Ginseng and Cancer-Related Fatigue: A Systematic Review of Clinical Trials.

PURPOSE: The data on the effect of ginseng on general fatigue were previously reviewed. However, there is limited data on the effect of various types of ginseng on cancer-related fatigue (CRF). CRF is one of the most pervasive symptoms of cancer and cancer treatment. The primary objective of the current study was to systematically review trials investigating the safety and efficacy of three different types of ginseng separately used in the treatment protocol for patients with CRF. METHODS: We searched the available online databases for relevant publications up to October 2019. Data were independently extracted by two reviewers. We assessed the risk of bias using the Cochrane Collaboration Review Manager (RevMan, version 5.3) and reported the results in a narrative summary. RESULTS: A total of 210 studies were identified by the initial search, from which seven clinical trials and one retrospective study were included in this systematic review. A total of two clinical trials and one retrospective review examined the impact of American ginseng on CRF symptoms, three studies tested Asian ginseng, and two trials were conducted using Korean ginseng. The quality of the selected studies varied greatly. All three types of ginseng were tolerated well with few low-grade adverse events. American ginseng, containing more than 5% ginsenosides, consumed at the dosage of 2000 mg/day for up to eight weeks significantly reduced fatigue. Asian ginseng, containing ≥ 7% ginsenosides, relieved symptoms of fatigue at the dosage of 400 mg/day in the majority of patients with CRF. Korean ginseng, consumed at the dosage of 3000 mg/day for 12 weeks, decreased symptoms of CRF. CONCLUSIONS: Although our findings support the safety and effectiveness of ginseng in the treatment of CRF, the number of high-quality studies is not adequate to adopt ginseng as a standard treatment option for CRF.

Lycopene Does Not Affect Prostate-Specific Antigen in Men with Non-Metastatic Prostate Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Several randomized controlled trials (RCTs) have investigated the effect of lycopene supplementation on serum levels of prostate-specific antigen (PSA) in patients with prostate cancer. However, results have been inconclusive. We systematically searched PubMed, Embase, and Scopus up to January 2020 to find RCTs investigating the effect of lycopene supplementation on serum levels of PSA in patients with non-metastatic prostate cancer. Using a random-effects model, the reported risk estimates were pooled. A total of six trials were included in the final analysis. we found no significant effect of lycopene on circulating PSA (WMD: -0.60, 95% CI: -2.01, 0.81 µg/L). However, we observed a significant reducing effect when the analysis was confined to studies that included patients with higher baseline levels of PSA (≥6.5 µg/L) (WMD: -3.74 µg/L, 95% CI: -5.15, -2.32, P < 0.001). Subgroup analysis based on the duration of intervention did not result in any significant effect. Non-linear dose-response analysis did not show any significant effects of lycopene dosage (Pnon-linearity = 0.50) and duration of the intervention (Pnon-linearity = 0.63) on serum levels of PSA. Although lycopene supplementation did not produce any reduction in PSA levels overall, a significant reducing effect was observed in patients with higher levels of baseline PSA. Due to the heterogeneity of our results, further high-quality clinical trials with long-term duration are required to determine the efficacy of lycopene in patients with non-metastatic prostate cancer.

Effects of saffron (Crocus sativus L.) supplementation on inflammatory biomarkers: A systematic review and meta-analysis.

