Publications by authors named "Cain C T Clark"

97 Publications

Soy intake is associated with lowering blood pressure in adults: A systematic review and meta-analysis of randomized double-blind placebo-controlled trials.

Complement Ther Med 2021 Feb 23:102692. Epub 2021 Feb 23.

Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Background: Soy has several beneficial effects on cardiovascular disease (CVD); however, results of clinical trial studies are equivocal. Thus, the present study sought to discern the efficacy of soy intake on blood pressure.

Methods: The search process was conducted in PubMed, Scopus, Web of Science, and Cochrane Library, to ascertain studies investigating the efficacy of soy intake on blood pressure in adults, published up to June 2020. A random-effects model was applied to pool mean difference and 95% confidence intervals (CIs). Meta-regression analysis was performed to discern potential sources of heterogeneity. Begg's and Egger's methods were conducted to assess publication bias.

Results: Pooled effects from 17 studies revealed a significant improvement in systolic blood pressure (SBP) (-1.64; -3.25 to -0.04 mmHg; I = 50.5 %) and diastolic blood pressure (DBP) (-1.21; -2.29 to -0.12 mmHg, I = 50.7 %) following soy consumption, in comparison with controls. Subgroup analysis demonstrated a reduction in both SBP and DBP in younger participants with lower baseline blood pressure and intervention durations of <16 weeks.

Conclusion: Our results suggest that soy intake is associated with an ameliorating effect on blood pressure in adults.
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http://dx.doi.org/10.1016/j.ctim.2021.102692DOI Listing
February 2021

Bariatric surgery reduces branched-chain amino acids' levels: a systematic review and meta-analysis.

Nutr Res 2021 Mar 29;87:80-90. Epub 2020 Oct 29.

Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Bariatric surgery is a metabolic surgery known to be an efficient treatment for weight loss, with adequate long-term maintenance. Interestingly, some studies have reported a reduction in branched chained amino acids (BCAAs) after bariatric surgery, which putatively contributes to post-surgical metabolic improvement. The current systematic review and meta-analysis investigated the effect of bariatric surgery on the level of BCAAs. PubMed, SCOPUS, EMBASE, and Web of Science databases were searched from their inception to July 2019. All clinical trials which investigated the effect of bariatric surgery on the levels of valine, leucine, and isoleucine, for more than one week, were included. Nine studies (11 effect sizes) were analyzed via meta-analytical techniques using random-effects models. The pooled data suggested that bariatric surgery significantly reduced the valine (standardized mean difference [SMD]: -1.89, 95% confidence interval [CI]: -2.79, -0.99, I = 90.9%), leucine (SMD: -0.96, 95% CI: -1.48, -0.44, I = 72.4%), and isoleucine (SMD: -0.58, 95% CI: -0.84, -0.31, I = 66.3%) levels after surgery compared with before the surgery. Overall, bariatric surgery significantly reduced the levels of valine, leucine, and isoleucine compared with before the surgery. Further large-scale and homogenous trials are needed to better discern the generalizability of our findings.
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http://dx.doi.org/10.1016/j.nutres.2020.10.008DOI Listing
March 2021

Technology-based methods for the assessment of fine and gross motor skill in children: A systematic overview of available solutions and future steps for effective in-field use.

J Sports Sci 2021 Feb 15:1-41. Epub 2021 Feb 15.

Department of Electric, Electronic and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna , Bologna, Italy.

The present review aims at providing researchers and practitioners with a holistic overview of technology-based methods for the assessment of fine and gross motor skill in children. We conducted a search of electronic databases using Web of Science, PubMed and Google Scholar, including studies published up to March 2020, that assessed fine and/or gross motor skills, and utilized technological assessment of varying study design. A total of 739 papers were initially retrieved, and after title/abstract screening, removal of duplicates, and full-text screening, 47 were included. Results suggest that motor skills can be quantitatively estimated using objective methods based on a wearable- and/or laboratory-based technology, for typically developing (TD) and non-TD children. Fine motor skill assessment solutions were; force transducers, instrumented tablets and pens, surface electromyography, and optoelectronic systems. Gross motor skill assessment solutions were; inertial measurements units, optoelectronic systems, baropodometric mats, and force platforms. This review provides a guide in identifying and evaluating the plethora of available technological solutions to motor skill assessment. Although promising, there is still a need for large-scale studies to validate these approaches in terms of accuracy, repeatability, and usability, where interdisciplinary collaborations between researchers and practitioners and transparent reporting practices should be advocated.
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http://dx.doi.org/10.1080/02640414.2020.1864984DOI Listing
February 2021

The effects of resveratrol supplementation on PPARα, p16, p53, p21 gene expressions, and sCD163/sTWEAK ratio in patients with type 2 diabetes mellitus: A double-blind controlled randomized trial.

