Maternal and fetal/neonatal outcomes in pregnancy, delivery and postpartum following bariatric surgery and comparison with pregnant women with obesity: a study protocol for a prospective cohort.

BACKGROUND: Being obese can lead to various complications during pregnancy, such as Gestational Diabetes Mellitus (GDM), pregnancy induced hypertension (PIH), Pre-Eclampsia (PE), and Large Gestational Age (LGA). Although bariatric surgery is an effective way to treat obesity, it can also result in complications and may be linked to having small for gestational age (SGA) babies. This cohort study protocol aims to compare the maternal and fetal/neonatal outcomes of two groups of Iranian pregnant women: those who have undergone bariatric surgery and those who are obese but have not had bariatric surgery. METHODS: In this study Pregnant women (< 14 weeks' gestation) (n = 38 per group) are recruited either from one of the obesity clinic (exposure group = with a history of bariatric surgery) or primary healthcare clinics in Tehran city (comparison group = pregnant women with obesity and and no history of bariatric surgery). Dietary intake and nutrient status are assessed at < 14, 28, and 36 weeks. Maternal and fetal/neonatal outcomes are compared between the two groups, including gestational diabetes, preeclampsia, preterm labor, intrauterine growth restriction, severe nausea and vomiting, abortion, placenta previa and abruption, venous thrombosis, vaginal bleeding, cesarean delivery, meconium aspiration, and respiratory distress. Maternal serum levels of ferritin, albumin, zinc, calcium, magnesium, selenium, copper, vitamins A, B9, B12, and 25-hydroxy Vit D are checked during 24th to 28th weeks. Maternal and neonatal outcomes, including height, weight, head circumference, fetal abnormality, infection, small or large fetus, low birth weight, macrosomia, NICU admission, and total weight gain during pregnancy, are measured at birth. Maternal and offspring outcomes, including weight, height, head circumference, total weight gain during pregnancy, newborn diseases, postpartum bleeding, breastfeeding, and related problems, are assessed 6 weeks after delivery. Child's weight, height, and head circumference are followed at 2, 4, 6, 8, 10, and 12 months after birth. Maternal stress, anxiety, and depression are assessed with the DASS-21 questionnaire, and physical activity is evaluated using the PPAQ questionnaire in the first and third trimesters. DISCUSSION: By assessing the levels of micronutrients in the blood of pregnant women along with the evaluation of pregnancy outcomes, it is feasible to gain a more accurate understanding of how bariatric surgery affects the health and potential complications for both the mother and the fetus/newborn. This information can help specialists and patients make more informed decisions about the surgery. Additionally, by examining issues such as stress, anxiety, and depression in women undergoing surgery, this study can contribute to recognizing these problems, which can also affect pregnancy outcomes.

The Effect of Calorie Restriction and Intermittent Fasting on Impaired Cognitive Function in High-Fat Diet-Induced Obesity Started Post-Weaning in Male Wistar Rat.

Background: Calorie Restriction (CR) is known as one of the most effective life-extending interventions. Therefore researchers are looking for other interventions or drugs to mimic the mentioned effects. Time-restricted feeding (TRF) has recently gained more attention recently as one of the CR mimetics. Here we evaluate and compare the effects of CR or TRF on cognitive function in young animals fed a high-fat diet (HFD). Methods: This is an experimental study that three-week-old male Wistar rats (n:52) were subjected to a control diet (n:11) or HFD (n:42). Then the HFD group was divided into 1) 30% calorie restriction (CR), 2) Night Intermittent Fasting (NIF), 3) Day Intermittent Fasting (DIF), and 4) Ad-Libitum (AL) with the standard diet for ten weeks (each of 9). An independent T-test or Mann-Whitney test was used for the first phase and in the second phase of the study, one-way analysis of variance (ANOVA), followed by Tukey post-hoc tests, or Kruskal-Wallis and post-hoc Bonferroni test were used. P-values of <0.05 were considered significant. Results: Deteriorated mental function was significantly lower in HFD than CON (p= 0.041). CR was still more efficient than NIF in cognitive function in obese subjects. Post-hoc test indicated that from day 2-4, escape latency was significantly shorter in NIF and CR, which was not seen in other groups (p=0.045). Conclusion: While TRF has garnered much attention recently, here we show that CR is still more efficient in learning and memory tasks. Longer fasting times and different fasting periods are recommended to study.

