Association of major dietary patterns with advanced glycation end products and high-sensitivity C-reactive protein in people with type 1 diabetes mellitus.

BACKGROUND: The associations of diet with serum levels of advanced glycation end products (AGEs) and high-sensitivity C-reactive protein (hs-CRP) have been examined in patients with type 2 diabetes mellitus (T2DM). However, data on patients with type 1 diabetes mellitus (T1DM) are limited. Therefore, this study was conducted to investigate the associations of major dietary patterns with serum levels of AGEs and hs-CRP among patients with T1DM. METHODS: A total of 229 patients with T1DM participated in this current cross-sectional study. We collected dietary data using a validated food frequency questionnaire (FFQ). The factor analysis approach was used to determine major dietary patterns. A fasting blood sample was collected from each participant to assess serum levels of AGEs and hs-CRP. The associations of dietary patterns with elevated levels of AGEs and hs-CRP were assessed using binary logistic regression. RESULTS: Patients with T1DM in the highest tertile of a Western dietary pattern had 4.32 times higher odds of having elevated AGEs than those in the lowest tertile (OR: 4.32, 95% CI: 1.86-10.05). Additionally, adherence to the Western diet was associated with 2.97 times greater odds of having elevated hs-CRP (> 3 mg/L) (OR: 2.97, 95% CI: 1.22-7.24) in these patients. Such positive associations were not observed for unhealthy and traditional dietary patterns. Moreover, higher adherence to a semi-healthy diet (characterized by high consumption of white meat, whole grains, processed meat, and a low salt intake) was associated with 87% lower odds of having elevated hs-CRP (OR: 0.13, 95% CI: 0.05-0.35). However, we found no significant association between the semi-healthy diet and AGEs levels. CONCLUSION: We found that adherence to a Western dietary pattern was associated with elevated levels of AGEs/hs-CRP in patients with T1DM. Also, we discovered a significant inverse association between adherence to a semi-healthy diet and hs-CRP levels.

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.

High Risk-pregnant Women's Experiences of Risk Management: A Qualitative Study.

Background: Maternal and fetal morbidity and mortality depend on identifying of pregnancy risks and risk management. There is a dearth of information about the experiences of high-risk pregnant mothers in self-mitigation of the risk in the socio-cultural setting of Iran. This research was conducted to explore the risk management experiences of high-risk pregnant mothers. Methods: This Qualitative study was conducted in educational hospitals in Mashhad, Iran, from July 2018 to December 2020. The purposive sampling method was used to recruit the participants based on medical or obstetric high-risk conditions in pregnancy. Qualitative data were obtained from in-depth and semi-structured 29 interviews. Mothers' experiences of pregnancy in a risky condition were asked, and the interview continued until data saturation. Data were analyzed using the MAXQDA 10 software and the Elo and Kyngäs method. Results: Maternal experiences for risk management in pregnancy were formed by nine sub-categories and three categories: the excitement of emotion including: "feeling worry and despair", "gladness in the shadow of hope and optimism", "momentary shocking and excitement", and "inactivity and helplessness"; self-contemplation including: "active analysis of the ways of moderating the risk", "cognitive denial", and "ignoring the risk"; and witnessed action including: "problem-focused and rational actions", and "avoidance and inefficient engagements". Conclusion: Risk management experiences of pregnant women with high-risk pregnancies include a wide range of positive and negative feelings, effective and ineffective thoughts, and behaviors. Mutual collaboration between mothers and midwives/obstetricians by providing high-quality risk management counseling can lead to choosing effective risk management strategies.

Perceived Risk in Women with High Risk Pregnancy: A Qualitative Study.

