Negative expectations (nocebo phenomenon) in clinical interventions: A scoping review.

Unpredictable, undesirable, and confusing reactions in the face of psychological or medical interventions make the clinical presentation more complicated and may represent clinically unexplained symptoms and also disturbed the doctor-patients relationship and decrease patients' benefits of treatment. It seems that negative expectations from the treatment (nocebo phenomenon) can explain such reactions. The aim of the current study is a scoping review and investigate different aspects of the nocebo phenomenon (negative expectations) in clinical interventions. This paper follows a scoping review of the existence, importance, and multidimensions of the nocebo phenomenon in medical and psychological interventions. Data sources include literature databases (ProQuest, PubMed, Google Scholar, and Scopus) reviewed from inception dates to 2023, and the terms negative expectations, nocebo effect, placebo effect, negative placebo, and clinical interventions were searched. The review of the available articles showed that negative expectations play an important role in the process and effectiveness of clinical interventions. Negative expectations (here named nocebo effect) can significantly interfere with rapport and treatment processes. Some underlying components of the nocebo effect include negative expectancies, conditioning, social learning, memory, cognitive distortions, meaning, motivation, somatic focus, negative reinforcements, personality, anxiety, and neurophysiological factors such as CCK, dopamine, and cortisol are proposed for development and presence of nocebo phenomenon in clinical practice. Negative expectations with its biopsychosocial aspects play an important and amazing role in disorganizing medical and psychological interventions. Using appropriate methods to reduce nocebo effects in therapeutic interventions may increase treatment compliance and adherence and increase the effectiveness of interventions.

Dietary patterns in relation to glioma: a case-control study.

Although the association of individual foods and nutrients with glioma have been investigated, studies on the association of major dietary patterns and glioma are scarce. The aim of this study was to examine the association between major dietary patterns and risk of glioma in a group of Iranian adults. In this hospital-based case-control design, we recruited 128 newly diagnosed glioma cases and 256 controls in Tehran from 2009 to 2011. A Willett-format-validated 126-item semi-quantitative Food Frequency Questionnaire (FFQ) was used to assess participants' dietary intake. Factor analysis was used to identify major dietary patterns. We identified 3 major dietary patterns using factor analysis: high protein, vegetarian and western dietary pattern. After several adjustments for potential confounders, adherence to the high protein dietary pattern was inversely associated with risk of glioma (OR: 0.47; 95% CI: 0.23, 0.95). Consumption of vegetarian dietary pattern was also associated with a reduced risk of glioma (OR: 0.16; 95% CI: 0.07, 0.34). Greater adherence to the western dietary pattern was associated with a greater chance of glioma (OR: 3.30; 95% CI: 1.52, 7.17). We found that high protein, vegetarian and western dietary pattern were significantly associated with glioma risk. Further prospective studies are needed to confirm these findings.

The association between dietary total antioxidant capacity and hearing loss: results from the Tehran employees Cohort Study.

BACKGROUND: Despite numerous studies that have explored the association between individual antioxidants or specific combinations and the risk of hearing loss, there is lack of information regarding the relationship between dietary total antioxidant capacity (dTAC) and hearing loss. The conflicting results on this association further highlight the need for more research in this area. This study aims to investigate the association between overall dietary antioxidant intake and the risk of hearing loss among Iranian adults. METHODS: This cross-sectional study recruited 3443 adult participants aged between 19 and 67 years (with an average age of 41.4 years ± 8.8) who were employed at Tehran University of Medical Sciences in Iran. Participants underwent dietary assessment using a validated Food Frequency Questionnaire (FFQ). The hearing status of each participant was evaluated by a licensed audiologist in a soundproof room, using diagnostic audiometry that adhered to American National Standards specifications and followed standard audiometric clinical procedures. The dietary total antioxidant capacity (dTAC) was calculated using the Ferric Reducing-Antioxidant Power (FRAP) values. RESULTS: 43.6% of male participants had hearing loss, while 26.8% among female participants. After accounting for various confounding factors, no significant association was observed between higher levels of dTAC and reduced odds of hearing loss in the overall population. However, among men under the age of 40, higher levels of dTAC were associated with decreased odds of hearing loss, even after adjusting for several covariates (OR: 0.56, 95% CI: 0.31-1.02, Ptrend = 0.02). This relationship was not evident in men over 40 years of age or among women. CONCLUSION: The study found an inverse relationship between higher antioxidant intake in the diet and lower odds of hearing loss, specifically among men who were 40 years old or younger. However, this relationship was not observed in the overall population or among women. Additional prospective studies are necessary to validate these results.

