The effect of conjugated linoleic acid supplementation in comparison with omega-6 and omega-9 on lipid profile: a graded, dose-response systematic review and meta-analysis of randomized controlled trials.

Conjugated linoleic acid (CLA) is a geometrical isomer of linoleic acid, which has anti-inflammatory, anti-diabetic, anti-cancer, and anti-obesity properties. However, the studies reported inconstant results about the CLA-related effects on lipid profiles. As a result, meta-analysis and systematic review were performed to survey the CLA supplementation-related effect on lipid profile including high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC), and triglycerides (TG). To identify the relevant research, a systematic comprehensive search was initiated on the medical databases such as Scopus and PubMed/Medline until December 2022. The overall effect size was estimated by weighted mean difference (WMD) and 95% confidence interval (CI) in a random effect meta-analysis. In the final quantitative analysis, the meta-analysis considered 35 randomized controlled trials (RCTs) with 1,476 participants (707 controls and 769 cases). The pooled results demonstrated that CLA supplementation, compared with olive oil, significantly increased serum TG levels (WMD: 0.05 mmol/L; 95% CI: 0.01 to 0.1; p = 0.04; I2 = 0.0%, p = 0.91). With regard to TC level, CLA supplementation compared with placebo significantly reduced TC concentrations (WMD: -0.08 mmol/L; 95% CI: -0.14 to -0.02; p < 0.001; I2 = 82.4%). Moreover, the non-linear dose-response analysis indicated a decreasing trend of TC serum level from the 15th week of CLA supplementation compared with olive oil (Pnon-linearity = 0.01). The present meta-analysis and systematic review of 35 RCTs showed that the CLA intervention was able to raise the level of TG in comparison to olive oil; however, it can decrease TC level compared with placebo and olive oil.

The effects of silymarin consumption on inflammation and oxidative stress in adults: a systematic review and meta-analysis.

BACKGROUND: Owing to the rich phytochemical content of Silymarin, it may effectively manage inflammation and oxidative stress. We, therefore, aimed to examine the existing evidence on the effect of Silymarin consumption on inflammation and oxidative stress factors by conducting a systematic review and meta-analysis of randomized controlled trials. METHODS: A systematic literature search up to September 2023 was completed in PubMed/Medline, Scopus, and Web of Science, to identify eligible RCTs. Heterogeneity tests of the selected trials were performed using the I2 statistic. Random effects models were assessed based on the heterogeneity tests, and pooled data were determined as weighted mean differences with a 95% confidence interval. RESULTS: Fifteen RCTs were included in this meta-analysis. Our findings showed that Silymarin consumption significantly decreased CRP (WMD, - 0.50 mg/L; 95% CI, (- 0.95 to - 0.04); p = 0.03), MDA (WMD, - 1.19 nmol/mL; 95% CI, (- 1.99 to - 0.38); p = 0.004), and IL-6 (WMD, - 0.44 pg/ml; 95% CI, (- 0.75 to - 0.12); p = 0.006). Silymarin consumption had no significant effects on IL-10, TAC, and GSH. A significant non-linear relationship was observed between the duration of the intervention and MDA changes. CONCLUSIONS: Silymarin can help reduce inflammation in patients with diabetes and thalassemia by reducing MDA as an oxidative stress marker and CRP and IL-6 as inflammatory markers.

The effects of Garcinia cambogia (hydroxycitric acid) on lipid profile: A systematic review and meta-analysis of randomized controlled trials.

Garcinia cambogia (GC) has antioxidant, anticancer, antihistamine, and antimicrobial properties. To determine the effect of GC on lipid profiles, a systematic review and meta-analysis was carried out. Up to February 9, 2023, six electronic databases (Web of Science, Cochrane Library, Embase, PubMed, Scopus, and Google Scholar) were searched at any time without limitations. Trials examining the impact of GC on serum levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol (HDL-C) in adults were included. The total effect was shown as a weighted mean difference (WMD) and 95% confidence interval (CI) in a random-effects meta-analysis approach. This systematic review and meta-analysis included 14 trials involving 623 subjects. Plasma levels of TC (WMD: -6.76 mg/dL; CI: -12.39 to -0.59, p-value = 0.032), and TG (WMD: -24.21 mg/dL; CI: -37.84 to -10.58, p < 0.001) were significantly reduced after GC use, and plasma HDL-C (WMD: 2.95 mg/dL; CI: 2.01 to 3.89, p < 0.001) levels increased. low-density lipoprotein cholesterol levels (WMD: -1.15 mg/dL; CI: -16.08 to 13.78, p-value = 0.880) were not significantly affected. The effects of lowering TC and TG were more pronounced for periods longer than 8 weeks. Consuming GC has a positive impact on TC, TG, and HDL-C concentrations. The limitations of this study include the short duration of analyzed interventions and significant heterogeneity. Nevertheless, it is imperative to conduct well-structured, and high-quality long-term trials to comprehensively evaluate the clinical effectiveness of GC on lipid profile, and validate these findings.

