Dietary inflammatory index and elevated serum C-reactive protein: A systematic review and meta-analysis.

Diet can affect the inflammatory state of the body. Accordingly, the dietary inflammatory index (DII) has been developed to quantify the inflammatory properties of food items. This study sought to investigate the association between dietary inflammation index (DII) and the odds ratio of elevated CRP (E-CRP) through a systematic review and meta-analysis study. The International electronic databases of PubMed, Web of Science (ISI), and Scopus were searched until May 2023 to find related articles. From 719 studies found in the initial search, 14 studies, with a total sample size of 59,941 individuals, were included in the meta-analysis. The calculated pooled odds ratio (OR) of E-CRP in the highest DII category was 1.39 (95% CI: 1.06, 1.14, test for heterogeneity: p = .63, and I 2 = .0%) in comparison with the lowest DII category. Also, the results of this study showed that each unit increase in DII as a continuous variable generally elicited a 10% increase in the odds of E-CRP (OR 1.10, 95% CI 1.06, 1.14, test for heterogeneity: p = .63, and I 2 = .0%). Subgroup meta-analyses showed that there is a higher E-CRP odds ratio for the articles that reported energy-adjusted DII (E-DII) instead of DII, the studies that measured CRP instead of hs-CRP, and the studies that used 24-h recall instead of FFQ as the instrument of dietary intake data collection. Individuals with a higher DII were estimated to have higher chances of developing elevated serum CRP. This value was influenced by factors such as the participants' nationality, instruments of data collection, methods used to measure inflammatory biomarkers, study design, and data adjustments. However, future well-designed studies can help provide a more comprehensive understanding of the inflammatory properties of diet and inflammatory serum biomarkers.

Association of Leptin and Retinol Binding Protein 4 with the Risk of Gestational Diabetes: A Systematic Review and Meta-Analysis of Observational Studies.

The positive correlation between serum levels of retinol binding protein 4 (RBP4) and gestational diabetes (GDM) has been proven in the previous meta-analysis on case-control studies. However, its association with serum levels of leptin is not studied in any meta-analysis. Therefore, we performed an updated systematic review of observational studies evaluating the association between serum RBP4 and leptin with the risk of GDM. A systematic search was performed on four databases, including PubMed, Scopus, Web of Science, and Google Scholar, up to March 2021. After screening and deleting duplicates, nine articles met our inclusion criteria. Studies had case-control and cohort design, and included 5074 participants with a mean age range between 18 and 32.65 years (2359 participants for RBP4 and 2715 participants for leptin). Interestingly, this meta-analysis revealed higher levels of RBP4 (OR=2.04; 95% CI: 1.37, 3.04) and leptin (OR=2.32; 95% CI: 1.39, 3.87) are significantly associated with the increased risk of overall GDM. The subgroup analysis approved the results based on the study design, trimester of pregnancy and serum/plasms to investigate the source of heterogeneity. The present meta-analysis determines serum leptin and RBP4 levels as predictors of GDM occurrence. However, studies included in this meta-analysis showed significant heterogeneity.

Adjuvant pomegranate juice intake improves the inflammatory status of hospitalized COVID-19 patients: A randomized and placebo-controlled trial.

BACKGROUND: This study aimed to evaluate the effect of pomegranate juice intake on the inflammatory status and complete blood count in hospitalized Covid-19 patients. METHODS: This randomized, double-blinded placebo-controlled trial included 48 patients with two parallel arms. In addition to the standard care provided at the hospital, the patients consumed 500 mL of whole pomegranate juice (PJ) daily or a placebo for 14 days. Inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR)) and complete blood count were determined at baseline and after the 14 days of intervention. RESULTS: At the end of the intervention, a significant decreased was observed in primary outcomes [mean difference (95 %CI)] including IL-6 [5.24(0.87-9.61)], CRP [23.19(11.93-34.44)] and ESR [10.52(1.54-19.50)] in the PJ group vs. before the intervention. In addition, significant changes were also observed in the some of the secondary outcomes, including neutrophils, lymphocytes, platelets, platelets-to-lymphocyte(PLR) and neutrophils-to-lymphocyte (NLR) ratios (p < 0.05) in the PJ group compared to before the intervention. At the end of the intervention period, the mean change of IL-6 [- 7.09(-12.21 to - 1.96)], white blood cells [- 3.09(- 6.14 to - 0.05)], neutrophils [- 9.12(-18.08 to -0.15)], lymphocyte [7.05(0.17-13.92)], platelets [- 94.54(- 139.33 to - 49.75)], PLR [- 15.99(- 29.31 to - 2.67)], blood oxygen saturation [1.75(0.13-3.37)] and MCV [0.31(- 0.25 to 0.88)] levels were significantly different between groups while no difference was observed between the two groups in other blood indices. CONCLUSION: Our results suggest that pomegranate juice intake might slightly improve the inflammatory status and CBC outcomes of COVID-19 patients and it may be beneficial.

