Effects of Chromium Picolinate Supplementation on Cardiometabolic Biomarkers in Patients with Type 2 Diabetes Mellitus: a Randomized Clinical Trial

Type 2 diabetes mellitus (T2DM) is a serious public health problem accompanies with several complications. This study was conducted to evaluate the effects of chromium picolinate (CrPic) supplementation on the glycemic status and lipid profile in patients with T2DM. The patients with T2DM (n = 52) were randomly allocated into 2 groups. One group received 400 μg CrPic per day and the other group took placebo; the intervention duration was 8 weeks. Anthropometric indices and metabolic factors were measured at the beginning, and at end of the study. The patients were recommended not to change their normal diet, life style and medication. No significant changes were observed for weight, body mass index, and fasting blood glucose (FBG) in both groups; while intra-groups changes in homeostatic model assessment for insulin resistance (HOMA-IR) value was significant (p < 0.05). Results of analysis of covariance showed that there were significance differences between groups in total cholesterol, low density lipoprotein cholesterol and HOMA-IR at the end of the intervention adjusting for baseline levels (p = 0.035, 0.030 and < 0.001, respectively). In this study, oral supplementation with 400 μg CrPic for eight weeks did not alter FBG concentration as well as anthropometric parameters in individuals with T2DM. However, the modest beneficial effects of chromium supplementation on insulin resistance as indicated by HOMA-IR and lipid profile were found.

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

Dietary patterns, nutrition, and risk of breast cancer: a case-control study in the west of Iran / 한국역학회지

OBJECTIVES@#Unhealthy dietary patterns are the most important changeable risk factors for breast cancer. The aim of this study was to assess the relationship between dietary patterns and the risk of breast cancer among under-50 year women in the west of Iran.@*METHODS@#All women under 50 years old with pathologically confirmed breast cancer between 2013 and 2015 who were referred to oncology clinics in the west of Iran, and 408 under-50 women referred to other outpatient clinics who were without breast or other cancers at the time of the study and 2 years later were selected as the control group. The data were collected using the middle-aged periodical care form of the Iranian Ministry of Health and analyzed using univariate and multivariate logistic regression in Stata.@*RESULTS@#The most powerful risk factor for breast cancer was fried foods; the odds ratio of consuming fried foods more than once a month for breast cancer was 4.5 (95% confidence interval, 2.1 to 9.4). A dose-response model indicated that increasing vegetable and fruit consumption up to 90 servings per month decreased the odds of breast cancer, but consuming more than 90 servings per month increased the risk.@*CONCLUSIONS@#Inadequate consumption of vegetables and consumption of soft drinks, industrially produced juices, fried foods, and sweets were identified as risk factors for breast cancer. In response to these findings, it is necessary to raise awareness and to provide education about healthy diets and the need to change unhealthy dietary patterns.

Dietary patterns, nutrition, and risk of breast cancer: a case-control study in the west of Iran / 한국역학회지

OBJECTIVES: Unhealthy dietary patterns are the most important changeable risk factors for breast cancer. The aim of this study was to assess the relationship between dietary patterns and the risk of breast cancer among under-50 year women in the west of Iran.METHODS: All women under 50 years old with pathologically confirmed breast cancer between 2013 and 2015 who were referred to oncology clinics in the west of Iran, and 408 under-50 women referred to other outpatient clinics who were without breast or other cancers at the time of the study and 2 years later were selected as the control group. The data were collected using the middle-aged periodical care form of the Iranian Ministry of Health and analyzed using univariate and multivariate logistic regression in Stata.RESULTS: The most powerful risk factor for breast cancer was fried foods; the odds ratio of consuming fried foods more than once a month for breast cancer was 4.5 (95% confidence interval, 2.1 to 9.4). A dose-response model indicated that increasing vegetable and fruit consumption up to 90 servings per month decreased the odds of breast cancer, but consuming more than 90 servings per month increased the risk.CONCLUSIONS: Inadequate consumption of vegetables and consumption of soft drinks, industrially produced juices, fried foods, and sweets were identified as risk factors for breast cancer. In response to these findings, it is necessary to raise awareness and to provide education about healthy diets and the need to change unhealthy dietary patterns.