Adherence to HEI-2010 and odds of breast cancer according to the menopause status: Evidence from Middle Eastern Country.

BACKGROUND: Majority of earlier studies have assessed the association between individual healthy eating index-2010 (HEI-2010) and the odds of breast cancer (BC). However, no study has been conducted on the effect of compliance with HEI-2010 and the odds of BC in the Iranian population with a large sample size. Therefore, we aimed to investigate the relationship between the HEI-2010 and the odds of BC in the Iranian population. METHOD: This population-based case-control study included 350 newly diagnosed cases of BC and 700 healthy controls randomly selected from adult women. HEI-2010 was examined using validated questionnaires. The adherence to HEI-2010 among the participants was divided into four categories. The general characteristics of the participants in the quartiles of the HEI score for categorical variables and continuous variables were evaluated using chi-square and one-way analysis of variance, respectively. Also, using logistic regression analysis, dietary intakes were evaluated in HEI score quartiles. Also, confounding variables were adjusted in different models. RESULT: People with the highest HEI score had 60% lower odds of BC (OR: 0.40; 95% CI: 0.27, 0.57) than those with the lowest score among post-menopause women. After controlling for age and energy intake, individuals with the highest HEI score were 78% less likely to have BC compared with those with the lowest score (OR: 0.22; 95% CI: 0.14, 0.33). Adjustments for other potential confounders including demographic factors made the association stronger (OR: 0.21; 95% CI: 0.13, 0.32). This association remained significant even after taking BMI into model (OR: 0.27; 95% CI: 0.17, 0.43). CONCLUSION: Finally, in this study we found an association between HEI-2010 and odds of breast cancer. This association was particularly seen in postmenopausal women. No significant association was found between adherence to HEI-2010 and odds of BC among pre-menopausal.

Mediterranean diet adherence and sleep pattern: a systematic review of observational studies.

BACKGROUND AND AIMS: Despite a huge body of evidence on the linkage between dietary intakes and pattern of sleeping, the findings are controversial. The current study aimed to summarize earlier findings on the association between adherence to Mediterranean diet (MD) and pattern of sleeping. METHODS: This study performed based on PRISMA guideline. Systematically search was applied in PubMed, Scopus and Google Scholar to find out relevant publications appeared up to February 2023. No restrictions on language and time of publication were applied. Duplicate citations were removed. We included observational studies which assessed MD as the main exposure and kind of sleep disorders as the main outcome. RESULTS: A total of 20 observational studies included. Out of these studies, two were cohort studies and 18 had a cross-sectional design. A total of 21,714 participants included. Usual dietary intakes were assessed using a validated Food Frequency Questionnaire, and a diet history questionnaire. Some studies did not report methods of measuring habitual dietary intakes. Adherence to MD was evaluated by KIDMED questionnaire, PREMED, alternate Mediterranean (aMed) questionnaire, MEDAS questionnaire, MedDietScore, MEDI-LITE score, modified Mediterranean Diet Score (mMDS), Mediterranean food pattern (MFP) and modified Mediterranean diet score (mMED). Pattern of sleeping was examined as sleep quality, sleep duration, sleep latency, sleep efficacy, sleepiness, sleep disturbance, taking a nap and some other sleep disorders. CONCLUSION: In conclusion, findings of published studies highlighted the importance of consumption of MD for better sleep quality.

Exploring the association between ultra-processed foods and COPD: a case-control study.