Adoption of IWGDF guidance on prevention and management of foot problems in diabetes for local use in Iran by ADAPTE methodology: a step toward best practice.

Purpose: Adoption of international working group on the diabetic foot (IWGDF) guidance on prevention and management of foot problems in patients with diabetes was the study aim. Methods: The ADAPTE process consisted of three main phases of set-up, adoption, and finalization with overall 24 steps was used. In set- up phase, organizing committee by a multidisciplinary approach was established. In adoption phase, comprehensive search in databases and guideline resources was done. According to the inclusion criteria, the 2015IWGDF guidance was selected for adoption process. Quality, currency, content and consistency of the guidance were assessed. Also, consensus on different level of agreement for each recommendation were reported. On finalization phase, the adopted version was reviewed by the guidance developer and the final guidance for local use in Iran was disseminated. Results: The 2015 IWGDF guidance with 77 recommendations was adopted after screening of 1760 documents retrieved from Jan. 2006 to Nov. 2016. An organizing committee was established according to a multidisciplinary approach including 73 members with endocrinology, orthopedic & vascular surgery, dermatology, infectious diseases, physical medicine and rehabilitation specialties, general practitioners and nurses. This guidance obtained a good quality in all six domains of AGREE II instrument (Score ≥ 80%), good currency, content, and consistency. Also, during the third round of Delphi, the consensus on the agreement level of each recommendation were greater than 80% and 77 recommendations of the original guidance were kept in the adopted version. Conclusion: The 2015 IWGDF guidance with 77 recommendations adopted for local use in different health care settings of Iran. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01121-0.

Dose-dependent effect of vinegar on blood pressure: A GRADE-assessed systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: There are controversial findings regarding the effect of vinegar on blood pressure based on the evidence accumulated so far. METHODS: A systematic search was conducted through PubMed, Scopus, and ISI Web of Science up to April 2022. We estimated the change in blood pressure for each 30 ml/d increments in vinegar consumption in each trial and then, calculated the mean difference (MD) and 95 %CI using a fixed-effects model. A dose-response meta-analysis of differences in means provided us with the estimation of the dose-dependent effect. The certainty of evidence was rated by the GRADE tool. RESULTS: Each 30 ml/d increment in vinegar consumption reduced SBP by - 3.25 mmHg (95 %CI: - 5.54, - 0.96; I2 = 67.5 %, GRADE = low). Levels of SBP decreased linearly and slightly (Pnonlinearity = 0.69, Pdose-response = 0.02) up to vinegar consumption of 30 ml/d (MD30 ml/d: - 3.36, 95 %CI: - 5.77, - 0.94). Each 30 ml/d increment in vinegar consumption reduced DBP by - 3.33 mmHg (95 %CI: - 4.16, - 2.49; I2 = 57.1 %, GRADE = low). Levels of DBP decreased linearly and slightly (Pnonlinearity = 0.47, Pdose-response = 0.004) up to vinegar consumption of 30 ml/d (MD30 ml/d: - 2.61, 95 %CI: - 4.15, - 1.06) CONCLUSIONS: According to the findings, vinegar significantly reduces systolic and diastolic blood pressure and may be considered an adjunct to hypertension treatment. Thus, clinicians could incorporate vinegar consumption as part of their dietary advice for patients.

The association between adherence to MIND diet and risk of breast cancer: A case-control study.

