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BackgroundThe association between linoleic acid (LA) intake and mental disorders has not been extensively studied in Middle-Eastern populations. We investigated the association between LA intake and the prevalence of depression, anxiety,... more
BackgroundThe association between linoleic acid (LA) intake and mental disorders has not been extensively studied in Middle-Eastern populations. We investigated the association between LA intake and the prevalence of depression, anxiety, and psychological distress in a large group of Iranian adults.MethodsThis cross-sectional study was conducted on 3,362 middle-aged adults. LA intake was determined through a validated dish-based 106-item semiquantitative food frequency questionnaire (FFQ). The validated Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ) were used to define psychological disorders.ResultsThe prevalence of depression, anxiety, and psychological distress among the study population was 28.6, 13.6, and 22.6%, respectively. After adjustment for potential confounders, individuals in the top quartile of LA intake had 41% more likely to be depressed compared to those in the bottom quartile (OR = 1.41, 95% CI: 1.02–1.95). Stratified analysis b...
Background: The relationship of the number of daily meals and snacks with gastroesophageal reflux disease (GERD) is less studied in Middle-Eastern countries. We aimed to find this relationship in a large sample of Iranian adults. Methods:... more
Background: The relationship of the number of daily meals and snacks with gastroesophageal reflux disease (GERD) is less studied in Middle-Eastern countries. We aimed to find this relationship in a large sample of Iranian adults. Methods: In this cross-sectional study, 4669 individuals fulfilled a questionnaire about their number of daily meals and snacks. Frequency of total meals was defined by summing up the frequency of main meals and snacks and participants were categorized into 4 categories: < 3, 3-5, 6-7 and ≥ 8 meals/day. GERD was defined as having heartburn sometimes or more during the last three months. The severity of disease was assessed using a four items scale rating mild, moderate, severe, and very severe. Findings: The prevalence of GERD in study population was 23.7%. After adjustment of all potential confounders, women who consumed 1-2 or 3-5 snacks per day, compared to those who never used snack, had a 41% (OR:0.59; 95% CI: 0.42-0.84) and 51% (OR: 0.49; 95% CI: 0.32-0.75) reduced risk of having GERD, respectively. Women who consumed 6-7 or ≥ 8 snacks and meals per day had a 38% (OR: 0.62; 95% CI: 0.41-0.96) and 43% (OR: 0.57; 95% CI: 0.34-0.95) risk reduction for GERD, in comparison with those who ate < 3 snacks and meals per day. There was no significant relationship between the meal frequency and GERD symptoms in men. Conclusion: We found an inverse significant relationship between the meal frequency and GERD symptoms in Iranian women, but not in men. Prospective studies are required to confirm this association in Middle-Eastern populations.
BackgroundAlthough several dietary factors have been reported to alleviate or aggravate the symptoms of irritable bowel syndrome (IBS), no information is available linking habitual dietary patterns to irritable bowel... more
BackgroundAlthough several dietary factors have been reported to alleviate or aggravate the symptoms of irritable bowel syndrome (IBS), no information is available linking habitual dietary patterns to irritable bowel syndrome.ObjectiveThis study was undertaken to assess the association between dietary patterns and the risk of IBS among Iranian adults.MethodsIn this cross‐sectional study, data on 3846 Iranian adults working in 50 different health centers were examined. Dietary intake of study participants was assessed using a 106‐item self‐administered Dish‐based Semi‐quantitative Food Frequency Questionnaire (DS‐FFQ) which was designed and validated specifically for Iranian adults. To identify major dietary patterns based on the 39 food groups, we used principal component analysis. A modified Persian version of the Rome III questionnaire was used for assessment of IBS.ResultsWe identified four major dietary patterns: (i) ‘fast food’, (ii) ‘traditional’, (iii) ‘lacto‐vegetarian’, and (iv) ‘western’ dietary pattern. After adjustment for potential confounders, we found that those in the highest quartile of ‘fast food’ dietary pattern were tended to have higher risk of IBS than those in the lowest quartile (OR = 1.32; 95% CI: 0.99, 1.75, ptrend = 0.05). An inverse association was also found between ‘lacto‐vegetarian’ dietary pattern and risk of IBS; such that even after adjustment for potential confounders, those in top quartile of this dietary pattern were 24% less likely to have IBS (0.76; 0.59, 0.98; ptrend = 0.02). No overall significant associations were observed between ‘traditional’ and ‘western’ dietary patterns and risk of IBS, either before or after adjustment for covariates.ConclusionWe found that ‘lacto‐vegetarian’ dietary pattern was associated with reduced risk, while ‘fast food’ dietary pattern was associated with a greater risk of IBS in Iranian adults.
