The effect of Mediterranean diet on inflammatory biomarkers and components of metabolic syndrome in adolescent girls.

BACKGROUND: The prevalence of obesity and metabolic syndrome (MetS) during childhood and adolescence is rising significantly worldwide. Previous studies have shown that following a healthy dietary pattern, like the Mediterranean diet (MD), might be an efficacious approach for the prevention and management of MetS during childhood. In the present study, we aimed to examine the effect of MD on inflammatory markers and components of MetS among adolescent girls with MetS. METHODS: This randomized controlled clinical trial was conducted on 70 girl adolescents with metabolic syndrome. Patients in the intervention group followed a prescribed MD, while participants in the control group received dietary advice according to the food pyramid. The length of intervention was 12 weeks. Participants' dietary intakes were evaluated using three 1-day food records throughout the study. Anthropometric measures, inflammatory markers, systolic and diastolic blood pressure, and hematological factors were assessed at the baseline and end of the trial. An intention-to-treat approach was taken into account for the statistical analysis. RESULTS: After 12 weeks, participants in the intervention group had lower weight (Ptime*group ≤ 0/001), body mass index (BMI) (Ptime*group ≤ 0/001), and waist circumference (WC) (Ptime*group ≤ 0/001) compared with those in the control group. In addition, MD resulted in a significantly reduced systolic blood pressure compared to the those in the control group (Ptime*group ≤ 0/001). In terms of metabolic variables, MD led to a significant decrease in fasting blood glucose (FBS) (Ptime*group ≤ 0/001), triglycerides (TG) (Ptime*group ≤ 0/001), low-density lipoprotein (LDL) (Ptime*group ≤ 0/001), homeostatic model assessment of insulin resistance (HOMA-IR) (Ptime*group = 0/02) and a meaningful increase in serum levels of high-density lipoprotein (HDL) (Ptime*group ≤ 0/001). In addition, adherence to the MD resulted in a significant reduction in serum levels of inflammatory markers including Interleukin 6 (IL-6) (Ptime*group = 0/02) and high-sensitivity C-reactive protein (hs-CRP) (Ptime*group = 0/02). However, no significant effect was seen on serum levels of tumor necrosis factor α (TNF-α) (Ptime*group = 0/43). CONCLUSION: Overall, the findings of the present study revealed that consumption of MD for 12 weeks resulted in a favorable effect on anthropometric measures, components of MetS, as well as on some inflammatory biomarkers.

Consumption of sugar-sweetened beverages and serum uric acid concentrations: a systematic review and meta-analysis.

BACKGROUND: Serum 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. METHODS: Using 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. RESULTS: After excluding non-relevant papers, five studies, with six effect sizes, remained in our systematic review. All studies included in the current systematic review were of cross-sectional design that were published between 2007 and 2013. The number of participants ranged from 483 to 14 761 people. Most studies had controlled for age, body mass index, weight and sex. We found that individuals in the highest category of SSB intake had 0.18 mg dL-1 greater concentrations of serum uric acid compared to those in the lowest category (summary effect size: 0.18 mg dL-1 ; 95% confidence interval = 0.11-0.25). No significant between-study heterogeneity was found (I2  = 0.0%, P = 0.698). In the sensitivity analysis, we found no particular study influence on the summary effect. There was no evidence of publication bias. CONCLUSIONS: We found that SSB consumption was significantly associated with increased serum uric acid concentrations in an adult population.

Effect of a newly developed ready-to-use supplementary food on growth indicators in children with mild to moderate malnutrition.

