A comparison between body mass index and waist circumference for identifying continuous metabolic syndrome risk score components in Iranian school-aged children using a structural equation modeling approach: the CASPIAN-V study.

PURPOSE: The purpose of this study was to investigate the association of anthropometric indices with continuous metabolic syndrome (cMetS) risk score components in a large population-based sample of children and adolescents. METHODS: This multi-centric study was performed on 3843 students aged 7-18 years who were selected by multistage, stratified cluster sampling method from 30 provinces of Iran. Demographic, anthropometric and biochemical factors were obtained and standardized residuals (z-scores) were calculated for MetS components. A structural equation modeling approach was applied to evaluate the relationships among the study variables and to implement the subsequent structural modeling. RESULTS: The mean age of the participants (52.3% boys) was 12.4 ± 3.05 years. Standardized scores of body mass index (ZBMI) and waist circumference (ZWC) had a direct effect on standardized scores of mean arterial pressure (ZMAP) (0.23 and 0.24 in boys and 0.22 and 0.23 in girls, respectively) and triglyceride (ZTG) (0.07 and 0.04 in boys and 0.02 and 0.06 in girls, respectively), but the effect of ZWC was stronger than ZBMI on these variables. Age, socioeconomic status and sedentary behaviors showed a positive direct effect on ZWC (0.01, 0.05 and 0.07 in boys and 0.05, 0.08 and 0.002 in girls, respectively). These variables induced indirect effects on cMets risk score components through ZWC. CONCLUSION: The magnitude of association between WC and continuous metabolic syndrome risk score components was higher compared to BMI in school-aged children, emphasizing on paying more attention to central obesity in childhood. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Effect of the herbal medicines in obesity and metabolic syndrome: A systematic review and meta-analysis of clinical trials.

Obesity is a medical situation in which excess body fat has gathered because of imbalance between energy intake and energy expenditure. In spite of the fact that the variety of studies are available for obesity treatment and management, its "globesity" still remains a big challenge all over the world. The current systematic review and meta-analysis aimed to evaluate the efficacy, safety, and mechanisms of effective herbal medicines in the management and treatment of obesity and metabolic syndrome in human. We systematically searched all relevant clinical trials via Web of Science, Scopus, PubMed, and the Cochrane database to assess the effects of raw or refined products derived from plants or parts of plants on obesity and metabolic syndrome in overweight and obesity adult subjects. All studies conducted by the end of May 2019 were considered in the systematic review. Data were extracted independently by two experts. The quality assessment was assessed using Consolidated Standards of Reporting Trials checklist. The main outcomes were anthropometric indices and metabolic syndrome components. Pooled effect of herbal medicines on obesity and metabolic syndrome were presented as standardized mean difference (SMD) and 95% confidence interval (CI). A total of 279 relevant clinical trials were included. Herbals containing green tea, Phaseolus vulgaris, Garcinia cambogia, Nigella sativa, puerh tea, Irvingia gabonensis, and Caralluma fimbriata and their active ingredients were found to be effective in the management of obesity and metabolic syndrome. In addition, C. fimbriata, flaxseed, spinach, and fenugreek were able to reduce appetite. Meta-analysis showed that intake of green tea resulted in a significant improvement in weight ([SMD]: -0.75 [-1.18, -0.319]), body mass index ([SMD]: -1.2 [-1.82, -0.57]), waist circumference ([SMD]: -1.71 [-2.66, -0.77]), hip circumference ([SMD]: -0.42 [-1.02, -0.19]), and total cholesterol, ([SMD]: -0.43 [-0.77, -0.09]). In addition, the intake of P. vulgaris and N. sativa resulted in a significant improvement in weight ([SMD]: -0.88, 95 % CI: [-1.13, -0.63]) and triglyceride ([SMD]: -1.67, 95 % CI: [-2.54, -0.79]), respectively. High quality trials are still needed to firmly establish the clinical efficacy of the plants in obesity and metabolic syndrome.

Breakfast consumption pattern and its association with overweight and obesity among university students: a population-based study.