Stress is a major risk factor for the development of various psychiatric disorders such as depression, anxiety and post-traumatic stress disorder. Previous studies showed that general self-efficacy, which is described as the belief to... more
Stress is a major risk factor for the development of various psychiatric disorders such as depression, anxiety and post-traumatic stress disorder. Previous studies showed that general self-efficacy, which is described as the belief to exert control over one’s own functioning, facilitates coping with new and stressful situations and can lead to less anxiety and depression [1, 2]. In other words, optimism and perceived control were associated with less depressive symptoms. In our recent article [3], entitled “Consumption of fruit and vegetables in relation with psychological disorders in Iranian adults”, we concluded that a higher intake of fruits was associated with a lower risk of depression, anxiety and psychological distress among Iranian women. Additionally, high consumption of vegetables was also associated with lower risk of depression and anxiety, respectively, in women and men. This finding supports the current recommendation of increasing fruits and vegetables intake to improve mental health. We thank Lopez-Ixta for her interest in our article. She claimed in her letter that the non-consideration of perceived behavioral control, self-efficacy or actual control might yield inaccurate results in the association between fruit and vegetable intakes and psychosocial disorders. In our recently published systematic review and metaanalysis [4], we summarized the published data regarding fruit and vegetable intake with depression and anxiety. We found that high consumption of fruit, vegetables and total fruit and vegetables was associated with reduced risk of depression. Among 24 studies included in that systematic review, common potential confounders—including age, sex, education, physical activity, energy intake, body mass index, smoking—were considered in most studies. Some investigations had also controlled for income, marital status and chronic diseases. However, only two included studies made adjustment for perceived stress score and another study adjusted for stressful life events. Although we agree that stress is a major risk factor, controlling of this variable in the analysis in the two above-mentioned studies did not significantly alter the findings. Furthermore, self-efficacy, perceived control or actual control were considered in none of the previous investigations. We agree that assessing the relation between fruit and vegetable intake with psychological disorders, without considering these psychological variables, might obtain misleading results, it is suggested that future investigations should consider the psychological factors such as perceived control, self-efficacy and coping skills. Due to the lack of sufficient data, we could not consider the psychological factors in the assessment.
Measuring the satiety index of food components has not been done in Iran yet. The aim of this study was to determine the satiety index (SI) of low-fat yogurt among healthy normal-weight adults in Isfahan. This semi-experimental study was... more
Measuring the satiety index of food components has not been done in Iran yet. The aim of this study was to determine the satiety index (SI) of low-fat yogurt among healthy normal-weight adults in Isfahan. This semi-experimental study was conducted on 30 healthy normal-weight adults for two consecutive days. In the first day, each participant consumed 90 grams white bread and in the second day 526 grams low-fat yogurt (1.5% fat) within 15 minutes. We evaluated the satiety of low-fat yogurt and white bread based on VAS and LIKERT scales. Anthropometric indices were measured. Food intakes, physical activity in the night before each test, hunger and palatability of each food were evaluated by food record, physical activity record, Three-Factor Eating Questionnaire (TFEQ), respectively. The satiety index of low-fat yogurt was 136.66±1.46 compared to white bread (with SI of 100). The changes of satiety 120 minutes after consumption of white bread and low-fat yogurt were not significant ba...