The effect of saffron supplementation on subclinical inflammation remains inconclusive. We performed a systematic review and meta-analysis to summarize available findings on the effect of saffron supplementation on inflammatory biomarkers (C-reactive protein [CRP], tumor necrosis factor-α [TNF-α], and interleukin-6 [IL-6]) in adults. We searched PubMed/Medline, Scopus, Web of Science, and Google Scholar databases up to November 2019 using relevant keywords to identify eligible trials. All randomized controlled trials (RCTs) that examined the effect of oral saffron supplementation on plasma concentrations of CRP, TNF-α, and IL-6 were included. For each outcome, mean differences and SDs were pooled using a random-effects model. Overall, eight RCTs were included in this meta-analysis. The pooled results showed that saffron supplementation did not result in significant changes in serum CRP (weighted mean difference [WMD]: -0.43 mg/L; 95% confidence interval [CI]: -1.04 to 0.17; p = .16), serum TNF-α (WMD: -1.29 pg/mL; 95% CI: -4.13 to 1.55; p = .37), and IL-6 concentrations (WMD: 0.11 pg/mL; 95% CI: -0.79 to 1.00; p = .81). Subgroup analysis indicated a significant reduction in serum CRP levels in studies with baseline CRP of ≥3 mg/L, saffron dosage of ≤30 mg/day, and intervention duration of <12 weeks, as well as trials that used crocin. Similarly, saffron was found to decrease TNF-α in studies that recruited non-diabetic subjects, subjects with baseline levels of ≥15 pg/mL, and participants with <50 years old, as well as trials that administered saffron at the dosage of ≤30 mg/day. We also found a significant non-linear effect of saffron dosage on serum CRP concentrations (pnon-linearity = .03). The overall results indicated that saffron supplementation did not affect inflammatory cytokines. Further high-quality studies are needed to firmly establish the clinical efficacy of supplemental saffron on inflammatory biomarkers.

The association of serum levels of zinc and vitamin D with wasting among Iranian pre-school children.

PURPOSE: Wasting is a main indicator of Child's undernutrition that is associated with several non-communicable diseases and child mortality. This is the first population-based study which evaluated the association of serum zinc and vitamin D levels with wasting in a Middle East region. We also reported the prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years. METHODS: This was a multicenter cross-sectional study that included 425 children aged between 5 and 7 years (on average 6 years) with BMI-for-age Z-scores of < - 1 SD resident in urban and rural areas of Iran in the spring of 2012 as part of the National Integrated Micronutrient Survey 2 (NIMS-2). Anthropometric measurements and blood sampling were obtained. The prevalence of vitamin D and zinc deficiencies together with the correlations of these variables with the increase of BMI-for-age Z-scores were evaluated. RESULTS: The prevalence of vitamin D and zinc deficiencies was 18.8% and 12.7%, respectively. In addition, 31.1% of children were wasted. Children in the second tertile of 25(OH)D levels were less likely to have wasting compared with those in the first tertile in both crude and adjusted models (OR 0.47, 95% CI 0.27-0.83). A significant inverse association was found between serum levels of zinc and wasting (OR 0.57, 95% CI 0.34-0.96); such that after adjusting for confounders, children in the highest tertile of serum zinc had 47% less odds of wasting compared with those in the first tertile (OR 0.53, 95% CI 0.31-0.91). CONCLUSION: The prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years was 18.8 and 12.7%, respectively. Serum levels of vitamin D and zinc were inversely associated with wasting either before or after controlling for confounders. LEVEL OF EVIDENCE: Level III, case-control analytic studies.

The effect of vitamin d-calcium co-supplementation on inflammatory biomarkers: A systematic review and meta-analysis of randomized controlled trials.

Data on the effect of vitamin d-calcium co-supplementation on inflammatory biomarkers, compared to placebo or intake of calcium and vitamin D supplements alone, are conflicting. The current systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to summarize available findings on the effect of vitamin d-calcium co-supplementation on inflammatory biomarkers in adults. Online databases including PubMed, Scopus, ISI Web of Science and Google Scholar were searched using relevant keywords up to June 2019. We included RCTs investigating the effect of vitamin d-calcium co-supplementation, compared to placebo or intake of calcium and vitamin D supplements alone, on inflammatory biomarkers. In total, 8 RCTs that enrolled 706 participants, aged ≥18 years, were included. Pooling 9 effect sizes from 8 RCTs on C-reactive protein (CRP) levels revealed a significant reducing effect of vitamin d-calcium co-supplementation on serum CRP concentrations compared to placebo intake (WMD: -0.82, 95% CI: -1.56, -0.07 mg/L, P = 0.03). However, this beneficial effect became non-significant when compared to the intake of calcium and vitamin D supplements alone. Also, we found that the associations of vitamin d-calcium dosages and duration of intervention with the reduction in CRP concentrations were in a non-linear fashion. Combining 5 effect sizes for IL-6 and 3 effect sizes for TNF-α, we found no significant effect of joint calcium and vitamin D supplementation on serum concentrations of IL-6 (WMD: -1.45, 95% CI: -5.31, 2.41 pg/mL, P = 0.46) and TNF-α (WMD: -0.79, 95% CI: -2.19, 0.61 pg/mL, P = 0.26). We found a beneficial effect of vitamin d-calcium co-supplementation on serum CRP concentrations. However, such a beneficial effect was not seen for IL-6 and TNF-α concentrations.