Validity of Self-reported Hypertension and Factors Related to Discordance Between Self-reported and Objectively Measured Hypertension: Evidence From a Cohort Study in Iran / 예방의학회지

OBJECTIVES@#Self-reporting can be used to determine the incidence and prevalence of hypertension (HTN). The present study was conducted to determine the validity of self-reported HTN and to identify factors affecting discordance between self-reported and objectively measured HTN in participants in the Ravansar Non-Communicable Diseases (RaNCD) cohort.@*METHODS@#The RaNCD cohort included permanent residents of Ravansar, Iran aged 35-65 years. Self-reported data were collected before clinical examinations were conducted by well-trained staff members. The gold standard for HTN was anti-hypertensive medication use and blood pressure measurements. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of self-reporting were calculated. Univariate and multivariate logistic regression were used to examine the discordance between self-reported HTN and the gold standard.@*RESULTS@#Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN despite receiving treatment. The sensitivity, specificity, and kappa for self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives became more likely with age, body mass index (BMI), low socioeconomic status, and female sex, whereas false negatives became more likely with age, BMI, high socioeconomic status, smoking, and urban residency.@*CONCLUSIONS@#The sensitivity and specificity of self-reported HTN were acceptable, suggesting that this method can be used for public health initiatives in the absence of countrywide HTN control and detection programs.

Dietary patterns, nutrition, and risk of breast cancer: a case-control study in the west of Iran / 한국역학회지

OBJECTIVES: Unhealthy dietary patterns are the most important changeable risk factors for breast cancer. The aim of this study was to assess the relationship between dietary patterns and the risk of breast cancer among under-50 year women in the west of Iran. METHODS: All women under 50 years old with pathologically confirmed breast cancer between 2013 and 2015 who were referred to oncology clinics in the west of Iran, and 408 under-50 women referred to other outpatient clinics who were without breast or other cancers at the time of the study and 2 years later were selected as the control group. The data were collected using the middle-aged periodical care form of the Iranian Ministry of Health and analyzed using univariate and multivariate logistic regression in Stata. RESULTS: The most powerful risk factor for breast cancer was fried foods; the odds ratio of consuming fried foods more than once a month for breast cancer was 4.5 (95% confidence interval, 2.1 to 9.4). A dose-response model indicated that increasing vegetable and fruit consumption up to 90 servings per month decreased the odds of breast cancer, but consuming more than 90 servings per month increased the risk. CONCLUSIONS: Inadequate consumption of vegetables and consumption of soft drinks, industrially produced juices, fried foods, and sweets were identified as risk factors for breast cancer. In response to these findings, it is necessary to raise awareness and to provide education about healthy diets and the need to change unhealthy dietary patterns.

Validity of Self-reported Hypertension and Factors Related to Discordance Between Self-reported and Objectively Measured Hypertension: Evidence From a Cohort Study in Iran / 예방의학회지

OBJECTIVES: Self-reporting can be used to determine the incidence and prevalence of hypertension (HTN). The present study was conducted to determine the validity of self-reported HTN and to identify factors affecting discordance between self-reported and objectively measured HTN in participants in the Ravansar Non-Communicable Diseases (RaNCD) cohort. METHODS: The RaNCD cohort included permanent residents of Ravansar, Iran aged 35-65 years. Self-reported data were collected before clinical examinations were conducted by well-trained staff members. The gold standard for HTN was anti-hypertensive medication use and blood pressure measurements. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of self-reporting were calculated. Univariate and multivariate logistic regression were used to examine the discordance between self-reported HTN and the gold standard. RESULTS: Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN despite receiving treatment. The sensitivity, specificity, and kappa for self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives became more likely with age, body mass index (BMI), low socioeconomic status, and female sex, whereas false negatives became more likely with age, BMI, high socioeconomic status, smoking, and urban residency. CONCLUSIONS: The sensitivity and specificity of self-reported HTN were acceptable, suggesting that this method can be used for public health initiatives in the absence of countrywide HTN control and detection programs.

Associations between Muscle Strength with Different Measures of Obesity and Lipid Profiles in Men and Women: Results from RaNCD Cohort Study

We aimed to examine associations between muscle strength and obesity and serum lipid profile in Ravansar Non-Communicable Disease (RaNCD) cohort study. This study was conducted on 6,455 subjects aged 35–65 years old from baseline data of RaNCD in Iran. The associations between grip strength and adiposity measurements were explored using linear regression with adjustment for age, height, smoking status, alcohol intake, social class, and prevalent disease. The mean of body mass index (BMI) and muscle strength was 27.2 ± 4.6 kg/m² and 33.3 ± 11.5, respectively. Muscular strength increased with increasing BMI and waist circumference (WC) in both sexes. Multivariate regression analysis revealed a 3.24 (95% confidence interval [CI], 2.29, 4.19) kg difference between BMI in top and bottom in men, and 1.71 (95% CI, 0.98, 2.34) kg/m² in women. After multivariable adjustment, a difference of 2.04 (95% CI, 1.12, 2.97) kg was observed between the top and bottom WC quartiles in men and 1.25 (95% CI, 0.51, 1.98) kg in women. In men, with increase of low-density lipoprotein and cholesterol, the mean muscle strength was significantly increased. Muscle strength may be associated with body composition and lipid profiles. Muscle strength can be an appropriate indicator for predicting some of the problems caused by body composition disorders, which requires further longitudinal studies.