Phytother Res 2021 Feb 13. Epub 2021 Feb 13.

Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

The present study sought to evaluate the effect of resveratrol supplementation on mRNA expression levels of peroxisome proliferator-activated receptor alpha (PPARα), p53, p21, p16, and serum levels of cluster of differentiation 163 (CD163) to TNF-like weak inducer of apoptosis (TWEAK) ratio in patients with type 2 diabetes. In this double-blind randomized controlled trial, 71 patients were randomly assigned to receive either 1,000 mg of trans-resveratrol or placebo (methyl cellulose) for 8 weeks. Expression levels of genes of interest, and serum levels of sCD163 and sTWEAK were assessed at baseline and at the end of the study. Resveratrol supplementation significantly increased mRNA expression levels of p53 and p21 genes, compared with the placebo group (fold change of p53 = 1.29, p = .04; fold change of p21 = 1.46, p = .006). However, no significant effect on expression levels of PPARα and p16 genes was observed after supplementation. In addition, resveratrol significantly reduced serum levels of sCD163/sTWEAK ratio compared with the placebo group (p = .003). Resveratrol supplementation resulted in significant changes in p53 and p21 genes expression, while serum levels of sCD163/sTWEAK ratio also improved in the resveratrol group, without any significant change in adjusted sCD163 levels. More research is needed to confirm the beneficial effects of resveratrol for patients with diabetes.
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http://dx.doi.org/10.1002/ptr.7031DOI Listing
February 2021

Association between physical education classes and physical activity among 187,386 adolescents aged 13-17 years from 50 low- and middle-income countries.

J Pediatr (Rio J) 2021 Feb 5. Epub 2021 Feb 5.

Institute for Health and Sport, Victoria University, Melbourne, Australia. Electronic address:

Objective: This study aimed to examine the association between physical education classes and PA among adolescents from 50 low- and middle-income countries (LMICs).

Methods: A self-reported questionnaire from the Global School-based Student Survey (GSHS) was used to collect information on participation frequency of physical education classes and being physically active over the last week, as well as other control variables (e.g., sex, age, country, sedentary behavior). Multivariable logistic regression and a pooled meta-analysis were performed to explore the association and compared country-wise differences.

Results: Included adolescents aged from 13 to 17 years (n=187,386, %boys=51.7; mean age=14.6 years), the prevalence of sufficient PA (meeting the PA guidelines) was 14.9%. The prevalence of 5 days or more to engage in physical education classes was 16.5%. Compared with adolescents who had 0 days for physical education classes, higher participation frequency was more likely related to sufficient PA (OR: 1 day=1.34, 2 days=1.66, 3 days=1.67, 4 days=1.79, 5 days or more=2.46), these findings were also observed in both sexes. A moderate inconsistency on the association across the included countries was found (I=53%, p<0.01), although the pooled OR was 1.50 (95% CI: 1.36-1.65).

Conclusions: Participating in more physical education classes may be an effective approach to increase physical activity levels among adolescents in LMICs. However, promoting physical activity levels among adolescents in LMICs through physical education classes should consider more country-specific factors.
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http://dx.doi.org/10.1016/j.jped.2020.11.009DOI Listing
February 2021

The association between major dietary patterns at dinner and obesity in adults living in Tehran: A population-based study.

J Cardiovasc Thorac Res 2020 28;12(4):269-279. Epub 2020 Nov 28.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Findings of studies on the association between evening meal and obesity are inconclusive. Thus, we sought to investigate the association between major dietary patterns at evening meal and obesity among apparently healthy adults in Tehran. This cross-sectional research was conducted using 833 adult men and women who lived in Tehran (age range: 20-59 years). Their dietary intake was evaluated by three, 24-h dietary recalls(24hDRs), and major patterns were identified using exploratory factor analysis. The association between major dietary patterns at dinner with general and central obesity was assessed using logistic regression analysis. We identified 3 major dietary patterns at dinner including "prudent", "potatoes and eggs" and"Western" patterns. There was no significant relationship between prudent and general obesity (OR:0.76, 95% CI = 0.21, 1.15, P value = 0.20), and, a significant association was not observed between potatoes and eggs and general obesity (OR: 0.89, 95% CI = 0.60, 1.32, P value = 0.57) also, there was no significant relationship between Western dietary pattern and general obesity in this study (OR: 0.95,95% CI = 0.63, 1.43, P value = 0.82). Further analyses showed that there was no significant relationship between central obesity with any of the dietary patterns. The results of this study do not support a possible relationship between major dietary patterns at dinner with general and central obesity. However, the presented findings should be confirmed in prospective studies.
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http://dx.doi.org/10.34172/jcvtr.2020.45DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828749PMC
November 2020

The effects of L-carnitine supplementation on lipid concentrations inpatients with type 2 diabetes: A systematic review and meta-analysis of randomized clinical trials.