BACKGROUND: While it is known that the overconsumption of ultra-processed foods (UPFs) is associated with a heightened risk of respiratory ailments, the specific effects of UPF intake on COPD remain unclear. This study was designed to explore the potential link between COPD and the consumption of UPFs among adult individuals in Iran. METHODS: In this hospital-based case-control study conducted at Alzahra University Hospital in Isfahan, Iran, we enrolled 84 patients newly diagnosed with COPD, along with 252 healthy controls matched for age and sex. COPD was defined based on the results of spirometry tests, specifically when the forced expiratory volume per second (FEV1) was less than 80% or the ratio of FEV1 to forced vital capacity (FVC) was less than 70%. To evaluate the dietary intake of the participants, we utilized a validated food frequency questionnaire (FFQ) consisting of 168 items. Additionally, we gathered data on potential confounding factors using a pre-tested questionnaire. RESULTS: The mean ages for the case and control groups were 57.07 and 55.05 years, respectively. Our study found no significant association between the intake of ultra-processed foods (UPFs) and the likelihood of COPD, with an odds ratio (OR: 0.78, 95% CI: 0.34-1.77). This lack of association persisted even after adjusting for factors such as energy intake, sex, and age (OR: 0.48; 95% CI: 0.19-1.21). Further controlling for potential confounders like body mass index (BMI), physical activity, and smoking status did not alter this finding (OR: 0.367; 95% CI: 0.123-1.1008, P = 0.074). CONCLUSIONS: In our study, we observed no significant association between the intake of Ultra-Processed Foods (UPFs) and the odds of Chronic Obstructive Pulmonary Disease (COPD). This finding remained consistent even after adjusting for factors such as energy intake, sex, age, Body Mass Index (BMI), physical activity, and smoking status. Therefore, within the scope of our study, it appears that the consumption of UPFs does not significantly impact the likelihood of developing COPD. However, we recommend further research to deepen our understanding of the intricate relationship between dietary habits and respiratory health.

Dietary Magnesium Intake Is Inversely Associated With Ulcerative Colitis: A Case-Control Study.

Background: Ulcerative colitis (UC) causes long-lasting inflammation and ulcers in the gut. Limited observational data are available linking dietary magnesium intake and UC. In the present study, we aimed to investigate the association between dietary magnesium intake and UC in adults. Methods: The current population-based case-control study was performed on 109 UC patients and 218 age (±2 years) and sex-matched controls. The diagnosis of UC was made according to the standard criteria by a gastroenterology specialist. Dietary intakes were assessed using a validated self-administrated 106-item dish-based Food Frequency Questionnaire (FFQ). We also used a pretested questionnaire to collect data on potential confounders. Results: Individuals in the top tertile of magnesium intake were less likely to have UC compared with those in the bottom tertile. A significant inverse relationship was found between dietary magnesium intake and UC (odds ratio [OR]: 0.32, 95% confidence interval [CI]: 0.18-0.59) in the crude model. This relationship was also observed when we took several potential confounding into account (OR: 0.30, 95% CI: 0.14-0.68). Conclusions: Adherence to a magnesium-rich diet may have a role in preventing UC. However, further studies are needed to confirm our findings.

Effects of vitamin D supplementation on liver fibrogenic factors, vitamin D receptor and liver fibrogenic microRNAs in metabolic dysfunction-associated steatotic liver disease (MASLD) patients: an exploratory randomized clinical trial.

BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a global metabolic problem which can lead to irreversible liver fibrosis. It has been shown that vitamin D and its receptors contribute to fibrogenic pathways in the liver. However, the effect of vitamin D supplementation on liver fibrosis related factors have not been examined. This double blinded placebo controlled clinical trial was designed to investigate the effects on vitamin D supplementation on serum levels of VDR, fibrogenic factors and fibrogenic MicroRNAs in MASLD patients. METHODS: Forty six MASLD patients after block matching for sex and BMI were randomly assigned to receive 4000 IU/d vitamin D or placebo for 12 weeks. Weight, height and waist circumference were measured. Serum fibrogenic microRNAs, laminin, collagen type IV, hyaluronic acid, vitamin D, VDR, PTH, blood fasting glucose, serum fasting insulin, lipid profile, ALT and AST were determined at the baseline and at the end of the trial. Insulin resistance and insulin sensitivity were calculated using the HOMA-IR and QUICKI equation. RESULTS: Supplementation with vitamin D for 12 weeks led to the significant increases in serum 25(OH) vitamin D, VDR and HDL-C compared to placebo (P < 0.001, P = 0.008 and P < 0.001). There were significant decreases in ALT, AST, FBS and LDL-C levels in the vitamin D group as compared to the placebo (P < 0.05). Laminin and hyaluronic acid concentrations were significantly decreased in the vitamin D group as compared to the placebo group, by -10.6 and - 28.7 ng/mL, respectively. Supplementation with vitamin D for 12 weeks resulted in a significant lower MiR-21 and MiR-122 gene expressions compared to the placebo group (P = 0.01 and P < 0.001, respectively). DISCUSSION: As the first randomized controlled trial on the effect of vitamin D supplementation on serum levels of VDR, fibrogenic factors and fibrogenic MicroRNAs in MASLD patients, we found a significant reduction in some liver fibrogenic factors, in liver transaminases and corresponding changes in some fibrosis-related MiRs and some metabolic factors. Further clinical trials with larger sample sizes and direct measures of liver fibrosis are needed to confirm these findings. TRIAL REGISTRATION NUMBER: (available at: http://www.irct.ir , identifier: IRCT201405251485N13), Registration date: 14-03-2017.

The association between dietary patterns and disease severity in patients with ulcerative colitis.

Ulcerative colitis (UC) is a chronic inflammatory disease involving the colon and rectum. One of the most modifiable environmental factors affecting UC severity is the patient's dietary pattern. Although the role of dietary patterns on UC aetiology has been investigated previously, its relationship with disease severity has not yet been elucidated. This study examined the association between UC patients' dietary patterns and disease severity. This cross-sectional study was conducted in 340 UC patients. Using an FFQ, food patterns were assessed. Twenty-five food categories were categorised based on the similarity of the nutrient composition of the food using the factor analysis method. A simple clinical colitis activity index was used to determine disease severity. Three dietary patterns were identified based on the factor analysis: healthy, unhealthy and Western dietary pattern. After adjusting for potential confounding factors, patients who were in the highest tertile of healthy dietary pattern compared with the lowest tertile were 92 % less likely to have severe UC (OR: 0·08; 95 % CI: 0·03, 0·22). Also, those in the highest tertile of the Western dietary pattern were 3·86 times more likely to have severe UC than those in the lowest tertile (OR: 3·86; 95 % CI: 1·86, 8·00). Even after controlling for confounding variables, unhealthy dietary pattern did not increase the risk of severe UC. Our data indicate the beneficial role of healthy dietary pattern in amelioration of disease severity in UC patients. To confirm this association, more studies are needed, especially prospective cohort studies.

Nutrient patterns in relation to insulin resistance and endothelial dysfunction in Iranian women.

Prior studies have mainly focused on the association of one specific nutrient with insulin resistance (IR) and endothelial dysfunction and limited studies have assessed the association with different nutrient patterns (NPs). We examined the association between various NPs and IR and endothelial dysfunction among Iranian women. This cross-sectional study was carried out on a sample of 368 female nurses. A 106-items food frequency questionnaire (FFQ) was applied for dietary assessments. Using factor analysis, the relationships between NPs and markers of insulin resistance (HOMA-IR, HOMA-ß, and QUICKY), and endothelial dysfunction (E-selectin, sICAM-1, and sVCAM-1) were assessed. Mean age and body mass index of participants were respectively 35.21 years and 24.04 kg/m2. Three major NPs were identified. NP1, named as "dairy, fruits, and vegetables" had high values of potassium, folate, vitamins A and C, magnesium, and beta carotene. No significant association was observed between this NP and insulin resistance or endothelial dysfunction indices. The second NP was full of chromium, selenium, copper, vitamin B6, monounsaturated fatty acid (MUFA), thiamin, vitamin D, and iron. Adherence to NP2 (named "legumes, nuts, and protein foods") was associated with lower values of insulin (6.8 ± 1.1 versus 8.4 ± 1.1, P = 0.01), homeostasis model assessment-Insulin resistance (HOMA-IR) (1.3 ± 0.2 versus 1.7 ± 0.2, P = 0.02), and vascular adhesion molecule 1 (VCAM-1) (444.2 ± 27.9 versus 475.8 ± 28.4, P = 0.03). However, adherence to the third NP, rich in saturated fatty acid (SFA), cholesterol, sodium, zinc, vitamin E, and B12, described as "animal fat and meat + vitamin E", was associated with higher amounts of homeostasis model assessment-ß (HOMA-ß) (531.3 ± 176.2 versus 48.7 ± 179.8, P = 0.03). In conclusion, following the NP2, correlated with higher intakes of chromium, selenium, copper, vitamin B6, MUFA and thiamin was associated with lower values of insulin, HOMA-IR, and sVCAM-1. Adherence to NP3, rich in SFA, cholesterol, vitamin E, vitamin B12, and zinc was associated with higher levels of HOMA-ß.

