COVID-19 Induces Body Composition and Metabolic Alterations.

Background Individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are highly susceptible to disease-related metabolic dysregulation given the hyperinflammatory immune response of coronavirus disease 2019 (COVID-19). These changes are remarkably involved in multiple steps in adipogenesis and lipolysis. This study aimed to elaborate on the significant relations of COVID-19 infection with body fat distribution, changes in serum insulin, and homeostasis model assessment-estimated insulin resistance (HOMA-IR) levels before and after the infection. Methods In this follow-up study, from July 2021 to September 2021, persons referred to a university-affiliated Nutrition Counselling Clinic were randomly selected for the study samples. Validated food frequency (FFQ) and physical activity questionnaires were completed. Body composition was assessed in this investigation. On the second visit, those who reported mild to moderate COVID-19 infection (without hospitalization) were selected as the case group and the asymptomatic individuals as the control group. All measurements were re-measured in the second visit. Results In a total of 441 patients, the mean age was 38.82±4.63 years. There were 224 (50.79%) male subjects, and 217 (49.20%) were females. There was a statistically significant difference in the longitudinal change in total fat percentage between subjects with and without COVID-19. Also, the difference in HOMA-IR before and after COVID-19 in case groups (both males and females) was statistically significant (P-value < 0.001). Moreover, serum insulin levels were significantly increased in all cases (P-value < 0.001), while remaining stable in control groups. When compared to their initial visit, COVID-19 patients' total fat percentage rose significantly (almost 2%) following a hypocaloric diet. Participants who were not infected with COVID-19 had a lower total fat percentage than those who were. Serum insulin and HOMA-IR levels increased significantly after infection compared to the primary measurements. Conclusion Individuals with COVID-19 infection may require tailored medical nutrition therapy to improve short and long-term COVID-19 outcomes such as muscle loss and fat accommodation.

Assessment of the association between body composition and risk of non-alcoholic fatty liver.

Non-alcoholic fatty liver disease (NAFLD) is defined as the condition of fat accumulation in the liver. This cross-sectional study aimed to investigate the relationship between body composition and fatty liver and determine of cut-off point for predicting NAFLD. Samples were selected from the nutrition clinic from 2016 to 2017 in Tehran, Iran. The liver steatosis was calculated using the CAP score through the FiroScan™ and body composition was measured using the dual-energy X-ray absorptiometry scan method. A total of 2160 patients participated in this study, 745 (34.5%) subjects had NAFLD. We found that fat-free tissue was inversely and fat tissue was directly correlated with the risk of NAFLD in almost all factors and the risk of developing NAFLD increases if the total fat exceeds 32.23% and 26.73% in women and men and abdominal fat exceeds 21.42% and 13.76% in women and men, respectively. Finally, we realized that the total fat percent had the highest AUC (0.932 for men and 0.917 for women) to predict the risk of NAFLD. Overall, the likelihood of NAFLD development rose significantly with increasing the amount of total fat and abdominal fat from the cut-off point level.

The association of vitamin D levels and insulin resistance.

OBJECTIVE: Vitamin D deficiency and insulin resistance have great prevalence in society. The latest studies indicate an inverse association between Vitamin D levels, insulin resistance, and Type 2 diabetes. The objective of this study was to investigate the effect of vitamin D status on insulin resistance. METHODS: In a cross-sectional study, 2160 participants were randomly recruited from a nutrition clinic in Tehran, Iran, 1057 (48.9%) were female and 1103 (51.1%) male. Information was gathered by a questionnaire. Following 12-h fasting, fasting plasma glucose (FPG) and insulin levels, as well as 25-hydroxy vitamin D levels were measured. 2-H glucose and insulin levels measured after consumption of 75 g glucose, HOMA2-IR, and HOMA-ß indices were then calculated. RESULTS: The average serum Vitamin D was 22.3 + 8.9 nmol/L and the prevalence of Vitamin D deficiency was 100%. There was an inverse relationship between Vitamin D levels and age, BMI, waist circumference, and all metabolic parameters (p < 0.001 in all) and a direct association with levels of exercise. Two logistic regression models were used to adjust for confounding variables; firstly, for age, gender, and smoking and secondly, additionally for BMI and energy intake. Both models showed a significant inverse relationship between Vitamin D levels and FPG and insulin levels, 2-h glucose and insulin levels, and HOMA2-IR. The optimum cut point for vitamin D was calculated at about 25 nmol/L for preventing insulin resistance. CONCLUSION: This study illustrated that there is a statistically significant inverse relationship between Vitamin D levels and insulin resistance.

