The probiotic supplementation role in improving the immune system among people with ulcerative colitis: a narrative review.

OBJECTIVES: The purpose of this paper is to summarize the current evidence on probiotics' uses as an adjuvant for ulcerative colitis (UC) and provide an understanding of the effect of probiotics supplement on the immune system and inflammatory responses among UC patients and subsequent therapeutic benefits. CONTENT: A narrative review of all the relevant published papers known to the author was conducted. SUMMARY: UC is a chronic inflammatory bowel disease (IBD) that results in inflammation and ulceration of the colon and rectum. The primary symptoms of active disease are diarrhea, abdominal pain, and rectal bleeding. About 70% of the human immune system (mucosal-associated lymphoid tissue) originates in the intestine. Probiotics are live microorganisms that help in stabilizing the gut microbiota (nonimmunologic gut defense), restores normal flora, and enhance the humoral immune system. Probiotics especially Bifidobacterium, Saccharomyces boulardii, and lactic acid-producing bacteria have been used as an adjunct therapy for treating UC to ameliorate disease-related symptoms and reduce relapse rate. Probiotics, in general, modulate the immune system through their ability to enhance the mucosal barrier function, or through their interaction with the local immune system to enhance regulatory T cell responses, decrease the pro-inflammatory cytokines such as tumor necrosis factor alpha and interleukin 1 beta and increase anti-inflammatory factor interleukin 10. OUTLOOK: More studies are needed to explore the properties of the various probiotic bacterial strains, their different uses, as well as the dosage of probiotics and duration for treating different disorders. Further clinical investigations on mechanisms of action and how probiotics modulate the immune system may lead to further advances in managing IBD.

Dietary and lifestyle habits among university students at different academic years.

BACKGROUND/AIMS: College serves as a transitionary period into adulthood where students begin making independent dietary and lifestyle choices and begin forming possibly detrimental habits. Such habits may persist into adulthood and negatively affect their long-term health and risk of disease. This study aimed at exploring the dietary and lifestyle habits among the Hashemite University students at different academic years. METHODS: A cross-sectional design was used to study dietary and lifestyle habits as well as the occurrence of obesity among a convenient sample of undergraduate students at the Hashemite University during the academic year 2015-2016. Five hundred and forty students (184 males: 356 females) were enrolled in this study. Bodyweight and height were measured and body mass index was calculated. Personal information, dietary habits and physical activity data were collected using constructed questionnaires. RESULTS: Around 36% of the students were overweight and obese. The percentage of overweight among the freshmen was about 31% and 26.5% among the seniors. Additionally, 8.6% of freshmen and 16.3% of seniors were found to be obese. One-third (30.2%) of the study sample was hookah smokers, while 15.4% were cigarette smokers. The students showed similar physical activity levels in the four academic years. The majority of students at different academic levels consumed fruits 1-2 times/week and 5 times cereals, grains, and starchy vegetables/day. CONCLUSION: Our results show that approximately one-third of students are overweight or obese, and practicing unhealthy dietary and lifestyle habits. This indicates a need to address this problem, possibly through implementing a nutrition and health education programs at the university in addition to improving the quality of food available on campus.

Dietary and Lifestyle Factors Associated with Gastric and Pancreatic Cancers: A Case-Control Study.

Gastric cancer (GC) and pancreatic cancer (PC) are the third and seventh most likely cancers to cause death worldwide. We aimed to determine the dietary and lifestyle factors of patients with GC or PC and their associated risk among Jordanians. This case-control study enrolled 587 adults (patients with PC, 101; patients with GC, 172; healthy controls, 314) between March 2015 and August 2018, who were assessed using interview-based personal and physical activity questionnaires. Multivariable logistic regression models were taken as measures for predictors of GC and PC risk. We showed that GC and PC patients had higher pre-diagnosis body-mass indexes, a greater proportion smoked and had a family history of cancer than controls. Furthermore, consumption of two snacks [odds ratios (OR)=0.44, 95% confidence intervals (CI): 0.23~0.85], three snacks (OR=0.04, 95% CI: 0.01~0.23) and no meals eaten outside (OR=0.31, 95% CI: 0.09~0.99) showed a protective effect against GC, and consumption of three snacks (OR=0.08, 95% CI: 0.02~0.40) reduced significantly the risk of PC. These results suggest that bodyweight, physical activity, smoking, and family history of cancer are among factors that affect GC and PC risk among Jordanians.

The probiotic supplementation role in improving the immune system among people with ulcerative colitis: a narrative review.