Effects of zinc supplementation on lipid profile in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND AIM: Findings on the effects of zinc supplementation on the lipid profile in patients with type 2 diabetes mellitus (T2DM) are conflicting. The current comprehensive systematic review and meta-analysis aimed to summarize available evidence in this regard. METHODS AND RESULTS: After a systematic search in the online databases, we included the randomized controlled trials (RCTs) investigating the effect of zinc supplementation on lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG)] in patients with T2DM. Altogether, 9 studies with a total sample size of 424 patients with T2DM were included in the analysis. Combining 9 effect sizes from 9 RCTs, we found a significant lowering effect of zinc supplementation on serum levels of TG (weighted mean difference (WMD): -17.08, 95% CI: -30.59, -3.58 mg/dL, P = 0.01) and TC (WMD: -26.16, 95% CI: -49.69, -2.62 mg/dL, P = 0.02). Although the overall effect of zinc supplementation on LDL-C levels was not significant, a beneficial effect was seen in studies that administered <100 mg/d zinc. Based on the non-linear dose-response analysis, a greater reduction in serum levels of TC and LDL-C following zinc supplementation was seen at <12 weeks' duration of intervention. Unlike the overall effect size, we found a significant increasing effect of zinc supplementation on serum HDL-C concentrations in most subgroups of RCTs according to the subgroup analyses. CONCLUSION: We found that zinc supplementation may beneficially influence lipid profile in patients with T2DM.

The effects of green coffee extract supplementation on glycemic indices and lipid profile in adults: a systematic review and dose-response meta-analysis of clinical trials.

BACKGROUND: The role of coffee consumption in the risk of cardiovascular diseases has been debated for many years. The current study aimed to summarize earlier evidence on the effects of green coffee extract (GCE) supplementation on glycemic indices and lipid profile. METHODS: We searched available online databases for relevant clinical trials published up to October 2019. All clinical trials investigating the effect of GCE supplementation, compared with a control group, on fasting blood glucose (FBG), serum insulin, total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were included. Overall, 14 clinical trials with a total sample size of 766 participants were included in the current meta-analysis. RESULTS: We found a significant reducing effect of GCE supplementation on FBG (weighted mean difference (WMD): -2.35, 95% CI: - 3.78, - 0.92 mg/dL, P = 0.001) and serum insulin (WMD: -0.63, 95% CI: - 1.11, - 0.15 µU/L, P = 0.01). With regard to lipid profile, we observed a significant reduction only in serum levels of TC following GCE supplementation in the overall meta-analysis (WMD: -4.51, 95% CI: - 8.39, - 0.64, P = 0.02). However, subgroup analysis showed a significant reduction in serum TG in studies enrolled both genders. Also, such a significant reduction was seen in serum levels of LDL and HDL when the analyses confined to studies with intervention duration of ≥8 weeks and those included female subjects. In the non-linear dose-response analyses, we found that the effects of chlorogenic acid (CGA) dosage, the main polyphenol in GCE, on FBG, TG and HDL were in the non-linear fashions. CONCLUSION: In conclusion, we found that GCE supplementation improved FBG and serum levels of insulin and TC. Also, there was a significant improvement in other markers of lipid profile in some subgroups of clinical trials.

Findings From the Meta-analysis on Whole-Grain Consumption and Biomarkers of Systemic Inflammation Are Misleading.