OBJECTIVES: Recently, a new eating pattern called "Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND)" has been coined. This study was aimed to examine the association between adherence to the MIND diet and risk of breast cancer (BC) among Iranian women. METHODS: In this hospital-based case-control study, 150 newly diagnosed BC cases and 150 age-matched controls were included. All cases were pathologically confirmed BC patients, with no history of any type of other pathologically confirmed cancers. Controls were selected from visitors, relatives and friends of non-cancer patients in other wards, which had no family relationship with cases. Dietary intakes of study participants were assessed using a validated 147-item semi-quantitative food frequency questionnaire (FFQ). The MIND diet score was computed based on participants' dietary intakes obtained from FFQ, Regression logistic models were used to examine the association between the MIND diet score and BC. RESULTS: Examining the whole study population, we found no significant association between the MIND diet score and odds of BC, either before (ORs for comparing T3 vs. T1: 0.818; 95% CI: 0.469-1.42, P-trend = .48) or after controlling for potential confounders (ORs for T3 vs. T1: 1.32; 95% CI: 0.31-5.64, P-trend = .633). This was also the case for pre-menopausal and post-menopausal when analyzed separately. We also failed to find any significant association between the MIND diet score and odds of BC after controlling for potential confounders in both pre-menopausal and post-menopausal. CONCLUSION: In conclusion, we found that adherence to the MIND diet was not associated with odds of BC in this case-control study. Further studies are required to confirm these findings.

Dietary Insulin Index and Insulin Load in Relation to Breast Cancer: Findings from a Case-Control Study.

BACKGROUND: No data are available on the association between dietary insulin index (DII) and dietary insulin load (DIL) and the risk of breast cancer (BC). PATIENTS AND METHODS: This hospital-based case-control study enrolled 150 newly diagnosed cases of BC and 150 age-matched controls. All cases were patients with pathologically confirmed BC, with no history of any type of other pathologically confirmed cancers. Controls were selected from visitors, relatives, and friends of non-cancer patients in other wards who had no family relationships with the cases. We assessed the dietary intakes of study participants using a validated 147-item semiquantitative food frequency questionnaire. DII and DIL were obtained from previously published data. RESULTS: A significant positive association was found between DII and BC (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.02-3.25), such that after considering energy intake and age, participants in the highest tertile of DII had 1.86 times greater risk of BC than those in the lowest tertile (OR, 1.86; 95% CI, 1.03-3.35). However, this association became non-significant after controlling for further potential risk factors (OR, 3.26; 95% CI, 0.9-11.7). Furthermore, we observed a significant positive association between DIL and BC (OR, 1.9; 95% CI, 1.06-3.40). The association remained significant even after controlling for age and energy intake. Further controlling for other potential confounders resulted in the disappearance of the association (OR, 3.06; 95% CI, 0.87-10.6). CONCLUSION: Adherence to a diet with high DII and DIL was not associated with odds of BC after controlling for potential confounders.

The Lack of Association between Plant-Based Dietary Pattern and Breast Cancer: a Hospital-Based Case-Control Study.

Our purpose was to assess the association between plant-based dietary patterns and breast cancer (BrCa) among Iranian women. This hospital-based case-control study included 150 newly diagnosed BrCa cases and 150 age-matched controls from the Cancer Research Center, Imam Khomeini hospital, Iran. Three indices of a plant-based diet were first calculated: plant-based diet index (PDI), the healthy PDI (hPDI), and the unhealthy PDI (uPDI). In the overall PDI, all plant foods scored positively. In hPDI and uPDI, healthy and less healthy plant foods scored positive, respectively. The adjusted odds ratio (OR) in the highest adherence of PDI was 1.00 (95% confidence interval [CI], 0.55-1.83). In hPDI, 0.89 (95% CI, 0.49-1.62); in uPDI, 1.80 (95% CI, 0.95-3.42). The adjusted OR after subgroup analysis for body mass index (BMI) was as follow, BMI > 25: 0.77(95% CI, 0.37-1.61) comparing highest with the lowest tertile of PDI, 0.91(95% CI, 0.44-1.89) comparing highest with the lowest tertile of hPDI and this value for uPDI was 2.04 (95% CI, 0.91-4.56). BMI < 25: OR for top tertile of PDI was 1.82 (95% CI, 0.48-6.93), top tertile of hPDI was 1.47 (95% CI, 0.35-6.22) and top tertile of uPDI was 2.29 (95% CI, 0.54-9.70). Our results revealed no significant association between none of the PDIs and the chance of BrCa in Iranian women. Continued and expanded research, evaluated by different methods and BrCa is urgently needed to build the foundation for future progress in evidence-based public health efforts.