J Cardiovasc Thorac Res 2020 7;12(4):246-255. Epub 2020 Sep 7.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

This meta-analysis was performed to assess the effect of L-carnitine supplementation on lipid profile. A systematic search were conducted in PubMed and Scopus to identify randomized clinical trials (RCTs) which evaluated the effects of L-carnitine on lipid profile. Pooled effect sizes were measured using random-effect model (Dersimonian-Laird). Meta-analysis showed that L-carnitine supplementation significantly reduced total cholesterol (TC) (weighted mean difference [WMD]: -8.17 mg/dL; 95% CI,-14.68 to -1.65, I=52.2%, = 0.041). Baseline level of TC was a source of heterogeneity, with a greater effect in studies with a baseline level of more than 200 mg/d (WMD: -11.93 mg/dL; 95% CI, -20.80 to-3.05). L-carnitine also significantly decreased low-density lipoprotein-cholesterol (LDL-C) (WMD:-5.22 mg/dL; 95% CI, -9.54 to -0.91, I=66.7%, = 0.010), and LDL-C level <100 mg/dL), trial duration,and L-carnitine dosage were potential sources of heterogeneity. L-carnitine supplementation appeared to have no significant effect on high-density lipoprotein-cholesterol (HDL-C) (WMD: -0.51 mg/dL;95% CI, -2.45 to 1.44) and triglyceride (TG) (WMD: 2.80 mg/dL; 95% CI, -8.09 to 13.69). This meta-analysisrevealed that L-carnitine may have favorable effects on lipid profile, especially LDL-C and TC. However, further RCTs are needed to confirm the veracity of these results, particularly among hyperlipidemic patients.
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http://dx.doi.org/10.34172/jcvtr.2020.43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828761PMC
September 2020

Dietary patterns and risk of non-alcoholic fatty liver disease.

BMC Gastroenterol 2021 Jan 28;21(1):41. Epub 2021 Jan 28.

Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Nutrition is a modifiable risk factor that plays an important role in the prevention or delaying of the onset of non-alcoholic fatty liver disease (NAFLD). Previous studies have focused on NAFLD and individual nutrients, which does not take into account combinations of food that are consumed. Therefore, we aimed to investigate the relationship between major dietary patterns and NAFLD.

Methods: This case-control study was conducted on 225 newly diagnosed NAFLD patients and 450 healthy controls. Usual dietary intake over the preceding year was assessed using a validated 168-item semi-quantitative food frequency questionnaire. Major dietary patterns were determined by exploratory factor analysis.

Results: Three dietary patterns, including "western dietary pattern", "healthy dietary pattern", and "traditional dietary pattern" were identified. Subjects in the highest tertile of healthy dietary pattern scores had a lower odds ratio for NAFLD than those in the lowest tertile. Compared with those in the lowest tertile, people in the highest tertile of "western dietary pattern" scores had greater odds for NAFLD. After adjusting for potential confounding factors, "western dietary pattern" had a positive significant effect on NAFLD occurrence. In contrast, "healthy dietary pattern" was associated with a decreased risk of NAFLD. Furthermore, Higher consumption of the "traditional dietary pattern" was significantly associated with NAFLD, albeit in the crude model only.

Conclusion: This study indicated that healthy and western dietary patterns may be associated with the risk of NAFLD. The results can be used for developing interventions in order to promote healthy eating for the prevention of NAFLD.
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http://dx.doi.org/10.1186/s12876-021-01612-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844966PMC
January 2021

The effect of meal frequency on biochemical cardiometabolic factors: A systematic review and meta-analysis of randomized controlled trials.

Clin Nutr 2021 Jan 11. Epub 2021 Jan 11.

Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Electronic address:

Background: Although several randomized controlled trials (RCTs) have supported the beneficial effects of higher meal frequency (MF) on cardiometabolic risk factors, the putative effects of higher MF on health remain inconclusive. This study systematically reviewed the evidence from RCTs of the effect of higher compared with lower MF on the blood lipid profile, glucose homeostasis, and adipokines.

Methods: PubMed, Scopus, ISI Web of Science, and the Cochrane database were searched up to October 2020 to retrieve relevant RCTs. A DerSimonian and Laird random effects model was used to pool mean differences and 95% CI for each outcome. The quality of studies and evidence was assessed through standard methods.