We have with great interest read the recent article by Hajihashemi et al. which systematically reviewed and meta-analyzed a number of published clinical trials about the effect of whole grains on serum levels of hs-CRP (high sensitiviy C-reactive protein), IL-6 (interlukin-6), TNF-α (tumor necrosis factor-α). The findings suggested that consumption of whole grains significantly decreased serum levels of hs-CRP and IL-6, but not TNF-α, compared with the control group. It is an interesting study, but there are some methodological limitations and missing data that need to be addressed. Therefore, we believe that the conclusions were misleading and further comprehensive meta-analysis is required to explain the effect of whole grain intake on serum concentrations of inflammatory biomarkers.

G1359A Variant of the Cannabinoid Receptor Gene (rs1049353) and Obesity-Related Traits and Related Endophenotypes: A Meta-Analysis.

BACKGROUND: This study aimed to investigate the comparison of G1359A variant of cannabinoid receptor gene (rs1049353) with obesity-related traits including body mass index (BMI), fat mass (FM), fat-free mass (FFM), food-related traits, and leptin among healthy and non-healthy adults. METHODS: We searched PubMed, Cochrane, Scopus, Web of Science, and EMBASE until December 2016 for observational studies assessing each of the anthropometric measurements, food-related traits, and leptin of 1359 G/A polymorphism of CNR1 gene. A total of 22 studies were included in the meta-analysis comparing mean and SD differences of the anthropometric measurements, leptin, and dietary intake between GA/AA and GG genotypes. RESULTS: The results showed that subjects with GA/AA genotype had significantly lower BMI (weighted mean difference = -0.59 kg/m2, p < 0.001) compared to those with the GG genotype. Dietary intake of fat, carbohydrate, and protein as well as serum levels of leptin was not significantly different between GA/AA and GG genotypes. CONCLUSION: It was revealed that subjects with mutant polymorphism (GA/AA) of CNR1, compared to the wild-type group (GG), had lower BMI (although there was unexplained heterogeneity).

Assessment of dietary patterns in celiac disease patients using factor analysis method and their relationship with dietary intakes and body mass index.

BACKGROUND/OBJECTIVES: Celiac disease (CD) is a systemic and autoimmune enteropathy of the gastrointestinal tract with malabsorption characteristics. The only effective treatment for CD is adhere strictly to a gluten-free diet (GFD) throughout life. We evaluated the dietary patterns in celiac disease patients and their association with dietary intakes and anthropometric measurements in Iran. SUBJECTS/METHODS: This is a case-control study on 182 participants who were referred to the Khuzestan Celiac Association, Iran. Nutritional information was collected using a validated 147-item semi-quantitative food frequency questionnaire (FFQ). The software Stata (StataCorp, Version 14.0) was used to analyze the data. Principal component analysis (PCA) was used to obtain participants' dietary patterns. RESULTS: A significant relationship was observed between age and body mass index (BMI) across quartiles of the healthy dietary pattern score (P < 0.001, P = 0.001, and P = 0.001, respectively), indicating that as age and BMI increased, participants demonstrated greater adherence to the healthy dietary pattern. Individuals with the highest adherence to the healthy dietary pattern had the lowest odds ratio for celiac disease (CD) (Q1: reference; Q2: 1.96, 95% CI: 0.84-4.55; Q3: 0.61, 95% CI: 0.27-1.42; Q4: 0.10, 95% CI: 0.03-0.33, P trend < 0.001), and this association remained significant after adjusting for BMI (adjusted P trend = 0.003) and energy intake (adjusted P trend < 0.001). Moreover, there was a significant association between the lowest odds ratio for CD and the highest adherence to the unhealthy dietary pattern after adjustment for energy intake (Q1: reference; Q2: 0.38, 95% CI: 0.13-1.12; Q3: 0.21, 95% CI: 0.06-0.71; Q4: 0.07, 95% CI: 0.02-0.29, adjusted P trend < 0.001). Additionally, a significant association was observed between the odds ratio for CD and the mixed dietary pattern score (Q1: reference; Q2: 6.01, 95% CI: 2.29-15.72; Q3: 2.47, 95% CI: 0.93-6.55; Q4: 4.84, 95% CI: 1.84-12.66, P trend = 0.02), and this association remained significant after adjustment for energy intake (adjusted P trend < 0.001). CONCLUSIONS: The findings of the present study indicate that individuals who adhere to healthy dietary patterns have a lower incidence of celiac disease.