Beneficial effects of Ginkgo biloba leaf extract on inflammatory markers: A systematic review and meta-analysis of the clinical trials.

The beneficial effects of Ginkgo biloba on cardio-metabolic markers have been reported. However, its effect on inflammation is not assessed in any meta-analysis. We performed a systematic review of randomized controlled trials evaluating the effects of Ginkgo biloba leaf extract (GBLE) on serum C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels. A systematic search was performed on four databases, including PubMed, Scopus, Web of Science, and Google Scholar, up to October 2021. After screening, 17 trials met our inclusion criteria. Trials were of 1-24 weeks of duration and included 1,104 participants. In the meta-analysis, the weighted mean differences (WMD) in change for serum CRP were -1.5 mg/L (95% CI: -2.16, -0.85, p < 0.001). Moreover, WMD for serum IL-6 and TNF-α were in favor of the GBLE compared to the placebo [(-16.86 pg/mL, 95% CI: -19.38, -14.34, p < 0.001); and (-4.19 pg/mL, 95%CI: -5.14, -3.23, p < 0.001), respectively]. Subgroup analysis showed that GBLE has a beneficial effect on serum CRP at the baseline levels≥3 mg/L and doses<500 mg/day. This meta-analysis showed that the GBLE could reduce serum inflammatory markers. Therefore, this medicinal herb might be a possible strategy for inflammation control.

The importance of nutritional status on clinical outcomes among both ICU and Non-ICU patients with COVID-19.

BACKGROUND AND AIMS: The current Covid-19 outbreak becomes a tremendous public health concern worldwide. Since a little information is available on nutritional status and its devastating effects on covid-19 complications in Iran, in the present study, we aimed to evaluate nutritional status of covid-19 population and its related factors. METHODS: We performed this observational study by recruiting 400 hospitalized covid-19 subjects. Thereafter, the needed clinical and para clinical data were collected and their nutritional status was then assessed using NRS-2002. RESULTS: Approximately 36% of the total sample size and 100% of the ICU- admitted cases were at the severe risk of malnutrition. The patients with NRS≥ 5 were significantly older (p < 0.0001). Non-survivals obtained higher scores in terms of both severity of disease (86%) and impaired nutritional status (67%), and this relationship was found to be statistically significant (p < 0.0001). In regard to the obtained prognostic inflammatory scores, 86% of the non-survivals obtained significantly highest scores for GPS (P = 0.015). CONCLUSION: Nutritional status has a considerable effect on clinical outcomes of covid-19 patients, which should be evaluated. Thereafter, rapid subsequent nutritional interventions must be implemented in this regard. As well, special attention must be paid to both elderly population and individuals with underlying diseases.

Effects of pomegranate juice (Punica Granatum) on inflammatory biomarkers and complete blood count in patients with COVID-19: a structured summary of a study protocol for a randomized clinical trial.

