Association of healthy eating index and self-rated health in adults living in Tehran: a cross-sectional study.

BACKGROUND: Self-rated health (SRH) has been identified in many studies as a valid predictor of mortality and healthcare utilization. There is limited research on SRH and dietary intake. This study aimed to investigate the association between healthy eating index (HEI) and SRH in adults living in Tehran. METHODS: This cross-sectional study was carried out among 850 adult men and women aged 20-59 years who visited health centers in Tehran from 2021 to 2022. Dietary intake was assessed using a validated and reliable semiquantitative food frequency questionnaire with 168 food items, and SRH was assessed with one question: "In general, how do you rate your health?". We categorized SRH into excellent/very good, good, and fair/poor. In the descriptive statistics part, we used mean ± standard deviation or number (ratio) for quantitative and qualitative variables, respectively. The chi-squared test and one-way analysis of variance were used to calculate the percentage and mean for demographic characteristics across tertiles of SRH. An analysis of covariance was used to compare the means of energy, macronutrients, the HEI, and its component variables across the tertiles of SRH. RESULTS: The final sample included 795 participants (68.2% female; mean ± standard deviation age: 44.81 ± 10.62 years) whose 40% reported excellent/very good SRH, and 30% reported good and fair/poor SRH separately. There was no association between body mass index, physical activity, education, health status, smoking, and sleep duration with SRH. After adjustment, the total HEI score and its component scores did not differ across the tertiles of SRH status. However, participants with good SRH had a higher intake of total energy (mean difference (MD): 180.33 Kcal, P value < 0.001), total fat (MD: 8.15 gr, P value = 0.002), and total carbohydrates (MD: 20.18 gr, P value = 0.004) than those with fair/poor SRH. CONCLUSION: According to our findings, fair/poor SRH was associated with a lower consumption of total energy, total fat, and total carbohydrates in Iranian adults. Additional observational studies would be necessary to clarify these findings.

Higher dietary methyl donor micronutrient consumption is associated with higher muscle strength in adults: a cross-sectional study.

Methyl donor micronutrients might affect muscle strength via DNA methylation. We aimed to evaluate the combined relationship of dietary methyl donor micronutrients containing betaine, choline, methionine, vitamin B12, vitamin B6 and folate on muscle strength. This cross-sectional study was conducted on 267 subjects including 113 men and 154 women. Dietary intake of micronutrients was assessed utilising a validated 168-item semi-quantitative FFQ, and methyl donor micronutrient score (MDMS) was calculated. The muscle strength of the participants was measured using a digital handgrip dynamometer. The association was determined using linear regression analysis. The mean age of participants was 36·8 ± 13·2 years. After taking into account potential confounding variables, there was no significant association between dietary methyl donor micronutrient score (MDMS) and the mean left-hand muscle strength (ß: 0·07, se: 0·05, P = 0·07); however, the changes were significant in the mean right-hand muscle strength (ß: 0·09, se: 0·04, P = 0·03). There was also a significant positive relationship between mean muscle strength and methyl donors' intake after fully adjusting for potential confounders (ß: 0·08, se: 0·04, P = 0·04). In conclusion, our findings revealed that higher dietary methyl donor micronutrient consumption is associated with enhanced muscle strength. As a result, advice on a higher intake of methyl donor-rich foods including grains, nuts, dairy products and seafood might be recommended by dietitians as a general guideline to adhere to. Additional prospective studies are needed to confirm the findings.

Nutritional interventions for exercise-induced muscle damage: an umbrella review of systematic reviews and meta-analyses of randomized trials.

CONTEXT: Several meta-analyses have been conducted on the effect of nutritional interventions on various factors related to muscle damage. However, the strength of the evidence and its clinical significance are unclear. OBJECTIVES: This umbrella review aimed to provide an evidence-based overview of nutritional interventions for exercise-induced muscle damage (EIMD). DATA SOURCES: PubMed, Scopus, and ISI Web of Science were systematically searched up to May 2022. DATA EXTRACTION: Systematic reviews and meta-analyses of randomized controlled trials investigating nutritional interventions' effects on recovery following EIMD were included. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS: Fifty-three randomized controlled trial meta-analyses were included, evaluating 24 nutritional interventions on 10 different outcomes. The results revealed a significant effect of hydroxymethylbutyrate (HMB) supplementation and l-carnitine supplementation for reducing postexercise creatine kinase; HMB supplementation for reducing lactate dehydrogenase; branched-chain amino acids and leaf extract supplementation for reducing the delayed onset of muscle soreness; and l-carnitine, curcumin, ginseng, polyphenols, and anthocyanins for reducing muscle soreness, all with moderate certainty of evidence. CONCLUSIONS: Supplementation with HMB, l-carnitine, branched-chain amino acids, curcumin, ginseng, leaf extract, polyphenols, and anthocyanins showed favorable effects on some EIMD-related outcomes. PROTOCOL REGISTRATION: PROSPERO registration no. CRD42022352565.