Soy Foods and the Risk of Fracture: A Systematic Review of Prospective Cohort Studies.

OBJECTIVES: The primary objective of our study was to systematically review all available prospective cohort studies which investigated the association of soy food intake and incident fracture risk. METHODS: We searched PubMed, Scopus, and Embase databases for relevant studies up to June 2021. SYNTHESIS: Of 695 records, a total of 5 cohort studies were included in the current systematic review. Two studies that were performed in China evaluated hip fracture while 2 studies that were done in Singapore evaluated any kind of fractures. The other study was conducted in Japan and evaluated osteoporosis fractures. All studies used a face-to-face interview to assess the dietary intake of soy foods. All 5 cohort studies were determined to be of high quality. One study considered soy food as a part of a vegetables-fruit-soy food dietary pattern. Others reported the association of dietary intake of soy foods with the risk of fractures. CONCLUSION: The evidence from prospective cohort studies was suggestive for a protective role of soy foods, alone or within a dietary pattern, in the risk of incident fracture among Asian women, particularly for those in early menopause and those who used fermented soy products. But for men, the association was not significant. However, more cohort studies, including non-Asian populations, are required to confirm this association fully.

A review of fasting effects on the response of cancer to chemotherapy.

BACKGROUND & AIMS: Studies suggest that fasting before or during chemotherapy may induce differential stress resistance, reducing the adverse effects of chemotherapy and enhancing the efficacy of drugs. In this article, we review the effects of fasting, including intermittent, periodic, water-only short-term fasting, and caloric restriction on the responsiveness of tumor cells to cytotoxic drugs, their protective effect on normal cells, and possible mechanisms of action. METHODS: We could not perform a systematic review due to the wide variation in the study population, design, dependent measures, and outcomes (eg, type of cancer, treatment variation, experimental setting, etc.). However, a systematic approach to search and review literature was used. The electronic databases PubMed (MEDLINE), Scopus, and Embase were searched up to July 2020. RESULTS: Fasting potentially improves the response of tumor cells to chemotherapy by (1) repairing DNA damage in normal tissues (but not tumor cells); (2) upregulating autophagy flux as a protection against damage to organelles and some cancer cells; (3) altering apoptosis and increasing tumor cells' sensitivity to the apoptotic stimuli, and preventing apoptosis-mediated damage to normal cells; (4) depleting regulatory T cells and improving the stimulation of CD8 cells; and (5) accumulating unfolded proteins and protecting cancer cells from immune surveillance. We also discuss how 'fasting-mimicking diet' as a modified form of fasting enables patients to eat a low calorie, low protein, and low sugar diet while achieving similar metabolic outcomes of fasting. CONCLUSION: This review suggests the potential benefits of fasting in combination with chemotherapy to reduce tumor progression and increase the effectiveness of chemotherapy. However, with limited human trials, it is not possible to generalize the findings from animal and in vitro studies. More human studies with adequate sample size and follow-ups are required to confirm these findings.

The effect of oral curcumin supplementation on health-related quality of life: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND AIMS: With an aging society, a multitude of physical, mental, and emotional challenges are being faced both in the general population and by those with chronic disorders. An enhanced understanding of 'quality of life' could be considered a major criterion for improved clinical care. We performed a meta-analysis to examine the effect of oral curcumin on improving the health-related quality of life (HRQOL). METHODS: A systematic search was performed through PubMed, Clarivate Web of Science, Scopus, and Embase up to February 2020 using relevant keywords. Trials that met the inclusion criteria were included in this study. We applied the standardized mean difference (SMD) in a random-effects model to analyze the impact of combined trials. Additionally, we used the Cochrane Risk Bias Tool to evaluate any potential risks of bias. RESULTS: A total of 10 studies were considered eligible and included in the meta-analysis. We found an overall significant effect of oral curcumin supplementation on improved HRQOL (SMD: 2.46, 95% CI: 1.30, 3.63; I2=97.4). In the subgroup analysis, curcumin showed significantly favorable effects on HRQOL in trials with a short duration of curcumin intervention (<5 months) and those that used curcumin formulations with high bioavailability. CONCLUSION: Oral curcumin has a strong positive impact on HRQOL. Our analysis supports the use of an improved-bioavailability formulation of curcumin to improve HRQOL. However, given the heterogeneity among the studies included in this review, additional evidence from well-designed, large, and long-term trials is still required.