Measuring and Decomposing Socioeconomic Inequalities in Adult Obesity in Western Iran / 예방의학회지

OBJECTIVES: Obesity is a considerable and growing public health concern worldwide. The present study aimed to quantify socioeconomic inequalities in adult obesity in western Iran. METHODS: A total of 10 086 participants, aged 35-65 years, from the Ravansar Non-communicable Disease Cohort Study (2014-2016) were included in the study to examine socioeconomic inequalities in obesity. We defined obesity as a body mass index ≥30 kg/m2. The concentration index and concentration curve were used to illustrate and measure wealth-related inequality in obesity. Additionally, we decomposed the concentration index to identify factors that explained wealth-related inequality in obesity. RESULTS: Overall, the prevalence of obesity in the total sample was 26.7%. The concentration index of obesity was 0.04; indicating that obesity was more concentrated among the rich (p < 0.001). Decomposition analysis indicated that wealth, place of residence, and marital status were the main contributors to the observed inequality in obesity. CONCLUSIONS: Socioeconomic-related inequalities in obesity among adults warrant more attention. Policies should be designed to reduce both the prevalence of obesity and inequalities in obesity by focusing on those with higher socioeconomic status, urban residents, and married individuals.

Nutritional Care in Iranian Intensive Care Units

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

Anthropometric Indices from Primary to High School in the West of Iran: Epidemiologic Trends

Examining the trend of anthropometric indices in children and adolescents in each region can be highly beneficial in providing effective strategies to improve the status of their growth. This study was conducted with the aim of determining the trend of anthropometric indices in students from primary to high school in the west of Iran. Data were collected using a demographic questionnaire and health certificates for anthropometric information of primary school students, and current anthropometric measurements with scale for high school students. Then, all of the data were analyzed in AnthroPlus and SPSS software. Of the 731 students, 350 were female and 381 were male. Mean height Z-score to age showed a significant reduction from primary to high school (from +0.0386 to −0.27416), and mean body mass index Z-score to age showed a significant increase (from −0.3916 to +0.1826). Prevalence of stunting and overweight/obesity in high school was 1.4 and 2.5 times higher than primary school, respectively, but the prevalence of wasting reduced by 2.3 fold. Girls were more affected by the increased trend of obesity and stunting compared to boys. Nutritional transition was evident in students. Healthcare policy-makers should design and implement a comprehensive health strategy to deal with this situation, especially in girls.

Comparison of 3 Nutritional Questionnaires to Determine Energy Intake Accuracy in Iranian Adults

A precision instrument is required to assess the nutritional status. This study was conducted on comparison of 3 nutritional questionnaires to determine energy intake (EI) accuracy in adults in Ravansar Non-Communicable Chronic Disease (RaNCD) cohort study. This cross-sectional study was conducted on 118 of participant's RaNCD. EI was evaluated with 3 questionnaires including food frequency questionnaire (FFQ), 24-hours recall (24HR), and food habits questionnaire (FHQ). Resting metabolic rate (RMR) was measured using indirect calorimetry. We used EI/RMR cut off to evaluate EI reporting status. The mean ± standard deviation of age in men and women were 44.1 ± 6.5 and 43.7 ± 5.25 respectively and 50.8% of participants were men. Among 3 EI estimating questionnaires, FFQ was more accurate than 2 other questionnaires (67.8%). We observed that implausible reporters of 24HR were likely overweight (p < 0.005) but we did not observe a significant difference between EI reporting of FFQ and FHQ with participants' body composition. Our finding showed that EI underreporting of 24HR and FHQ were high. Under reporters were seemed to be overweight. Therefore, these results suggested that among 3 nutritional questionnaires the FFQ was an appropriate approach to determine EI in this population due to plausible EI reporting was higher than 2 other nutritional questionnaires (24HR and FHQ).

Dietary Diversity Score and Its Related Factors among Employees of Kermanshah University of Medical Sciences

Dietary diversity score (DDS) is known as an indicator of food quality. Dietary diversity can promote health status. The aim of this study was determined DDS and its related factors in Kermanshah University of Medical Sciences (KUMS) employees. This cross-sectional study was conducted on 190 employees of KUMS in 2015. According to the population of KUMS centers which were selected randomly (Paramedical, Public Health faculties, Imam Reza Hospital and province health center), subjects were selected by convenience sampling method. Food frequency questionnaire (FFQ) was used to calculate DDS. Foods were divided into 5 main groups: grains, vegetables, fruits, meat, and dairy products. The main groups had 23 subgroups. Total DDS divided to 4 quartiles: less than 3.0, 3.0–5.5, 5.6–8.5, and more than 8.5. Anthropometric parameters including: weight, height, waist circumference (WC), and hip circumference were measured. Data were analyzed by Kolmogorov-Smirnov test, χ² test, and analysis of variance (ANOVA) test with SPSS 20 software (IBM Corp., Chicago, IL, USA). The mean ± standard deviation of DDS and body mass index (BMI) were 5.68 ± 1.73 and 25.1 ± 3.42 kg/m², respectively. The average of the waist-to-hip ratio (WHR) in men and women was 0.92 ± 0.04 and 0.86 ± 0.06, respectively. There was statistically significant difference between DDS and self-reported economic status (p < 0.022). No significant difference was observed between DDS and BMI or WC. However, significant negative correlation was observed between DDS and WHR in men (p < 0.019). This study showed that DDS had a negative correlation with the WHR. Therefore, dietary diversity may improve health status by effect on fat distribution in body.