OBJECTIVES: The purpose of this paper is to summarize the current evidence on probiotics' uses as an adjuvant for ulcerative colitis (UC) and provide an understanding of the effect of probiotics supplement on the immune system and inflammatory responses among UC patients and subsequent therapeutic benefits. CONTENT: A narrative review of all the relevant published papers known to the author was conducted. SUMMARY: UC is a chronic inflammatory bowel disease (IBD) that results in inflammation and ulceration of the colon and rectum. The primary symptoms of active disease are diarrhea, abdominal pain, and rectal bleeding. About 70% of the human immune system (mucosal-associated lymphoid tissue) originates in the intestine. Probiotics are live microorganisms that help in stabilizing the gut microbiota (nonimmunologic gut defense), restores normal flora, and enhance the humoral immune system. Probiotics especially Bifidobacterium, Saccharomyces boulardii, and lactic acid-producing bacteria have been used as an adjunct therapy for treating UC to ameliorate disease-related symptoms and reduce relapse rate. Probiotics, in general, modulate the immune system through their ability to enhance the mucosal barrier function, or through their interaction with the local immune system to enhance regulatory T cell responses, decrease the pro-inflammatory cytokines such as tumor necrosis factor alpha and interleukin 1 beta and increase anti-inflammatory factor interleukin 10. OUTLOOK: More studies are needed to explore the properties of the various probiotic bacterial strains, their different uses, as well as the dosage of probiotics and duration for treating different disorders. Further clinical investigations on mechanisms of action and how probiotics modulate the immune system may lead to further advances in managing IBD.

Nutrient intake patterns and breast cancer risk among Jordanian women: a case-control study.

OBJECTIVES: Breast cancer (BC) is the most common type of cancer worldwide. Globally, BC is rapidly becoming a major common health problem among women. This study aimed to evaluate the association between nutrient intake patterns and BC risk among Jordanian women. METHODS: A total of 400 Jordanian women 20-65 years of age were recruited in this case-control study. Two hundred women recently diagnosed with BC were matched in age, income, and marital status to 200 BC-free women. A food frequency questionnaire was used to assess nutrient intake patterns. RESULTS: In this study, 3 nutrient intake patterns were identified: a high vitamin C and ß-carotene nutrient intake pattern; a high calcium, phosphorus, and vitamin D nutrient intake pattern; and a high-fat nutrient intake pattern. A significant increase in BC risk was associated with the high vitamin C and ß-carotene nutrient pattern (the highest for the fourth quartile; odds ratio [OR], 5.42; 95% confidence interval [CI], 2.11 to 13.91; ptrend=0.001). In the high calcium, phosphorus, and vitamin D nutrient pattern, a significant inverse trend was detected for the risk of BC. The high-fat nutrient pattern showed a significant direct association with BC risk in the third (OR, 3.88; 95% CI, 1.58 to 9.51) and fourth (OR, 3.87; 95% CI, 1.53 to 9.77) quartiles (ptrend=0.001). CONCLUSIONS: A significant increase in BC risk was detected for the high vitamin C and ß-carotene nutrient intake pattern and the high-fat nutrient intake pattern. However, for the high calcium, phosphorus, and vitamin D nutrient intake pattern, a significant inverse trend was observed.

Relationship between lifestyle factors and nutritional status and non-alcoholic fatty liver disease among a group of adult Jordanians.

BACKGROUND AND STUDY AIMS: Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide. NAFLD may progress from simple steatosis to nonalcoholic steatohepatitis, cirrhosis and finally decompensated liver failure. This study aims at assessing the relationship between lifestyle factors and nutrients intake and the development of non-alcoholic fatty liver disease (NAFLD) in a group of Jordanian adults 30-60 years of age. PATIENTS AND METHODS: In this case-control study, a total of 120 Jordanian adults 30-60 years of age were recruited. Sixty NAFLD patients and 60 control subjects were enrolled. The diagnosis of NAFLD was made based on the basis of ultrasonography. Weight, height and waist circumference (WC) were measured and body mass index (BMI) was calculated. Nutrients intake and physical activity level were assessed using validated questionnaires. RESULTS: The results showed that patients with NAFLD had a higher significant difference in BMI, WC, and weight compared to controls (p = 0.001). Physical activity level was significantly higher in control subjects than in cases (p = 0.001). The metabolic parameters were significantly different both groups. The mean daily intakes of macronutrients were significantly higher in cases than in control subjects (p = 0.001). A significant difference was detected in the daily intake of some vitamins and minerals among cases compared to control subjects (p < 0.05). CONCLUSION: The present study supports the findings of the presence of a relationship between macro- and micronutrients intake and some anthropometric and biochemical variables and NAFLD.