PURPOSE: To determine the association between breakfast consumption habit and overweight and obesity in a sample of Iranian university students. METHODS: A sample of 78,905 university students, aged 18 years or older, was recruited from 28 provinces in Iran to assess breakfast consumption pattern. Breakfast consumption habit was evaluated using a pre-tested questionnaire. Weight and height were measured using standard protocol and then body mass index (BMI) was calculated. Overweight (obesity included) and obesity were defined as BMI ≥ 25 and BMI ≥ 30 kg/m2, respectively. RESULTS: Mean age of participants was 21.50 ± 4.01. After controlling for potential confounders, participants who ate breakfast > 4 days/week had 15% lower risk of overweight compared with those who ate < 1 day/week (OR: 0.85, 95% CI 0.78-0.92). Such significant association was also seen in female students (OR: 0.82, 95% CI 0.72-0.93); however, it was marginally significant in male ones (OR: 0.89, 95% CI 0.79-1.00). In addition, a significant inverse association was found between breakfast consumption and obesity (OR: 0.74, 95% CI 0.64-0.85) such that after adjusting for potential confounders, students who consumed breakfast > 4 days/week were 33% less likely to be obese compared with those who consumed it < 1 day/week (OR: 0.67, 95% CI 0.57-0.78). Such significant inverse association was also seen in either gender. CONCLUSIONS: Breakfast consumption was inversely associated with odds of overweight and obesity in university students. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive studies.

Utility of waist circumference-to-height ratio as a screening tool for generalized and central obesity among Iranian children and adolescents: The CASPIAN-V study.

BACKGROUND: Waist-to-height ratio (WHtR) is regarded as a simple anthropometric index for evaluating central adiposity because of its independence of age, gender, and ethnicity. OBJECTIVE: The purpose of this study was to determine the optimal WHtR cutoff value in screening obesity and to compare it with other obesity indicators including body mass index (BMI) and waist circumference (WC) in Iranian children and adolescents. METHODS: This large survey was conducted on 14 274 Iranian children and adolescents as a national school-based surveillance study (CASPIAN) in 2015. The receiver operating characteristic curve analysis was performed to estimate the optimal cut-off points of WHtR for the prediction of general and central obesity. The area under curve (AUC) was used to compare the ability of WHtR cut-off points, BMI and WC percentiles to discriminate students with and without obesity according to age and sex. RESULTS: The optimal WHtR cutoff value for predicting general obesity was 0.49 and 0.48 for boys and girls, respectively and for central obesity according to WC ≥ 90th percentile was 0.50 for both genders. AUC values of WHtR for predicting general and central obesity were 87% and 96%, which indicates its strong predictive ability. For central obesity, the AUCs of WHtR were superior to those of WC percentiles. The kappa agreement coefficient was 0.55 between WC ≥ 90th percentile and WHtR ≥ 0.5. CONCLUSIONS: The WHtR ≥ 0.5 as a simple and useful screening tool is better than WC, for predicting general and central obesity in different age and sex groups of Iranian children and adolescents.

Association of healthy foods intake with anthropometric measures and blood pressure in a national sample of Iranian children and adolescents: the CASPIAN-IV Study.

BACKGROUND: This study aims to evaluate the association of consuming healthy foods with anthropometric measures and blood pressure (BP) in a national sample of Iranian children and adolescents. METHODS: This nationwide study was conducted in 2011-2012 among 13,486 students, aged 6-18 years, selected by multistage cluster sampling from 30 provinces. Weight, height, waist circumference (WC), hip circumference (HC), wais to height ratio (WHtR), waist to hip ratio (WHR), as well as systolic and diastolic blood pressures (SBP, DBP) were measured. Healthy foods were considered as four categories including fresh fruits, dried fruits, vegetables, and dairy products. The frequency consumption of each of these foods was recorded as daily, weekly, and seldom. RESULTS: The intake of fruits was significantly associated with anthropometric indices. Moreover, a significant association was found between vegetables consumption, DBP levels, and anthropometric indices (except for WHtR and WHR). Milk consumption was significantly associated with anthropometric indices (except for WHtR and WHR). The odds of general obesity among participants who seldom consumed dried fruits was less than those who consumed daily (OR: 0.84, 95%CI: 0.74-0.96). We did not find any significant association for the frequency of fresh fruits and vegetables consumption with obesity, abdominal obesity, DBP and SBP. CONCLUSIONS: Consumption of dried fruits was associated with general obesity in children and adolescents. These results highlight the effect of dietary quality and food choices on weight control in children and adolescents.