The effects of intermittent fasting diet alone or in combination with probiotic supplementation in comparison with calorie-restricted diet on metabolic and hormonal profile in patients with polycystic ovary syndrome: study protocol for a randomized clinical trial.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in females characterized by ovulatory dysfunction, hyperandrogenism, and other metabolic disorders. Both intermittent fasting and specific probiotics have been suggested to help improve patients with PCOS through changes in gut microbial composition, circadian clock, and metabolic regulation. Therefore, the present study aims to investigate the effects of intermittent fasting alone or in combination with probiotic supplementation compared to the calorie-restricted (CR) diet on anthropometric measures, metabolic status, inflammation, and oxidative stress in women with PCOS. METHODS: We will carry out a randomized clinical trial for 8 weeks. Participants will be randomly assigned (1:1:1) to one of the three groups: (1) a 14:10 early time-restricted feeding (TRF) diet with probiotic supplementation (n = 30); (2) a 14:10 early TRF diet with placebo supplementation (n = 30); (3) a CR diet (energy-restricted 25% of required calories) with placebo supplementation as a control group (n = 30). The primary outcomes will be changes in body weight and insulin resistance. However, glycemic control, lipid profile, metabolic parameters, sex hormone-binding globulin, dehydroepiandrosterone, anti-Mullerian hormone, free androgen index, hirsutism, acne, antioxidant and oxidant status, inflammation, anthropometric measures, mental health, sleep quality, appetite, eating behavior, food craving, and blood pressure are secondary outcomes. All outcomes of this study will be evaluated in pre- and post-intervention. DISCUSSION: We hypothesized that 10-h TRE administered alone or in combination with probiotic supplementation to overweight and obese PCOS subjects would lead to weight loss and improved metabolic, hormonal, inflammatory, and antioxidant markers compared to control subjects following a standard 3-meal-per-day CR diet. ETHICAL ASPECTS: The current trial received approval from the Medical Ethics Committee of Tehran University of Medical Sciences, Tehran, Iran (IR.TUMS.MEDICNE.REC.1401.425). TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20121110011421N5. Registered on 3 October 2022.

The combined association of dietary inflammatory index and resting metabolic rate on cardiorespiratory fitness in adults.

BACKGROUND: No study has examined the combined association of dietary inflammatory index (DII) of the diet and resting metabolic rate (RMR) on cardiorespiratory fitness (CRF). Therefore, we investigated the combined association between DII and RMR on CRF. METHODS: This cross-sectional study was conducted on 270 adult subjects. The DII was calculated using a validated semi-quantified food frequency questionnaire. RMR was measured using an indirect calorimetric method. Socioeconomic status, anthropometric measures, body composition and blood pressure were documented by a trained interviewer. CRF was assessed by using Bruce protocol. Binary logistic regression was performed to find the association of CRF with DII/RMR categories in various models. RESULTS: The participants categorized into four groups including: (1) low DII/high RMR, (2) low DII/low RMR, (3) high DII/low RMR, (4) high DII/high RMR. The mean of VO2Max (mL/kg/min), VO2max (L/min) and VO2max relative to lean body mass (LBM) was lower in participants that were classified as high DII/low RMR compared to those in low DII/high RMR. After controlling for age, sex, education status, smoking status, and physical activity those who were in the high DII/low RMR group, compared to the low DII/high RMR group were 28% less likely to have higher VO2max (ml/kg/min) (OR 0.72; 95% CI 0.18, 0.82, p = 0.04). Moreover, had 25% lower odds of VO2max (L/min) which was significant (OR 0.75, 95% CI 0.11, 0.89, p = 0.03). In addition, were 21% less likely to have higher VO2max (LBM) (OR 0.79; 95% CI 0.30, 0.92, p = 0.02). CONCLUSIONS: Overall, consumption of a pro-inflammatory diet in combination with low RMR status is associated with lower odds of CRF compared to those who had anti-inflammatory diet in combination with high RMR status among Iranian healthy adults. This study suggests that researchers should focus on combined relationships rather than single pair-wise associations for having a better judgment.

