The Effects of Curcumin Administration on Carotid Intima-Media Thickness and Pulse Wave Velocity in Diabetic Hemodialysis Patients: A Randomized, Double-Blinded, Placebo-Controlled Trial.

Background: Prior studies have reported that curcumin is inversely associated with reduced markers of atherosclerosis risk, including carotid intima-media thickness (CIMT). This study was designed to assess the effects of curcumin on CIMT and pulse wave velocity (PWV) in diabetic hemodialysis (HD) patients. Methods: This randomized, double-blinded, placebo-controlled trial was conducted on 39 diabetic HD patients. People were assigned to receive curcumin or placebo (starch) for 24 weeks. Individuals in the curcumin group (n = 26) received 80 mg/day. CIMT and PWV levels were taken at baseline and after 24 weeks of intervention. Results: After 24 weeks of intervention, curcumin intake did not affect mean levels of left (P = 0.83) and right (P = 0.47) CIMT and maximum levels of left (P = 0.84) and right (P = 0.11) CIMT, and PWV (P = 0.12) compared to the placebo. Furthermore, within-group difference demonstrated a significant reduction in mean levels of PWV (P = 0.01) in the curcumin group. We did not observe any significant change in C-reactive protein (CRP) concentrations after curcumin intake (P = 0.69). Conclusions: Curcumin intake did not affect mean levels of left and right CIMT and maximum levels of left and right CIMT, PWV, and CRP levels compared to the placebo. Additionally, within-group difference demonstrated a significant reduction in mean levels of PWV in the curcumin group.This trial was registered at www.irct.ir as http://www.irct.ir: IRCT20200527047584N1.

Dietary Magnesium Intake and Proteinuria: Is There a Relationship?

The possible relationship between dietary magnesium status and proteinuria has been suggested by a number of previous studies. However, human studies on this association are limited. Therefore, the present study aimed to investigate the independent relationship between dietary magnesium intake and urinary protein excretion. The present study was a post hoc analysis of the previous randomized clinical trial that evaluated the effect of dietary phosphorus restriction on proteinuria. The baseline data of 90 participants with proteinuria and chronic kidney disease was used to measure the association between dietary magnesium intake and proteinuria. Participants were asked to record their 24-h food intake for three days a week in a questionnaire. Urinary protein to creatinine ratio (UPCR) in a random urine sample was measured to be a marker for proteinuria. Out of 90 patients included in the study, 47 were men and 43 were women. The mean ± standard deviation of age and body mass index were 59.05 ± 14.16 years and 29.02 ± 5.54 kg/m2, respectively. The patients' average daily dietary intake of energy and magnesium were 2183 kcal and 169.44 mg, respectively. A significant inverse correlation was found between the dietary intake of magnesium and UPCR (r = - 0.219, p = 0.042). This association remained significant even after adjusting for confounding variables (ß = - 0.222, p = 0.028). The findings of the present study showed a significant inverse relationship between the magnesium intake and proteinuria. Although, the design of the current research was cross-sectional, it has provided a basis for conducting future longitudinal studies and trials to better elucidate such a relationship.

Implementation of an In-House Platform for Rapid Screening of SARS-CoV-2 Genome Variations.

BACKGROUND: Global real-time monitoring of SARS-CoV-2 variants is crucial to controlling the COVID-19 outbreak. The purpose of this study was to set up a Sanger-based platform for massive SARS-CoV-2 variant tracking in laboratories in low-resource settings. METHODS: We used nested RT-PCR assay, Sanger sequencing and lineage assignment for 930-bp of the SARS-CoV-2 spike gene, which harbors specific variants of concern (VOCs) mutations. We set up our platform by comparing its results with whole genome sequencing (WGS) data on 137 SARS-CoV-2 positive samples. Then, we applied it on 1028 samples from March-September 2021. RESULTS: In total, 125 out of 137 samples showed 91.24% concordance in mutation detection. In lineage assignment, 123 out of 137 samples demonstrated 89.78% concordance, 65 of which were assigned as VOCs and showed 100% concordance. Of 1028 samples screened by our in-house method, 78 distinct mutations were detected. The most common mutations were: S:D614G (21.91%), S:P681R (12.19%), S:L452R (12.15%), S:T478K (12.15%), S:N501Y (8.91%), S:A570D (8.89%), S:P681H (8.89%), S:T716I (8.74%), S:L699I (3.50%) and S:S477N (0.28%). Of 1028 samples, 980 were attributed as VOCs, which include the Delta (B.1.617.2) and Alpha (B.1.1.7) variants. CONCLUSION: Our proposed in-house Sanger-based assay for SARS-CoV-2 lineage assignment is an accessible strategy in countries with poor infrastructure facilities. It can be applied in the rapid tracking of SARS-CoV-2 VOCs in the SARS-CoV-2 pandemic.