Consumption of dairy products and odds of ulcerative colitis: An Iranian case-control study.

The association between dairy product consumption and the risk of ulcerative colitis (UC) is not well elucidated. This case-control study examined the association between Iranian adults' dairy consumption and UC risk. We used a valid food frequency questionnaire to analyze dietary intakes in 340 patients with pathologically confirmed cases of UC and 782 controls as part of a case-control research. Pasteurized milk, cheese, and yogurt dietary intakes were calculated along with dairy products. Other variables were acquired using questionnaires. Study participants' mean (± SD) age and body mass index were 41.5 ± 14.1 years and 27.4 ± 4.77 kg/m2, respectively. After adjusting for potential variables, individuals who consumed more total dairy products were less likely to get UC than those who consumed less (odds ratio [OR]: 0.44; 95% confidence interval (CI): 0.24, 0.79). We found a significant reverse association between milk intake (OR: 0.13; 95% CI: 0.07-0.24) and yogurt intake (OR: 0.52; 95% CI: 0.29-0.91) and UC, after controlling for potential confounders. Also, no significant association was found between cheese and UC risk (OR: 1.38; 95% CI: 0.84-2.28). Higher consumption of total dairy products may reduce UC risk. To be specific, milk and yogurt are inversely associated with this disorder. However, no link was found between cheese intake and UC. Longitudinal observational studies, especially cohorts, are needed to further assess these associations.

Associations of major dietary patterns with cardiometabolic risk factors among Iranian patients with type 1 diabetes.

Objective: To examine the associations between dietary patterns and cardiometabolic risk factors among type 1 diabetic (T1D) patients. Methods: This cross-sectional study was conducted on 229 Iranian T1D patients. Data on dietary intakes were collected using a 168-item food frequency questionnaire. To identify major dietary patterns, we merged data on the 168 food items to obtain 23 food groups. Then, we constructed major dietary patterns using factor analysis with varimax rotation. We used binary logistic regression to assess the association between dietary patterns and cardiometabolic risk factors, in which potential confounders were adjusted. Results: Four dietary patterns were identified: Western, unhealthy, traditional, and semi-healthy patterns. After adjusting for confounders including demographic variables, physical activity, energy intake, and medical history, participants in the highest tertile of the Western dietary pattern had 2.53 (95 % CI: 1.03-6.22) and 3.37 (95 % CI: 1.18-9.63) times more odds of elevated HbA1c and low estimated glucose disposal rate (eGDR), respectively, compared with those in the lowest tertile. Such the positive association was also seen for elevated fasting blood glucose (FBG). Moreover, individuals in the top tertile of unhealthy diet had more odds of elevated LDL-c and abdominal obesity than those in the lowest tertile. Regarding the semi-healthy diet, higher adherence was associated with 51 % lower odds of elevated FBG (OR: 0.49, 95 % CI: 0.24-0.99). For other outcomes, no significant association was found. Conclusion: We found that T1D patients may take benefit from adherence to a semi-healthy diet with a low amount of unhealthy and Western-related foods.

The association between diet quality and chronic obstructive pulmonary disease: a case-control study.