Selenium supplementation decreases CRP and IL-6 and increases TNF-alpha: A systematic review and meta-analysis of randomized controlled trials.

Inflammation is an initiating cause of infectious and non-infectious diseases. Studies have shown that selenium (Se) has anti-inflammatory effects. However, its' effects on serum c-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) plasma concentrations are equivocal. Therefore, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs), evaluating the effects of per oral (PO) and intravenous (IV) Se supplementation on CRP, TNF-α, and IL-6. A systematic search was conducted using four databases, including PubMed, Google Scholar, Cochrane Library, and Scopus to find randomized clinical trials, published up to April 2023. From 19476 papers, after screening and removing duplicate articles, 24 studies were analyzed in the present meta-analysis. In the pooled analysis, PO Se administration showed no significant effect on CRP (WMD: 0.12; 95 % CI -0.11, 0.38; P-value= 0.30). However, IV Se supplementation had a significant negative association with CRP concentration (-2.24; 95 % CI: -4.24, -0.24; p-value: 0.02). Se administration had no significant association with TNF-α plasma concentration (9.64, 95 % CI: -0.59, 19.88, p-value= 0.06; and heterogeneity: 98 %). However, a significant positive association was present between Se and plasma TNF-α concentrations (0.15, 95 % CI: 0.14, 0.17, P-value<0.0001). Moreover, Se supplementation had a significant negative correlation with IL-6 plasma concentration in PO (-0.54; 95 % CI: -1.61, 0.52; P-value = 0.31) and IV administrations (-4.77; 95 % CI: -7.61, -1.93; P-value<0.0001), respectively. This study demonstrated that IV Se administration reduced CRP and IL-6 plasma concentrations. Conversely, IV Se supplementation increased TNF-α plasma concentration. It is evident that further, well-controlled clinical trials are required.

Association of meal-specific protein intake and cardiometabolic risk factors: a cross-sectional study.

We aimed to investigate the association of main meals' specific protein intake with cardiometabolic risk factors, including general and abdominal obesity, serum lipid profile, and blood pressure (BP). This cross-sectional study was conducted on 850 subjects aged 20-59 years. Dietary intakes were assessed by completing three 24-h recalls, and the protein intake of each meal was extracted. Anthropometric measures, lipid profile, fasting blood sugar and BP were measured. Multivariate logistic regression controlling for age, physical activity, sex, marital status, smoking status, BMI and energy intake was applied to obtain OR and CI. The mean age was 42 years, and the mean BMI of the participants was 27·2. The mean protein intake for breakfast, lunch and dinner was 12·5, 22·2 and 18·7 g/d, respectively. After adjustment for confounders, higher protein intake was not associated with any of the cardiometabolic risk factors, including LDL-cholesterol, HDL-cholesterol, total cholesterol (TC), TAG, body weight, BP and fasting plasma glucose, in any of the three main meals consumed within a day. Adherence to a higher protein intake at each meal was not associated with cardiometabolic risk factors in Iranian adults. Further prospective studies are needed to justify our findings.

The association of meal-specific food-based dietary inflammatory index with cardiovascular risk factors and inflammation in a sample of Iranian adults.

BACKGROUND: This study aimed to evaluate the association of meals-specific food-based dietary inflammatory index (FDII), with cardiovascular (CVD) risk factors and inflammation among Iranian adults. METHODS: In this cross-sectional study, we recruited 816 participants living in Tehran via two-staged cluster sampling. Three non-consecutive 24-h dietary recalls (two working days and one day off) were obtained from individuals to specify the main meals and meal-specific FDIIs. Anthropometric measures were done. Insulin and high-sensitivity c-reactive protein (hs-CRP) were measured. Multiple linear regressions were used to investigate the association of FDII with Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), hs-CRP, Triglyceride Glucose Index (TyG), and Lipid Accumulation Product Index (LAP). RESULTS: The range of FDIIs for breakfast, lunch, and dinner were (-2.47,1.98), (-2.66,3.23) and (-4.09,3.13) in order, and the mean age was 42.2 ± 10.5 years. We found that there was no significant association between FDII and hs-CRP level in the three meals (ß = -0.003; 95% CI: -0.030, 0.025 for breakfast,ß = -0.020; 95% CI: -0.041, 0.001 for lunch, and ß = 0.006; 95% CI: -0.016, 0.028 for dinner) after adjusting for age, sex, education, occupation, maritage, physical activity, smoking, morningness-eveningness score, energy, body mass index, and other FDIIs. Also, we found no significant association between breakfast, lunch, and dinner-specific FDII and HOMA-IR (ß = -0.368, -0.223, 0.122), TyG index (ß = -0.009, 0.060, -0.057) and LAP (ß = 2.320, -0.278, -0.297). CONCLUSIONS: We found no associations between meal-based FDII scores and CVD and inflammation. Further research of prospective nature is needed to confirm these findings.