Investigating the relationship between insulin resistance and adipose tissue in a randomized Tehrani population.

OBJECTIVES: Insulin resistance is the most common metabolic change associated with obesity. The present study aimed to investigate the relationship between insulin resistance and body composition especially adipose tissue in a randomized Tehrani population. METHODS: This study used data of 2,160 individuals registered in a cross-sectional study on were randomly selected from among subjects who were referred to nutrition counseling clinic in Tehran, from April 2016 to September 2017. Insulin resistance was calculated by homeostasis model assessment formula. The odds ratio (95% CI) was calculated using logistic regression models. RESULTS: The mean age of the men was 39 (±10) and women were 41 (±11) (the age ranged from 20 to 50 years). The risk of increased HOMA-IR was 1.03 (95% CI: 1.01-1.04) for an increase in one percent of Body fat, and 1.03 (95% CI: 1.00-1.05) for an increase in one percent of Trunk fat. Moreover, the odds ratio of FBS for an increase in one unit of Body fat percent and Trunk fat percent increased by 1.05 (adjusted odds ratio [95% CI: 1.03, 1.06]) and 1.05 (95% CI: 1.02, 1.08). Also, the risk of increased Fasting Insulin was 1.05 (95% CI: 1.03-1.07) for an increase in one unit of Body fat percent, and 1.05 (95% CI: 1.02-1.08) for an increase in one unit of Trunk fat percent. CONCLUSIONS: The findings of the present study showed that there was a significant relationship between HOMA-IR, Fasting blood sugar, Fasting Insulin, and 2 h Insulin with percent of Body fat, percent of Trunk fat.

Faculty retention in regional medical schools in Iran: a qualitative content analysis.

BACKGROUND AND PURPOSE: Recruitment and retention of competent faculty members are important in maintaining and improving the quality of education and research performance of universities. The aim of the present study was to find out the faculty members' views, experiences, and attitudes to identify the reasons for faculty attrition and retention in regional medical schools in Iran. METHODS: In this qualitative study, we used a content analysis method. The participants included 12 faculty members who had been transferred to type I universities, four faculty members who had applied for transfer, four with more than 10 years of experience and working in the type 3 universities with no intention to be transferred. Data were collected using semi-structured interviews, which were conducted either face-to-face or via phone calls. The interview was developed for this study (Supplementary file). To measure the trustworthiness of the data, we evaluated four components of credibility, transferability, dependability, and conformability, as proposed by Lincoln and Guba. RESULTS: The findings were classified into three categories and 14 subcategories. The first category was "retention facilitators" including four subcategories of facilitated communication, proximity to major universities, gaining experience, and support by authorities. The second category was "retention threats" including six subcategories of social infrastructure, individual dimension, occupation dimension, economic dimension, sense of respect, and executive management. The third category was "retention strategies" which included four subcategories of recruitment and promotion processes, inter-university collaboration with type I universities, facilitation of the scientific growth, and fulfilment of the safety needs. CONCLUSION: Several factors play a role in the faculty members' retention in regional medical schools in Iran. Authorities can create a more positive environment by devising a suitable reward system, supporting academic activities, and increasing the level of faculty autonomy practically to develop a sense of belonging among them and reduce the intention to be transferred among their human resources.

Dietary inflammatory index and metabolic syndrome in Iranian population (Fasa Persian Cohort Study).