Weight Changes and Metabolic Outcomes in Calorie-Restricted Obese Mice Fed High-Fat Diets Containing Corn or Flaxseed Oil: Physiological Role of Sugar Replacement with Polyphenol-Rich Grape.

OBJECTIVE: Because diet components are important during dieting in obesity treatment, we examined possible beneficial effects of substituting corn oil and sugar with flaxseed oil and grape in calorie-restricted high-fat diets on weight changes as well as improvement in some metabolic markers and related gene expression. METHODS: Seventy-five C57BL/6J male mice were given free access to a high-fat (36% of energy from fat) diet containing corn oil plus sugar (CO + S). After 11 weeks, 15 mice were sacrificed and another 60 were divided among 4 high-fat diet groups with 30% calorie restriction (CR) for the next 12 weeks. The diets contained corn oil (CO) or flaxseed oil (FO) with sugar (S) or grape (G). RESULTS: Despite CR, a weight loss trend was observed only during the first 4 weeks in all groups. CR did not significantly increase SIRT1 gene expression. Higher liver weight was observed in mice consuming FO (p < 0.05). Proliferator-activated receptor gamma (PPARγ) expression decreased in FO + G-CR significantly and even with a reduction of adiposity and higher adiponectin levels, fasting blood sugar (FBS) was significantly higher than in CO + G-CR. Grape intake increased Peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) expression and decreased insulin resistance in CO + G-CR. CONCLUSIONS: Sugar replacement with polyphenol-rich grape along with CR improved glucose homeostasis, and substituting corn oil with flaxseed oil in obese mice reduced fat mass, but even with no change in adiponectin levels it could not decrease insulin resistance. However, none of the food item combinations facilitated weight reduction in the long-term CR. Therefore, regardless of the total calorie intake, different diet components and fat contents may have unexpected effects on metabolic regulation.

New insight into determining indicators of metabolic status in women: Expression of PPARγ and FABP4 in PBMCs.

Adiposity and its metabolic disturbances could be regulated by adipocyte-specific peroxisome proliferator-activated receptor gamma and fatty acid-binding protein4. Although these two proteins are mainly expressed in adipose tissues, they can also be expressed in peripheral blood mononuclear cells, which could be useful for predicting body composition and blood parameters. Thus, this cross-sectional study was performed during January 2013-January 2014 with 229 women (age range, 22-52 years) who were classified as obese or nonobese. Serum glucose, insulin, lipids, and body composition were measured in the fasting state. Peripheral blood mononuclear cells were isolated to extract ribonucleic acid (RNA) and to determine gene expression by real time polymerase chain reaction (PCR). All serum parameters and components of body composition were significantly higher in obese than in nonobese women. Gene expression analysis showed that serum levels of glucose and lipids, except high-density lipoprotein (HDL), were higher in the group that expressed high fatty acid-binding protein4. Increased expression of the peroxisome proliferator-activated receptor gamma was associated with a significant reduction of blood sugar and increased HDL and other lipids and visceral fat. Therefore, it seems that the level of expression of these genes in peripheral blood mononuclear cells may indicate metabolic status.

The Effect of Maternal Bariatric Surgery on Offspring Anthropometry: A Mixed Cohort.