Correlation Between Serum Homocysteine Levels and Carotid Intima-media Thickening in Hemodialysis Patients.

NTRODUCTION: Hyperhomocysteinemia is an important risk factor for cardiovascular disease in ESKD patients. Homocysteine, as an inflammatory factor, and carotid intima-media thickness (CIMT) could predict atherosclerosis in hemodialysis-treated ESKD patients. In this regard, the present study was conducted to investigate serum homocysteine level and its relationship with internal carotid intima thickness in ESKD patients undergoing routine hemodialysis. METHODS: This study comprised 56 ESKD patients, older than 40 years, undergoing hemodialysis for at least 1 year. All participants were taking Nephrovit for at least 6 months. The study participants were patients who underwent ultrasonography for CIMT determination and laboratory test Results. There was no statistically significant relationship between the mean homocysteine level and hypertension, diabetes mellitus, duration of dialysis, and body mass index (BMI). Among the study participants, the results also showed that the mean value of CMIT homocysteine and C-reactive protein (CRP) were 0.89 millimeters, 30.44 (mcmol/L), and 35.60 mg/L; respectively. Despite hypertension, there was a significant difference between the mean values of CMIT in patients with diabetes mellitus and those who had been on dialysis for a longer period (more than 3 years). Also, the mean value of CMIT was significantly higher in obese patients than those with normal BMI. None of the other variables including homocysteine serum level, C-reactive protein (CRP), and CMIT showed a significant correlation. CONCLUSION: The results of the study suggest that there is no relationship between serum homocysteine level and carotid intima-media thickness in hemodialysis patients.  DOI: 10.52547/ijkd.7424.

Pure Graphene Acts as an "Entropic Surfactant" at the Octanol-Water Interface.

Graphene oxide (GO) has proved itself as a nanomaterial capable of acting as a surfactant by lowering the interfacial tension of the oil-water interface due to its polar oxygen groups. However, the surfactant behavior of the pure graphene sheet─since prevention of edge oxidation in experimental setups is nontrivial─is still an unresolved issue in graphene research despite significant progress in the field in recent years. Here, we conduct both atomistic and coarse-grained simulations to demonstrate that─surprisingly─even pristine graphene, which only consists of hydrophobic carbon atoms, is attracted to the octanol-water interface and consequently reduces its surface tension by 2.3 kBT/nm2 or about 10 mN/m. Interestingly, the location of the free energy minimum is not precisely at the oil-water interface itself but is rather buried about two octanol layers into the octanol phase, being about 0.9 nm from the water phase. We demonstrate that the observed surfactant behavior is purely entropically driven and can be attributed to the unfavorable lipid-like structuring of octanol molecules at the free octanol-water interface. In essence, graphene enhances the inherent lipid-like behavior of octanol at the water interface rather than directly acting as a surfactant. Importantly, graphene does not display surfactant-like behavior in corresponding Martini coarse-grained simulations of the octanol-water system since the free liquid-liquid interface loses essential structure at the lower coarse-grained resolution. However, a similar surfactant behavior is recovered in coarse-grained simulations of longer alcohols such as dodecan-1-ol and hexadecan-1-ol. The observed discrepancies at different model resolutions enable us to construct a comprehensive model of the surfactant behavior of graphene at the octanol-water interface. The here-gained insights may facilitate the broader utilization of graphene in numerous domains of nanotechnology. Furthermore, since a drug's octanol-water partition coefficient is a crucial physicochemical parameter in rational drug discovery, we also believe that the universality of the here-illustrated entropic surfactant behavior of planar molecules deserves special attention in the drug design and development field.

Molecular investigation of Toxocara infection from the serum of people living with HIV in Alborz, Iran.