Despite the growing body of evidence from Western societies on the association between dietary patterns and stroke, limited data are available in this regard from developing countries. This study was conducted to examine the association... more
Despite the growing body of evidence from Western societies on the association between dietary patterns and stroke, limited data are available in this regard from developing countries. This study was conducted to examine the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and risk of stroke among the Iranian population. This hospital-based case-control study included 194 stroke patients and 194 controls and was conducted at the Alzahra University Hospital, Isfahan, Iran. The cases were stroke patients who were hospitalized in the neurology ward of the Alzahra University Hospital. Controls were randomly selected from among hospitalized patients in the orthopedic or surgical wards of this center. A validated food frequency questionnaire (FFQ) was used to assess the patients' usual dietary intake. We constructed the DASH diet score based on food and nutrients emphasized or minimized in the DASH diet. The prevalence of stroke among those in the top quartile of the DASH diet score was 40%, which was 15% lower than among those in the bottom quartile; this difference was marginally significant (p = 0.10). After controlling for age, sex, and total energy intake, adherence to the DASH diet was inversely associated with the risk of stroke (OR: 0.52; 95% CI: 0.28; 0.98). These associations remained significant even after additionally controlling for physical activity, smoking, hypertension, and diabetes, such that individuals in the highest quartile of the DASH diet score had a 58% lower risk of stroke than those in the lowest category (OR: 0.48; 95% CI: 0.24, 0.96). However, after further adjustment for body mass index (BMI), the association disappeared (OR: 0.62; 95% CI: 0.29, 1.31), indicating an obesity-dependent association. We found an inverse relationship between the DASH-style diet and prevalence of stroke. Prospective studies are needed to confirm this association.
Findings from few studies that investigated the relation between dietary behaviors and obesity are inconsistent. We aimed to assess the relation between patterns of dietary habits, identified by latent class analysis (LCA), and obesity in... more
Findings from few studies that investigated the relation between dietary behaviors and obesity are inconsistent. We aimed to assess the relation between patterns of dietary habits, identified by latent class analysis (LCA), and obesity in a large sample of Iranian adults. In a cross-sectional study on 7958 adults, dietary behaviors were assessed in five domains (meal patterns, eating rate, intra-meal fluid intake, meal-to-sleep interval, and fatty foods intake) using a pretested questionnaire. LCA was applied to identify classes of diet-related practices. Anthropometric measures were assessed through the use of a validated self-reported questionnaire. General and abdominal obesity were defined as a body mass index ≥30 kg/m(2), and a waist circumference ≥88 cm for women and ≥102 cm for men. General and abdominal obesity were prevalent in 9.7 and 27.7 % of the study population, respectively. We identified three distinct classes of eating rates (moderate, moderate to slow, and moderate to fast), two classes of meal patterns (regular and irregular), two classes of intra-meal fluid intake (moderate and more intra-meal drinking), three classes of meal-to-sleep interval (short, moderate, and long meal-to-sleep interval), and three classes of fatty food intake (low to moderate, moderate to high, and low intake of fatty foods). After adjustment for potential confounders, individuals with 'irregular meal pattern' were 21, 24, and 22 % more likely to be overweight/obese, abdominally overweight/obese, and abdominally obese, compared with those who had a 'regular meal pattern.' Individuals with 'more intra-meal drinking' had greater odds of overweight (OR 1.37; 1.19-1.458) and obesity (OR 1.51; 1.16-1.97) than those with 'moderate intra-meal drinking.' Moderate-to-high intake of fatty foods was inversely associated with abdominally overweight/obese (OR 0.85; 0.73-1.00) and abdominally obesity (OR 0.80; 0.68-0.96) compared with 'low-to-moderate intake of fatty foods.' No significant association was observed between eating rate, meal-to-sleep interval, and general or abdominal obesity, after controlling for confounders. Irregular meal pattern and more intra-meal drinking were associated with increased odds of general and abdominal obesity, whereas moderate-to-high intake of fatty foods was related to the decreased odds of central obesity among Iranian adults.