Association of adolescents' weight status with life satisfaction: role of self, peers, family and school perception; the CASPIAN-IV Study.

BACKGROUND: Although many public health programs have focused on prevention and control of obesity, their efficacy mostly depends on personal factors including perception of weight and personal understanding of the concept of being overweight. This study aims to investigate the association of adolescent's weight status with life satisfaction and explore the role of self, peers, family and school perception in this association. METHODS: Data were obtained from the fourth school-based survey entitled "Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease" (CASPIAN) Study. This survey was conducted among 14,880 urban and rural students aged 6-18 years. Two sets of valid and reliable questionnaire obtained from Global School Health Survey (GSHS) were completed by students and their parents. The students' questionnaire had several questions including life satisfaction and the perception of weight, peers, family and school. RESULTS: The study had a participation rate of 90.6% including 50.8% boys and 76% urban residents. Significant differences existed in Body Mass Index (BMI) and in perception of weight among girls and boys. Moreover, the prevalence of depression and being bullied were higher among girls and boys, respectively. Significant association was documented between life satisfaction and all variables including perception of weight, peers, family and school; the only exception was for BMI (P<0.05). In addition, students with normal weight had significantly higher life satisfaction in comparison with their obese counterparts (P<0.05). CONCLUSIONS: The present study documented significant association between life satisfaction and perception of self, peer, family and school with the exception of BMI in both genders.

Adaptation of human gut microbiota to bariatric surgeries in morbidly obese patients: A systematic review.

BACKGROUND: Bariatric surgeries have turned to be a popular therapeutic option for morbid obesity nowadays. Gut microbiota is supposed to be responsible as a part of the bariatric surgeries success. In this systematic review, we detailed the human studies which investigated the effect of different bariatric surgeries on the composition of gut microbiota. METHODS: We did a comprehensive search in PubMed, Web of Science, and Scopus for all clinical trials and longitudinal observational studies documented up to December 2015. RESULTS: Our initial search yielded 1423 articles. After screening abstracts and full texts, 7 articles were included. In 6 studies, the type of surgical intervention was Roux-en-Y gastric bypass (RYGB) where one study assessed vertical banded gastroplasty (VBG), too. Only in one study the effect of laparoscopic sleeve gastrectomy (LSG) had been investigated. RYGB caused an increase in Proteobacteria and a decrease in Firmicutes. LSG led to less severe intestinal microbiota alteration compared to RYGB. Fecalibacterium prausnitzii species with anti-inflammatory properties increased after LSG. However, inconsistent alterations have been shown in abundance of Fecalibacterium species after RYGB. CONCLUSION: Weight loss after bariatric surgeries are associated with microbiota modifications caused by surgical procedures.

Association of anthropometric indices with continuous metabolic syndrome in children and adolescents: the CASPIAN-V study.

PURPOSE: This study aims to examine the association of anthropometric indices with continuous metabolic syndrome (cMetS) among Iranian children and adolescents. METHODS: This multicentric study was conducted on 14138 students aged 7-18 years, who participated in a national surveillance program. Fasting blood sample was obtained from a subsample of 3843 randomly selected students. Physical examination including the measurement of anthropometric indices and blood pressure was conducted; fasting blood glucose and lipid profile were measured; and cMetS score was computed. Standardized residuals (z-scores) were calculated for MetS components. A higher cMetS score indicates a less favorable metabolic profile. Linear regression models were applied to determine the association between cMetS and anthropometric indices. RESULTS: The study participants consisted of 3843 children and adolescents (52.3% boys) with mean (SD) age of 12.45 ± 3.04 years. All anthropometric indices had positive correlation with standardized scores of mean arterial pressure, waist circumference and cMetS (P < 0.05). Standardized scores of triglycerides were positively correlated with weight and body mass index (P < 0.05). In multivariate model, general and abdominal obesity, as well as high circumferences of neck, wrist, and hip circumferences increased the standardized cMetS risk score to 1.8, 1.9, 1.6, 1.5 and 1.5, respectively (P < 0.05 for all variables). CONCLUSION: The results demonstrated that higher anthropometric indices are associated with higher cMetS risk score in children and adolescents. This information could be valuable for screening and prevention of MetS at population level. LEVEL OF EVIDENCE: V, cross-sectional descriptive study (National surveillance study).