BACKGROUND: Toxocara infection is one of the most common neglected infections of poverty and a helminthiasis of global importance. Traditional diagnostic methods such as antibodies detection in serum samples are limited due to cross-reactivity and poor sensitivity. The use of molecular base methods for diagnosis of Toxocara infection in Iran has not been fully explored. The purpose of the current study was to estimate the prevalence of Toxocara infection from serum samples of people living with HIV in Alborz province, Iran using serological and molecular methods. METHODS: Blood samples were collected from 105 people living with HIV. Epidemiological data of participant were obtained through a structured questionnaire to investigate the risk factors. Patients CD4+ T cell count were recorded. Anti-Toxocara IgG antibodies were detected by ELISA, with a cut-off point of 11. PCR was performed to detect genetic material of Toxocara species in the serum samples. RESULTS: The mean CD4+ count in HIV-infected individuals with positive toxocariasis serology was 255.1 ± 21.6 cells/µL. Seropositivity for Toxocara species was observed in 12/105 (11.4%) people living with HIV. Three samples gave positive results on PCR analysis. Based on the data, a statistically significant relationship was found between anti-Toxocara IgG antibodies seropositivity and underlying conditions (p = 0.017). No significant statistical association was observed between seropositivity for Toxocara and gender, age, exposure to domestic animals or pet keeping, education levels, and occupation (p > 0.05). The findings of PCR confirmed Toxocara DNA in 3/12 (25.0%) serum samples. CONCLUSION: These findings demonstrated for the first time that people living with HIV from Alborz province, are being exposed to this zoonosis and a relatively high seroprevalence of Toxocara in HIV/AIDS people needs comprehensive health education regarding personal hygiene and how to avoid exposure to this parasite infection, especially in people with an impaired immune system.

Influence of hormones in multiple sclerosis: focus on the most important hormones.

Hormonal imbalance may be an important factor in the severity of multiple sclerosis (MS) disease. In this context, hormone therapy has been shown to have immunoregulatory potential in various experimental approaches. There is increasing evidence of potentially beneficial effects of thyroid, melatonin, and sex hormones in MS models. These hormones may ameliorate the neurological impairment through immunoregulatory and neuroprotective effects, as well as by reducing oxidative stress. Expanding our knowledge of hormone therapy may be an effective step toward identifying additional molecular/cellular pathways in MS disease. In this review, we discuss the role of several important hormones in MS pathogenesis in terms of their effects on immunoregulatory aspects and neuroprotection.

Association of Zinc Status with Matrix Metalloproteinases, Advanced Glycation End-Products, and Blood Pressure in Patients with Chronic Kidney Disease.

Inflammation, oxidative stress, and hypertension trigger the development of chronic kidney disease (CKD). Zinc is known to have antioxidant and anti-inflammatory properties and a possible role in regulating blood pressure. The aim of this study was to investigate the correlation of serum zinc with matrix metalloproteinase-2 and-9 (MMP-2, MMP-9), advanced glycation end products (AGEs), and blood pressure in patients with CKD. This cross-sectional study included 90 patients with CKD. Serum zinc and the levels of MMP-2, MMP-9, AGEs, and creatinine were measured using validated biochemical methods. Three 24-h food recalls were completed to evaluate dietary zinc intake. Systolic and diastolic blood pressure (SBP, DBP) were measured using a digital sphygmomanometer. Participants' mean age was 60.68 ± 8.81 years. The prevalence of zinc deficiency in our participants was 10%. Serum zinc was negatively correlated with MMP-9 (r = - 0.231, p = 0.032) and creatinine (r = - 0.304, p = 0.004). However, after adjusting for confounding variables, the association between serum zinc and MMP-9 was near the significance level (ß = - 0.174, p = 0.09) and zinc remained in the model as one of the predictors. Serum zinc was positively correlated with the dietary intake of zinc (r = 0.241, p = 0.025) and estimated glomerular filtration rate (eGFR) (r = 0.259, p = 0.015). In conclusion, our results showed that serum zinc might be one of the predictors of serum MMP-9 in patients with CKD. In addition, serum zinc was positively associated with its dietary intake and eGFR. Future longitudinal studies or clinical trials are required to reveal any causal association between zinc status and profibrotic or inflammatory biomarkers among patients with CKD.

Dietary Acid Load and Predialysis Serum Bicarbonate Levels in Patients With End-Stage Renal Disease.