Non-alcoholic fatty liver disease and associated dietary and lifestyle risk factors.

Nonalcoholic fatty liver disease (NAFLD) has emerged as the most common chronic liver disease worldwide with a reported prevalence ranging 20-30% depending on the studied populations. The high prevalence of NAFLD is probably due to the contemporary epidemics of obesity, unhealthy dietary pattern, and sedentary lifestyle. NAFLD patients are at increased risk of cardiovascular and liver related mortality. The cornerstone of any treatment regimen for patients with NAFLD is lifestyle modification focused on weight loss, exercise, and improving insulin sensitivity. The purpose of this review is to outline the effect of diet and lifestyle factors on developing NAFLD.

Nutrient intake and lifestyle factors by diabetes status of Circassians and Chechans in Jordan.

OBJECTIVES: Diabetes is one of the most prevalent diseases in Jordan. However, little is known about nutrient intakes of minority groups in Jordan with and without diabetes. Our study aimed to examine if the intake of energy, macronutrients and some micronutrients differed between normal and diabetic adults among Circassians and Chechans in Jordan. DESIGN, SETTING, PARTICIPANTS: This cross-sectional study was conducted among 437 Circassians (160 males and 277 females) and 355 Chechans (119 males and 236 females) aged > or = 18 years. They were recruited from the Chechan and Circassian communities living in Jordan. MAIN OUTCOME MEASURES: A participant was defined as affected by type 2 diabetes mellitus if diagnosis was known to patient or if his or her condition complied with the American Diabetes Association definition. One 24-hour dietary recall for each participant was collected by face-to-face interview. RESULTS: Most of the measured anthropometric and biochemical parameters showed a significant difference between normal individuals and those with impaired fasting glucose or diabetes. Intakes of nutrients involved in the pathogenesis of diabetes including protein, fat and fiber did not differ between stratified participants according to blood glucose status for both Circassians and Chechans. CONCLUSIONS: Intake of nutrients did not differ in participants with normal blood glucose from those who had impaired fasting glucose or diabetes in the two studied populations. These two populations may need genetic studies to identify the risk factors other than dietary and lifestyle factors for type 2 diabetes.

Validation of a food frequency questionnaire to assess macronutrient and micronutrient intake among Jordanians.

The aim of this study was to examine the validity and reliability of a food frequency questionnaire (FFQ) among a convenience sample of healthy adults in Jordan. A modified version of the questionnaire known as Diet History Questionnaire I, which measures dietary intakes over a 1-year period, was administrated to 101 apparently healthy men and women recruited from three large medical centers in Jordan. Fifty-five participants completed the modified FFQ and three 24-hour recalls. Participants (N=101) completed the FFQ two times separated by a 1-month period. Reliability of the FFQ was assessed using test-retest method. Mean age of participants was 33.4±18.5 years. Energy, carbohydrate, fiber, fat, saturated fat, calcium, and iron had deattenuated correlations of .732, .563, .544, .487, .484, .451, and .459, respectively. The FFQ and 24-hour recalls produced similar agreement percentages ranging between 25.5% and 43.6%. Mean energy-adjusted reliability coefficients ranged from .695 to .943. A Cronbach's α for the total FFQ items of .857 was found. The modified FFQ has reasonable relative validity and reliability for energy, carbohydrate, fiber, fat, saturated fat, calcium, and iron intakes in Jordanian adults over a 1-year period. However, its application may require additional modifications and validation efforts. Future research is warranted to further modify and test the FFQ in a larger and more diverse sample of Jordanians as well as to develop FFQ for the use among other age groups.

Physical inactivity, water intake and constipation as risk factors for colorectal cancer among adults in Jordan.

BACKGROUND: Physical activity has been found to play a role in cancer prevention. The purpose of this matched case-control study was to investigate the association between physical activity levels, water intake, constipation and colorectal cancer (CRC). MATERIALS AND METHODS: Two hundred and thirty-two patients diagnosed with CRC (125 male, 107 female) were enrolled in this case-control study. Cases were matched to 271 population controls (137 male, 134 female). RESULTS: Drinking more than 4 cups of water daily decreased the risk of CRC by 33-42%; however, this effect was non-significant. Having constipation was found to be a significant risk factor for developing CRC with an OR=6.284 (95%CI=2.741-14.40). With reference to sedentary behavior, minimum activity (600-3000 Metabolic Equivalents Task (MET)) had 43% protection against CRC and the level of Health Enhancing Physical Activity OR was 0.58 (at 95%CI; 0.37-0.92). A significant negative association was found between CRC and physical activity levels expressed as both METs and MET-hours/week (p for trend=0.017 and 0.03, respectively). Among females, a significant trend of reduction in CRC by 62% was observed with increasing the level of physical activity expressed in MET (p for trend=0.04). CONCLUSIONS: The risk of CRC may be reduced by adopting a healthy lifestyle and practicing physically activity regularly, especially among females. Consuming adequate amounts of water and healthy bowel motility could also reduce the risk of CRC.