OBJECTIVES: Malnutrition is one of the leading causes of death among children younger than five years. In this study, we aimed to formulate a ready-to-use supplementary food (RUSF), based on local food products, and investigate its efficacy on growth indicators in children with mild to moderate malnutrition. STUDY DESIGN: This is a randomized controlled clinical trial. METHODS: This study was performed in six health centers in Shahr-e-Rey, Tehran, Iran, between April and October 2017. One hundred children, aged 24-59 months, with mild to moderate malnutrition (weight-for-height Z-score [WHZ] between -3 and -1) were randomly assigned to two groups to receive either 1-3 sachets of RUSF or normal diet for 8 weeks. All mothers and caregivers received nutrition education. Growth indicators including weight and height, WHZ, and body mass index (BMI), along with clinical outcomes, were assessed. RESULTS: Children who received RUSF had a significant increase in weight (1.44 ± 0.38 vs 0.7 ± 0.32 kg, respectively, P < 0.001), and BMI (1.2 ± 0.47 vs 0.35 ± 0.33 kg/m2, respectively, P < 0.001) compared with the control group. There was a greater daily weight gain during the first 4 weeks (P < 0.001) and throughout the study (P = 0.013) in the RUSF group. Daily height gain was considerably higher in the RUSF group during the first 4 weeks (P = 0.027). Children in the RUSF group had more improvement in WHZ (1.18 ± 0.41 vs 0.41 ± 0.31, P < 0.001) after supplementation. Besides, 92% of the RUSF and 12% of the control group reached to WHZ > -1 at the end of the study (P < 0.001). There was lower prevalence of diarrhea (12% vs 28.6%, respectively, P = 0.01) and marginally lower fever (16% vs 36.7%, respectively, P = 0.05) in the intervention than in the control group. CONCLUSIONS: A newly developed RUSF improved growth indicators and clinical outcomes in children with mild to moderate malnutrition. CLINICAL TRIAL REGISTRY NUMBER: IRCT2017021315536N6 (registered at www.irct.ir).

Association of vitamin D, retinol and zinc deficiencies with stunting in toddlers: findings from a national study in Iran.

OBJECTIVE: The objective of this study was to investigate the association of serum levels of 25(OH)D3 (vitamin D), retinol (vitamin A) and zinc with stunting in a large sample of Iranian toddlers. STUDY DESIGN: This was a cross-sectional study. METHODS: A total of 4261 children, aged 10-36 months, who had Iranian birth certificates were included in the present study. Weight and height were measured by experienced professionals in accordance with standard protocols. Stunting was defined as a height-for-age z-score of <-1 standard deviation (SD) based on the World Health Organization (WHO) criteria (the WHO Child Growth Standards median). Serum levels of 25(OH)D3, retinol and zinc were examined based on standard methods. RESULTS: The mean age of the study participants was 19.2 ± 8.4 months. A significant inverse association was found between serum retinol concentrations and the odds of stunting such that after controlling for potential confounders, toddlers in the highest quartile of serum retinol levels had 29% lower odds of stunting than those in the lowest quartile (odds ratio [OR]: 0.71, 95% confidence interval [CI]: 0.53-0.97). Furthermore, a significant inverse association was found between serum levels of retinol and stunting in girls (OR: 0.57, 95% CI: 0.34-0.94), urban toddlers (OR: 0.66, 95% CI: 0.44-0.99) and those who did not use nutritional supplements (OR: 0.70, 95% CI: 0.52-0.95). Although serum 25(OH)D3 levels were not significantly associated with stunting in the overall study population, we found a positive association among toddlers who used nutritional supplements. No significant association was found between serum levels of zinc and stunting. CONCLUSION: We found a significant inverse association between serum levels of retinol and stunting in toddlers aged 10-36 months.

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.

Resveratrol supplementation significantly influences obesity measures: a systematic review and dose-response meta-analysis of randomized controlled trials.

This study aimed to summarize earlier randomized controlled trials on the effects of resveratrol supplementation on body weight (BW), body mass index (BMI), waist circumference (WC) and fat mass (FM). We searched PubMed, SCOPUS, Cochrane Library and Google Scholar from inception to April 2018 using relevant keywords. All clinical trials investigating the effects of resveratrol supplementation on BW, BMI, WC and FM in adults were included. Overall, 28 trials were included. Pooled effect sizes suggested a significant effect of resveratrol administration on weight (weighted mean differences [WMD]: -0.51 kg, 95% confidence interval [CI]: -0.94 to -0.09; I2  = 50.3%, P = 0.02), BMI (WMD: -0.17 kg m-2 , 95% CI: -0.32, -0.03; I2  = 49.6%, P = 0.02) and WC (WMD: -0.79 cm, 95% CI: -1.39, -0.2; I2  = 13.4%, P = 0.009), respectively. However, no significant effect of resveratrol supplementation on FM was found (WMD: -0.36%, 95% CI: -0.88, 0.15; I2  = 0.0%, P = 0.16). Findings from subgroup analysis revealed a significant reduction in BW and BMI in trials using resveratrol at the dosage of <500 mg d-1 , those with long-term interventions (≥3 month), and performed on people with obesity. Taken together, the data suggest that resveratrol supplementation has beneficial effects to reduce BW, BMI and WC, but not FM.