Association of low-carbohydrate diet score and carbohydrate quality with visceral adiposity and lipid accumulation product.

The present study examined the association between low-carbohydrate diet (LCD) score, glycemic index (GI), and glycemic load (GL) with visceral fat level (VFL) and lipid accumulation product (LAP). This cross-sectional study was conducted on 270 adults (118 men and 152 women) aged between 18-45 living in Tehran, Iran, between February 2017 and December 2018. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Body composition were also assessed. We used analyses of covariance and binary logistic regression to explore associations after controlling for age, energy intake (model 1), education, smoking status, physical activity, occupation, marriage and metabolic diseases. There were no significant differences between tertiles of GI, GL and LCD for means of anthropometric measures, LAP and VFL index in men, while women in the highest tertile of GI and GL had significantly higher mean LAP in the crude model (P = 0·02) and model 1(P = 0·04), which disappeared after controlling for other confounders (P = 0·12). Moreover, the OR and CIs for having high LAP and VFL was not associated with dietary GI, GL and LCD in crude and adjusted models. However, chance of high VFL reduced by 65% and 57% among women with high adherence to LCD score (OR = 0·35, 95% CI = 0·16-0·78, P = 0·01) and model 1 (OR = 0·43, 95% CI = 0·18-1, P = 0·05), respectively. However, this significant association disappeared after controlling for other confounders (P = 0·07). Overall, we found carbohydrate quality and LCD score are not associated with LAP and VFL index. However, gender-specific relationship should not be neglect and warrants further investigation.

Association of Perceived Stress and Physical Activity Level with Severity of Coronary Artery Disease in Gaza Strip, Palestine: A Cross-Sectional Study.

BACKGROUND: The association between life-event stressors and low physical activity linked to the severity of coronary artery disease (CAD) is poorly understood. Therefore, this study aimed to determine the perceived stress status and physical activity level associated with the severity of CAD. METHODS: The study was conducted among 423 patients with newly discovered CAD (both sexes, aged 35-65 years) confirmed by coronary angiography results. CAD severity was classified according to the Gensini score as severe or non-severe. The fasting blood glucose and lipid profiles were also investigated. Anthropometric and brachial blood pressure measurements were obtained. A structured questionnaire including participants' characteristics, the Perceived Stress Scale (PSS-14), and the International Physical Activity Questionnaire were used via face-to-face interviews. Multivariable binary logistic regression was used to assess the predictors of CAD severity using IBM SPSS ver. 24.0 (IBM Corp., Armonk, NY, USA). RESULTS: Most participants were classified as having severe CAD (63.8%). Adjusting for age, sex, smoking status, systolic blood pressure, body mass index, and history of hypertension, the severity of CAD increased by 9% for a onescore increase in the PSS (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.01-1.14; P=0.030). Moreover, sufficiently active (600-1,500 metabolic equivalents [METs]/wk) patients had lower odds of severe CAD (OR, 0.43; 95% CI, 0.23-0.72; P=0.027) than those with insufficient activity. However, no significant association was found between physical activity (≥1,500 METs/wk) and CAD severity. CONCLUSION: The odds of CAD severity significantly increased with increasing perceived stress score but decreased with sufficient physical activity.

The effect of curcumin supplementation on delayed-onset muscle soreness, inflammation, muscle strength, and joint flexibility: A systematic review and dose-response meta-analysis of randomized controlled trials.

