Metformin use and risk of fracture: a systematic review and meta-analysis of observational studies.

INTRODUCTION: No study is available summarizing earlier publications on the association between metformin use and risk of fracture. This systematic review and meta-analysis were conducted to summarize earlier findings on the association between metformin use and risk of fracture. METHODS: We conducted a systematic search on all published articles up to October 2018 using online databases including PubMed/Medline, ISI Web of Science, and Scopus. Observational studies that considered metformin use as the exposure variable and bone fracture as the main outcome variable or as one of the outcome variables and participants included were 18 years and older were included in the systematic review. Publications in which hazard ratios (HRs), rate or risk ratios (RRs), or odds ratios (ORs) were reported as effect size were included in the meta-analysis. RESULTS: Totally, three cohort studies, one cross-sectional study, one nested case-control study, and one case-control study were included in this systematic review and meta-analysis. When seven effect sizes from six studies were combined, a significant inverse association between metformin use and risk of fracture was observed (RR 0.82; 95% CI 0.72, 0.93). No significant between-study heterogeneity was found (I2 = 22.4%, Pheterogeneity = 0.25). In addition, no evidence of publication bias was seen using Egger's test (P = 0.99). CONCLUSION: We found that metformin use was inversely associated with the risk of fracture.

Breakfast consumption in relation to lowered risk of psychological disorders among Iranian adults.

OBJECTIVES: This study aims to find whether breakfast consumption is associated with human mental health. STUDY DESIGN: This cross-sectional study was conducted to investigate the association between breakfast consumption and psychological disorders, including depression and anxiety, among Iranian adults. METHODS: This cross-sectional study was conducted on 4378 general public adults in Isfahan, Iran. Breakfast consumption was assessed using a validated detailed dietary habits' questionnaire. Depression and anxiety were screened using an Iranian validated Hospital Anxiety and Depression Scale questionnaire. Psychological distress was examined by means of Iranian validated version of General Health Questionnaire (GHQ-12 items). Depression, anxiety, and psychological distress were defined based on standard criteria. RESULTS: Overall, 13.95% (n = 611) of study participants had anxiety, 28.62% (n = 1253) were depressive, and 23.18% (n = 1015) had psychological distress. After controlling for potential confounding variables, participants with every day breakfast consumption had lower odds for depression (odds ratio [OR]: 0.49, 95% confidence interval [95% CI]: 0.36-0.66) compared with those with the least frequent intake of breakfast, even after further adjustment for body mass index [BMI] (OR: 0.47, 95% CI: 0.34-0.63). Frequent breakfast consumption was inversely associated with anxiety before (OR: 0.53, 95% CI: 0.37-0.76, P < 0.001) and after controlling for BMI (OR: 0.52, 95% CI: 0.36-0.75, P < 0.001). The same findings were obtained for psychological distress (OR: 0.46, 95% CI: 0.33-0.62, P < 0.001). CONCLUSION: We found an inverse association between breakfast consumption and depression, anxiety, and psychological distress among Iranian adults. Further prospective studies are needed to confirm these findings.

Dietary glycaemic index and glycaemic load and upper gastrointestinal disorders: results from the SEPAHAN study.

BACKGROUND: Little is known about the effects of carbohydrate, particularly any association between dietary glycaemic index or glycaemic load and uninvestigated heartburn or uninvestigated chronic dyspepsia in the community. The present study aimed to determine associations between dietary glycaemic index or glycaemic load and uninvestigated heartburn or uninvestigated chronic dyspepsia. METHODS: This cross-sectional study was conducted in 2987 adults. Dietary glycaemic index and glycaemic load were estimated using a validated food-frequency questionnaire. Uninvestigated heartburn and uninvestigated chronic dyspepsia were determined using a modified and validated version of the Rome III questionnaire. RESULTS: After controlling for various confounders, high glycaemic load was associated with an increased risk of uninvestigated heartburn [odds ration (OR) = 1.75; 95% confidence interval CI = 1.03, 2.97; P = 0.04] and uninvestigated chronic dyspepsia (OR = 2.14; 95% CI: 1.04, 4.37; P = 0.04) in men but not in women. In normal-weight individuals, high glycaemic index was related to an increased risk of uninvestigated heartburn (OR = 1.52; 95% CI: 1.07, 2.15; P = 0.02) and high glycaemic load to an increased risk of uninvestigated chronic dyspepsia (OR=1.78; 95% CI: 1.05, 3.01; P = 0.03). No significant associations were observed in subjects with excess body weight. CONCLUSIONS: Our data suggest that there are body mass index- and sex-specific associations between dietary carbohydrate quality with uninvestigated heartburn and uninvestigated chronic dyspepsia.