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.

Adherence to Healthy Eating Index-2010 is inversely associated with metabolic syndrome and its features among Iranian adult women.

BACKGROUND/OBJECTIVES: Nowadays, metabolic syndrome (MetS) is deemed as a major public health challenge in both developed and developing countries. Therefore, the aim of this study was to determine the association between Healthy Eating Index-2010 (HEI-2010) score and MetS and its features among Iranian female nurses. SUBJECTS/METHODS: This cross-sectional study was performed among 1036 Iranian women. A validated, self-administered, dish-based, semiquantitative food frequency questionnaire was used to assess the habitual intake of participants. HEI-2010 score was used to assess diet quality of participants. MetS was defined based on the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (ATP III). Multivariate logistic regression adjusted for potential confounders was used to assess the relation between HEI-2010 and MetS. RESULTS: After adjusting for potential confounders, participants in the highest quartile of HEI-2010 had the lowest risk of MetS compared with those in the first quartile (odds ratio: 0.72; 95% confidence interval: 0.50-0.96). Furthermore, the risk of MetS features including abdominal obesity, high blood pressure, high serum triacylglycerol and low serum high-density lipoprotein-cholesterol significantly decreased across HEI-2010 quartiles (P<0.05). CONCLUSIONS: Higher HEI-2010 scores were inversely associated with lower risk of MetS and its components among Iranian women.

Dietary patterns and mortality from cardiovascular disease: Isfahan Cohort Study.

BACKGROUND/OBJECTIVES: Evidence about the relation between dietary patterns and cardiovascular disease (CVD) is scarce in Middle Eastern countries. This study was performed to examine the association between major dietary patterns and CVD mortality in Iranian adults. SUBJECTS/METHODS: This population-based prospective cohort study was conducted among 4834 randomly selected participants aged ⩾35 years from urban and rural areas of central Iran (2001-2009) (the Isfahan Cohort Study). Dietary intakes were assessed using a food frequency questionnaire, and major dietary patterns were identified by means of exploratory factor analysis. Subjects or their next of kin were interviewed biannually looking for possible occurrence of events. Cardiovascular mortality was defined as fatal myocardial infarction, fatal stroke and sudden cardiac death. RESULTS: During the median follow-up of 9.0 years and 50 282 person-years, we found a total of 118 CVD mortalities. Four major dietary patterns were identified: 'Western', 'Mediterranean', 'Animal fat' and 'Fast food'. Adherence to the Mediterranean dietary pattern was protectively associated with CVD mortality, such that those in the highest quartile were 46% (hazard ratio (HR): 0.54; 95% confidence interval (CI): 0.32-0.91; P-value for trend=0.03) less likely to have incident CVD mortality than those in the lowest quartile. Further adjustment for potential confounders strengthened this association (HR: 0.42; 95% CI: 0.19-0.96; P-value for trend=0.02). We found no significant association between adherence to the Western, animal fat and fast food dietary patterns and CVD mortality. CONCLUSIONS: Adherence to a Mediterranean dietary pattern was associated with reduced risk for cardiovascular mortality even in a developing country setting.

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.

The Impact of a Low Glycemic Index Diet on Inflammatory Markers and Serum Adiponectin Concentration in Adolescent Overweight and Obese Girls: A Randomized Clinical Trial.