Human Microbiome as an Approach to Personalized Medicine.

Personalized medicine is an approach for medical decisions, practices, and interventions that considers individual variations in genes, environment, and lifestyle for each person. Regarding complex metabolic patterns associated with different diseases, characterizing unique metabolic patterns of each patient seems like a practical approach. We can imagine a future in which routinely analyzing the microbiome allows us to predict individualized responses to different foods and drugs. Microbiome analysis of individuals may be added to future routine personalized medicine protocols after comparing the costs and benefits of microbiome-sequencing technology. Moreover, improved understanding of the human microbiome could lead to the development of novel therapeutic strategies for different diseases. Potential therapeutic agents, such as personalized probiotic and prebiotic supplements, dietary interventions, and fecal microbiota transplantation that can be used to reshape the gut microbiome, represent a reasonable strategy in an era of personalized medicine.

Adiponectin gene variants and abdominal obesity in an Iranian population.

INTRODUCTION: Waist-to-height ratio (WHtR) can be effective for the diagnosis of abdominal obesity and the risk of type 2 diabetes. The role of genetic factors in the development of obesity has been broadly recognized. Adiponectin's level is inversely correlated with body fat percentage and is reduced in obesity and type 2 diabetes. The aim of this study is to investigate the association between WHtR and adiponectin gene polymorphisms in Iranian population. METHODS: This study was conducted on 610 subjects from two Iranian populations. Anthropometric characteristics were measured by routine methods. Blood samples were collected in tubes (3-5 mL) containing EDTA and were stored at 20 °C. After DNA extraction, genotyping was performed using PCR-RFLP technique. RESULTS: There were statistically significant differences in genotype frequencies of -11391 G/A in centrally obese (WHtR >0.5) and noncentrally obese (WHtR ≤0.5) subjects (P value <0.044). In the former, the frequencies of GG and GA + AA genotypes were 89.4 and 10.6 %, respectively, while the frequencies of GG and GA + AA genotypes were 95.9 and 4.1 %, respectively, in noncentrally obese subjects. CONCLUSIONS: The frequency of GG genotype was significantly increased in subjects with WHtR >0.5 compared to the other group. After adjustment for diabetes, abdominal obesity was significantly associated with the -11391 G/A polymorphism.

Investigation of the probiotic supplement's effect on obese adults demonstrated a reduction in fasting insulin levels: a double-blind randomized clinical trial.

Purpose: Regarding the importance of obesity concerns and trying to help obese individuals, we planned to develop an effective probiotic formula for weight control. So, this double-blind randomized clinical trial study investigated the impact of probiotics supplementation on anthropometric and biochemical parameters in obese adults. Methods: In this study, 66 obese patients with BMI in the range of 30-40 kg/m2, were enrolled and randomly assigned to either the probiotic or placebo group. They all received advice to maintain a reduction in daily caloric intake and for 3 months received two unlabeled placebo or probiotic (Lactobacillus plantarum, Lactobacillus rhamnosus, Lactobacillus casei and Bifidobacterium langum) capsules per day. For each participant demographic and medical history questionnaire, semi-quantitative food frequency questionnaire (FFQ), and modifiable activity questionnaire (MAQ) were completed at the beginning of the study and anthropometric and biochemical measurements were done before and after intervention. Results: At the end of the trial 25 subjects in the probiotic group and 26 subjects in the placebo group were analyzed. After the intervention, in the probiotic group, the level of fasting insulin was reduced significantly (P < 0.05). Weight, body mass index, waist circumference, and hip circumference decreased within both groups. This reduction amount's mean was higher in the probiotic group. Also, total cholesterol, triglycerides, and LDL levels were decreased, but not statistically significant. Conclusion: This study may suggest the potential of this combined probiotic supplement for treating obesity and related metabolic disorders. However, further researches are warranted for a definitive determination of its properties.