[Nutritional Status of Working Children in Kermanshah, 2013]

Background: Starting to work from early age can have negative impact on the growth and nutritional status, especially if the children are employed in dangerous jobs. This study aimed to assess nutritional status and growth in working children who were working in Kermanshah.

Materials and Methods: This survey was a case-control study that wasdoneon90 working childrenand90not- working children in Kermanshah. Information related to anthropometric indices with measurements of height and weight, demographic data using demographic questionnaire and food intake using food frequency questionnaire were collected. To compare growth of children with standards we use body mass index percentiles for sex and age provided by Centres for Disease Control and Prevention [CDC].Data analysis was performed using SPSS software version 16.

Results: Mean of age working children was 16.4 +/- 1.8 years and 15.7% of them were illiterate. Consumption of all food groups except the miscellaneous group in working children was significantly lower than not- working children[p<0.001].The prevalence of stunting in working children was 10% more than the not- working children. The prevalence of malnutrition based on body mass index in working children[36.1%], was approximately 50% more than the not- working children[16.5%], [P <0.01].

Conclusion: The finding so this study showed that indicators of nutritional status in working children have not favourable condition. This could bea risk factor for health of this group of children and a warning for affecting of them by kind of disease.

Fasting consequences during Ramadan on lipid profile and dietary patterns

The aim was to assess the effects on lifestyle and lipid profile while fasting during holy month of Ramadan. An interventional cohort study designed with 160 subjects who were fasting during Ramadan recruited from different mosques in Kermanshah. Data were collected in three stages at the beginning and at the end of Ramadan as well as one month following Ramadan using demographic and FFQ questionnaires. Blood pressure was measured and a 5 ml blood sample was collected in order to measure BUN, Creatinine, and lipid profile analysis. Significant increases was observed in total cholesterol [P=0.02], LDL-C [P=0.001], HDL-C [P=0.001], and BUN [P=0.002] following Ramadan compared with earlier measurements. Triglyceride [TG] level decreased following Ramadan [P=0.04] but returned to the same level one month later. Systolic blood pressure increased and diastolic blood pressure decreased during fasting period. There was a significant decrease in cereals, dairy products, and meat consumption while consumption of fruits and vegetables have been increased during Ramadan [P=0.003]. Our results revealed increased levels of T-Chol and LDL-C in fasting as well as HDL-C. Increased HDL-C may prevent the side effects of T-Chol and LDL-C in healthy subjects. Given the metabolic changes that occurred during Ramadan, healthy eating and intake of low fat and low sugar diet during Ramadan are highly recommended

[ effect of short time diet therapy on lipid profiles in hyperlipidemia]

Hyperlipidemia is a risk factor for cardio vascular diseases [CVD], which may be protected by diet therapy and physical activity. The aim of the present study was the determination of the effects of diet therapy and nutritional education on lipid profiles in hyperlipidemic pateints. 73 subjects out of 183 subjects with hyperlipidemia were selected from our previous research for this semi-clinical trial study. Written consent forms were obtained and 5ml fasting blood sample was collected for TG, T-C, LDL-C and HDL-C analysis before and after intervention. Body composition was assessed using bioelectric impedance [Plusavis 333]. All participants received low fat, low cholesterol and high fiber diet including a nutritional guide booklet. Subjects were followed up using phone call every two weeks and data was analyzed using pair T-test and SPSS16. 45 subjects with average age of 45+8 year completed the study [16 female and 29 male]. There was significant reduction in BMI and weight after two months diet therapy [p<0.05]. Significant decrease was showed in LDL-C after two month intervention [104.2+2.3 vs. 90.1+2.9, p= 0.001]. The study showed borderline reduction in diastolic blood pressure. There was no significant difference for TG, T-C and systolic blood pressure before and after intervention. Reduction in BMI, weight and LDL-C during short time revealed the effects of diet therapy and nutritional education. Screening for hyperlipidemia and improving public nutritional knowledge using appropriate media to prevent CVD is highly recommended