To quantify the effects of curcumin supplementation on exercise-induced muscle damage, muscle soreness, inflammatory biomarkers, muscle strength, and joint flexibility via assessment of creatine kinase (CK), visual analogue scale (VAS) score, maximal voluntary contraction (MVC), and range of motion (ROM), respectively. Online databases, including PubMed, Google Scholar, and Scopus, were searched up to February 2021. RevMan® software (version 5.3) was used for assessing the risk of bias to assess the quality of studies. The mean differences (MD) and confidence intervals (95% CI) of CK activity (IU/L), VAS score, tumor necrosis factor (TNF-α) (pg/ml), interleukin-6 (IL-6) (pg/ml), IL-8 (pg/ml), MVC (nm) and ROM (degree) were pooled using a random- or fixed-effect model. Between-study heterogeneity was assessed using χ-square or I2 statistic. Ten trials met the eligibility criteria and were included in the pooled analysis. Meta-analysis showed that curcumin supplementation significantly reduced serum CK activity [WMD = -65.98 IU/L, 95% CI (-99.53 to -32.44)], muscle soreness [WMD = -0.56, 95% CI (-0.84 to -0.27)], and TNF-α concentration [WMD = -0.22 pg/ml, 95% CI (-0.33 to -0.10)]. Also, curcumin supplementation elicited significant improvements in MVC [WMD = 3.10 nm, 95% CI (1.45-4.75)] and ROM [WMD = 6.49°, 95% CI (3.91-9.07)], although no significant changes in IL-6 and IL-8 levels were found. Dose-response analysis indicated that there is a significant non-linear association between the daily dose and the final effect size regarding TNF-α. Curcumin supplementation may improve some aspects of DOMS, including muscle damage, muscle soreness, inflammation, muscle strength, and joint flexibility. Further, well-designed and high-quality studies with larger sample sizes are needed to ascertain the long-term effects and safety of curcumin supplementation.

Association of Dietary and Lifestyle Inflammation Score With Cardiorespiratory Fitness.

Objective: We aimed to assess the potential association of dietary (DIS) and lifestyle inflammation score (LIS) and their joint association (DLIS) with cardiorespiratory fitness (CRF) in Tehranian adults. Design: The present study was designed cross-sectional. Participants: A total of 265 males and females aged 18-70 years (mean ± SD: 36.9 ± 13.3) were entered in the present cross-sectional study. Eligible participants were healthy men and women who were free of medications and had no acute or chronic infection or inflammatory disease. Measures: The DIS was calculated by the use of data from 18 anti- and pro-inflammatory dietary components, and the LIS by three non-dietary components including physical activity, smoking status, and general adiposity, with higher scores indicating a more pro-inflammatory diet and lifestyle, respectively. The DLIS was calculated by summing the DIS and LIS. CRF was assessed by the Bruce protocol and VO2 max was measuredas the main variable of CRF. The odds ratio (OR) and 95% confidence interval (CI) of CRF across tertiles of the DIS, LIS, and DLIS were estimated by logistic regression analysis with considering age, gender, energy intake, marital and education status, and occupation as confounders. Results: The DLIS ranged from -2.10 to 0.38 (mean ± SD: -1.25 ± 0.64). In the model that controlled for all variables, the ORs of CRF for the second and third tertiles of the DLIS as compared to the first tertile were 0.42 (95%CI: 0.20, 0.90) and 0.12 (95%CI: 0.05, 0.32), respectively (P-trend < 0.001). There was a strong inverse association between the LIS and CRF (ORthirdvs.firsttertile: 0.12, 95%CI: 0.05, 0.32). There was no association between DIS and CRF. Conclusion: The present study examined the joint association of inflammation-related lifestyle behaviors with CRF and found a strong inverse association between a pro-inflammatory lifestyle with CRF. We did not find any association between dietary inflammatory properties with CRF. Future studies should address the relationship between the inflammatory potential of the diet and CRF.

No association between dietary magnesium intake and body composition among Iranian adults: a cross-sectional study.