PURPOSE: Although bariatric surgery is associated with a decrease in obesity complications, it may affect the children's growth by a maternal nutritional deficiency. This study was conducted to assess the effect of maternal bariatric surgery on offspring anthropometry. MATERIALS AND METHODS: In a mixed cohort, anthropometric status of children aged 5 years or less born to mothers with a history of bariatric surgery was compared with a control group consists of peers born to mothers with obesity but without bariatric surgery. Anthropometric indices including crude and quantile values for BMI, weight, height, and head circumference at birth and the first 5 years of life were measured. Then, the adjusted effect of maternal surgical history on anthropometric status was estimated by linear regression. RESULTS: From a total of 56 children, 28 born to mothers with a history of bariatric surgery, and 28 born to mothers with obesity but without bariatric surgery. At birth, weight (2915 vs 3225 g) and BMI (11.72 vs 12.94 kg/m2) were lower in the group with maternal bariatric surgery than in the control group (P = 0.02 and P = 0.03, respectively), although after regression adjustment, there was only a significant difference between the two groups in height for age value in children less than 5 years old (B = 0.872, P-value = 0.001). CONCLUSION: Bariatric surgery with decrease of weight indices at birth has a probable influence on growth and development in next years. Therefore, it is recommended further studies to identify unknown effect of types of preconception surgical procedures on childhood outcomes.

National and sub-national trends of salt intake in Iranians from 2000 to 2016: a systematic analysis.

BACKGROUND: One fifth of the global burden of cardiovascular diseases (CVDs) in 2017 was attributable to excessive salt intake. As a member of the World Health Organization (WHO), Iran has committed itself to a 30% reduction in salt intake by 2025. Evidence on the amount and trend of salt intake among the Iranian population at national and sub-national levels is scarce. This study aimed to estimate the Iranian population's salt intake during 2000-2016 at the national and sub-national levels, by sex and age groups. METHODS: Data on national and sub-national mean salt intake was obtained through systematically searching the literature and contacting the research studies' principal investigators. Data collected through various methods were harmonized using the cross-walk method. Bayesian hierarchical and spatio-temporal-age regression models and simulation analysis were used to estimate the mean salt intake and its uncertainty interval across sex, age, year, and province. RESULTS: National age-sex standardized mean salt intake decreased from 10·53 g/day (95% uncertainty interval [UI]: 10·2 to 10·9) in 2000 to 9·41 (9·2 to 10·6) in 2016 (percent change: - 9·8% [- 21·1-3·1]). The age-standardized mean salt intake in women had decreased from 9·8 g/day (95% UI: 9·0-10·6) in 2000 to 9·1 g/day (8·6-9·7) in 2016 (percent change: - 6·6% [- 19·0-7·9]). The same measure in men was 11·1 g/day in 2000 (95% UI: 10·3-11·8) and 9·7 g/day (9·1-10·2) in 2016 (percent change: - 12·7% [- 23·0 - -0·9]). Age-sex standardized mean salt intake at the sub-national level in 2016 varied from 8·0 (95% UI: 7·0-9·0) to 10·5 (10·0-11·1). The difference between the provinces with the highest and the lowest levels of salt intake in 2016 was 31·3%. CONCLUSION: Salt intake decreased in Iran from 2000 to 2016, while persistently exceeding the recommended values. This declining trend was more pronounced between 2010 and 2016, which might be attributed to Iran's compliance to WHO's Action Plan for reducing NCDs.

Changes in Body Composition and Biochemical Parameters Following Laparoscopic One Anastomosis Gastric Bypass: 1-Year Follow-Up.