Although the effects of dietary glycemic index (GI) on insulin resistance are well documented in adults, the complex interaction among glucose intolerance, inflammatory markers, and adipokine concentration has not been well studied, especially among adolescents. We investigated the effect of a low glycemic index (LGI) diet on insulin concentration, fasting blood sugar (FBS), inflammatory markers, and serum adiponectin concentration among healthy obese/overweight adolescent females. In this parallel randomized clinical trial, 2 different diets, an LGI diet and a healthy nutritional recommendation diet (HNRD) with similar macronutrient composition were prescribed to 50 obese and overweight adolescent girls with the same pubertal status. Biochemical markers FBS, serum insulin concentration, high sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and adiponectin were measured before and after a 10 week intervention. Using an intention-to-treat analysis, data from 50 subjects were analyzed. According to a dietary assessment, GI in the LGI group was 43.22±0.54. While the mean for FBS, serum insulin concentration, the homeostasis model assessment (HOMA), the quantitative insulin sensitivity check index (QUICKI), and adiponectin concentration did not differ significantly within each group, the average hs-CRP and IL-6 decreased significantly in the LGI diet group after the 10 week intervention (p=0.009 and p=0.001; respectively). Comparing percent changes, we found a marginally significant decrease in hs-CRP in the LGI group compared with the HNRD group after adjusting for confounders. Compliance with an LGI diet may have favorable effect on inflammation among overweight and obese adolescent girls.

The effects of vitamin D plus calcium supplementation on metabolic profiles, biomarkers of inflammation, oxidative stress and pregnancy outcomes in pregnant women at risk for pre-eclampsia.

BACKGROUND: The present study was designed to examine the effects of vitamin D plus calcium administration on metabolic profiles and pregnancy outcomes among women at risk for pre-eclampsia. METHODS: In a prospective, double-blind, placebo-controlled trial, 60 women at risk for pre-eclampsia were randomised to take either 50 000 IU vitamin D3 every 2 weeks plus 1000 mg day(-1) calcium supplements (as calcium carbonate) (n = 30) or to receive placebos at the same times (n = 30) from 20 to 32 weeks of gestation. Fasting blood samples were taken at baseline and 12 weeks after intervention to determine related variables. Newborn anthropometric measurements were determined. RESULTS: Taking combined cholecalciferol and calcium supplements, compared to placebo, led to significant reductions in fasting plasma glucose (FPG) [mean (SD)] [-5.7 (5.5) versus -0.6 (12.6) mg dL(-1) , P = 0.04], serum insulin concentrations [-2.8 (6.0) versus +7.7 (9.8) µIU mL(-1) , P < 0.001], homeostasis model of assessment-insulin resistance [-0.8 (1.3) versus +1.6 (2.2), P < 0.001], homeostatic model assessment-beta cell function [-8.2 (25.8) versus +32.6 (41.3, P < 0.001] and a significant rise in quantitative insulin sensitivity check index score [+0.02 (0.02) versus -0.02 (0.02, P < 0.001]. Additionally, pregnant women who received cholecalciferol plus calcium supplements had increased serum high-density lipoprotein (HDL)-cholesterol [+4.6 (8.3) versus -2.9 (7.7) mg dL(-1) , P = 0.001] and plasma total glutathione (GSH) concentrations [+23.4 (124.0) versus -94.8 (130.2) µm, P = 0.001] compared to placebo. However, after adjustment for the baseline levels, maternal age and baseline body mass index, the effects on FPG levels (P = 0.13) and systolic blood pressure (P = 0.13) disappeared. CONCLUSIONS: Vitamin D plus calcium administration for 12 weeks had beneficial effects on glycaemic status, HDL-cholesterol, GSH and blood pressure among women at risk for pre-eclampsia.

Dietary magnesium intake, bone mineral density and risk of fracture: a systematic review and meta-analysis.