Nutrient pattern analysis is an easy way to compare nutrient intakes across different nations due to the universality of nutrients nature. The purpose of this study was to examine the relationship between dietary nutrient patterns (NPs)... more
Nutrient pattern analysis is an easy way to compare nutrient intakes across different nations due to the universality of nutrients nature. The purpose of this study was to examine the relationship between dietary nutrient patterns (NPs) and circulating 25(OH)D concentrations with sleep duration and sleep quality among Iranian adults. We used a multistage cluster random sampling method to enroll 535 adults in this cross-sectional investigation. A validated food frequency questionnaire was applied to evaluate typical dietary intakes. Fasting blood samples were obtained to determine levels of circulating 25(OH)D. Sleep characteristics were assessed using the Pittsburgh Sleep Quality Index (PSQI). Participants had a mean age of 42.57 years and 51.2% of them had insufficient or deficient levels of serum vitamin D. Three NPs were identified: "high animal protein", "high vegetable" and "high carbohydrate". After adjustments for potential confounders, no signif...
Previous studies have rarely investigated dietary phytochemicals consumption in relation to metabolic health of adolescents. The current study was performed to investigate dietary phytochemical index (DPI) in relation to metabolic health... more
Previous studies have rarely investigated dietary phytochemicals consumption in relation to metabolic health of adolescents. The current study was performed to investigate dietary phytochemical index (DPI) in relation to metabolic health status in overweight and obese adolescents. This cross-sectional study was conducted among 203 adolescents with overweight or obesity. Dietary intakes of participants were obtained through a validated 147-item food frequency questionnaire. DPI was calculated [(dietary energy derived from phytochemical-rich foods (kcal)/total daily energy intake (kcal)) ⨯100]. Glycemic and lipid profiles, blood pressure, and anthropometric indices were also measured. A metabolically unhealthy overweight/obesity (MUO) profile was determined based on the International Diabetes Federation (IDF) and IDF/Homeostasis Model Assessment Insulin Resistance (HOMA-IR) definitions. Study subjects had a mean age of 13.98 years and 50.2% of them were girls. According to IDF and IDF...
Findings of earlier investigations on association between dietary riboflavin intake and psychological disorders are contradictory. Therefore, the relation between dietary riboflavin intake and depression, anxiety, and psychological... more
Findings of earlier investigations on association between dietary riboflavin intake and psychological disorders are contradictory. Therefore, the relation between dietary riboflavin intake and depression, anxiety, and psychological distress was assessed in Iranian adults. In this cross-sectional study, dietary intakes of 3362 middle-aged adults were collected using a validated dish-based food frequency questionnaire. Daily intake of riboflavin for each participant was calculated by summing up the amount of riboflavin contents of all foods and dishes. Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ), as validated questionnaires among Iranians, have been applied to assess depression, anxiety, and psychological distress. After considering potential confounders, adults in the top energy-adjusted quartile of riboflavin intake, compared to the bottom quartile, had decreased odds of depression (OR = 0.66; 95%CI 0.49, 0.88), anxiety (OR = 0.64; 95%CI 0.44,...
BackgroundLittle is known about the association of plant-based diet indices with metabolic syndrome (MetS) and its novel predictive biomarkers, including the atherogenic index of plasma (AIP) and adropin. We aimed to investigate the... more
BackgroundLittle is known about the association of plant-based diet indices with metabolic syndrome (MetS) and its novel predictive biomarkers, including the atherogenic index of plasma (AIP) and adropin. We aimed to investigate the association of plant-based diets with adropin, atherogenic index of plasma, and MetS and its components in adults.MethodsThe present population-based cross-sectional study was conducted on a representative sample of adults aged 20–60 years in Isfahan, Iran. Dietary intake was obtained through a validated 168-item semi-quantitative food frequency questionnaire (FFQ). Peripheral blood was obtained after an overnight fast of at least 12 h from each participant. MetS was identified based on the Joint Interim Statement (JIS). AIP was calculated as a logarithmically transformed ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-c), and serum levels of adropin were measured by an ELISA kit.ResultsA total of 28.7% of subjects had MetS. No signi...