Adherence to the Mediterranean diet can beneficially affect the gut microbiota composition: a systematic review.

AIM: Dietary patterns could have a notable role in shaping gut microbiota composition. Evidence confirms the positive impact of the Mediterranean diet (MD), as one of the most studied healthy dietary patterns, on the gut microbiota profile. We conducted this systematic review to investigate the results of observational studies and clinical trials regarding the possible changes in the gut microbiota composition, metabolites, and clinical outcomes following adherence to MD in healthy cases or patients suffering from metabolic disorders. METHODS: A systematic literature search was conducted on PubMed, Web of Science, and Scopus databases until October 2023. Two researchers separately screened the titles, abstracts, and then full-text of the articles and selected the relevant studies. Quality assessment of observational and interventional studies was performed by Newcastle-Ottawa and Cochrane checklists, respectively. RESULTS: A total of 1637 articles were obtained during the initial search. Ultimately, 37 articles, including 17 observational and 20 interventional studies, were included in this systematic review. Ten observational and 14 interventional studies reported a correlation between MD adherence and microbiota diversity. Faecalibacterium and Prevotella were the most frequent bacterial genera with increased abundance in both observational and interventional studies; an Increment of Bacteroides genus was also reported in observational studies. Better glycemic control, lowering fat mass, better bowel movement, decreased bloating, inflammation, and hospitalization risk were the reported clinical outcomes. CONCLUSION: Adherence to the MD is associated with significant beneficial changes in the gut microbiota diversity, composition, and functions and major clinical improvements in most populations.

The Effect of Fecal Microbiota Transplantation on Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis.

PURPOSE: Cardiometabolic disease (CMD) is increasing along with its predisposing factors and adverse consequences. As gut microbiota dysbiosis is established in these patients, fecal microbiota transplantation (FMT), which alters the bacterial composition of the intestine, supposedly can help improve cardiometabolic disturbances. We conducted a systematic review and meta-analysis evaluating the impact of FMT on the cardiometabolic parameters and gut microbiota composition of patients experiencing at least one cardiometabolic issue. METHODS: Eligible studies were searched through the PubMed, Web of Science, and Scopus databases until December 2022. The initial search results underwent duplication removal and screening until each included study was scanned for intended data. The Cochrane risk of bias tool was used to evaluate the methodologic accuracy of studies and the random effects model was used for conducting the meta-analysis. FINDINGS: Eighteen of the original 2414 articles from the literature search were entered into the systematic review; of these, 11 were included in the meta-analysis. Insulin showed a significant decrease by 24.7 pmol/L (weighted mean difference [WMD], -24.77; 95% CI, -48.704 to -0.848) after short-term follow-up, and HDL increased by 0.1 mmol/l(WMD, 0.106; 95% CI, 0.027 to 0.184) and 0.12 mmol/l(WMD, 0.120; 95% CI, 0.003 to 0.237) in those using a capsule deliver mode and in short-term follow-up, respectively. No significant changes were seen in other lipid profiles, blood glucose, insulin resistance, or anthropometric indices. In addition, multiple studies reported gut microbiota alterations after the intervention, including an increase in butyrate-producing species. IMPLICATIONS: Although some articles reported the beneficial effects of FMT on metabolic parameters, we failed to find a clinically significant alteration. Also, information regarding proper donors and the best method to induce FMT have not yet been sufficiently investigated, which should be considered along with means to prevent potential damages. PROSPERO identifier: CRD42022380705.

Estrogen-insensitivity syndrome (EIS) in a female adolescent patient - a case report.

OBJECTIVES: Estrogen insensitivity syndrome (EIS) is a rare genetic disorder characterized by an autosomal dominant inheritance pattern. The disease results from a pathogenic variant in the ESR1 (estrogen receptor 1) gene, leading to estrogen resistance in individuals possessing the 46, XX karyotype. The alpha receptor, which is predominant in peripheral tissues, is responsible for estrogen action. As a result, pathogenic variants in the ESR1 gene can cause various disorders, such as changes in secondary sexual characteristics, increased concentrations of estrogen and gonadotropins, and delayed bone maturation. CASE PRESENTATION: Here, the case of a 13-year-old girl, with high estrogen and gonadotropin concentrations, lack of breast development, uterine growth and delayed bone age is described. The patient's parents were related. She was found to have a homozygous pathogenic variant in the ESR1 gene located on chromosome 6q25, which interferes with estrogen signaling. CONCLUSION: This case supports that disruption of ESR1 causes profound estrogen resistance in females.