BACKGROUND: Previous investigations have primarily examined the relationship between various dietary patterns and the risk of chronic obstructive pulmonary disease (COPD); however, there have been limited studies that have evaluated the association between diet quality presented by Healthy Eating Index 2010 (HEI-2010) and COPD. The aim of this study was to investigate this association in Iranian population. METHODS: This case-control study recruited 84 cases and 252 healthy controls who were randomly selected. Diet, smoking, and physical activity were assessed using validated questionnaires. The HEI-2010 score ranged from zero to hundred twenty, with zero indicating an unhealthy diet and hundred twenty indicating a healthy diet. Logistic regression models were utilized to analyze the association between HEI-2010 and the odds of COPD. RESULTS: Results from logistic regression showed that individuals with higher HEI scores had a significantly lower odds of COPD (OR: 0.34; 95% CI: 0.16-0.72). After adjusting for confounders, individuals with the highest HEI score were 82% less likely to have COPD (OR: 0.18; 95% CI: 0.03-0.96). This association remained significant after adjusting for smoking and physical activity (OR: 0.08; 95% CI: 0.01-0.93) and with additional adjustment for BMI (OR: 0.08; 95% CI: 0.01-0.92). CONCLUSIONS: This study found a significant association between a higher HEI-2010 score and a lower odd of COPD in the Iranian population. These results suggest that a healthy diet may play a crucial role in reducing the odds of COPD and in improving the function of the lungs. However, further prospective studies are warranted to elucidate this relationship.

Dietary linoleic acid intake in relation to breast cancer: A case-control study.

Background: The present study aimed to investigate the association between dietary linoleic acid (LA) intake and breast cancer in women. Methods: In this population-based case-control study, we enrolled 350 pathologically confirmed breast cancer cases and 700 controls which were matched with cases in terms of age and socioeconomic status. Dietary intakes were assessed using a 106-item Willett-format semi-quantitative dish-based food frequency questionnaire (DS-FFQ). Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were estimated. Results: A significant inverse association was found between LA intake and odds of breast cancer (OR: 0.41, 95% CI: 0.30-0.56). After adjusting for potential confounders, women in the highest tertile of dietary LA intake were 48% less likely to have breast cancer compared with those in the lowest tertile (OR: 0.52, 95% CI: 0.28-0.95). Such a significant inverse association was also seen among normal-weight women (OR: 0.29, 95% CI: 0.14-0.63), and premenopausal women (OR: 0.15, 95% CI: 0.02-0.95). Conclusion: The findings of current study provide evidence for a protective role of LA against breast cancer particularly among normal-weight and premenopausal women. Prospective studies are needed to confirm this association.

Dietary intake of phytochemicals in association with irritable bowel syndrome in adults.

BACKGROUND & AIM: There is limited data regarding the association between phytochemical-rich diets and irritable bowel syndrome (IBS). The current study aimed to cross-sectionally evaluate the association of dietary phytochemical index (DPI) with the odds and severity of IBS. METHODS: In this study, which included 3362 Iranian healthcare staffs, a dish-based semi-quantitative food frequency questionnaire (DS-FFQ) was utilized to collect dietary information. The DPI was defined as the daily percentage of calories consumed from phytochemical-rich foods. The IBS assessment was performed using a revised Iranian version of the Rome III questionnaire. We applied the restricted cubic spline (RCS) to detect the possible non-linear dependency of the relationship between DPI and the odds of IBS. RESULTS: The mean age, Body Mass Index (BMI), and DPI scores of the participants were 36.29 ± 7.8 years, 24.90 ± 3.8 kg/m2, and 16.07 ± 9.01, respectively. After adjusting for possible confounders, no significant association was observed between DPI and odds of IBS in the whole study population or in gender- and BMI-stratified analyses. We found a significant inverse association between DPI and IBS severity in the study population (OR: 0.70; 95% CI: 0.51-0.98). Concerning gender, such an association was only found in women (OR: 0.65; 95% CI: 0.44-0.96). However, there was no significant relationship between DPI and IBS severity in BMI subgroups. In addition, we found no meaningful relationship between DPI and IBS subtypes. The RCS model showed that there is no non-linear relationship between DPI classification and IBS (non-linear test, χ2 = 1.14, Pnon-linearity = 0.513). CONCLUSIONS: Higher phytochemical intake was associated with reduced IBS severity, particularly in women. Further prospective studies are required to confirm these findings.