Effect of Fasting-Mimicking Diet or Continuous Energy Restriction on Weight Loss, Body Composition, and Appetite-Regulating Hormones Among Metabolically Healthy Women with Obesity: a Randomized Controlled, Parallel Trial.

BACKGROUND: Fasting-mimicking diet (FMD) has been recently promoted to achieve similar metabolic changes of fasting. The purpose of our study was to compare the effect of FMD versus continuous energy restriction (CER) on anthropometric measurements, body composition, glucose metabolism, and serum levels of leptin, neuropeptide Y (NPY), and total ghrelin. METHODS: A randomized controlled trial (RCT) was conducted on 60 women with obesity aged 18-55 years. Subjects received either a 5-day FMD (low in energy, sugars, and proteins, but high in unsaturated fats) or a CER (an average daily energy deficit of 500 kcal) for 2 months. Anthropometric and biochemical factors were measured at baseline and the end of the study. Serum levels of leptin, total ghrelin, and NPY were tested with an ELISA kit. Physical activity and dietary intakes were also recorded. RESULTS: There was no significant difference in weight loss between the two groups: mean weight change for CER was - 2.29 (standard deviation [SD], 1.95) kg compared to - 1.13 (2.27) kg for FMD (p = 0.06). There was more reduction in the basal metabolic rate (BMR) in the CER group (p = 0.045). Favorable effects on fat mass and muscle mass were only seen in the FMD group. Although insulin resistance was reduced in the FMD group compared to the CER group, results were not significant after adjustment. After controlling for potential confounders, there was a significant increase in serum levels of total ghrelin (p = 0.048) and NPY (p = 0.041) following CER; however, results for circulating leptin were not statistically significant (p = 0.48). CONCLUSIONS: There was no significant difference in weight loss following FMD and CER. However, FMD was more effective at reducing insulin resistance and regulating appetite-regulating hormones as well as preserving muscle mass and BMR. TRIAL REGISTRATION: This trial was registered at the Iranian Clinical Trial Registry ( https://www.irct.ir/trial/40881 ) with the IRCT identification number IRCT20190717044244N1.

Association of Total Nut, Tree Nut, Peanut, and Peanut Butter Consumption with Cancer Incidence and Mortality: A Comprehensive Systematic Review and Dose-Response Meta-Analysis of Observational Studies.

Data on the association of nut intake with risk of cancer and its mortality are conflicting. Although previous meta-analyses summarized available findings in this regard, some limitations may distort their findings. Moreover, none of these meta-analyses examined the dose-response associations of total nut intake with the risk of specific cancers as well as associations between specific types of nuts and cancer mortality. Therefore, this study aimed to summarize available findings on the associations of total nut (tree nuts and peanuts), tree nut (walnuts, pistachios, macadamia nuts, pecans, cashews, almonds, hazelnuts, and Brazil nuts), peanut (whole peanuts without considering peanut butter), and peanut butter consumption with risk of cancer and its mortality by considering the above-mentioned points. We searched the online databases until March 2020 to identify eligible articles. In total, 43 articles on cancer risk and 9 articles on cancer mortality were included in the current systematic review and meta-analysis. The summary effect size (ES) for risk of cancer, comparing the highest with lowest intakes of total nuts, was 0.86 (95% CI: 0.81, 0.92, P < 0.001, I2 = 58.1%; P < 0.01), indicating a significant inverse association. Such a significant inverse association was also seen for tree nut intake (pooled ES: 0.87, 95% CI: 0.78-0.96, P < 0.01, I2 = 15.8%; P = 0.28). Based on the dose-response analysis, a 5-g/d increase in total nut intake was associated with 3%, 6%, and 25% lower risks of overall, pancreatic, and colon cancers, respectively. In terms of cancer mortality, we found 13%, 18%, and 8% risk reductions with higher intakes of total nuts, tree nuts, and peanuts, respectively. In addition, a 5-g/d increase in total nut intake was associated with a 4% lower risk of cancer mortality. In conclusion, our findings support the protective association between total nut and tree nut intake and the risk of cancer and its mortality.