BACKGROUND/AIM: Little data is available on body composition and biochemical parameter changes after one anastomosis gastric bypass (OAGB) surgery. This study was therefore conducted to assess body composition and biochemical parameter changes in patients who underwent OAGB. The relationship between the percentage of total weight loss (%TWL) with percentage changes in body composition and biochemical parameters was measured in the first year after surgery. MATERIALS AND METHODS: This retrospective study was carried out on 363 patients (mean age 39.93 ± 9.98 years) who underwent OAGB between January 2011 and November 2018. Anthropometric, body composition and biochemical measurements were recorded before and 1 year after surgery. For paired data, a paired sample t test or Wilcoxon test was used. Spearman or Pearson correlation test was used to evaluate the relationship between % TWL and changes in body composition and biochemical parameters. RESULTS: The average %TWL at 1 year following surgery was 35.72 ± 6.85. Fat and muscle tissue and also serum levels of glycemic parameters, low density lipoprotein, triglycerides (TG), total cholesterol, zinc, albumin, hemoglobin, hematocrit, and platelet had decreased a year after OAGB (P < 0.05). The postoperative levels of HDL-c, vitamins D, B12, and folic acid were dramatically higher than the preoperative values. Higher %TWL significantly correlated to greater decreases in body fat, muscle mass, and serum TG at 1 year post-surgery, compared to preoperative values. CONCLUSION: OAGB may be effective over a follow-up period of 1 year in achieving weight, fat mass reduction, and improved serum levels of glycemic parameters and lipid profiles.

Changes in serum albumin and liver enzymes following three different types of bariatric surgery: six-month follow-up. A retrospective cohort study.

BACKGROUND: Few reports have examined the effects of Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG) on changes to serum albumin (Alb) and liver enzyme levels. OBJECTIVE: To compare short-term post-surgery changes in serum Alb, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALKP) levels. Body composition changes were also measured and compared among three groups. DESIGN AND SETTING: Retrospective cohort study conducted in Tehran, Iran. METHODS: 151 OAGB, RYGB and SG patients referred to the obesity clinic of Hazrat-e Rasool General Hospital, Tehran, Iran, were evaluated. Physical characteristics and biochemical parameters were measured pre-surgery and then after three and six months. RESULTS: Through repeated measurements to determine intragroup changes, significant changes in serum AST (P = 0.003) and ALT (P < 0.001) were observed in follow-ups. However, Alb levels did not change (P = 0.413). Body fat, fat-free mass and muscle mass decreased significantly in each group (P < 0.05). In a univariate general linear model for determining intergroup changes, SG showed greater decreases in ALT and AST at three and six months (P < 0.05) and in ALKP at six months (P = 0.037), compared with OAGB. There were no significant differences in Alb levels. Also, RYGB had a greater effect on reducing fat percentage (three months, P = 0.011; six months, P = 0.059) and fat mass (three months, P = 0.042) than OAGB. CONCLUSION: SG and RYGB may be superior to OAGB in reducing liver enzymes and body fat, respectively. However, Alb levels showed no significant differences.

The Effects of Calorie Restriction and Time-Restricted Feeding on IGF1 Serum Level and Lipid Profile in Male Wister Rats with Previous Obesity.

BACKGROUND: Calorie restriction (CR) is known as a nutritional gold standard for life extension and different studies have shown that insulin-like growth factor (IGF1) reduction through CR may be involved in CR's anti-aging effects. Besides, time-restricted-feeding (TRF) is also highlighted due to more feasibility and positive health effects. We designed this study to compare the effects of CR and TRF on IGF1 and other metabolic parameters. METHODS: Fifty-two male Wistar rats (3 weeks old) were subjected to either a control (CON, n = 11) diet or high-fat diet (HFD, n = 42) for 17 weeks. In the second phase of the study, the HFD group were divided into four groups (n = 9) 1) 30% CR, 2) Night Intermittent Fasting (NIF, active phase), 3) day intermittent fasting (DIF, rest phase), and 4) Ad-Libitum (AL) with a standard diet for 10 weeks. Blood samples were collected at the end of both phases. RESULTS: HFD increased IGF1 and deteriorated lipid profiles, except for triglycerides (P: 0.018, 0.008.0.012, 0.032) but CR in these obese subjects could not lower the IGF1 level. HDL significantly decreased in DIF compared to CON and CR (P; 0.001). Meanwhile, HOMA-IR increased in DIF and was significant compared to CR (P: 0.002). Serum glucose levels decreased in CR compared to all groups except for CON (P: 0.001). CONCLUSION: Data indicates the role of previous obesity on the effect of CR on the IGF1 level and highlights the effect of inappropriate time of food intake on HDL and APOA1.