Metabolic syndrome (MetS) is one of the risk factors for all causes of mortality. Inflammation is an important risk factor for MetS. The present cross-sectional study aimed to investigate the relationship between MetS and pro-inflammatory diet by using the food inflammation index (DII). This study consists of 10,017 participants with an age range of 35 to 70 years. The Fasa Cohort Study (FACS) population (Fars Province, Iran) was used to collect data. The DII was estimated according to Shivappa et al. method using a validated 125-item FFQ. To determine the association between MetS components and DII Logistic regression was used (P > 0.05). The overall mean of DII was - 0.89 ± 1.74. However, adjusted multinomial logistic regression indicates each unit increase in waist circumference (WC) (OR 0.98, 95% CI 0.96-0.99) and HDL-C (OR 0.99, 95% CI 0.98-0.99) was associated with significantly decreased odds of being in the 4th DII quartile in men and all participations respectively, there is no statistically significant relationship between MetS and DII. Overall, although people in the highest quartile of inflammatory food consumption had more likely to develop MetS, this relationship was not statistically significant among males and females.

The role of adipose tissue secretion in the creation and pain level in osteoarthritis.

OBJECTIVES: With increasing evidence regarding the metabolic basis of osteoarthritis (OA), we studied the relationship between adipose tissue and OA. METHODS: This study is part of an OA registry in the eastern part of Fars Province, Iran. Overall, 150 patients with OA and 300 sex matched individuals were selected as a control group. They were compared regarding adipokine concentration (leptin, adiponectin, resistin and visfatin), anthropo-metric indices, the Western Ontario and McMaster universities arthritis index score (WOMAC). RESULTS: All adipokine levels were higher among OA patients (p<0.001). After adjusting for age, sex, and body mass index (BMI), adipokines showed a significant and positive association with OA (B: 14.12, B: 9.92, B: 24.71 and B: 12.29 for leptin, adiponectin, visfatin, and resistin, respectively; p<0.001). Except the adiponectin that had a negative relationship with BMI in the OA group (r=-0.570, p<0.001), other adipokines had positive relationships with BMI (r=0.781, p<0.001; r=0.530, p<0.001; r=0.549, p<0.001 for leptin, visfatin, and resistin, respectively). Only leptin and adiponectin levels were correlated with pain (B: 0.045, -0.079 and p<0.05). CONCLUSION: The present study shows that aside to the well-known role of mechanical stress in OA pathogenesis (weight load), leptin, adiponectin, visfatin, and resistin, which represent the adi-pose tissue independent on the weight, may play a chemical role in OA pathogenesis. In addition, leptin and adiponectin may be involved in the pain levels among patients with OA.

Association between dietary patterns with insulin resistance in an Iranian population.

AIM: To assess the association between dietary patterns no single food or group, and risk of insulin resistance (Fasting blood sugar (FBS), Fasting insulin, 2h-glucose, 2h-insulin and HOMA-IR). METHODS: In a cross-sectional, population-based study in Tehran, Iran, 2016-2017. Adults (n = 1500, 38% men) mean age 43.72 ± 14.9 years. Dietary intake was collected by semi-quantitative food frequency questionnaire and insulin resistance was evaluated by Fasting blood sugar (FBS), Fasting insulin, 2h glucose, 2h insulin and HOMA-IR. Associations were assessed by using correlation and multivariable linear regression. RESULTS: After controlling of the confounding factor or possible underlying such as gender, age, menopausal, BMI, physical activity and the amount of daily energy intake, unhealthy dietary pattern had a positive relationship with all indexes of insulin resistance except 2h glucose and HOMA-IR, healthy dietary pattern had negative and significant relationship with indexes of insulin resistance but apart from 2h glucose. CONCLUSIONS: It can be figured out that receiving diet rich in healthy foods might reduce the risk of creating insulin resistance.