A multidisciplinary obesity registry for Iranian adults: a protocol.

Purpose: Obesity is a global health challenge due to its high prevalence and increased related morbidity and mortality. Accordingly, creating a platform to enter data on patients with obesity, treatment process and outcome is mandatory. The objective of this registry is to provide such a database regarding Iranian adults with obesity in order to facilitate future research designs and effective decision making to control this condition. Methods: After obtaining informed consent from eligible individuals, a practical questionnaire will be used to gather information about basic characteristics, family history, past medical history, regular medications, dietary intakes and other relevant information of adults with obesity. This data along with the results of laboratory tests, physical examination, and anthropometric measurements will be registered into the registry system by trained members of the team during an in-person visit. Patients will undergo a specific treatment plan based on the multidisciplinary medical team's decision. Then, changeable variables and the outcomes of their treatment process will be registered later in the follow-up sessions. Conclusion: This registry aims to provide a comprehensive dataset on the epidemiology, outcomes and management process of obesity to serve as a foundation for later research projects and improve medical approaches toward this condition.

Evaluation of the Effect of the Pre-Operative Exercise Training on Weight Loss, Quality of Life, and Cardiopulmonary Parameter in Bariatric Metabolic Surgery: A Systematic Review and Meta-Analysis.

The purpose of this study is to assess the impact of pre-surgery exercise training on cardiopulmonary fitness. Ten articles (six RCTs and four non-RCTs) involving 281 individuals were finally included in the synthesis. Regarding the effect on VO2 peak, overall standardized mean differences were 0.71 (95% CI, 0.31 to 1.11, n = 103) with heterogeneity (I2 = 0%, P = 0.49). For 6MWT, overall weighted mean differences (distance in meters) were 31.87 (95% CI, 27.84 to 35.89, n = 100) with heterogeneity (I2 = 0%, P = 0.96). Engaging in pre-bariatric metabolic surgery exercise training might improve anthropometric parameters and cardiopulmonary fitness with no significant changes in components of quality of life. However, considering high levels of heterogeneity, the results should be generalized cautiously.

A case report on POEMS syndrome with high parathyroid hormone and repeated surgery, a rare presentation of a rare disease.

INTRODUCTION: Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes (POEMS) syndrome is a rare multisystemic disease that is named for its constellation which can easily be mistaken for other disorders. CASE PRESENTATION: In present study we evaluated a 39-year-old man with hypercalcemia and parathyroid hormone. He underwent two failed surgeries for parathyroid adenoma but due to the presence of other features of the syndrome, a diagnosis of POEMS syndrome was made. His symptoms were multiple peripheral neuropathies, monoclonal plasma cell proliferative disorder, multiple bony lesions alongside endocrinopathy, lymphadenopathy, extravascular volume overload, mildly hypocellular marrow with polymorphic population, trilineage hematopoiesis, and progressive maturation less than 5 % plasma cell in bone marrow biopsy and aspiration. Patient was treated with the administration of Pomalidomide and autologous stem cell transplantation after which his symptoms improved and laboratory test results normalized. DISCUSSION: POEMS syndrome is a rare disorder that is challenging to diagnose due to its variable clinical presentation and similarity to other disorders. However, specific criteria can help distinguish it from other syndromes. In this case, we witness the comorbidity of Ganglioneuroma. Also, hyperglycemia with hypercalcemia and high PTH in this patient are not common endocrine disorders in POEMS syndrome which there are some possible explanations for these symptoms' presentation. CONCLUSION: Although endocrine disorders are an important part of POEMs syndrome, some characteristic of this disease is unknown, and it becomes more difficult to diagnose in early stages, that in these cases, thorough physical examinations and laboratory results may help with the early diagnosis.