Comparison of anthro-metabolic indicators for predicting the risk of metabolic syndrome in the elderly population: Bushehr Elderly Health (BEH) program.

BACKGROUND: Metabolic syndrome (MetS) is a cluster metabolic disorder that includes central obesity, insulin resistance, hypertension, and dyslipidemia, and is highly associated with an increased risk of developing non-communicable diseases (NCDs). This study aimed to compare the reliability of anthro-metabolic indices [visceral adiposity index (VAI), body roundness index (BRI), and a body shape index (BSI), body adiposity index (BAI), lipid accumulation product (LAP), waist to hip ratio, and waist to height ratio] in predicting MetS in Iranian older people. METHODS: This cross-sectional study was conducted based on the data of 2426 adults aged ≥60 years that participated in the second stage of the Bushehr Elderly Health (BEH) program, a population-based prospective cohort study being conducted in Bushehr, Iran. MetS was defined based on the revised National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. The receiver operating characteristic (ROC) curve analysis was used to assess predictive performance of anthro-metabolic indices and determine optimal cutoff values. Logistic regression analysis was applied to determine the associations between MetS and indices. RESULTS: 2426 subjects (48.1% men) with mean ± SD age of 69.34 ± 6.40 years were included in the study. According to ATP III criteria, 34.8% of men and 65.2% of women had MetS (P < 0.001). Of the seven examined indices, the AUCs of VAI and LAP in both genders were higher than AUCs of other anthro-metabolic indices. Also, in general population, VAI and LAP had the greatest predictive power for MetS with AUC 0.87(0.86-0.89) and 0.87(0.85-0.88), respectively. The lowest AUC in total population belonged to BSI with the area under the curve of 0.60(0.58-0.62). After adjusting for potential confounders (e.g. age, sex, education, physical activity, current smoking) in the logistic regression model, the highest OR in the total population was observed for VAI and LAP, which was 16.63 (13.31-20.79) and 12.56 (10.23-15.43) respectively. The lowest OR for MetS was 1.93(1.61-2.30) for BSI. CONCLUSION: This study indicated that both VAI and LAP are the most valuable indices among the anthro-metabolic indices to identify MetS among the elderly in both genders. So, they could be used as proper assessment tools for MetS in clinical practice. However, the cost-benefit of these indices compared to the ATP III criteria need further studies.

Major dietary patterns in relation to obesity and quality of sleep among female university students.