OBJECTIVES: This study is conducted to investigate efficacy of pomegranate juice on inflammatory biomarkers, C-reactive protein (CRP), interleukin 6(IL-6), erythrocyte sedimentation rate (ESR) and complete blood count (CBC) in hospitalized patients with mild to moderate coronavirus disease 2019 (COVID- 19). TRIAL DESIGN: This is a randomized, placebo-controlled, double-blind, parallel 2-arm (1:1 ratio) clinical trial. PARTICIPANTS: Patients with COVID-19 admitted to hospitals in Yasuj City, Kohgiluyeh and Boyer-Ahmad Province, Iran. INCLUSION CRITERIA: Informed consent Patients 18 years of age or older Diagnosis of COVID-19 based on real-time polymerase chain reaction (RT-PCR) test EXCLUSION CRITERIA: Pregnancy or lactation Immunoglobulin A (IgA) level <61 mg/dl Disseminated intravascular coagulation or any other types of coagulopathy Severe congestive heart failure Participation in any clinical trial within 30 days prior to enrollment in this RCT Other contraindications determined by the specialist. INTERVENTION AND COMPARATOR: Intervention: 500 ml pomegranate juice and standard of care hospital treatment for COVID-19 Comparator: matching placebo containing 500 ml of red water and standard of care hospital treatment for COVID-19 Both intervention and comparator to be taken twice a day, after lunch and dinner, for 14 days. CRITERIA FOR DISCONTINUING: Transfer of patients to intensive care unit (ICU) Death Unwillingness to continue participating in the study MAIN OUTCOMES: The main outcomes of this study are levels of inflammatory biomarkers, CRP, IL-6, ESR, and CBC after 14 days of treatment. RANDOMIZATION: Eligible patients will be randomly assigned into the intervention or control group in a 1:1 ratio. Randomization will be performed based on 8 permuted blocks with block sizes of 6 and they will be stratified according to sex and age categories. Randomization sequences will be prepared by the trial's pharmacist using computer-generated random numbers. BLINDING (MASKING): This study is a double-blind clinical trial (participant, researcher). The pomegranate juice and placebo juice are packaged in identical bottles, and the researcher and all the patients will be unaware of the study assignment until the end of the study. To ensure blinding, the randomization sequences will be kept in identical, opaque, sealed, and sequentially numbered envelopes. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): The calculated total sample size is 48 patients, with 24 patients assigned into each group. TRIAL STATUS: The protocol is Version 1.0, on March 3, 2021. Recruitment started on February 28, 2021, and is anticipated to be completed by May 21, 2021. TRIAL REGISTRATION: The Name of registering trial Effects of Pomegranate Juice (Punica Granatum) on Inflammatory Biomarkers and CBC in Patients with COVID-19: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Iranian registry of clinical trials (IRCT) Registration Number: IRCT20150711023153N2 Date of Trial Registration February 28, 2021, retrospectively registered FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials҆ website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

Effects of Quercetin Supplementation on Hematological Parameters in Non-Alcoholic Fatty Liver Disease: a Randomized, Double-Blind, Placebo-Controlled Pilot Study.

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease which has become a public health concern. Since oxidative stress plays a crucial role in the pathogenesis of NAFLD, subsequent hematological disorders are expected. Therefore, antioxidant compounds such as quercetin could ameliorate the related side-effect of oxidative stress. The aim of the current study was to assess the effect of quercetin on hematological parameters in NAFLD patients. A randomized, double-blind, placebo-controlled trial was conducted as a pilot study. In this study 90 patients with NAFLD were supplemented with either a quercetin or a placebo capsule twice daily (500 mg) for 12 weeks. Blood sample was obtained for laboratory parameters at baseline and the end of week 12. End of trial values for red blood cell (RBC; p = 0.002), mean corpuscular hemoglobin concentration (p = 0.029), and mean platelet volume (p = 0.017), significantly increased and the levels of mean corpuscular volume (MCV; p = 0.023), RBC distribution width-coefficient of variation (p = 0.005), platelet distribution width (p = 0.015), and ferritin (p = 0.002) significantly decreased compared to the baseline in group receiving quercetin. Between group analysis revealed that RBC significantly increased (p = 0.025) but, mean corpuscular volume (p = 0.004), mean corpuscular hemoglobin (MCH; p = 0.002), and ferritin (p = 0.013) significantly decreased compared to placebo group. In this work quercetin showed significant effect on RBC, ferritin, MCV, and MCH in intervention group. TRIAL REGISTRATION: Iranian Center for Clinical Trials Identifier: IRCT2016060628299N1.

Pattern of Kebab Intake as a Potential Carcinogenic Risk Factor in Adults of Kermanshah, Iran: 2015.