The association of dietary energy density and the risk of obesity, type 2 diabetes and metabolic syndrome: A systematic review and meta-analysis of observational studies.

OBJECTIVES: There is a growing body of evidence linking dietary energy density (DED) with metabolic disorders like obesity, type 2 diabetes (T2D) and metabolic syndrome (MetS). However, according to our knowledge, there has been no systematic review and mate-analysis on T2D and MetS with DED. Therefore, this study aimed to investigate the association between DED with the risk of obesity, T2D and MetS in a systematic review and meta-analysis of observational studies. METHODS: We searched all published studies according to the defined keywords up to march 2020 in the PubMed/Medline and Scopus databases. We excluded those that did not calculate DED for total intake, no observed association between obesity, T2D, MetS as the primary or one of the outcomes with DED, no reported odds ratio (OR), relative risk (RR) or hazard ratio (HR) estimates with 95% confidence intervals (CIs), studies in children under 2 years old, patients with cancer and pregnant women. RESULTS: From 2282, after deleting the duplicates and irrelevant studies, we entered 58 articles ( 47 systematic reviews and 11 meta-analyse). We indicated an increased risk of T2D in relation to DED (OR: 1.25, 95% CI: 1.18-1.33, P < .001). But studies reviewed were inconsistent. All studies which examined the relationship between DED and MetS showed a positive relationship with an increased significant risk (OR: 1.59, 95% CI: 1.22-2.07, P < .001). Most articles reported a direct association between DED and obesity but the relationship between DED and risk of obesity was not significant (OR: 1.04, 95% CI: 0.92-1.17, P = .543). CONCLUSION: In this systematic review and meta-analysis of observational studies, we found that the DED increased the risk of T2D and MetS but was not significant with the risk of obesity.

Potato Consumption and Risk of Site-Specific Cancers in Adults: A Systematic Review and Dose-Response Meta-Analysis of Observational Studies.

The etiology of cancer type may vary significantly due to anatomy, embryology, and physiology of the cancer site. Although the association between potato consumption and colorectal cancer (CRC) was summarized in a 2018 meta-analysis of 5 cohort studies, to the best of our knowledge, no meta-analysis has evaluated potato consumption in relation to multiple cancer sites in adults. Medline/PubMed, ISI Web of Knowledge, Scopus, and the Cochrane Database of Systematic Reviews were searched for relevant publications through August 2020. We selected cohort or case-control studies conducted in adults that reported risk estimates (relative risk [RRs], HRs, and ORs) of potato intake for any cancer type. Random effects meta-analyses compared high and low intake categories. Twenty prospective cohort studies (total n = 785,348) including 19,882 incident cases, and 36 case-control studies (21,822 cases; 66,502 controls) were included. Among cohort studies, we did not find an association between high versus low intake of total potato (white and yellow) consumption and overall cancers: 1.04 (95% CI: 0.96, 1.11; tau2 = 0.005, n = 18). We found no relation between total potato consumption (high compared with low intake) and risk of CRC, pancreatic cancer, colon, gastric, breast, prostate, kidney, lung, or bladder cancer in cohort or case-control studies. We did not find an association between high versus low consumption of potato preparations (boiled/fried/mashed/roasted/baked) and risk of gastrointestinal-, sex-hormone-, or urinary-related cancers in cohort or case-control studies. Certainty of the evidence was low for total cancer, CRC, colon, rectal, renal, pancreatic, breast, prostate, and lung cancer and very low for gastric and bladder cancer. In conclusion, potato intake or potato preparations were not associated with multiple cancer sites when comparing high and low intake categories. This finding was consistent with the findings from the 2018 meta-analysis regarding potato intake and risk of CRC.

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.