Psychological distress, perceived stress and nocebo effect (multifood adverse reaction) in irritable bowel syndrome patients.

BACKGROUND: Psychological distress and perceived stress may complicate the clinical presentation, course, and treatment of patients with functional gastrointestinal disorders. The correlation between psychological distress, perceived stress, and the nocebo effect (multifood adverse reaction) in patients with irritable bowel syndrome (IBS) was the main aim of the present study. MATERIALS AND METHODS: In this cross-sectional correlation study, data on 4,763 Iranian adults, 748 of whom by purposive sampling were patients with IBS (65.1% female), working in 50 different health centers affiliated to the Isfahan University of Medical Sciences across Isfahan province were examined. For assessing dietary intake, a 106-item self-administered Dish-based Semi-Quantitative Food Frequency Questionnaire that was specifically designed and validated for Iranian adults was used. General Heath Questionnaire 12 and Stressful Life event Questionnaire were used to assess psychological distress and perceived stress. By using a modified Persian version of the Rome III questionnaire, IBS was assessed. Based on researcher-made definition of nocebo effect (multiitem food intolerance), 164 people had the nocebo phenomenon in IBS group. RESULTS: Age, sex, education, marital status, antidepressant use, and specifically chronic underlying disease (odds ratio [OR]: 3.54, 95% confidence interval [CI]: 1.73-7.23) of general characteristics had a significant correlation (P <.05) with presenting nocebo responses in IBS patients. Psychological distress (OR: 1.415; 95% CI: 0.992-2.020; P = 0.056) had a significant correlation with nocebo effect and did not find significant correlation with perceived stress (OR: 0.999; 95% CI: 0.990-1.008; P = 0.865). Data were analyzed by Chi-square test, analysis of variance, and OR. CONCLUSION: The present study showed that psychological distress with chronic underlying disease and antidepressant use are important elements in presenting multifood adverse reactions that we named here as the nocebo effect in IBS patients. Reducing psychological distress and managing chronic underlying diseases appear to be an effective factor in reducing the nocebo phenomenon in IBS patients. For managing the nocebo responses in IBS patients, these findings may help clinicians to improve their interventions. Further studies are required to confirm these findings.

The Effect of Mediterranean Diet on Body Composition, Inflammatory Factors, and Nutritional Status in Patients with Cachexia Induced by Colorectal Cancer: A Randomized Clinical Trial.

BACKGROUND: Along with high calorie and high protein diet, a new comprehensive dietary approach is needed to control cachexia caused by cancer and its related outcomes. This study was done to evaluate the effect of a Mediterranean diet on body composition, nutritional status, and inflammatory markers among cancer cachexia patients. METHODS: In this randomized clinical trial, 46 patients with colorectal cancer-induced cachexia were included. After randomization, 23 patients were allocated to the intervention group (Mediterranean diet) and 23 to the control group (nutritional counseling for weight gain and prevention of weight loss in cancer patients). The primary outcome including muscle health, nutritional status, and inflammatory markers along with secondary outcomes such as quality of life, and serum proteins were evaluated at the start and the eighth week of the study. Statistical analysis was performed according to the intention-to-treat concept. To compare changes in dependent variables between the 2 groups, analysis of covariance (ANCOVA) was performed. RESULTS: After adjustment for the baseline values, age, sex, and supplements use, in the Mediterranean diet group mean of weight (P < .001), lean body mass (P = .001), fat mass (P = .002), and muscle strength (P < .001) were significantly increased compared to the control group. Regarding inflammatory markers, the mean serum level of tumor necrosis factor-alpha (TNF-α) (P < .001), high sensitive-C-reactive protein (hs-CRP) (P = .01) and Interleukin 6 (IL-6) (P < .001) were significantly improved in the Mediterranean diet group. Moreover, in the Mediterranean diet group, the score for global health status (P = .02) and physical performance score (P < .001) were significantly increased. CONCLUSION: It appears that the implementation of the Mediterranean diet might be a strategy to improve nutritional status, quality of life, inflammatory markers, and body composition in patients with colorectal cancer cachexia. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (www.irct.ir); ID: IRCT20211027052884N1.