PURPOSE: Obesity is becoming more prevalent worldwide. Magnesium (Mg) intake may play a role in the regulation of energy metabolism and body weight. Therefore, in this cross-sectional study, we aimed to investigate the association between dietary Mg intake and body composition among healthy adults. METHODS: A total of 778 adult men and women aged 18-59 years who attended health care centers in Tehran, Iran, entered the final analysis. Dietary intake was assessed with a validated and reliable food frequency questionnaire with 168 items and the dietary Mg intake was estimated using Nutritionist IV software. Anthropometric measurements and blood samples were collected and body composition was evaluated employing the Body Mass Index (BMI), A Body Shape Index (ABSI), Body Adiposity Index (BAI), Body Roundness Index (BRI), Visceral Adiposity Index (VAI), Lipid Accumulation Index (LAP), and Triglyceride-Glucose index (TyG). Multiple linear regression analysis was used to determine the association of the dietary Mg intake with body composition indices. RESULTS: The mean daily dietary Mg intake was 294 ± 140 mg in men and 262 ± 112 mg in women. Unadjusted linear regression showed that dietary magnesium intake is significantly associated with a waist to hip ratio (WHR) and total cholesterol (TC) in men, and hip circumference (HC) in women. After adjusting for potential confounders including age, education, marriage, occupation and smoking, total energy intake, and activity score, there remained no significant association between dietary Mg intake and any of the body composition indices including BMI, ABSI, BAI, BRI, VAI, LAP, and TyG neither in men nor women. CONCLUSION: Higher Mg intake was not associated with anthropometric indices in Iranian adults, according to our findings. Additional observational studies would be beneficial in clarifying the existing findings.

The effect of probiotic cheese consumption on inflammatory and anti-inflammatory markers, disease severity, and symptoms in patients with rheumatoid arthritis: study protocol for a randomized, double-blind, placebo-controlled trial.

BACKGROUND: In recent decades, several studies have shown changes in the intestinal microflora among patients with rheumatoid arthritis (RA). Therapeutic measures using probiotics have shown favorable effects on the recovery of these patients. However, most studies have used probiotic supplements. In this study, we aimed to investigate the effect of probiotic cheese consumption on inflammatory and anti-inflammatory factors, disease severity, and symptoms in these patients. METHODS: This study is a randomized, double-blind clinical trial, in which forty patients with mild to moderate severity of RA will be randomly allocated to receive either 30 g/day probiotic cheese (n = 20) or only low-salt and low-fat cheese without any added probiotic (n = 20) for 12 weeks. Assessment of anthropometric measures and biochemical indicators, including serum concentrations of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10), will be done at the study baseline and end of the trial. In addition, disease severity and disability will be assessed by DAS-28 and the HAQ-DI questionnaire, respectively. DISCUSSION: Diet is the leading environmental factor affecting the gut microbiota. A prebiotic-rich diet and probiotics might be beneficial in this regard. To the best of our knowledge, the effect of probiotic supplements on inflammation in these patients has widely been assessed; however, there is only one study that examined the effect of probiotic-containing food in these patients. Further studies are needed to investigate the effect of probiotic-containing foods on inflammatory markers and symptoms in patients with RA. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20201120049449N1 . Registered on 14 February 2021.

The association between dietary inflammatory index, muscle strength, muscle endurance, and body composition in Iranian adults.

PURPOSE: Dietary factors may modulate inflammation status which contributed to the various chronic diseases like sarcopenia. Therefore, we aimed to examine the association of dietary inflammatory index (DII) and muscle strength (MS), muscle endurance (ME), and body composition. METHODS: This cross-sectional study was conducted in 270 adults living in Tehran, Iran. The DII was calculated using a validated food frequency questionnaire. Body composition (fat-free mass (FFM), fat mass (FM), percent body fat (PBF), skeletal muscle mass (SMM)) was measured using body composition analyzer. Anthropometric measures (weight, body mass index (BMI), waist circumference (WC)), were done. MS was measured by a digital handgrip dynamometer in both right (MSR) and left (MSL) hand. Mean of MSR and MSL was considered as MS. RESULTS: A significant decrease was found for MS (p < 0.01) and MSR (p < 0.01) across tertiles of DII. Participants who had greater scores of DII also had lower MER (p < 0.01), even after adjustment for confounding factors (age, sex, education status, income, smoking, physical activity, body mass index and energy intake) (p < 0.02). Adherence to DII was significantly related to MSL (p < 0.01), ME (p < 0.01), and ME of the MEL (p = 0.02) in the crude model, which was disappeared after controlling for covariates. Those in the third compared to the lowest tertile of DII, had no significant difference in mean of FFM (p < 0.001), SMM (p < 0.001), and WC (p < 0.001). CONCLUSIONS: Higher DII scores were associated with less muscle strength and endurance among Iranian adults. Further studies are needed to confirm the veracity of our results. LEVEL OF EVIDENCE: Descriptive cross-sectional study, Level V.

The Nordic diet and the risk of non-communicable chronic disease and mortality: a systematic review and dose-response meta-analysis of prospective cohort studies.