Waist circumference is a mediator of dietary pattern in Non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is an example of pathological fat accumulation in the liver and one of the major health conditions in the world. This study aimed to examine the independent role of dietary patterns in the development of NAFLD. In a cross-sectional study, 1500 individuals referred to a nutrition clinic were randomly selected, their demographic, anthropometric and blood metabolic indices were obtained, and food frequency questionnaires were completed for them. Liver stiffness was calculated using the NAFLD score formula and fibroscan. The two dominant dietary patterns identified were the "healthy" and "unhealthy dietary patterns". A significant percentage of those with NAFLD (45%) were in the upper quartile of the unhealthy model; however, only 10% had the healthy pattern (p < 0.001). In this study, 32.9 and 13.9% of the healthy and unhealthy participants were in the upper quartile of the healthy diet pattern. Also, it was shown that waist circumference is a strong mediator of dietary patterns and NAFLD relationship, and the indirect effect of diet through abdominal circumference is 28 times greater than the direct effect on NAFLD. The results suggested that healthy and unhealthy dietary patterns are respectively associated with lower- and higher-risk of NAFLD but the role of waist circumference as a mediator deserves more consideration.

Dietary pattern in pregnancy and risk of gestational diabetes mellitus (GDM).

AIM: Among the most common metabolic disorders during pregnancy is gestational diabetes mellitus (GDM). This research was conducted to examine the dietary pattern in women with GDM. MATERIAL AND METHODS: In this case-study, 204 pregnant women (104 cases and 100 control women) were chosen through convenient sampling and random sampling. The subjects' food intakes were assessed using semi-quantitative food frequency questionnaire, while their activities evaluated by physical activity questionnaire. Anthropometric indices were measured based on standard instructions, and the body mass index was calculated. The dietary patterns were determined using principal component analysis and its relationship with preeclampsia was tested using logistic regression method. RESULTS: Unhealthy and healthy dietary patterns were found among the pregnant women. In the unhealthy group, after modifying the effect of confounding variables, a significant relationship was observed between dietary pattern and having gestational diabetes (OR = 2.838,95% CI:1.039-7.751). In the healthy group, on the other hand, the people in the fourth quartile had 149% and 184% higher chance not to catch gestational diabetes before and after modification with confounders, respectively (OR = 0.284,95% CI:0.096-0.838), when compared with people in the first quartile. CONCLUSION: The findings indicated that selection of foods including fruits, vegetables, low-fat dairies, etc. as healthy dietary pattern is associated with diminished risk of GDM among pregnant women. Determining healthy dietary pattern during pregnancy, considering the foods consumed among pregnant women, as a useful and practical guide during this period can be publicized for training and nutritional interventions.

Relationship between metabolic syndrome and osteoarthritis: The Fasa Osteoarthritis Study.

BACKGROUND: An association between metabolic syndrome (MeS) and osteoarthritis (OA) has been reported in recent years; however, conflicting findings have been reported regarding this matter. Inhere we evaluated the relationship between different components of MeS and OA in a Fasa osteoarthritis registry (FOAS). METHODS: The registry includes all OA cases who referred to Fasa hospital (Iran) since 2013. Overall, 131 patients with OA with a Kellgren & Lawrence (K&L) score >1 and 261 controls were compared. RESULTS: Overall, 82.4% of individuals in the OA group and 40.8% of participants in the control group had MeS (P<0.001). Patients with OA had a 6.8 (95% CI: 4.1-11.4) higher chance of acquiring MeS. After adjusting for sex, age, and BMI, odds' ratio (OR) for acquiring MeS in OA group increased to 10.9 (95% CI: 5.5-21.8). Among MeS criteria's, high waist circumference (WC) has strongest correlation for acquiring OA (OR=27.535, 95% CI: 6.003-126.306). CONCLUSION: Our findings revealed that metabolic markers are strongly associated with OA and the addition of each component of the MeS, significantly increases the risk of developing OA, therefore control of metabolic factors and appropriate screening must be considered in health policy making and prevention programs.

Serum insulin in pathogenesis and treatment of osteoarthritis.

Osteoarthritis (OA) is one of the major health problems that's development and progression is obesity-related. We believe that higher levels of insulin may explains this link especially. High levels of insulin in obesity and metabolic syndrome can induce numerous complications. Insulin can increase proliferation of chondrocyte but simultaneously, it prevents their differentiation. Moreover, hyperinsulinemia reduces the circulating level of serum T4 and conversion of T4 to T3, mimicking hypothyroidism, because thyroid hormones are necessary for the maturation of chondrocytes. So maybe decreasing insulin levels, prevents OA progression or improve the treatment process.