OBJECTIVES: Maintaining the predialysis serum bicarbonate at a recommended level is critical in patients undergoing hemodialysis. Therefore, the present study investigated the association between dietary acid load (DAL) and serum predialysis bicarbonate levels in patients with end-stage renal disease. METHODS: Adult patients undergoing hemodialysis were enrolled in this cross-sectional study. Diet was assessed using a semiquantitative food frequency questionnaire. DAL was calculated with 2 validated indices: potential renal acid load (PRAL) and net endogenous acid production (NEAP). Values regarding predialysis serum bicarbonate level and serum electrolytes were obtained from the participant's medical records. The multiple linear regression analysis was used to determine the association between DAL indices and predialysis serum bicarbonate level. RESULTS: The number of hemodialysis patients eligible for this study was 122. The participants' mean age and body mass index was 57.14 ± 3.8 years and 25.2 ± 4.9 kg/m2, respectively. About 65.6% of participants were male. The mean serum levels of predialysis bicarbonate were 21.59 ± 3.1 mEq/L. Also, 47.5% of patients had predialysis serum bicarbonate levels below the recommended value. The mean values of PRAL and NEAP were -2.8 ± 7.48 and 42.7 ± 10.1 mEq/day, respectively. PRAL significantly and inversely predicted predialysis serum bicarbonate level independent of covariates (standardized ß = -0.38; P < .001). Also, NEAP was independently and inversely associated with predialysis bicarbonate level (standardized ß = -0.40; P < .001). Consuming vegetables such as lettuce, tomato, cucumber, spinach, and dried fruits as well as low-fat milk, plain yogurt, and cream cheese were positively correlated to predialysis serum bicarbonate level. However, the canned tuna had a negative correlation with the predialysis serum bicarbonate. CONCLUSIONS: The study's findings showed that the lower DAL was associated with higher predialysis serum bicarbonate levels in patients with end-stage renal disease. Due to the cross-sectional nature of the present study, prospective cohorts or well-controlled clinical trials are needed to confirm our result.

The effects of melatonin administration on carotid intima-media thickness and pulse wave velocity in diabetic nephropathy: A randomized, double-blind, placebo-controlled trial.

BACKGROUND: Previous studies have reported that melatonin intake is inversely associated with reduced markers of atherosclerosis development such as carotid intima-media thickness (CIMT). OBJECTIVE: This study was designed to assess the effects of melatonin administration on CIMT and pulse wave velocity (PWV) in patients with diabetic nephropathy (DN). MATERIALS AND METHODS: This randomized, double-blind, placebo-controlled trial was conducted on 32 DN patients. Subjects were assigned to receive melatonin or placebo (starch) for 24 weeks. Individuals in the melatonin group (n = 19) received 10 mg/day. CIMT and PWV levels were taken at the study baseline and after 24 weeks of intervention. RESULTS: After 24 weeks of intervention, melatonin intake did not affect mean levels of left (P = 0.51) and right (P = 0.16) CIMT and maximum levels of left (P = 0.76) and right (P = 0.15) CIMT, and PWV (P = 0.55) compared with the placebo. In addition, within-group difference demonstrated a significant reduction in mean levels of right CIMT (P = 0.01) in the melatonin group. We did not observe any significant change in C-reactive protein (CRP) concentrations after melatonin intake (P = 0.81). CONCLUSIONS: Melatonin intake did not affect mean levels of left and right CIMT and maximum levels of left and right CIMT, PWV, CRP levels compared with the placebo. In addition, within-group difference demonstrated a significant reduction in mean levels of right CIMT in the melatonin group. This trial was registered at www.irct.ir as http://www.irct.ir: IRCT20200527047584N2.

Salivirus infection: Systematic review and meta-analysis of association with gastrointestinal symptoms in children.

Salivirus (SaV) is a newly described member of the family Picornaviridae that has been associated with gastrointestinal (GI) symptoms, particularly in children. The aim of the present study was to evaluate the prevalence of SaV in symptomatic children and its potential association with GI complications. A systematic search was conducted from 01 December 2009 to 10 December 2020, in three major English databases, including Scopus, PubMed and Web of Science as well as Google scholar search engine. Random effect model-based overall prevalence and odds ratio (OR) were assessed in cross-sectional and case-control studies by STATA 14.1. The random effect model-based pooled prevalence of SaV was 1.6% (95% CI, 0.010-0.022%) and overall OR for all eight case-control studies indicated an association (3.19 with 95% confidence interval 1.35-7.57) that was not statistically significant, due to the small number of studies available. More comprehensive case-control studies in multiple geographies should be conducted on the prevalence of SaV in children.