Social Awareness of Whole Grains and the Feasibility of Replacement with Refined Grains: A Qualitative Study.

BACKGROUND: A correlation between type 2 diabetes and refined carbohydrates has been proven, while several studies have indicated that Iranian daily diets are poor in term of proper carbohydrates. It was thus considered absolutely critical to conduct a qualitative study in terms of people's attitudes toward whole grains, and the feasibility of their replacing existing refined carbohydrates in their diets. The aim of this study is to probe Iranian awareness of whole grains, to explore barriers to refined-grain substitution with whole grains and legumes, and to assess whole-grain sensory perceptions. METHODS: Focus group discussions (FGDs) and taste tests conducted between July 2016 and March 2017 in urban and rural areas of Kurdistan, Yazd, and Tehran provinces in Iran. A total of 96 healthy men and women (aged 40-65, BMI ≥25 kg/m2) were selected through purposive sampling with maximum variation. FGDs were categorized by content analysis method. As for taste test, ANOVA analysis with Bonferroni post-hoc was used to determine significant differences (P < 0.05). RESULTS: Four themes and 11 sub-themes emerged. Cultural beliefs, traditional eating patterns, sensory properties, and familial acceptance were the most influential factors in choosing the type of bread and rice. Simultaneously they are the most prominent barriers to consuming whole grains and legumes. Plain cooked brown rice had the lowest mean sensory attribute score and traditional whole-wheat flatbread was the highest. CONCLUSIONS: There was a higher acceptance tendency toward using traditional whole-wheat flatbread rather than refined grains, as it was consistent with preference and priority. However, low availability was the largest substitution problem.

Distribution of Dietary Risk Factors in Iran: National and Sub-National Burden of Disease.

BACKGROUND: Non-communicable diseases (NCDs) are one of the greatest threats to public health, and have been related to poor quality dietary patterns. This study was conducted to determine the distribution of dietary risk factors in Iran. METHODS: Cross-sectional data was gathered between April and November 2016 from 30,541 eligible adults (out of 31 050 individuals who were selected through systematic proportional to size cluster random sampling) living in urban and rural areas, using the WHO-based STEPs risk factor questionnaire. Low intakes of fruits, vegetables, dairy products, and fish, and high intakes of salty processed food (SPF), as well as daily intake of hydrogenated fat (HF) were considered as nutritional risk factors. RESULTS: At the national level, 82.8% (95% CI: 82.4-83.2), 57.8% (95% CI: 57.2-58.4), 80.6% (95% CI: 80.1-81) and 90.3% (95% CI: 90-90.6) of participants of all age groups had sub-optimal intakes of fruits, vegetables, dairy products and fish, respectively. Furthermore, 12.8% (95% CI: 12.4-13.1), and 29.4% (95% CI: 28.9-29.9) of respondents had high SPF intakes and HF use, respectively. At the sub-national level, the highest distribution of suboptimal intake of fruits (97.2%; 95% CI:96-98.3), vegetables (79.2%; 95% CI: 76.3-82.1) and dairy products (92.9%; 95% CI: 91-94.7) was observed in Sistan and Baluchistan. Except for Boushehr and Hormozgan, the majority of the population of other provinces consumed fish less than twice a week. Similarly, the high intake of SPF was found mostly in the population of Yazd (23.7; 95% CI: 20.2-27.2). HF consumption was the highest in North Khorasan (64.2%; 95% CI: 60.3-68.1). CONCLUSION: These findings highlight the widespread distribution of dietary risk factors in Iran, which should be a priority for the people and the politicians in order to prevent NCDs.

Relationship Between Modified Body Adiposity Index and A Body Shape Index with Biochemical Parameters in Bariatric Surgery Candidates.