Limited data are available on the association of legumes and nuts consumption with health status in pediatrics. So, we assessed the relation of legumes and nuts intake with metabolic health status in Iranian adolescents. A random sample... more
Limited data are available on the association of legumes and nuts consumption with health status in pediatrics. So, we assessed the relation of legumes and nuts intake with metabolic health status in Iranian adolescents. A random sample of overweight/obese adolescents aged 12 to 18 years was included in this cross-sectional study. Dietary intakes were gathered using a validated 147-item food frequency questionnaire (FFQ). We measured metabolic indices including blood pressure, lipid profile, glycemic and anthropometrics indices. Two strategies were used for classification of adolescents to metabolically healthy obese (MHO) or unhealthy obese (MUO): International Diabetes Federation (IDF) and combination of IDF with Homeostasis Model Assessment Insulin Resistance (HOMA-IR). Information on 203 overweight/obese adolescents (50.2% girls and 49.8% boys) with an average age of 13.98 (± 1.61) years and a mean weight of 73.48 (± 11.60) kg/m2 was evaluated. Based on the IDF and IDF/HOMA-IR d...
Background: Although fish consumption has inversely been associated with several metabolic abnormalities, limited and inconsistent data have reported the relationship between fish consumption and metabolic syndrome. The aim of this study... more
Background: Although fish consumption has inversely been associated with several metabolic abnormalities, limited and inconsistent data have reported the relationship between fish consumption and metabolic syndrome. The aim of this study was to identify the association between fish consumption and metabolic syndrome and its components. Methods : In a cross-sectional study conducted on 420 Iranian female adults, usual fish consumption was assessed by the use of a dish-based semi-quantitative FFQ. Fasting blood samples were taken for biochemical assessment. Anthropometric and blood pressure measurements were done according to standard protocols. The metabolic syndrome was defined based on the National Cholesterol Education Program Adult Treatment Panel III guidelines. Findings: Mean daily intake of fish was 14.4 g/d. Fish consumption was inversely associated with prevalence of metabolic syndrome; such that those in the highest tertile of fish intake were 65% less likely to have the me...
BackgroundSerum uric acid concentration has been linked with metabolic abnormalities. The available evidence on the association of Sugar‐Sweetened Beverage (SSB) intake with serum uric acid concentrations is conflicting. The present study... more
BackgroundSerum uric acid concentration has been linked with metabolic abnormalities. The available evidence on the association of Sugar‐Sweetened Beverage (SSB) intake with serum uric acid concentrations is conflicting. The present study aimed to summarise earlier findings on the association of SSB consumption with serum uric acid concentrations in adults.MethodsUsing relevant keywords, we conducted a search in PubMed (https://pubmed.ncbi.nlm.nih.gov), Scopus (https://www.scopus.com) and Google Scholar (https://scholar.google.com) up to September 2017 for all published papers assessing SSB intake and serum uric acid concentrations. SSBs were defined as the dietary intake of Sugar‐Sweetened Soft Drinks and Fruit Juice (FJ), or as Sugar‐Sweetened Soft Drinks, Diet Soft Drinks and Orange Juice or as Soda and FJ.ResultsAfter excluding non‐relevant papers, five studies, with six effect sizes, remained in our systematic review. All studies included in the current systematic review were o...
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Objective:We investigated the association of dietary Mg intake with insulin resistance and markers of endothelial function among Iranian women.Design:A cross-sectional study.Setting:Usual dietary intakes were assessed using a validated... more
Objective:We investigated the association of dietary Mg intake with insulin resistance and markers of endothelial function among Iranian women.Design:A cross-sectional study.Setting:Usual dietary intakes were assessed using a validated FFQ. Dietary Mg intake was calculated by summing up the amount of Mg in all foods. A fasting blood sample was taken to measure serum concentrations of glycemic indices (fasting plasma glucose and insulin) and endothelial function markers (E-selectin, soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1). Insulin resistance and sensitivity were estimated using the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), Homeostasis Model Assessment β-cell function (HOMA-β) and quantitative insulin sensitivity check index (QUICKI).Participants:Iranian female nurses (n 345) selected by a multistage cluster random sampling method.Results:The Mg intake across energy-adjusted quartiles was 205 (se 7), 221·4 (se 8), 254·3 (se 7) and 355·2 (se 9) mg/d, respectively. After adjustments for potential confounders, QUICKI level was significantly different across quartiles of Mg intake (Q1: 0·34 (se 0·02), Q2: 0·36 (se 0·01), Q3: 0·40 (se 0·01), and Q4: 0·39 (se 0·02), P = 0·02); however, this association disappeared after considering markers of endothelial function, indicating that this relation might be mediated through endothelial dysfunction. After controlling for all potential confounders, Mg intake was inversely, but not significantly, associated with serum concentrations of sICAM (Q1: 239 (se 17), Q2: 214 (se 12), Q3: 196 (se 12), and Q4: 195 (se 17), P = 0·29). There was no other significant association between dietary Mg intake and other indicators of glucose homoeostasis or endothelial markers.Conclusions:Higher dietary Mg intake was associated with better insulin sensitivity in Iranian females. This linkage was mediated through reduced endothelial dysfunction.