Trimethylamine N-Oxide as a Potential Risk Factor for Non-communicable Diseases: A Systematic Review.

BACKGROUND: Trimethylamine N-Oxide (TMAO), as a gut microbiota-derived metabolite, has been associated with a number of chronic diseases like cardiovascular diseases. OBJECTIVE: Considering the increasing prevalence of non-communicable diseases (NCDs), we conducted a systematic review to discuss the TMAO association with NCDs. METHODS: A comprehensive search has been conducted on PubMed, Web of Science, and Scopus databases up to December, 2020. The inclusion criteria were all related observational studies that surveyed the association between TMAO levels and non-communicable diseases. Interventional studies, animal experiments, reviews, case reports, letters, congress abstracts, and studies that were not published in English were excluded. Moreover, related review studies were separately discussed. RESULTS: Within 2191 recorded studies, 99 cross-sectional, case-control and cohort studies met the inclusion criteria. The most common diseases associated with TMAO levels are cardiovascular diseases, diabetes, kidney disease, stroke, inflammatory diseases, neurological disorders, and cancer. Elevated TMAO levels as a consequence of alteration in gut microbiota composition and dietary intake can lead to the incidence of NCDs. The high levels of TMAO can disrupt the homeostasis of glucose and lipids and induce inflammation that leads to serious NCDs. CONCLUSION: There is a dose-response relationship between TMAO levels and NCDs progression. Therefore, it can be studied as a therapeutic target or prognostic biomarker for dealing with NCDs.

Comparison of Framingham Cardiovascular Risk Criteria and ASCVD Score in Iranian Obese Patients.

Background: Calculating and predicting the risk of disease plays an important role in preventive medicine. Today, some risk scores have been designed to estimate the risk of cardiovascular diseases (CVDs) by assessing different factors. Obesity is associated with an increased risk of cardiovascular disease, so we decided to calculate the possible risk of heart disease in obese Iranian people to suggest a more accurate calculator. Methods: In this cross-sectional study, we compared the data of 289 people from Framingham Risk Score and ASCVD Risk Score calculations who had been referred to Shariati Hospital Obesity Clinic, Tehran, Iran from 2016 to 2019. In the form of sub-goals, we examined other factors such as blood pressure and hepatic aminotransferases, etc. Results: The mean age of participants was 51.20±7.58 years, 86.2% being women. Of the whole, 19.72%, 31.83%, 21.11%, and 27.34% were categorized as overweight, Obese I, II, and III, respectively. According to the ASCVD score 80.3%, 4.8%, and 14.9%, and according to the Framingham score 95.5%, 3.5%, and 1% were classified as low-risk, intermediate-risk, and high-risk. Moreover, a fair agreement was observed between the two-risk score in the whole (Kappa=0.236; P<0.001), overweight (Kappa=0.304; P=0.028), Obese I (Kappa=0.210; P=0.048), Obese II (Kappa=0.268; P=0.015), and obese III (Kappa=0.202; P=0.023). Conclusion: Despite its age limit, ASCVD has a higher risk of CVDs, causing statin care (which has a protective role for cardiovascular disease) to be given to a larger population.

Evaluating the effectiveness of melatonin in reducing the risk of foot ulcers in diabetic patients.

Objectives: Diabetes and its complications, as a major health concern, are associated with morbidity and mortality around the world. One of these complications is diabetic foot ulcer. Factors such as hyperglycemia, neuropathy, vascular damage and impaired immune system can cause foot ulcers. The present review aims to study the potential effects of melatonin, the main product of pineal glands, on diabetic foot ulcers. Methods: A narrative review was performed using present literature in an attempt to identify the different aspects of melatonin's impact on diabetic foot ulcers by searching related keywords in electronic databases without any restriction. Results: This review shows that, melatonin has anti-diabetic effects. It is effective in reducing the risk of hyperglycemia, neuropathy, vascular damage and immune system impairment in diabetic patients. By reducing these complications with melatonin, correspondingly, the incidence of diabetic foot ulcers may also decrease in these patients. Conclusions: The results of this study indicate promising properties of melatonin while dealing with diabetic foot ulcers and their common underlying conditions, but still, it needs to be investigated more in future studies.