BACKGROUND: Body mass index, an estimate of body fat percentage, has been previously shown to be associated with metabolic disorders. However, there is little data on the associations between a body shape index (ABSI) or modified body adiposity index (MBAI), which provide valuable definitions of body fat, with serum biochemical parameter levels. Therefore, this study was conducted to find either ABSI or MBAI associations with serum biochemical parameter levels in bariatric surgery candidates. METHODS: This cross-sectional study was conducted on 776 bariatric surgery candidates (age range 18-69 years) between November 2010 and September 2017. Demographic data, anthropometric indices, biochemical parameters, and body composition analysis data were drawn from the National Obesity Surgery Database, Iran. ABSI and MBAI were calculated using related equations. A stepwise multivariate linear regression was used to evaluate whether ABSI or MBAI was associated with each serum biochemical parameter. RESULTS: ABSI, age, and multivitamin/mineral supplementation (MVMS) were independently associated with serum vitamin D (ß = 24.374, SE 10.756, P value 0.026; ß = 0.022, SE 0.007, P value 0.002; ß = 0.639, SE 0.235, P value 0.008). However, a negative association was observed between MBAI and vitamin D (ß = - 0.037, SE 0.016, P value 0.025) in a model adjusted for age and MVMS. Additionally, MBAI and age showed a significant positive association with serum HDL-c (ß = 0.185, SE 0.085, P value 0.028; ß = 0.171, SE 0.033, P value < 0.001), although there was a negative association between male sex and HDL-c (ß = - 4.004, SE 0.891, P value < 0.001). CONCLUSION: ABSI and MBAI may be appropriate indices in predicting serum vitamin D and HDL-c levels.

Weight Loss After One Anastomosis Gastric Bypass-Mini Gastric Bypass (OAGB-MGB): Patient-Related Perioperative Predictive Factors.

AIM: The aim of this study was to find independent perioperative factors predicting unsuccessful weight loss following one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB), a recently developed technique of bariatric surgery. METHODS: Using regression analysis, this prospective cohort study assessed the role of demographic and socioeconomic factors, clinical features, body composition, length of biliopancreatic limb (LBL), nutritional habits, comorbidities, and early post-operative weight reduction values, in predicting 1-year weight loss after OAGB-MGB. All patients at the center who underwent laparoscopic OAGB-MGB between October 2010 and May 2017 were included. The dependent variable was the percent of excess weight loss (%EWL) after 12-month follow-up. Weight loss outcome was defined as successful EWL (≥ 50%) or unsuccessful EWL (< 50%). RESULTS: Follow-up data at 1 year was available for 1309 (77%) patients. Mean EWL and BMI reduction were 81.63% and 16.82 ± 4.37 kg/m2 at 1 year. In addition, 48 (3.7%) patients had unsuccessful weight loss. Pre-operative higher BMI (OR, 1.34; p = 0.001), type 2 diabetes (OR, 4.26; p = 0.039), pre-surgery volume eating habit (OR, 0.12; p = 0.003), weight reduction value in the first month after surgery (OR, 0.80; p = 0.002), and length of biliopancreatic limb (LBL) (OR, 1.05; p = 0.017) were independently associated with unsuccessful weight loss at 1-year follow-up. CONCLUSIONS: OAGB-MGB provides considerable weight loss for most patients. Initial lower BMI, absence of diabetes, being volume eater, and higher first month weight loss are independently associated with successful weight loss after 1 year.

Glycemic Index (GI) Values for Major Sources of Dietary Carbohydrates in Iran.