Results: Twenty-one RCTs (686 participants) were included in this meta-analysis. Overall results showed a significant improvement in total cholesterol [weighted mean difference (WMD) = -6.08 mg/dl; 95% CI: -10.68, -1.48; P = 0.01; I = 88%], and low-density cholesterol (LDL-C) (WMD = -6.82 mg/dl; 95% CI: -10.97, -1.60; P = 0.009; I = 85.7%), while LDL-C to high-density cholesterol ratio (LDL-C: HDL-C) increased (WMD = 0.22; 95% CI: 0.07, 0.36; P = 0.003; I = 0.0%) in higher MF vs. lower MF. No significant effects were found on measures of glycemic control, apolipoproteins-A1 and B, or leptin. In subgroup analyses, higher MF significantly reduced serum triglyceride (TG), and increased HDL-C, compared with lower MF in interventions > 12 weeks, and decreased serum TC and LDL-C in healthy participants. A significant reduction in LDL-C also was observed in studies where the same foods given both arms, simply divided into different feeding occasions, and in feeding studies, following higher MF compared to lower MF.

Conclusion: Our meta-analysis found that higher, compared with lower MF may improve total cholesterol, and LDL-C. The intervention does not affect measures of glycemic control, apolipoproteins-A1 and B, or leptin. However, the GRADE ratings of low credibility of the currently available evidence highlights the need for more high-quality studies in order to reach a firm conclusion.
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http://dx.doi.org/10.1016/j.clnu.2020.12.038DOI Listing
January 2021

Effects of the dietary approach to stop hypertension (DASH) diet on blood pressure, blood glucose, and lipid profile in adolescents with hemophilia: A randomized clinical trial.

Food Sci Nutr 2021 Jan 29;9(1):145-153. Epub 2020 Oct 29.

Food Security Research Center and Department of Community Nutrition School of Nutrition and Food Science Isfahan University of Medical Sciences Isfahan Iran.

Children with hemophilia are an enhanced risk of modifiable cardiovascular and metabolic abnormalities. There is currently no nutritional guideline to prevent or manage cardiometabolic risk factors in these patients. Therefore, the present study sought to investigate the effect of the Dietary Approaches to Stop Hypertension (DASH) diet on cardiovascular and metabolic risk factors among children with hemophilia. In this parallel randomized clinical trial, 40 children (all male) with hemophilia were randomly allocated to the DASH group ( = 20) or control group ( = 20) for 10 weeks. The intervention group received the DASH diet (50%-55% of energy from carbohydrate, 27%-30% of energy from fat and 16%-18% energy from protein), and the control group received nutritional recommendations based on healthy eating practices. Systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood sugar (FBS), triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were measured at the beginning and end of the study. Serum vitamin C was measured as a biomarker of compliance with the DASH diet. Study was registered at IRCT.ir (IRCT20130903014551N6). A significant increase in serum vitamin C in the DASH diet group was observed compared to the control group ( = .001), indicating good compliance with the DASH diet. There was a significant reduction in SBP (-0.48 mmHg), DBP (-0.48 mmHg), FBS (-5.86 mg/dl), TC (-16.07 mg/dl), TG (-17.21 mg/dl), and LDL-C (-9.79 mg/dl), and a significant increase in HDL-C (3.39 mg/dl), in the DASH diet group compared with the control group. Adherence to the DASH diet in children with hemophilia yielded beneficial effects in blood pressure, lipid profiles, and FBS.
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http://dx.doi.org/10.1002/fsn3.1972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802541PMC
January 2021

Brain function during central fatigue induced by intermittent high-intensity cycling.

Neurol Sci 2021 Jan 13. Epub 2021 Jan 13.

Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, CV1 5FB, UK.

Background: The central governor model putatively explains the mechanism of endurance exercise-induced central fatigue, however high-intensity exercise-induced central fatigue strategies have not been investigated yet. This study aimed to examine how central fatigue affects neural response alterations, as measured by electroencephalographic (EEG) recordings, in intermittent high-intensity cycling.

Methods: Neural responses were assessed by measuring the alteration of brainwaves based on spectral energy band estimates during an intermittent, high-intensity, 60-min exercise bout on a cycle ergometer. The cycle ergometer incline was changed every 10 min in an intermittent pattern (10-20-5-20-5-10°). EEG was used to analyze altering brain function. Heart rate (HR), blood lactate (BL), and rating of perceived exertion (RPE) were measured after the participants completed each change in incline.

Results: The results showed that HR, BL, and RPE increased at an incline of 20° in comparison to a 5° incline. The spectral power of EEG was significantly increased (P ˂ 0.01) in the alpha and beta frequency ranges with a change in inclines between 5 and 20°. The spectral power of the EEG was significantly increased (P ˂ 0.01) over the whole frequency range from rest (theta + 251%, alpha + 165%, beta + 145%).