Dietary magnesium intake has been related to osteoporosis and risk of fractures in earlier studies; however, findings were conflicting. This meta-analysis indicated that high magnesium intake was not associated with increased risk of fracture; however, a positive marginally significant correlation was found between magnesium intake and bone mineral density (BMD) in total hip as well as in femoral neck. Although there is some evidence on the association between magnesium intake, BMD and fractures, no previous study has summarized findings in this regard. We aimed to systematically review the current evidence on this association and to perform a meta-analysis of observational studies. We searched MEDLINE, Scopus, EMBASE and Google Scholar up to January 2015 for studies that examined the relationship between magnesium intake and BMD or fracture. Studies that had reported correlation coefficients between magnesium intake and BMD or those that reported odds ratios (ORs) or relative risks (RRs) for risk of fracture in different sites were included. In total, 12 studies were included in the meta-analysis. We found that high intakes of magnesium were not significantly associated with risk of total hip fracture (summary effect size 1.92; 95 % CI 0.81, 4.55) or total fractures (1.01; 0.94-1.07). Combining four effect sizes, a positive marginally significant correlation was observed between magnesium intake and total BMD (pooled r 0.16; 95 % CI 0.001, 032). Based on nine effect sizes, we found a marginally significant association between magnesium intake and femoral neck BMD (0.14; 0.001, 0.28). However, no significant correlation was found between magnesium intake and BMD in lumbar spine (0.09; -0.01, 0.19). We found that high intakes of magnesium were not associated with increased risk of hip and total fractures. There was a positive marginally significant correlation between magnesium intake and BMD in femoral neck and total hip. No significant correlations were observed between magnesium intake and BMD in lumbar spine.

Total, dietary, and supplemental calcium intake and mortality from all-causes, cardiovascular disease, and cancer: A meta-analysis of observational studies.

AIMS: This systematic review and meta-analysis of observational studies was conducted to summarize the evidence on the association between calcium intake and mortality. METHODS AND RESULTS: PubMed, Institute for Scientific Information (ISI) (Web of Science), SCOPUS, SciRUS, Google Scholar, and Excerpta Medica dataBASE (EMBASE) were searched to identify related articles published through May 2014. We found 22 articles that assessed the association between total, dietary, and supplementary intake with mortality from all-causes, cardiovascular disease (CVD), and cancer. Findings from this meta-analysis revealed no significant association between total and dietary calcium intake and mortality from all-causes, CVD, and cancer. Subgroup analysis by the duration of follow-up revealed a significant positive association between total calcium intake and CVD mortality for cohort studies with a mean follow-up duration of >10 years (relative risk (RR): 1.35; 95% confidence interval (CI): 1.09-1.68). A significant inverse association was seen between dietary calcium intake and all-cause (RR: 0.84; 95% CI: 0.70-1.00) and CVD mortality (RR: 0.88; 95% CI: 0.78-0.99) for studies with a mean follow-up duration of ≤10 years. Although supplemental calcium intake was not associated with CVD (RR: 0.95; 95% CI: 0.82-1.10) and cancer mortality (RR: 1.22; 95% CI: 0.81-1.84), it was inversely associated with the risk of all-cause mortality (RR: 0.91; 95% CI: 0.88-0.94). CONCLUSIONS: We found a significant relationship between the total calcium intake and an increased risk of CVD mortality for studies with a long follow-up time and a significant protective association between dietary calcium intake and all-cause and CVD mortality for studies with a mean follow-up of ≤10 years. Supplemental calcium intake was associated with a decreased risk of all-cause mortality.

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.

Favorable effects of vitamin D supplementation on pregnancy outcomes in gestational diabetes: a double blind randomized controlled clinical trial.