The effects of selenium administration on carotid intima-media thickness and metabolic status in diabetic hemodialysis patients: A randomized, double-blind, placebo-controlled trial.

BACKGROUND: Intake of dietary antioxidants is inversely associated with reduced markers of atherosclerosis development such as carotid intima-media thickness (CIMT). OBJECTIVE: This study was designed to assess the effects of selenium supplementation on CIMT and metabolic profiles of in diabetic hemodialysis (HD) patients. MATERIALS AND METHODS: This randomized, double-blind, placebo-controlled trial was performed on 60 diabetic HD patients. Subjects were randomly assigned to receive selenium supplements or placebo (starch). Individuals in the selenium group (n = 30) received 200 µg selenium per day in the placebo group (n = 30) received for 24 weeks. Fasting blood samples were taken at the study baseline and after 24 weeks of intervention. RESULTS: Following the administration of selenium supplements, was observed a significant reduction in serum insulin levels (P = 0.003), insulin resistance (P = 0.003), total cholesterol (P = 0.008), LDL-cholesterol (P < 0.001) and C-reactive protein (CRP) (P < 0.001), and a significant increase in insulin sensitivity (P < 0.001), HDL-cholesterol (P < 0.001) and total glutathione (GSH) (P < 0.001) compared with the placebo. CONCLUSIONS: Selenium supplementation in diabetic HD patients had beneficial effects on markers of insulin metabolism, total-, LDL-, HDL-cholesterol, CRP and GSH levels. This trial was registered at www.irct.ir as http://www.irct.ir: IRCT20170513033941N47.

Disease Waves of SARS-CoV-2 in Iran Closely Mirror Global Pandemic Trends.

BACKGROUND: Complete SARS-CoV-2 genome sequencing in the early phase of the outbreak in Iran showed two independent viral entries. Subsequently, as part of a genome surveillance project, we aimed to characterize the genetic diversity of SARS-CoV-2 in Iran over one year after emerging. METHODS: We provided 319 SARS-CoV-2 whole-genome sequences used to monitor circulating lineages in March 2020-May 2021 time interval. RESULTS: The temporal dynamics of major SARS-CoV-2 clades/lineages circulating in Iran is comparable to the global perspective and represent the 19A clade (B.4) dominating the first disease wave, followed by 20A (B.1.36), 20B (B.1.1.413), 20I (B.1.1.7), leading the second, third and fourth waves, respectively. We observed a mixture of circulating B.1.36, B.1.1.413, B.1.1.7 lineages in winter 2021, paralleled in a fading manner for B.1.36/B.1.1.413 and a growing rise for B.1.1.7, prompting the fourth outbreak. Entry of the Delta variant, leading to the fifth disease wave in summer 2021, was detected in April 2021. This study highlights three lineages as hallmarks of the SARS-CoV-2 outbreak in Iran; B4, dominating early periods of the epidemic, B.1.1.413 (B.1.1 with the combination of [D138Y-S477N-D614G] spike mutations) as a characterizing lineage in Iran, and the co-occurrence of [I100T-L699I] spike mutations in half of B.1.1.7 sequences mediating the fourth peak. It also designates the renowned combination of G and GR clades' mutations as the top recurrent mutations. CONCLUSION: In brief, we provided a real-time and comprehensive picture of the SARS-CoV-2 genetic diversity in Iran and shed light on the SARS-CoV-2 transmission and circulation on the regional scale.

Association of parvovirus B19 and myocarditis/dilated cardiomyopathy: A systematic review and meta-analysis.