Conclusion: Higher, relative intensities (10 and 20°) increased brain function, regardless of fatigue occurrence. HIIT (high-intensity interval training) led to an alteration in the neural response. Further work investigating the usefulness of HIIT to improve brain function is warranted.
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http://dx.doi.org/10.1007/s10072-020-04965-7DOI Listing
January 2021

The association between serum homocysteine and depression: A systematic review and meta-analysis of observational studies.

Eur J Clin Invest 2021 Jan 10:e13486. Epub 2021 Jan 10.

Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Hyperhomocysteinaemia is known to interfere with neurological functions; however, there is a controversy regarding the relationship between homocysteine and depression.

Materials And Methods: Science Direct, MEDLINE and ISI Web of Science were searched to find relevant articles, published up to August 2020. Studies were included if they compared homocysteine levels in healthy subjects with subjects with depression. Also, articles that reported the association between hyperhomocysteinaemia and risk of depression were included. Odds ratios of depression and means of homocysteine were used to ascertain the overall effect size.

Results: Homocysteine level was higher in subjects with depression in comparison with healthy controls (weight mean difference = 2.53 µmol/L, 95% confidence interval: 1.77, 3.30), and the depression diagnostic tool was a source of heterogeneity. Homocysteine level was significantly higher in subjects with depression in studies that used Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), Geriatric Depression Scale (GDS), Zung Self-Rating Depression Scale (ZDRS) and Beck Depression Index II (BDI-II) as depression diagnostic tools. Also, participants with hyperhomocysteinaemia had a higher chance of depression (Pooled risk = 1.34, 95% confidence interval: 1.19, 1.52), where the depression diagnostic tool was a source of heterogeneity. In contrast to ZDRS and Patient Health Questionnaire (PHQ) subgroups, hyperhomocysteinaemia yielded a significantly higher risk of depression in DSM-IV, GDS and 'other' subgroups.

Conclusion: Homocysteinemia level is higher in individuals with depression. However, the depression diagnostic tool used is instrumental in influencing their association, and thus, future studies should focus on the tools for depression assessment.
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http://dx.doi.org/10.1111/eci.13486DOI Listing
January 2021

Impact of Body Mass Index on the Development of Inflammatory Bowel Disease: A Systematic Review and Dose-Response Analysis of 15.6 Million Participants.

Healthcare (Basel) 2021 Jan 3;9(1). Epub 2021 Jan 3.

Division of Occupational Medicine, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada.

Background: A growing trove of literature describes the effect of malnutrition and underweight on the incidence of inflammatory bowel disease (IBD). However, evidence regarding the association between underweight or obesity and IBD is limited. The study aimed to assess the association of body mass index (BMI) with a risk of IBD (Crohn's disease (CD) and ulcerative colitis (U.C.)) incidence.

Methods: We systematically searched PubMed/Medline, Cochrane, Web of Science, and Scopus for observational studies assessing the association between BMI and IBD that were published up to 30 June 2020. We estimated pooled hazard ratios (HR) with corresponding 95% confidence intervals (CI). Random effect dose-response meta-analysis was performed using the variance weighted least-squares regression (VWLS) models to identify non-linear associations.

Results: A total of ten studies involving 15.6 million individuals and 23,371 cases of IBD were included. Overall, obesity was associated with an increased IBD risk (HR: 1.20, 95% CI: 1.08-1.34, = 0%). Compared to normal weight, underweight (BMI < 18.5 kg/m) and obesity (BMI ≥ 30 kg/m) were associated with a higher risk of CD, and there was no difference in the risk of U.C. among those with BMI < 18.5 kg/m and BMI ≥ 30 kg/m. There was a significant non-linear association between being underweight and obesity and the risk of development of CD (Coef = -0.0902, < 0.001 Coef = 0.0713, < 0.001).

Conclusions: Obesity increases the risk of IBD development. Underweight and obesity are independently associated with an increased risk of CD, yet there is no evident association between BMI and the risk of U.C. Further studies are needed to clarify the underlying mechanism for these findings, particularly in CD.
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http://dx.doi.org/10.3390/healthcare9010035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824000PMC
January 2021

Bempedoic Acid and Ezetimibe for the Treatment of Hypercholesterolemia: A Systematic Review and Meta-Analysis of Randomized Phase II/III trials.

Clin Drug Investig 2021 Jan 23;41(1):19-28. Epub 2020 Dec 23.

Department of Community Nutrition, Student Research Committee, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

BACKGROUND AND OBJECTIVE: A limited number of trials have evaluated the efficacy of a fixed-dose combination of bempedoic acid and ezetimibe for the treatment of hypercholesterolemia. The aim of this meta-analysis of existing studies was to evaluate the efficacy and safety of fixed-dose bempedoic acid and ezetimibe combination therapy for the treatment of hypercholesterolemia.