Background Despite the prior evidence of the impacts of sumac on glycemic indices, lipid profile and visceral fat, there is a lack of evidence regarding the efficacy of sumac in cases with metabolic syndrome (MetS). Therefore, we aimed to... more
Background Despite the prior evidence of the impacts of sumac on glycemic indices, lipid profile and visceral fat, there is a lack of evidence regarding the efficacy of sumac in cases with metabolic syndrome (MetS). Therefore, we aimed to assess the effect of sumac supplementation on MetS markers among adults with this syndrome. Methods In this triple-blinded randomized placebo-controlled cross-over clinical trial 47 adults with MetS were randomly assigned to receive 500 mg sumac or placebo (lactose) capsule, twice a day. Each phase took 6 weeks and there was a 2-week washout between phases. All clinical evaluations and laboratory tests were conducted before and after each phase. Results At the baseline of the study, mean (± SD) age, weight, and waist circumference of participants were respectively 58.7 (± 5.8) yr, 79.9 (± 14.3) kg, and 107.6 (± 10.8) cm. Intention to treat analysis (ITT) analyses revealed that sumac supplementation decreased systolic blood pressure by 5 mmHg (128.8...
Several epidemiological studies investigated the relation of Ca intake with type 2 diabetes mellitus (T2DM), but there were inconsistencies in their findings. So, we conducted a systematic review and dose–response meta-analysis to... more
Several epidemiological studies investigated the relation of Ca intake with type 2 diabetes mellitus (T2DM), but there were inconsistencies in their findings. So, we conducted a systematic review and dose–response meta-analysis to quantify the relation of dietary Ca intake with the risk of T2DM/hyperglycemia in adults. A systematic search was conducted up to May 2021, in MEDLINE (Pubmed), Web of Science (WOS), Scopus electronic databases and Google Scholar, for epidemiological studies that investigated the relation of dietary Ca intake (as the exposure) and T2DM/hyperglycemia (as the outcome) in adults, without restriction in publication date and language. Finally, 8 cohort and 9 cross-sectional studies were included in the analysis. The body of evidence was assessed by the GRADE approach. Combining effect sizes from prospective cohort studies included 255,744 general adult population illustrated that highest level of dietary Ca intake, compared to lowest category, was related to an...
Vitamin E supplementation might have favorable effects on risk factors of polycystic ovary syndrome (PCOS). This systematic review and meta-analysis aimed to summarize the effects of vitamin E supplementation or vitamin E in combination... more
Vitamin E supplementation might have favorable effects on risk factors of polycystic ovary syndrome (PCOS). This systematic review and meta-analysis aimed to summarize the effects of vitamin E supplementation or vitamin E in combination with omega-3 or magnesium on PCOS. PubMed, Scopus, ISI Web of Science, Cochrane, Embase electronic databases, and Google scholar were searched for all available articles up to September 2022. Randomized controlled trials (RCTs) that examined the effect of vitamin E supplementation or vitamin E in combination with omega-3 or magnesium on lipid and glycemic profiles, anthropometric measurements, biomarkers of inflammation and oxidative stress, hormonal profile, and hirsutism score in patients with PCOS were included. Ten RCTs (with 504 participants) fulfilled the eligible criteria. Vitamin E supplementation or vitamin E in combination with omega-3 or magnesium in comparison to placebo could significantly reduce serum levels of TG (weighted mean differe...

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