BACKGROUND: The glycemic index (GI) values of staple foods are not available in a standardized method in Iran. OBJECTIVES: The aim of this study was to measure the GI values of the major carbohydrate sources in a typical Iranian diet. METHODS: Using the international standard method, the GI values were determined for four wheat flatbreads, barley and rye bread, white and brown rice, as well as white and brown rice mixed with lentils. Twelve healthy adults were given 50 g anhydrous glucose three times (as the reference carbohydrate) and the test foods once each throughout the study. Using finger-prick blood samples, capillary blood glucose was measured using a reliable glucometer. The GI was calculated using the trapezoidal method. RESULTS: The GI values of the following types of bread were: Barley 66, Lavash 72, Taftoon 79, Sangak 82, rye 84, and Barbari 99. The GI values for brown and white rice were 65 and 71, respectively. The mixture of brown rice with lentils had a GI value of 55, and the mixture of white rice with lentils had a GI of 79. CONCLUSIONS: The most common types of bread and white rice consumed in Iran have high GI values. There is potential to reduce the overall GI values in the Iranian diet by encouraging the consumption of barley bread and brown rice.

Mortality Attributable to Nutritional Deficiencies among Iranian Children under the Age of Five at National and Subnational Level: 1995-2015.

BACKGROUND: Under-five mortality is considered an indicator of population well-being and health equality in societies. Under-five mortality caused by nutritional deficiencies is a public health concern in developing countries. In this study, we aimed to report the trend and mortality rate of nutritional deficiencies from 1995 to 2015 in children aged under five years. METHODS: In this study, we used the death registration system (DRS) data to estimate age- and sex-specific nutritional deficiency mortality rates at national and sub-national levels in Iran from 1995 to 2015. The Iranian DRS used the 10th revision of International Classification of Diseases (ICD-10) but we report our results based on Global Burden of Diseases (GBD) study codes. We used the average annual percent change (AAPC) to quantify trend in under-five mortality rate attributable to nutritional deficiencies from 1995 to 2015. RESULTS: At national level, mortality rates in both sexes were 8.53 (95% uncertainty interval [UI]: 7.69-9.47), 1.04 (0.86-1.36), and 0.37 (95% UI: 0.28-0.57) per 100,000 in 1995, 2005, and 2015, respectively. AAPC was estimated between 1995 and 2015. At sub-national level, the highest and lowest mortality rates across provinces ranged from 17.7 per 100000 in 1995 to 1.1 per 100000 in 2015. In the latest years, protein-energy malnutrition (PEM) was the most frequent cause of mortality among other nutritional deficiencies. CONCLUSION: The results show a substantial reduction in terms of mortality caused by nutritional deficiencies at national, as well as provincial, level among children under-five years of age.

Selenium Status after Roux-en-Y Gastric Bypass: Interventions and Recommendations.

BACKGROUND: Selenium is an essential element that plays a vital role in maintaining human health and its deficiency can lead to cardiovascular and hypothyroidism complications. In this context, the main concern is about morbidly obese patients who undergo a Roux-en-Y Gastric Bypass (RYGB). Although RYGB leads to 60-70% excess weight loss, micronutrient deficiencies are common after this procedure and can be problematic if not promptly detected. This review will therefore examine the evidence regarding selenium deficiency in RYGB patients, as well its nutritional treatment methods. METHODS: There were a total of 6 studies regarding RYGB and selenium deficiency, which were retrieved from PUBMED and SCOPUS electronic databases, ranging from 2006 to 2017. CONCLUSION: Selenium deficiency was observed before and after RYGB. Lifelong supplementation and regular patient monitoring after surgery are recommended.

Elevated liver enzymes and cardiovascular mortality: a systematic review and dose-response meta-analysis of more than one million participants.