BACKGROUND: Few studies reported the association of dietary patterns with obesity, central adiposity, and quality of sleep. We aimed to investigate the association between major dietary patterns and anthropometric indices in relation to obesity and quality of sleep among female students of Ahvaz Jundishapur University of Medical Sciences (AJUMS). METHODS: This cross-sectional study was conducted on 245 female university students aged 18-38 years. To assess sleep quality, we used a self-reported Pittsburgh sleep quality index (PSQI). Usual dietary intakes were assessed with the use of a 168 items food frequency questionnaire (FFQ). We used factor analysis to identify dietary patterns. RESULTS: Four major dietary patterns were identified: mixed, high protein, Western, and healthy dietary patterns. After adjustment for energy intake, subjects in the upper tertile of the mixed dietary pattern were more likely to have a high quality of sleep than those in the first tertile (odds ratio [OR]: 0.27; 95% CI: 0.13, 0.55). Individuals with greater adherence to Western dietary pattern had greater odds of having low quality of sleep compared to those in the first tertile (OR: 1.99; 95% CI: 1.04, 3.82). A healthy dietary pattern was associated with a higher quality of sleep; however, the association was no longer significant after adjustment for dietary energy intake. No significant association was found for high protein dietary patterns. Compared to the first tertile of the healthy dietary pattern, individuals in the upper tertile were less likely to be centrally obese (OR = 0.15; 95% CI = 0.50-0.52). Participants in the last tertile of the high protein dietary pattern were less likely to be generally obese (OR = 0.34; 95% CI = 0.12-0.99), whereas those in the upper tertile of the Western dietary pattern were more likely to be generally obese (OR = 1.84; 95% CI = 1.08-4.93). CONCLUSIONS: Adherence to a mixed dietary pattern was associated with a high quality of sleep; however, the result was not significant for a high protein dietary pattern. While the high protein dietary pattern was negatively associated with general and central obesity, students in the upper tertile of the Western dietary pattern were more likely to be generally obese.

Oral Magnesium Supplementation Improved Lipid Profile but Increased Insulin Resistance in Patients with Diabetic Nephropathy: a Double-Blind Randomized Controlled Clinical Trial.

Low serum magnesium concentrations were associated with development of renal failure. We aimed to determine whether magnesium supplementation improves renal function, insulin resistance, and metabolic profiles in patients with diabetic nephropathy. A total of 80 hypomagnesemic patients diagnosed with type 2 diabetes and early-stage nephropathy were recruited. Subjects received either daily magnesium oxide or placebo for 12 weeks. Biochemical and anthropometric variables were measured. Physical activity and dietary intakes were also recorded. This study was approved by the ethics committee of Isfahan University of Medical Sciences and was registered on the Iranian Registry of Clinical Trials website (IRCT registration no. IRCT201404271485N12). Serum magnesium levels were not changed significantly. Although the supplementation did not influence glycemic indices, patients in the magnesium group had greater insulin resistance compared with the placebo group after intervention (0.3 ± 2.3 µIU/mL vs. - 0.04 ± 2.05, P = 0.04). No significant changes were observed in serum total cholesterol, triglycerides, HDL, LDL, and total cholesterol/HDL cholesterol ratio. Furthermore, magnesium did not affect inflammation, serum levels of creatinine, and blood urine nitrogen. However, a marginal decrease in microalbuminuria (- 3.1 ± 2.2 mg/L vs. - 14 ± 9.9, P = 0.09) was observed. Oral magnesium supplementation slightly improved microalbuminuria but resulted in increased insulin resistance in patients with diabetic nephropathy.

The Effects of Probiotic/Synbiotic on Serum Level of Zonulin as a Biomarker of Intestinal Permeability: A Systematic Review and Meta-Analysis.

BACKGROUND: This systematic review and meta-analysis was conducted to obtain a conclusive result on the influence of probiotics/synbiotic on serum levels of zonulin. Data related to serum levels of zonulin were extracted to determine the effects of probiotic/synbiotic on intestinal permeability. METHODS: The literature search was conducted across the Cochrane Central Register of Controlled Trials, Pub-Med, Scopus and ISI Web of Science, Search up to Nov 2018. Clinical trials evaluating the effect of probiotic/synbiotic on serum zonulin levels of all human subjects were included. RESULTS: Nine studies (including 496 intervention and 443 control subjects) met the inclusion criteria for the meta-analysis. According to the meta-analysis, probiotic/synbiotic has a significant effect on serum zonulin reduction (WMD=-10.55 [95% CI: -17.76, -3.34]; P=0.004). However, the high level of heterogeneity was observed among the studies (I2=97.8, P<0.001). The subgroup analysis suggested study quality, blinding, study duration, Participants age, subject's health status and supplement type as sources of heterogeneity. CONCLUSION: Probiotic/synbiotic have favorable effects on serum levels of zonulin as a measure of intestinal permeability. However, the results should be interpreted with caution due to the high heterogeneity and further evidence is required before definitive recommendations can be made.