Evaluation of Self-Perceived Changes in Gastrointestinal Symptoms During Ramadan Fasting.

Little is known regarding the effects of Ramadan fasting on common gastrointestinal symptoms. The aim of this study was to assess the alterations of these symptoms in a healthy Iranian adult population during Ramadan. In a cross-sectional study, self-administered questionnaires were used to evaluate the alterations in seven groups of gastrointestinal symptoms (esophageal symptoms, dyspeptic symptoms, bloating and abdominal distension, constipation, diarrhea, abdominal pain, and nausea) after Ramadan. A total of 900 individuals participated in the study. Almost 87 % of participants reported to fast for at least 2 weeks during Ramadan. After adjusting for potential confounders, we found no relationship between alteration in frequency of gastrointestinal symptoms and Ramadan fasting, except for constipation which increased significantly after Ramadan fasting (odds ratio 1.99, 95 % confidence interval 1.05-3.80, P < 0.05). In addition, those who fasted for at least 2 weeks reported to experience severe or very severe constipation-related symptoms three times more in comparison with those who fasted for less than 2 weeks (P < 0.05). There was no relationship between severity of other gastrointestinal symptoms and Ramadan fasting. We found that Ramadan fasting does not increase frequency and severity of common gastrointestinal symptoms in the general population except for constipation that may be experienced more frequently and severely among those who fast for 2 weeks or more.

Dietary patterns and prevalence of irritable bowel syndrome in Iranian adults.

BACKGROUND: Although 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. OBJECTIVE: This study was undertaken to assess the association between dietary patterns and the risk of IBS among Iranian adults. METHODS: In 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. RESULTS: We 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. CONCLUSION: We 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.

Is tooth loss associated with irritable bowel syndrome?

Although the relationship between number of teeth and gastric disturbances has been recognised, limited data are available linking tooth loss and irritable bowel syndrome (IBS). This study aimed to investigate the relation between dental status and IBS among Iranian adults. In a cross-sectional study on 4669 Iranian adults, dental status was evaluated using a self-administered questionnaire. Participants were categorised into five main groups: those with full dentition (without denture), those with denture, individual who had lost 1-2 teeth, 3-5 teeth and half of one jaw or more. IBS and its subtypes were defined using Rome III criteria. After adjusting for different confounding variables, those who had lost 1-2 and 3-5 teeth had 1·35 and 1·33 times greater odds for IBS than fully dentate subjects, respectively. After controlling for different confounders, individuals who had denture had 103% greater odds to have constipation-predominant IBS than those with full dentition (95% confidence interval: 1·29-3·21). Neither in crude nor in adjusted models were any significant association between dental status and other subtypes of IBS. In addition, we did not find any association between losing half of one jaw or more and IBS. We found that losing 1-2 or 3-5 teeth might significantly be associated with increased risk of IBS. Having denture might be related to constipation-predominant IBS. There should be further prospective studies to confirm these findings.

Fish consumption is inversely associated with the metabolic syndrome.