Methods: A systematic literature search was conducted to identify randomized controlled trials (RCTs) comparing bempedoic acid and ezetimibe, versus placebo or ezetimibe alone, to 30 August 2020. A meta-analysis was conducted to investigate the efficacy of bempedoic acid and ezetimibe on lipid parameters and highly sensitive C-reactive protein (hsCRP) levels in patients with hypercholesterolemia or established atherosclerotic cardiovascular disease (ASCVD). Mean differences (MDs) or relative risk (RR) with their corresponding 95% confidence intervals (CIs), using random-effects models, were used to provide pooled estimates.

Results: A total of three phase II and III RCTs, comprising 388 patients, of whom 49.2% were treated with bempedoic acid and ezetimibe, and 197 controls, were identified. The duration of treatment was 12 weeks. Bempedoic acid and ezetimibe significantly reduced low-density lipoprotein cholesterol (MD - 29.14%, 95% CI - 39.52 to - 18.76; p < .001), total cholesterol (MD - 15.78%, 95% CI - 20.84 to - 10.72; p = 0.01), non-high-density lipoprotein cholesterol (MD - 18.36%, 95% CI - 24.60 to - 12.12; p = 0.01), and hsCRP levels (MD - 30.48%, 95% CI - 44.69 to - 16.28; p = 0.04). No significant effects on triglycerides (MD - 8.35%, 95% CI - 16.08 to - 0.63; p = 0.72) and improvement in high-density lipoprotein cholesterol (MD 1.63%, 95% CI - 4.03 to 7.28; p = 0.92) were observed with the fixed-dose combination therapy. Regarding safety, bempedoic acid and ezetimibe combination was associated with a non-significant increased risk of drug-related adverse events (RR 1.61, 95% CI 0.86-2.35) and overall adverse events (RR 1.16. 95% CI 0.97-1.35); however, the incidence of discontinuation of therapy (RR 0.75, 95% CI 0.35-1.49) was lower.

Conclusion: This review found bempedoic acid and ezetimibe significantly lowered lipid parameters, attenuated hsCRP levels, and had an acceptable safety profile for the treatment of hypercholesterolemia and ASCVD.
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http://dx.doi.org/10.1007/s40261-020-00989-1DOI Listing
January 2021

Impaired Cardiorespiratory Fitness and Muscle Strength in Children with Normal-Weight Obesity.

Int J Environ Res Public Health 2020 12 9;17(24). Epub 2020 Dec 9.

Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992 Munich, Germany.

Despite the health-related implications of normal-weight obesity in children, very little research has explored the fundamental associations between this status and important long-term health parameters. Therefore, the aim of the current study was to investigate the physical fitness of children with normal-weight obesity, in comparison to normal-weight non obese and overweight and obese counterparts. A total of 328 middle-school-aged children (9.8 ± 0.5 y) took part in this study ( = 44 normal-weight obese; = 237; normal-weight non obese; = 47 overweight and obese). Height, weight, and body-fatness were measured. Four physical fitness tests were conducted: (1) Multistage fitness test; (2) shuttle run 4 × 10 m; (3) sit-ups for 60 s; (4) the broad jump. Welch's analysis of variance (ANOVA), stratified by sex, with post-hoc testing where necessary, was performed. Children with normal-weight obesity had significantly ( < 0.01) lower cardio-respiratory and muscular fitness than normal-weight non obese peers. In addition, normal-weight obese and overweight and obese boys had comparable deficits in strength and explosiveness of lower limbs, speed coordination, and endurance, compared to normal-weight non obese counterparts. Normal-weight obese children appear to have similar deficits in PF as their overweight and obese peers, compared to normal-weight non obese counterparts, whilst boys had larger deficits than girls.
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http://dx.doi.org/10.3390/ijerph17249198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763693PMC
December 2020

The effect of probiotics, parabiotics, synbiotics, fermented foods and other microbial forms on immunoglobulin production: a systematic review and meta-analysis of clinical trials.

Int J Food Sci Nutr 2020 Dec 12:1-19. Epub 2020 Dec 12.

Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

The aim of this systematic review and meta-analysis was to evaluate the effect of probiotics, parabiotics, synbiotics, fermented foods and other microbial forms on immunoglobulin production. We searched PubMed, Scopus, Web of Science, National Institute of Health Clinical Trials Register, and Cochrane Central Register of Clinical Trials, up to February 2020. All clinical trials that investigated the effects of oral intake of probiotics, parabiotics, synbiotics, fermented foods and other microbial forms on immunoglobulin (Ig)A, IgE, Japanese cedar pollen (JCP)-specific IgE, IgG, and IgM, for a duration of >7 days were included. Fifty-nine studies met the inclusion criteria, of these 54 studies were included in the analysis. The results indicated a significant increase in salivary IgA secretion rate (SMD = 0.21, 95% CI 0.02-0.39), while no significant effect was observed on other Igs. In conclusion, mentioned supplementation induced a small but significant effect on salivary secretion rate of IgA.
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http://dx.doi.org/10.1080/09637486.2020.1857710DOI Listing
December 2020

The lack of association between dietary antioxidant quality score with handgrip strength and handgrip endurance amongst Tehranian adults: A cross-sectional study from a Middle East country.

Int J Clin Pract 2020 Nov 30:e13876. Epub 2020 Nov 30.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Objective: The association between dietary antioxidant quality score (DAQS) and handgrip strength (HS) and handgrip endurance (HE) is still unclear. We aimed to investigate whether adherence to dietary antioxidant quality score (DAQS) is associated with handgrip strength (HS) and handgrip endurance (HE) amongst adults in Tehran.

Methods: This cross-sectional study was conducted on 270 (43.7% males, mean age 37 years and 56.3% females, mean age 35 years) apparently healthy adult subjects (53.2% were married) selected from different parts of Tehran, Iran. Dietary intake was assessed using a 168-item validated food frequency questionnaire. DAQS was calculated using antioxidant-nutrient intake. Body composition was measured using a body composition analyser. Handgrip strength and endurance were measured by a digital handgrip dynamometer. Relative muscle strength was expressed as the ratio of handgrip strength by body mass index (BMI).

Results: The results showed that DAQs had no significant association with HS (P = .67, adjusted R  = .60) and HE (P = .19, adjusted R  = .08) after adjusting for potential confounders. However, a significant positive association was found between selenium intake and HE even after adjusting for potential confounders (P = .01, adjusted R  = .10). After controlling for potential confounders no differences in the mean of HS (P = .29) and also HE (P = .61) amongst tertiles of DAQS was found. Positive linear association was found between vitamin C (P = .02, adjusted R  = .53) and vitamin E (P = .03, adjusted R  = .55) intake with relative muscle strength.

Conclusion: Our results revealed that no significant association between DAQS and HE and HS. It was found that more intake of selenium was positively linked to HE. Dietary intake of vitamin C and vitamin E are associated with higher relative muscle strength. It is evident that more prospective studies are needed to confirm the veracity of our results.
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http://dx.doi.org/10.1111/ijcp.13876DOI Listing
November 2020

A Digital Program (Hope) for People Living With Cancer During the COVID-19 Pandemic: Protocol for a Feasibility Randomized Controlled Trial.

JMIR Res Protoc 2020 Dec 4;9(12):e24264. Epub 2020 Dec 4.

Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom.

Background: During the COVID-19 lockdown period in the United Kingdom that began on March 23, 2020, more than a quarter of a million people with cancer reported worsening mental health. Help to Overcome Problems Effectively (Hope) is a self-management program for people with cancer, designed to provide support for distress, unmet needs, and poor psychological health. In light of social distancing during the COVID-19 pandemic, digital delivery of the Hope Programme has become ever more vital for people with cancer. Previous pre-post studies of the digital Hope Programme have found reduced anxiety and depression and improved well-being for people with cancer. However, evaluation of this evidence has been limited by the lack of a control group in these previous studies.

Objective: We now present a protocol for a feasibility randomized controlled trial of the digital Hope Programme for people with cancer during the COVID-19 pandemic. Primary outcomes will be recruitment, dropout, and adherence rates, and estimations of sample and effect size. To detect signals of efficacy, secondary outcomes will be participant mental health and well-being.

Methods: Participants will be recruited by Macmillan Cancer Support (MCS) through their social media networks. The study will employ a feasibility wait-list randomized controlled trial (RCT) design, with people with cancer being randomized to join the digital Hope Programme immediately (intervention group [IG]) or join a 6-week waiting list (wait-list control group [WLCG]) with a 1:1 allocation ratio. Participants will complete digital measures of depression, anxiety, mental well-being, and confidence in managing their own health. Online questionnaires will be administered preprogram and 6 weeks postprogram.

Results: All people who had requested access to the Hope Programme from MCS (N=61) will be invited to participate in the trial. Baseline data collection commenced in April 2020, and the Hope Programme began for the IG in May 2020 and for the WLCG in June 2020. Postprogram data collection was completed by the end of August 2020.

Conclusions: This feasibility study will provide data to inform the design of a future definitive trial. Wider-scale provision of the digital Hope Programme has potential to improve the lives of thousands of people with cancer and reduce the burden on health care providers during these unprecedented times.