We aimed to investigate the association between adherence to the Nordic diet (ND) and the risk of chronic disease. PubMed, Scopus, and ISI Web of Science were searched to February 2020 to find prospective cohort studies. The relative risks (RRs) were calculated using a fixed-effects/random-effects model. The certainty of evidence was rated using the GRADE approach. Thirteen prospective cohort studies with 930,153 participants were included. The RRs for the highest compared to the lowest category of adherence to the ND were 0.78 (95%CI: 0.69, 0.87; I2 = 51%, n = 6) for all-cause mortality, 0.78 (95%CI: 0.74, 0.83; I2 = 70%, n = 4) for cardiovascular mortality, 0.86 (95%CI: 0.80, 0.93; I2 = 83%, n = 4) for cancer mortality, 0.88 (95%CI: 0.79, 0.98; I2 = 3%, n = 3) for stroke, 0.80 (95%CI: 0.68, 0.95; I2 = 47%, n = 3) for myocardial infarction, and 0.90 (95%CI: 0.82, 0.99; I2 = 33%, n = 4) for type 2 diabetes. There was an inverse linear association between the ND score and the risk of mortality, and an inverse monotonic association for type 2 diabetes. The certainty in the estimates ranged from very low to low.

Mediterranean diet quality index is associated with better cardiorespiratory fitness and reduced systolic blood pressure in adults: A cross-sectional study.

BACKGROUND: Literature suggests higher cardiorespiratory fitness (CRF) is inversely related to chronic diseases such as metabolic syndrome and cardiovascular disease and hypertension. The aim of this study was to assess the association of Mediterranean dietary quality index (Med-DQI) with CRF and hypertension in a sample of Iranian adults. METHODS: This was a cross-sectional study on 270 healthy men and women, aged 18-45 years. Dietary intake and physical activity level were assessed through a validated food frequency questionnaire (FFQ); and the International Physical Activity Questionnaires (IPAQ), respectively. Cardiorespiratory fitness was assessed by using a graded exercise treadmill test. The association between Med-DQI and CRF was investigated using multiple regression models. RESULTS: Participants in the top tertiles of Med-DQI, had higher VO2 max (mL/kg/min) (p = 0.02) and lower SBP (p = 0.01). When we controlled for age, sex, weight, smoking, physical activity and energy intake, the significant results were remained. Results of unadjusted linear regression shows that CRF was positively associated with cholesterol (p < 0.001) and fish (p < 0.001). Also, CRF was positively associated with vegetables and fruits (p < 0.001) and olive oil (p = 0.05). After adjustments for confounders, the significant associations of olive oil and cholesterol with CRF were disappeared while vegetables and fruits and total score of Med-DQI remained significant. There were no significant relations between saturated fatty acids meat, and cereals with Med-DQI. CONCLUSIONS: Our results demonstrated that Med-DQI was associated with better CRF in Iranian adults and SBP. Further studies with interventional approaches are needed to better clarify the causal inference of these associations.

Association of Dietary and Lifestyle Inflammation Score With Metabolic Syndrome in a Sample of Iranian Adults.

Objective: We aimed to evaluate the association between the dietary and lifestyle inflammation score (DLIS) and metabolic syndrome (MetS) and its components in a sample of Iranian adults. Design: Population-based cross-sectional study. Setting: General adult population living in Tehran, Iran. Subjects: We included 827 adult men and women with an age range of 18-59 years who were referred to health centers in different districts of Tehran, Iran. Dietary intake was assessed by a semiquantitative food frequency questionnaire with 168 items. The DLIS was calculated based on four components, including dietary inflammation score, physical activity, cigarette smoking, and general obesity. Higher DLIS represents a more proinflammatory diet and lifestyle. The odds ratio (OR) and 95% confidence interval (CI) of the MetS across quartiles of the DLIS was calculated by using logistic regression analysis, controlling for age, sex, energy intake, marital status, education status, and occupation. Results: A total of 827 participants (31% men) were included, with a mean age of 44.7 ± 10.7 years. The prevalence of the MetS was 30.5%. The DLIS ranged between -2.35 and +3.19 (mean ± SD: 0.54 ± 1.09). There was a significant positive association between the DLIS and odds of MetS (OR fourthvs.thefirstquartile: 1.57, 95% CI: 1.01-2.45) in the fully adjusted model. Conclusion: Our results showed a significant positive association between the DLIS and odds of MetS. The results of the present crosssectional study suggested that having a more proinflammatory lifestyle can be associated with MetS. More prospective studies are needed to confirm the findings.