BACKGROUND: The potential association between Parvovirus B19 and heart disease has been controversial. The aim of the present study was to report the prevalence of B19 in myocarditis and dilated cardiomyopathy (DCM) as well as measure the statistical association between them. METHODS: Our systematic search was carried out to retrieve published articles between January 2000 and March 2021 using three major databases: PubMed, Scopus, and Web of Science, as well as the Google Scholar search engine. The overall prevalence of HAV, pooled odds ratio, and heterogeneity were estimated by comprehensive meta-analysis (V2.2, Biostat) software. RESULTS: The overall prevalence results in myocarditis and DCM were 23.7% (95% CI: 18.7%-29.5%) and 34.1% (95% CI: 23.8%-46.1%) respectively; in addition, the overall OR for B19 and myocarditis was 4.317 (95% CI, 1.831-10.180) versus 1.163 (95% CI: 0.706-1.916) for B19 and DCM. CONCLUSION: Our findings have shown a significant association between Parvovirus B19 and myocarditis with a high prevalence. In the case of DCM, no significant association was found while the prevalence of the virus was relatively high.

Human Herpesvirus 6 Infection and Risk of Chronic Fatigue Syndrome: A Systematic Review and Meta-Analysis.

INTRODUCTION: Chronic fatigue syndrome (CFS) is a neurological disease that is accompanied by excessive fatigue or tiredness. There are several reports confirming the association between human herpesvirus 6 (HHV-6) infection and CFS illness. This systematic review and meta-analysis was performed to integrate the information of published studies with regard to this association until May 2021. METHODS: The literature search was based on keywords including "chronic fatigue syndrome and HHV 6," "chronic fatigue syndrome and HHV-6," "chronic fatigue syndrome and HHV6," "chronic fatigue syndrome and Herpes virus 6," and "chronic fatigue syndrome and Herpesvirus6" in MEDLINE (PubMed), Web of Science, and EMBASE. RESULTS: The literature search identified 17 studies to be included in the systematic review and 11 studies in meta-analysis. The symmetry funnel plot and Egger's test (p value = 0.2) identified no publication bias among studies. Moreover, the low level of I2 revealed homogeneity across studies. DISCUSSION: In conclusion, the association between the HHV-6 infection and CFS incidence was substantiated. However, the results of this study also suggest that further comprehensive studies are needed to solidify the association between HHV-6 and CFS. Future studies should consider additional factors that may have affected the significance of such a correlation.

SARS-CoV-2 outbreak in Iran: The dynamics of the epidemic and evidence on two independent introductions.

The SARS-CoV-2 virus has been rapidly spreading globally since December 2019, triggering a pandemic, soon after its emergence. While Iran was among the first countries confronted with rapid spread of virus in February 2020, no real-time SARS-CoV-2 whole-genome tracking in early phase of outbreak was performed in the country. To address this issue, we provided 50 whole-genome sequences of viral isolates ascertained from different geographical locations in Iran during March-July 2020. The corresponding analysis on origins, transmission dynamics and genetic diversity of SARS-CoV-2 virus, represented at least two introductions of the virus into the country, constructing two major clusters defined as B.4 and B.1*. The first entry of the virus might have occurred around very late 2019/early 2020, as suggested by the time to the most recent common ancestor, followed by a rapid community transmission that led to dominancy of B.4 lineage in early epidemic till the end of June. Gradually, reduction in dominancy of B.4 occurred possibly as a result of other entries of the virus, followed by surge of B.1* lineages, as of mid-May. Remarkably, variation tracking of the virus indicated the increase in frequency of D614G mutation, along with B.1* lineages, which showed continuity till October 2020. The increase in frequency of D614G mutation and B.1* lineages from mid-May onwards predicts a rapid viral transmission that may push the country into a critical health situation followed by a considerable change in composition of viral lineages circulating in the country.

Association of adenovirus 36 infection and obesity; An updated meta-analysis of community-based studies.

As a health problem, obesity has several risk factors; it has been suggested that human adenovirus type 36 (HAdV-36) infections may possibly be associated with obesity. This updated meta-analysis was designed and conducted with an emphasis on articles published from 2015 to 2020. The PubMed, Web of Science, and Scopus databases were searched up to 1 December 2020. Overall, pooled prevalence and odds ratio of antibodies against HAdV-36 in people with obesity and controls was assessed among different ages. Case-control and cohort studies were included in the analysis. The overall prevalence of HAdV-36 infection in obese population was 31% (CI: 0.24%-0.38%) which was 32% in cases and 27% in controls, respectively; a significant association was found between the cases and the controls (OR, 1.84; 95% CI, 1.39-2.43), especially in children younger than 18 years of age (OR, 2.44; 95% CI, 1.85-3.22). A significant association between adenovirus infection and obesity was found, especially in adolescents.