Gestational diabetes mellitus (GDM) has been recognized as a significant risk factor for unfavorable pregnancy outcomes. Prevalence of vitamin D deficiency is highly prevalent among women with GDM. This study was designed to assess the effect of vitamin D supplementation on pregnancy outcomes of pregnant women with GDM who were not on oral hypoglycemic agents. This randomized controlled clinical trial was performed among 45 pregnant women diagnosed with GDM at 24-28 weeks' gestation. Subjects were randomly assigned to consume either vitamin D supplements (cholecalciferol) or placebo. Individuals in the vitamin D group (n=22) received 50 000 IU vitamin D3 pearl 2 times during the study: at study baseline and day 21 of intervention and those in placebo group (n=23) received 2 placebos at the mentioned times. Fasting blood samples were taken at baseline to measure fasting plasma glucose. Participants underwent a 3-h oral glucose tolerance tests (OGTT) and the blood samples were collected at time 60, 120, and 180 min to measure plasma glucose levels. Newborn's weight, height, head circumference, Apgar score, and hyperbilirubinemia were determined. Taking vitamin D supplements, compared with placebo, resulted in improved pregnancy outcomes; such that those in the vitamin D group had no case of polyhydramnios, while 17.4% of subjects in placebo group had this condition (p=0.04). In addition, newborn's hyperbilirubinemia was significantly lower in vitamin D group than that in placebo group (27.3% vs. 60.9%, p=0.02). In conclusion, vitamin D supplementation for 6 weeks among pregnant women with GDM resulted in decreased maternal polyhydramnios and infant hyperbilirubinemia compared with placebo. Clinical trial registration number www.irct.ir:IRCT201305115623N7.

DASH diet, insulin resistance, and serum hs-CRP in polycystic ovary syndrome: a randomized controlled clinical trial.

UNLABELLED: This study was designed to assess the effects of Dietary Approaches to Stop Hypertension (DASH) eating plan on insulin resistance and serum hs-CRP in overweight and obese women with PCOS. This randomized controlled clinical trial was done on 48 women diagnosed with PCOS. Subjects were randomly assigned to consume either the control (n=24) or the DASH eating pattern (n=24) for 8 weeks. The DASH diet consisted of 52% carbohydrates, 18% proteins, and 30% total fats. It was designed to be rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats, cholesterol, refined grains, and sweets. Sodium content of the DASH diet was designed to be less than 2 400 mg/day. The control diet was also designed to contain 52% carbohydrates, 18% protein, and 30% total fat. Fasting blood samples were taken at baseline and after 8 weeks intervention to measure -insulin resistance and serum hs-CRP levels. -Adherence to the DASH eating pattern, compared to the -control diet, resulted in a significant reduction of serum insulin levels (-1.88 vs. 2.89 µIU/ml, p=0.03), HOMA-IR score (-0.45 vs. 0.80; p=0.01), and serum hs-CRP levels (-763.29 vs. 665.95 ng/ml, p=0.009). Additionally, a significant reduction in waist (-5.2 vs. -2.1 cm; p=0.003) and hip circumference (-5.9 vs. -1 cm; p<0.0001) was also seen in the DASH group compared with the control group. In conclusion, consumption of the DASH eating pattern for 8 weeks in overweight and obese women with PCOS resulted in the improvement of insulin resistance, serum hs-CRP levels, and abdominal fat accumulation. CLINICAL TRIAL REGISTRATION NUMBER: www.irct.ir: IRCT201304235623N6.

Influence of Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure: a systematic review and meta-analysis on randomized controlled trials.

BACKGROUND AND AIMS: Findings were not consistent on the therapeutic effect of Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure. We aimed to review systematically and perform a meta-analysis to assess the magnitude of the effect of the DASH diet on blood pressure in randomized controlled trials (RCTs) among adults. METHODS AND RESULTS: We conducted a systematic review and random effects meta-analysis of all RCTs which evaluated the effect of the DASH diet on blood pressure including published papers until June 2013, using PubMed, ISI Web of Science, Scopus and Google scholar database. Subgroup analysis and meta-regression were used to find out possible sources of between-study heterogeneity. Seventeen RCTs contributing 20 comparisons with 2561 participants were included. Meta-analysis showed that the DASH diet significantly reduced systolic blood pressure by 6.74 mmHg (95%CI: -8.25, -5.23, I(2) = 78.1%) and diastolic blood pressure by 3.54 mmHg (95%CI: -4.29, -2.79, I(2) = 56.7%). RCTs with the energy restriction and those with hypertensive subjects showed a significantly greater decrease in blood pressure. Meta-regression showed that mean baseline of SBP and DBP was explained 24% and 49% of the variance between studies for SBP and DBP, respectively. CONCLUSION: The results revealed the profitable reducing effect of the DASH-like diet on both systolic and diastolic blood pressure in adults; although there was a variation in the extent of the fall in blood pressure in different subgroups.