant capacity, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), total cholesterol (TC), waist circumference (WC), insulin resistance, homeostatic model assessment of insulin resistance (HOMA-IR), insulin, obesity, glucose, C-reactive protein (CRP), blood pressure (BP), and body mass index. In total, 16 papers were identified for inclusion in the present systematic review. RESULTS: Most well-designed studies that evaluated associations between DTAC and CVD risk factors showed inverse associations for fasting blood glucose, CRP, BP, and WC and positive associations for HDL-C. However, there was no association between DTAC and LDL-C or TC in any of the studies. Results regarding the association of DTAC with insulin, HOMA-IR, high-sensitivity CRP, and TG in the published literature were inconsistent. CONCLUSIONS: Findings indicated a substantial association between high DTAC and most CVD-related risk factors.

How is food variety conceptualised and measured as a diet quality indicator in developed settings? Protocol for a systematic scoping review.

OBJECTIVES: Dietary diversity (DD) is a pillar of healthy eating guidance and can be used to assess diet quality. Despite being an established nutrition concept, many inconsistencies in its definition and measurement exist and meanings vary across the development spectrum. This protocol outlines a research trajectory, whereby a scoping review will be undertaken to illustrate and map the methodological approaches that have been utilised to measure diversity as a marker of diet quality in the general population. It seeks to determine the most common and less used methodological approaches to measure DD in the diet of healthy adults. METHODS AND ANALYSIS: Scoping review of peer-reviewed and grey literature from five bibliographic databases, supplemented by handsearching of reviews and reference lists. Search terms will include DD, food variety, mixed diet, balanced diet and food group variety. Eligible articles must include a measure for DD as an indicator of diet quality in the general population living in developed settings. Two independent reviewers will screen titles or abstracts, and read full-texts. Consensus will resolve any disagreements on study eligibility with a third reviewer consulted if needed. Data will be extracted using a standardised evidence table and analysed using a narrative synthesis approach. Data will be managed using Covidence. ETHICS AND DISSEMINATION: No ethics is required for this study using public documents. Results will be disseminated through peer-reviewed papers and scientific conferences. DISCUSSION: This scoping review will help to map, classify and assess the methodological approaches used in the nutrition literature to measure DD as a diet quality indicator. We anticipate a wide range of DD measures and expect to identify the most prevalent DD measures used to assess diet quality. Our findings will inform standardisation to improve future research on this nutritional concept.