New anthropometric indices or old ones: Which is the better predictor of body fat?

BACKGROUND: The percent and distribution of body fat are important factors in the pathogenesis of numerous diseases. Our aim was to investigate common anthropometric indices in their relationship with body fat content. METHODS: In a cross-sectional study 1360 healthy individuals (580 men and 780 women) in a cluster sampling, from Ahvaz, Iran, body fat content (using bioelectrical impedance) and anthropometric measurements [weight, waist circumference, a body shape index, abdominal volume index, body adiposity index, conicity, body mass index, hip circumference, waist to hip ratio and waist to height ratio] was obtained. The ROC curve analysis was used to compare each index with body fat percent. RESULTS: Significant difference was found between men and women in all anthropometric parameters (p < 0.001). Women displayed higher percentages in the overweight and obese categories (33.6% vs. 32.9% and 26.4% vs. 22.1%, respectively). In both men and women, the strongest correlations were seen between body fat percent and BMI, AVI and WHtR (r>7.9 and p<0.001). BMI, WHtR and AVI in men and BAI, BMI and WHtR in women showed the most accuracy for estimating body fat percent, respectively. CONCLUSION: All anthropometric parameters could predict body fat percent with relatively good power, however BMI, WHtR and AVI are more powerful predictors. Based on our findings, we suggest using the AVI and WHtR instead of other indexes, as they are better able to assess the accumulation of fat in the abdominal area and are able to more accurately assess body fat percent, which are indicators of chronic disease.

Ability of dairy fat in inducing metabolic syndrome in rats.

BACKGROUND: The risk of heart diseases, diabetes and stroke is increased with higher metabolic risk factors. Models of diseases resulting from high-calorie diets have a significant role in pathophysiologic analysis of metabolic syndrome in rodents; but, these diets are considerably different from each other in various studies and may not be very similar to the metabolic syndrome model in humans. This study sought to make a model close to the disease in humans. 20 five-week old male Wistar rats were randomly assigned to two groups. For one of the groups, a high-calorie diet with 416 calories per 100 g with dairy-based fat was considered and, for another group, a control diet was given for 12 weeks. Weight changes, lipid profile, glucose values, Blood pressure, insulin and HOMA indices, were measured for both groups and weight changes were compared using repeated measures and independent t test; also, serum results were compared using independent t test. RESULTS: Values of weight, glucose, insulin, lipid profile and blood pressure, except HDL, had a tangible difference between two groups at the end of the study. HOMA-IR, HOMA-B and HOMA-S indicates a significant difference between the two groups after consumption high-energy diet. CONCLUSION: The present study showed ability of dairy fat in gaining weight, insulin resistance and metabolic syndrome and provided the necessity of paying serious attention to the amount of fat intake from dairy sources.

Anxiety as a consequence of modern dietary pattern in adults in Tehran--Iran.

Food intake patterns in relation to mental health have already been revealed. To investigate the relationship between processed food consumption behavior and anxiety disorder, a cross sectional study was conducted. Overall, 1782 young adults aged 18-35 years were randomly selected using cluster sampling method from 22 districts of Tehran-Iran in 2011. Diet assessment was done using a 24 hour recall questionnaire in two times with a week interval. Anxiety level was determined using the validated Speilburger test (Persian version). A proportional odds regression model was used to assess the effect of processed food consumption on anxiety variables. A significant statistical difference was found between men and women in terms of processed food consumption (p<0.001). Adjusting for age, total calorie intake, gender, body mass index, socioeconomic status, and history of sedative drug consumption as well as mental health disorders, the proportional odds regression model showed a significant relationship between increased consumption of processed foods and anxiety (OR=4.73, 95% CI: 2.89-12.54 for state and OR=4.91, 95% CI: 2.88-13.99 for trait). Identification, modification and adjusting incorrect food patterns in the community could be considered as valuable steps to turn down nutritional-based health difficulties.