BACKGROUND/OBJECTIVES: 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. SUBJECTS/METHODS: In a cross-sectional study conducted on 420 Iranian female adults, usual fish consumption was assessed using a dish-based semiquantitative food frequency questionnaire (FFQ). Fasting blood samples were taken for biochemical assessment. Anthropometric and blood pressure measurements were carried out according to standard protocols. Metabolic syndrome was defined based on the National Cholesterol Education Program Adult Treatment Panel III guidelines. Multivariate logistic regression adjusted for lifestyle and dietary variables was applied to assess fish-metabolic syndrome association. RESULTS: The prevalence of metabolic syndrome was 8.2%. Mean daily intake of fish was 14.4 g per day. Individuals in the highest tertile of fish intake were 65% less likely to have the metabolic syndrome than those in the lowest tertile (odds ratio: 0.35; 95% confidence interval (CI): 0.14-0.88). Controlling for potential confounders and dietary variables strengthened this association (odds ratio: 0.05; 95% CI: 0.004-0.64). After adjustment for potential cofounders, high fish intake was inversely associated with hypertriglyceridemia (odds ratio: 0.11; 95% CI: 0.01-0.85), low high-density lipoprotein cholesterol (odds ratio: 0.57; 95% CI: 0.19-0.89) and elevated blood pressure (odds ratio: 0.23; 95% CI: 0.14-0.89). CONCLUSIONS: We found that increased fish intake was independently related to the lower odds of metabolic syndrome and its features. Further prospective investigations are warranted to confirm this association.

Epidemiology and risk factors of tooth loss among Iranian adults: findings from a large community-based study.

OBJECTIVES: To investigate the prevalence of tooth loss and different prosthetic rehabilitations among Iranian adults, as well as the potential determinants of tooth loss. METHODS: In a cross-sectional community-based study conducted among 8094 Iranian adults living in Isfahan province, a self-administered questionnaire was used to assess epidemiologic features of tooth loss. RESULTS: Thirty-two percent of subjects had all their teeth, 58.6% had lost less than 6, and 7.2% of participants had lost more than 6 teeth. One hundred and sixty-nine individuals (2.2%) were edentulous. Among participants, 2.3% had single jaw removable partial denture, 3.6% had complete removable denture in both jaws, and 4.6% had fixed prosthesis. Others reported no prosthetic rehabilitation (89.5%). In the age subgroup analysis (≤35 and >35 years old) tooth loss was more prevalent among men than women (OR = 2.8 and 1.9, resp., P < 0.01). Also, in both age groups, current and former smokers had higher levels of tooth loss than nonsmokers (P < 0.001 and P < 0.05, resp.). In addition, tooth loss was positively related to metabolic abnormality for age group >35 years (adjusted OR = 1.29, P < 0.01). CONCLUSIONS: Tooth loss is highly prevalent in Iranian adult population. Community programs promoting oral health for prevention of tooth loss should be considered taking into account its major determinants including lower educational level, male gender, smoking, and metabolic abnormality.

Patterns of diet-related practices and prevalence of gastro-esophageal reflux disease.

BACKGROUND: No studies have evaluated associations between patterns of diet-related practices as determined by latent class analysis (LCA) and gastro-esophageal reflux disease (GERD). We aimed to assess this relationship in a large sample of Iranian adults. METHODS: In a cross-sectional study in 4763 adults, diet-related practices were assessed in four domains, 'meal pattern', 'eating rate', 'intra-meal fluid intake', and 'meal-to-sleep interval', using a pretested questionnaire. LCA was applied to identify classes of diet-related practices. We defined GERD as the presence of heartburn sometimes, often or always. KEY RESULTS: The prevalence of GERD in the study population was 23.5% (n = 1120). We identified two distinct classes of meal patterns: 'regular' and 'irregular', three classes of eating rates: 'moderate', 'moderate-to-slow', and 'moderate-to-fast', two major classes of fluid ingestion with meals: 'moderate' and 'much intra-meal drinking', and two classes regarding the interval between meals and sleeping: 'short' and 'long meal-to-sleep' interval. After adjustment for potential confounders, subjects with 'irregular meal pattern' had higher odds of GERD compared with subjects with 'regular meal pattern' (OR: 1.21; 1.00-1.46). However, when taking into account BMI, the association disappeared. 'Long meal-to-sleep interval' was inversely associated with GERD compared with 'short meal-to-sleep interval' (OR: 0.73; 95% CI: 0.57-0.95). 'Eating rate' and 'intra-meal fluid intake' were not significantly associated with GERD. CONCLUSIONS & INFERENCES: Our data suggest certain associations between dietary patterns and GERD. These findings warrant evaluation in prospective studies to establish the potential value of modifications in dietary behaviors for the management of GERD.