Clinical effectiveness of zinc supplementation on the biomarkers of oxidative stress: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Oxidative stress plays an important role in the occurrence of chronic diseases. Zinc supplementation is also known to be an antioxidant agent. While, there is no review on the effects of zinc supplementation on oxidative stress, this study aimed to systematically summarize randomized clinical trials (RCTs) which have evaluated the impacts of zinc supplementation on oxidative stress biomarkers. METHODS: Systematic searches were performed using the PubMed/Medline, Scopus, and Google Scholar databases, up to April 2020. All RCTs assessed the effect of oral zinc supplementation on serum malondialdehyde (MDA), total antioxidant capacity (TAC), glutathione (GSH), and nitric oxide (NO) levels, were included. For each variable, mean differences (MD) and standard deviations (SDs) were combined using the random-effects model, and the fractional polynomial model was used to implement the dose-response analysis. RESULTS: Ten RCTs were included. The pooled analysis of data showed that zinc supplementation significantly reduced MDA levels (MD: -0.42 µmol/L; 95 % CI: -0.71 to -0.13), increased serum TAC (MD: 225.96 mmol/L; 95 % CI: 68.42-383.5) and GSH levels (MD: 49.99 µmol/L; 95 % CI: 2.25 t 97.73), compared with the placebo group. In contrast, no significant changes were seen in NO levels following zinc supplementation (MD: -1.66 µmol/L; 95 % CI: -5.89 to 2.57). Dose-response analysis showed a significant non-linear relationship between zinc supplementation dosage and serum levels of MDA (p < 0.01), but not other biomarkers. CONCLUSIONS: The current study showed that zinc supplementation would significantly decrease MDA and increase TAC and GSH, but not NO levels. Thus, it encourages the use of zinc supplementation in oxidative stress-related diseases.

Bushehr Elderly Health (BEH) Programme, phase I (cardiovascular system).

PURPOSE: The main objective of the Bushehr Elderly Health Programme, in its first phase, is to investigate the prevalence of cardiovascular risk factors and their association with major adverse cardiovascular events. PARTICIPANTS: Between March 2013 and October 2014, a total of 3000 men and women aged ≥ 60 years, residing in Bushehr, Iran, participated in this prospective cohort study (participation rate=90.2%). FINDINGS TO DATE: Baseline data on risk factors, including demographic and socioeconomic status, smoking and medical history, were collected through a modified WHO MONICA questionnaire. Vital signs and anthropometric measures, including systolic and diastolic blood pressure, weight, height, and waist and hip circumference, were also measured. 12-lead electrocardiography and echocardiography were conducted on all participants, and total of 10 cc venous blood was taken, and sera was separated and stored at -80 °C for possible future use. Preliminary data analyses showed a noticeably higher prevalence of risk factors among older women compared to that in men. FUTURE PLANS: Risk factor assessments will be repeated every 5 years, and the participants will be followed during the study to measure the occurrence of major adverse cardiac events. Moreover, the second phase, which includes investigation of bone health and cognition in the elderly, was started in September 2015. Data are available at the Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran, for any collaboration.

Treatment of hyperfunctioning thyroid nodules by percutaneous ethanol injection.

BACKGROUND: Autonomous thyroid nodules can be treated by a variety of methods. We assessed the efficacy of percutaneous ethanol injection in treating autonomous thyroid nodules. METHODS: 35 patients diagnosed by technetium-99 scanning with hyperfunctioning nodules and suppressed sensitive TSH (sTSH) were given sterile ethanol injections under ultrasound guidance. 29 patients had clinical and biochemical hyperthyroidism. The other 6 had sub-clinical hyperthyroidism with suppressed sTSH levels (<0.24 &mgr;IU/ml) and normal thyroid hormone levels. Ethanol injections were performed once every 1-4 weeks. Ethanol injections were stopped when serum T3, T4 and sTSH levels had returned to normal, or else injections could no longer be performed because significant side effects. Patients were followed up at 3, 6 and, in 15 patients, 24 months after the last injection. RESULTS: Average pre-treatment nodule volume [18.2 PlusMinus; 12.7 ml] decreased to 5.7 PlusMinus; 4.6 ml at 6 months follow-up [P < 0.001]. All patients had normal thyroid hormone levels at 3 and 6 months follow-up [P < 0.001 relative to baseline]. sTSH levels increased from 0.09 PlusMinus; 0.02 &mgr;IU/ml to 0.65 PlusMinus; 0.8 &mgr;IU/ml at the end of therapy [P < 0.05]. Only 3 patients had persistent sTSH suppression at 6 months post-therapy. T4 and sTSH did not change significantly between 6 months and 2 years [P > 0.05]. Ethanol injections were well tolerated by the patients, with only 2 cases of transient dysphonia. CONCLUSION: Our findings indicate that ethanol injection is an alternative to surgery or radioactive iodine in the treatment of autonomous thyroid nodules.