Gamma glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) are commonly used liver function markers. We performed a dose-response meta-analysis to investigate the association between liver enzymes and cardiovascular disease (CVD) mortality in prospective cohort studies. We conducted a systematic search up to April 2018 in Medline/PubMed, Scopus, Cochrane, and Embase databases. Combined hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using a random-effects model as described by DerSimonian and Laird. Dose-response analysis was also carried out. Twenty-three studies with 1 067 922 participants reported association between GGT and CVD mortality and were included in our analysis. Pooled results showed a significant association between GGT and risk of CVD mortality (HR: 1.62; 95% CI: 1.47-1.78, P=0.001, P-heterogeneity=0.001) and it was HR: 0.87; 95% CI: 0.73-1.07; P=0.221, P-heterogeneity=0.028, for ALT. There was a direct association between baseline levels of ALP and AST/ALT ratio with CVD mortality (HR: 1.45; 95% CI: 1.11-1.89; P=0.005, P-heterogeneity=0.026, and HR: 2.20; 95% CI: 1.60-3.04; P=0.001, P-heterogeneity=0.540, respectively). Pooled results did not show any significant association between AST and the risk of CVD mortality (HR: 1.20; 95% CI: 0.83-1.73; P=0.313, P-heterogeneity=0.024). Moreover, there was a significant nonlinear association between GGT and ALP levels and the risk of CVD mortality (P=0.008 and 0.016, respectively). Our dose-response meta-analysis revealed a direct relationship between GGT and ALP levels and the risk of CVD mortality. High levels of GGT, ALP and AST/ALT were associated with an increased CVD mortality rate.

Peroxisome proliferator-activated receptor gamma coactivator 1α variation: a closer look at obesity onset age and its related metabolic status and body composition.

There is a lack of knowledge regarding the effect of polymorphisms of the peroxisome proliferator-activated receptor gamma coactivator 1α (PGC-1α) gene on the age of obesity onset. Hence, 3 polymorphisms of the PGC-1α gene (PGC-1α rs17574213, rs8192678, and rs3755863) were examined in association with obesity onset age. Also, obesity onset age-related metabolic status and body composition were evaluated. This cross-sectional study was conducted with a total of 321 obese participants. Anthropometric and biochemical information, body composition, and PGC-1α gene sequences were analyzed. The rs17574213 polymorphism was associated with obesity onset in children aged <1 years and 10-18 years. The rs8192678 polymorphism was associated with obesity onset in adulthood. Body mass index, body fat percent, and trunk fat were higher in groups whose obesity began at age <1 year or 10-18 years than in other groups. Serum levels of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol were lowest in the group with obesity onset between the ages of 10 and 18 years. Visceral fat and fasting blood glucose were highest in those whose obesity began in adulthood. In conclusion, 2 polymorphisms of the PGC-1α gene were associated with obesity onset age.

Changes in serum albumin and liver enzymes following three different types of bariatric surgery: six-month follow-up. A retrospective cohort study

ABSTRACT BACKGROUND: Few reports have examined the effects of Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG) on changes to serum albumin (Alb) and liver enzyme levels. OBJECTIVE: To compare short-term post-surgery changes in serum Alb, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALKP) levels. Body composition changes were also measured and compared among three groups. DESIGN AND SETTING: Retrospective cohort study conducted in Tehran, Iran. METHODS: 151 OAGB, RYGB and SG patients referred to the obesity clinic of Hazrat-e Rasool General Hospital, Tehran, Iran, were evaluated. Physical characteristics and biochemical parameters were measured pre-surgery and then after three and six months. RESULTS: Through repeated measurements to determine intragroup changes, significant changes in serum AST (P = 0.003) and ALT (P < 0.001) were observed in follow-ups. However, Alb levels did not change (P = 0.413). Body fat, fat-free mass and muscle mass decreased significantly in each group (P < 0.05). In a univariate general linear model for determining intergroup changes, SG showed greater decreases in ALT and AST at three and six months (P < 0.05) and in ALKP at six months (P = 0.037), compared with OAGB. There were no significant differences in Alb levels. Also, RYGB had a greater effect on reducing fat percentage (three months, P = 0.011; six months, P = 0.059) and fat mass (three months, P = 0.042) than OAGB. CONCLUSION: SG and RYGB may be superior to OAGB in reducing liver enzymes and body fat, respectively. However, Alb levels showed no significant differences.