Comparing the Effects of Group and Home-based Physical Activity on Mental Health in the Elderly.

BACKGROUND: The present study focuses on comparing the effects of home-based (HB) and group-based (GB) physical activity on mental health in a sample of older adults in Shahr-e-kord. METHODS: In this quasi-experimental study, a twice-weekly physical activity program for 2 months was provided either individually at home or in a group format for 181 people who were divided into two groups (HB and GB). The outcome, mental health, was measured with the 28-item General Health Questionnaire (GHQ-28). RESULTS: Mental health status improved after participation in the physical activity program. The decrease in GHQ-28 total score in GB group, 3 months after intervention, was 3.61 ± 2.28 (P < 0.001). In HB group, this reduction was 1.20 ± 2.32 during the same period (P < 0.001). The difference of these "before-after differences" between the two groups in the GHQ-28 and all its subscales was statistically significant (P < 0.001). Also, the effects of GB physical activity on mental health compared with HB physical activity, adjusted for related baseline variables, were significant. CONCLUSIONS: These findings reveal the probable effects of GB rather than HB physical activity on mental health among the elderly.

Premedication with peppermint oil capsules in colonoscopy: a double blind placebo-controlled randomized trial study.

BACKGROUND: Colonic spasm is an important problem in colonoscopy for endoscopists to advance the colonoscope and visualize the mucosa. STUDY AIMS: In the present study, we evaluated the efficacy of enteric-coated peppermint oil capsules (Colpermin) as an orally administered antispasmodic premedication in colonoscopy. PATIENTS AND METHODS: Sixty-five adult patients undergoing colonoscopy were randomized to receive either Colpermin (n = 33) or placebo capsules (n = 32) as premedication, 4 hours before the procedure. An experienced endoscopist performed colonoscopy. Outcome measures included cecal intubation and total procedure time, spasm score, pain score, endoscopist satisfaction and patients' willingness to repeat colonoscopy. RESULTS: Duration of both total procedure time and cecal intubation time in patients in the Colpermin group were shorter than that in ones in the placebo group. Scores for colonic spasm and pain were significantly lower in the Colpermin group. The endoscopist satisfaction score was higher in the Colpermin group and patients in the Colpermin group were more willing to repeat colonoscopy in the future. CONCLUSIONS: Premedication with Colpermin was beneficial in terms of the time required for cecal intubation and total procedure time, reducing colonic spasm, increasing endoscopist satisfaction and decreasing pain in patients during colonoscopy.

The role of thyroid autoantibodies in the etiology of endemic goiter in schoolchildren of Isfahan, Iran.

BACKGROUND: Eleven years after the initiation of universal salt iodization program in Iran, the prevalence of goiter is still high in some areas. AIM: To investigate the role of thyroid autoimmunity in the etiology of residual goiter in schoolchildren of Isfahan, Iran. MATERIAL AND METHODS: In a cross-sectional study, 2331 schoolchildren were selected by multi-stage random cluster sampling. Thyroid size was estimated in each child by inspection and palpation. Urinary iodine concentration (UIC), serum anti-thyroperoxidase antibody (anti-TPO Ab), and anti-thyroglobulin antibody (Anti-Tg Ab) were measured. RESULTS: Overall, 32.9% of children had goiter. The median UIC was 1955.5 microg/dl. There was significant difference in prevalence of positive anti-TPO Ab in goitrous (grade 2) and non-goitrous children (9.7 vs 3.7%, p= 0.02). Goitrous children had higher prevalence of positive anti-Tg Ab than non-goitrous ones (15.1 vs 3.1%, p<0.001). CONCLUSIONS: According to the present study, goiter is still a public health problem in this region. This study suggests that thyroid autoimmunity is among the contributors of goiter persistence after elimination of iodine deficiency in Isfahan.