Background: Epidemiologic studies indicated that dietary pattern plays a determinant role in cancer incidence. They also indicated that 1/3 of cancers are associated to foods. Diet contains different carcinogenic agents: naturally occurring chemicals, synthetic components and compounds produced during cooking such as kebab. This traditional food is one of the most popular foods in the Middle East, particularly in Iran. Red meat, especially lamb or veal, is the most common meat used in preparation of kebab. Since kebab is considered as a food containing carcinogenic compounds, so the purpose of this study was to assess the consumption pattern of kebab in a sample of Iranian adults and its relationship with demographic characteristics. Materials and Methods: This cross-sectional study was conducted between March and April 2015 on 705 Iranian adults who were living in Kermanshah province in the west of Iran. Subjects were selected randomly from different districts of Kermanshah. Data were collected through a questionnaire survey which had been designed by academic members of Department of Nutrition at Kermanshah University of Medical Sciences. Data analysis was performed using SPSS Version 20. The results were expressed as mean ± SD. Student's t-test, ANOVA and chi-square tests were performed to compare the study groups. The normality of data was assessed using the Kolmogorov-Smirnov test. All results were analyzed using a significance level of P <0.05. Results: The results indicated that nearly 60% of subjects have a high tendency to consume kebab. The average of kebab consumption among the participants in this study was 4 times per month. Nearly, 85% of study participants tended to consume kebab with a large amount of salt. The chi-square test determined the significant difference between education and tendency to consume kebab; individuals with higher level of education had more tendency to consume kebab than those having lower level of education (p=0.021). In this study, 93.9% of participants used charcoal, a cooking fuel, to prepare kebab. Conclusion: The results of this study point out that the study participants, regardless of socio-economic status, consume high amounts of kebab, and thus this unhealthy eating habit will increase the risk of carcinogenesis. Therefore, the immediate attention of Public Health Officials is required.

Nutritional Care in Iranian Intensive Care Units.

Intensive care units (ICUs) provides intensive treatment medicine to avoid complications such as malnutrition, infection and even death. As very little is currently known about the nutritional practices in Iranian ICUs, this study attempted to assess the various aspects of current nutrition support practices in Iranian ICUs. We conducted a cross-sectional study on 150 critically ill patients at 18 ICUs in 12 hospitals located in 2 provinces of Iran from February 2015 to March 2016. Data were collected through interview with supervisors of ICUs, medical record reviews and direct observation of patients during feeding. Our study showed that hospital-prepared enteral tube feeding formulas are the main formulas used in Iranian hospitals. None of the dietitians worked exclusively an ICU and only 30% of patients received diet counselling. Regular monitoring of nutritional status, daily energy and protein intake were not recorded in any of the participating ICUs. Patients were not monitored for anthropometric measurements such as mid-arm circumference (MAC) and electrolyte status. The nasogastric tube was not switched to percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEGJ) in approximately 85% of patients receiving long-term enteral nutrition (EN) support. Our findings demonstrated that the quality of nutritional care was inappropriate in Iranian ICUs and improvement of nutritional care services within Iranian ICUs is necessary.

Molecular and Cellular Interactions of Allogenic and Autologus Mesenchymal Stem Cells with Innate and Acquired Immunity and Their Role in Regenerative Medicine.

Mesenchymal stem cells (MSCs), as major stem cells for cell therapy, have been studied from different aspects in preclinical and clinical settings for more than a decade. These cells modulate the immune system (humoral and cellular immune responses) in vitro by producing soluble factors (anti-inflammatory molecules) and/or making cell-cell contacts. Hence, they could be used in regenerative medicine, tissue engineering and immune therapy. MSCs-based therapy have been recently used for treatment of cancer regarding the migratory potential of these cells towards tumor cells which makes them considerable candidates, also for cell therapy in both allogeneic and autologous settings. So, this review attempts to focus on the factors secreted by MSCs such as cytokines, their functional role in mounting and controlling immune responses mediated by different immune cell subpopulations and their significance in regenerative medicine in clinical trials. Although, further studies remain to be done to increase our knowledge of regulating development mechanisms, homeostasis and tissue repair in order to provide new tools to implement the efficacy of cell therapy trials. Although MSCs have been proved safe and effective for cell therapy, there are still challenges to overcome before widely applying MSCs in clinic.