BACKGROUND: Risk perception in high-risk pregnancies influences the mothers' adherence to medical treatments and recommendations. Because of the lack of information about the women's perception of risk, the aim of this study was to explain perception of risk in high-risk pregnancies. MATERIALS AND METHODS: This qualitative study was conducted on 25 women with a high-risk pregnancy in educational hospitals of Mashhad, Iran, from August 2017 to August 2018. Data were collected through semi-structured interviews and data saturation was reached after 29 interviews. Data collection and analysis were simultaneously carried out using the qualitative content analysis method adopted by Elo and Kyngäs in MAXQDA software. RESULTS: Data analysis resulted in the four main categories of perception of risk control ability (risk controlling through experience, risk tolerance through relying on a higher power, and risk tolerance to reach family goals), wrong estimation of risk (wrong calculation of possible risks based on wrong beliefs and knowledge, and incorrect risk estimation caused by misunderstanding), possibility of mutual vulnerability of pregnancy and risk condition (possibility of vulnerability of the fetus to risk factors, and possibility of the mother's vulnerability to risk factors), and induced risk (risk induced by negative experiences, induced threat of unknown pregnancy outcome, and fear of ambiguous medical terms). CONCLUSIONS: The results of this study promoted our understanding of risk perception in women with high-risk pregnancies. Therefore, it will help to establish a-Z better link between women with a high-risk pregnancy and the health team, enhance and improve maternal and fetal care.

Knowledge Valuation by Iranian Women with High-Risk Pregnancy: A Qualitative Content Analysis.

BACKGROUND: Gaining adequate knowledge about high-risk pregnancy (HRP) and correct understanding of the condition, empowers women to improve the use of prenatal care, practice better self-care, and reduce the risk of pregnancy complications. The present study aimed to assess the valuation of knowledge by Iranian women with HRP. METHODS: The present qualitative study was conducted on 25 women with HRP from August 2017 to August 2018 at various educational hospitals in Mashhad, Iran. The data were collected through in-depth semi-structured interviews. The data collection process continued until data saturation. The data were analyzed using the conventional content analysis method and MAXQDA software (version10.0). Data collection and data analysis were conducted concurrently. RESULTS: Based on the analysis of the interviews, two main categories and eight sub-categories were extracted. The main categories were "Positive valuation of credible problem-relevant knowledge" and "Avoidance of misleading and stressful information". The results showed that various factors had a positive impact on knowledge gathering, namely personal and other people's experiences, obtaining need-based information, sympathetic advice from others, and faith-based health recommendations. On the other hand, factors that had a negative impact were related to the type of information that caused stress, was unreliable, inefficient or incompatible with personal goals. CONCLUSION: The findings of the present study would help health care providers to offer suitable and empathetic counseling to women with HRP. Providing valid and accessible sources of information will lead to faster and timely referrals of such patients.

Calcium and vitamin D supplementation effects on metabolic factors, menstrual cycles and follicular responses in women with polycystic ocvary syndrome: A systematic review and meta-analysis.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most popular endocrine disorder in reproductive age with unknown etiology and many comorbidities. This systematic review focused on the effectiveness of calcium and vitamin D (Ca/ Vit.D) supplementation on metabolic factors, menstrual cycles, and follicular responses in PCOS patients. METHODS: Relevant studies were identified from the following electronic databases including Pub Med, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, issue Oct. 2018, Evidence Based Medicine Reviews (EBMR), Google Scholar, EMBASE, as well as Farsi databases including Magiran and SID from 2000 to 2018. Out of 449 articles, six clinical trials met the inclusion criteria. RESULTS: Out of six studies included in the study, only three studies had sufficient data for meta-analysis. Overall, studies showed that prescribing Ca/ Vit. D supplementation with metformin improved menstrual regularity and follicular maturation and significant decreases in serum insulin levels, homeostasis model of assessment-insulin resistance (HOMA-IR) and fasting blood sugar (FBS) and also significant rises on quantitative insulin sensitivity check index (QUICKI) at two studies. Hirsutism and level of testosterone decreased significantly after adding Ca/ Vit. D to metformin in two different studies. Based on two different trials, co-supplementation of Ca/ Vit. D had a significant impact to decrease serum triglycerides and VLDL-cholesterol levels as well as levels of cholesterol and LDL. CONCLUSION: It is possible that calcium and vitamin D supplementation improve menstrual disturbances and metabolic factors in PCOS in a long-term period, but further trials are still needed to confirm these findings.