Stage of change of 6 health-related behaviors among patients with type 2 diabetes.

AIMS: Assessing patients' current stage of change toward 6 healthy behaviors related to diabetes control. Behaviors studied were smoking cessation (2) regular exercise; (3) consuming 5 servings or more of fruits and vegetables; (4) decreasing intake of refined sugar; (5) reducing saturated fat; and (6) self monitoring of blood glucose (SMBG). METHODS: Stage of change (SOC) for several diabetes control-related behaviors was assessed for 737 patients with type 2 diabetes using a staging algorithm. Socio-demographic data were collected by a structured interview-based questionnaire. RESULTS: There was high degree of readiness toward consuming diets with less saturated fat and simple sugar. Very low degree of readiness was reported for self-monitoring of blood glucose on a regular bases and for practicing physical exercise. Half of the participants (50.9%) were in the precontemplation stage for consuming ≥5 servings of fruits and vegetables every day. Significant correlations were obtained between the degree of readiness for several behaviors (p<0.01). Age, gender, income and education were all related to the stage of change of the studied behaviors (p<0.01). CONCLUSIONS: Patients with diabetes in Jordan are still in the pre-action stages for practicing exercise, consuming 5 servings or more of fruit and vegetable, and self-monitoring of blood glucose. The current finding suggests a need for nutritional education and interventions to raise awareness of lifestyle factors influencing glycemic control among diabetics.

Food insecurity is related to glycemic control deterioration in patients with type 2 diabetes.

BACKGROUND & AIMS: Poor glycemic control has been shown to play a major role in the development and progression of diabetes complications. This cross-sectional study tested the hypothesis that food insecurity may deteriorate glycemic control in patients with type 2 diabetes. The objectives of this study were to assess the prevalence of food insecurity among type 2 diabetics in a major hospital that serves the area of northern Jordan, and to investigate its relation to glycemic control. METHODS: A sample of 843 patients diagnosed with type 2 diabetes participated in the study. Socioeconomic and health data were collected by interview-based questionnaire. Weight and height were measured by a trained nutritionist. Dietary assessment was done using food frequency questionnaire. Dietary data were processed using food processor software. Food insecurity was assessed by the short form of the U.S. food security survey module. Glycemic control was assessed by measuring glycosyated hemoglobin (HbA1c). Statistical procedures used to analyze the data were chi-square, and post-hoc analysis of variance. RESULTS: About 22% of the tested sample were food secure (FS); 51% were moderately food insecure (MFIS); and 27% were severely food insecure (SFIS). Higher BMI was associated with SFIS patients. After adjusting for age, gender, income, education, and duration of diabetes, body mass index, and caloric consumption; moderate and severe food insecurity were associated with poor glycemic control (p = 0.04). CONCLUSION: food insecurity may be associated with glycemic control deterioration in patients with type 2 diabetes.

The association between periodontal disease and obesity among adults in Jordan.

AIM: To determine the relationship between periodontitis and overweight/obesity among Jordanians. MATERIAL AND METHODS: A systematic random sample of 340 persons aged between 18 and 70 years was selected from those who accompanied patients during their visit to the outpatient clinics in the medical centre of Jordan University of Science and Technology in north of Jordan. All participants underwent periodontal examination, had anthropometric measurements, and completed the questionnaire. Periodontitis was defined as presence of four or more teeth with one or more sites with probing pocket depth >or=4 mm and clinical attachment loss >or=3 mm. RESULTS: Only 14% of normal weight participants had periodontal disease whereas 29.6% of overweight and 51.9% of obese participants had periodontal disease. Periodontitis was more prevalent among subjects with high waist circumference (WC) and among subjects with high waist-to-hip ratio. After adjusting for important variables, only body mass index (BMI)-defined obesity [odds ratio (OR)=2.9, 95% confidence interval (CI): 1.3, 6.1], high WC (OR=2.1, 95%CI: 1.2, 3.7), and high fat per cent (OR=1.8, 95% CI: 1.03, 3.3) remained significantly associated with increased odds of periodontitis. CONCLUSION: BMI-defined obesity, high WC, and high fat per cent were significantly associated with increased odds of having periodontitis.