Effects of modified-Paleo and moderate-carbohydrate diets on body composition, serum levels of hepatokines and adipocytokines, and flow cytometric analysis of endothelial microparticles in adults with metabolic syndrome: a study protocol for a randomized clinical trial.

BACKGROUND: Metabolic syndrome is a combination of metabolic risk factors causing a pathological condition that increases the risk of non-communicable diseases, such as diabetes and cardiovascular diseases. A variety of dietary approaches have been examined to halt this rapid trend; however, the effects of modified-Paleo diet and medium-carbohydrate diet on inflammation, adipokines, hepatokines, and the profile of endothelial microparticles in individuals with metabolic syndrome have not been investigated in detail. The present study is designed to examine the effect of modified-Paleo and moderate-carbohydrate diet with two delivery modes: "fixed diet plan" vs "calorie counting" on weight, body composition, serum levels of some hepatokines and adipocytokines, and flow cytometric analysis of endothelial microparticles in adults with metabolic syndrome. METHODS: Eighty metabolic syndrome patients will be recruited in this study. They will be randomly allocated to one of the following 4 groups: (1) receiving a modified-Paleo diet with calorie counting, (2) receiving a modified-Paleo diet with a fixed diet plan, (3) receiving a medium-carbohydrate diet with calorie counting, and (4) receiving a medium-carbohydrate diet with a fixed diet plan for 10 weeks. Weight, height, waist circumference, and body composition will be assessed at the study baseline and at the end of the trial. Serum insulin, asprosin, chemerin, FGF-21, CTRP-1, PYY, ghrelin, plasma EMPs (CD31+/CD42b- and CD144+/CD42b-), lipid profile, glycemic indices, hs-CRP, leptin, vitamin C, creatinine and satiety, hunger, fullness, and desire to eat (via visual analog scales) will be measured at the study baseline and at the end of the trial. Insulin resistance and insulin sensitivity will be determined using the HOMA-IR and QUICKI equations. DISCUSSION: To the best of our knowledge, this is the first randomized controlled trial that will determine the effect of modified-Paleo and moderate-carbohydrate diet on weight, body composition, serum levels of some hepatokines and adipocytokines, and the profile of EMPs in adults with metabolic syndrome. Moreover, the effects of different diet delivery modes, including "fixed diet plan" and "calorie counting" will also be analyzed. The results of this trial can provide clinical witnesses on the effectiveness of carbohydrate-restricted diets in ameliorating metabolic status and prevent the development of chronic diseases. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT2016121925267N4 . Registered on 26 July 2017.

Dietary networks identified by Gaussian graphical model and general and abdominal obesity in adults.

BACKGROUND: Gaussian graphical model (GGM) has been introduced as a new approach to identify patterns of dietary intake. We aimed to investigate the link between dietary networks derived through GGM and obesity in Iranian adults. METHOD: A cross-sectional study was conducted on 850 men and women (age range: 20-59 years) who attended the local health centers in Tehran. Dietary intake was evaluated by using a validated food frequency questionnaire. GGM was applied to identify dietary networks. The odds ratios (ORs) and 95% confidence intervals (CIs) of general and abdominal adiposity across tertiles of dietary network scores were estimated using logistic regression analysis controlling for age, sex, physical activity, smoking status, marital status, education, energy intake and menopausal status. RESULTS: GGM identified three dietary networks, where 30 foods were grouped into six communities. The identified networks were healthy, unhealthy and saturated fats networks, wherein cooked vegetables, processed meat and butter were, respectively, central to the networks. Being in the top tertile of saturated fats network score was associated with a higher likelihood of central obesity by waist-to-hip ratio (OR: 1.56, 95%CI: 1.08, 2.25; P for trend: 0.01). There was also a marginally significant positive association between higher unhealthy network score and odds of central obesity by waist circumference (OR: 1.37, 95%CI: 0.94, 2.37; P for trend: 0.09). Healthy network was not associated with central adiposity. There was no association between dietary network scores and general obesity. CONCLUSIONS: Unhealthy and saturated fat dietary networks were associated with abdominal adiposity in adults. GGM-derived dietary networks represent dietary patterns and can be used to investigate diet-disease associations.