Trial Registration: ISRCTN Registry ISRCTN79623250; http://www.isrctn.com/ISRCTN79623250.

International Registered Report Identifier (irrid): DERR1-10.2196/24264.
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http://dx.doi.org/10.2196/24264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721632PMC
December 2020

The effect of cinnamon supplementation on lipid profiles in patients with type 2 diabetes: A systematic review and meta-analysis of clinical trials.

Complement Ther Med 2020 Dec 29;55:102571. Epub 2020 Sep 29.

Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK.

Objective: The present systematic review and meta-analysis was performed to evaluate the effect of cinnamon supplementation on blood lipid profiles in patients with type 2 diabetes.

Methods: A systematic search (with no language restrictions) was performed in PubMed, Embase, Scopus, Web of Science, and Cochrane Library to identify relevant clinical trials up to 8th March 2020. Weighted mean differences (WMDs) and 95 % confidence intervals (CI) were pooled based on the random-effects model. Heterogeneity, publication bias, and sensitivity analyses were performed based on standard methods.

Results: Sixteen studies, involving 1025 participants, were included in the meta-analysis. This study found a significant decrease in triglycerides (TG) (WMD: -26.27 mg/dl, 95 % CI: [-38.93, -13.61], P < 0.001), total cholesterol (TC) (WMD: -13.93 mg/dl, 95 % CI: [-25.64, -2.22], P = 0.020), and low-density lipoprotein cholesterol (LDL-C) levels (WMD: -6.13 mg/dl, 95 % CI: [-10.72, -1.53], P = 0.009), while no change was observed on high-density lipoprotein cholesterol (HDL) concentration (WMD: 0.64 mg/dl, 95 % CI: [-0.18, 1.46], P = 0.128), in patients with type 2 diabetes. The reduction in TG, TC, and LDL-C was greater in; Eastern compared to Western countries, and studies with a duration of < 2 compared to ≥ 2 months. The increase in HDL was greater in; participants with a BMI ≥ 30 compared to <30, Western compared to Eastern countries, and intervention durations of ≥ 2 compared to < 2 months.

Conclusions: Cinnamon supplementation significantly decreased serum TG, TC, and LDL-C concentrations, but did not change HDL-C levels, in patients with type 2 diabetes.
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http://dx.doi.org/10.1016/j.ctim.2020.102571DOI Listing
December 2020

Association of Nutrient Patterns with Metabolic Syndrome and Its Components in Iranian Adults.

Clin Nutr Res 2020 Oct 30;9(4):318-331. Epub 2020 Oct 30.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 14167-53955, Iran.

We aimed to examine the association between nutrient patterns and metabolic syndrome (MetS) in Iranian adults. In a cross-sectional study of 850 self-certified healthy women and men aged 20-59 years old, dietary data were assessed using three 24-hour recall. Anthropometric measures were done and blood samples were collected to measure serum fasting serum glucose and lipid profile. The MetS was defined using the International Diabetes Federation. Major nutrient patterns were identified using principle competent analysis. In the first nutrient pattern, the individuals in the fifth quintile had a higher intake of vitamins B, B, B, B, B, B, zinc, iron, saturated fatty acids (SFAs), and protein. In the second nutrient pattern, individuals in the first quintile had lower consumption of zinc, SFAs, vitamin E, α-tocopherol, oleic acid, polyunsaturated fatty acids, β-carotene, linolenic acid, and monounsaturated fatty acids, compared to the fifth quintile. Furthermore, in the third nutrient pattern, the individuals in the fifth quintile had a higher intake of potassium, magnesium, phosphorous, calcium, protein, carbohydrate, vitamin C, and folate compared to other quintiles. We identified the second pattern had an indirect association with systolic and diastolic blood pressure, triglycerides, fasting blood sugar (p < 0.001 for all), and total cholesterol (p = 0.04) when it was controlled for body weight. Our findings showed that nutrient patterns may have an association with MetS components with mediating body weight.
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http://dx.doi.org/10.7762/cnr.2020.9.4.318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644369PMC
October 2020

Change-of-Direction Performance in Elite Soccer Players: Preliminary Analysis According to Their Playing Positions.

Int J Environ Res Public Health 2020 11 12;17(22). Epub 2020 Nov 12.

M2S (Laboratoire Mouvement, Sport, Santé)-EA 1274, University of Rennes, F-35000 Rennes, France.

Our objective was to examine the relationship between change of direction (CoD) performance, with (CoDb), and without the ball (CoDwb), and selected measures of physical fitness (jump performance, speed, balance) in elite soccer players, according to players' positions. Forty elite male soccer players performed the change-of-direction and acceleration test (CODAT) with (CODATb), and without the ball (CODATwb), 5- and 20-m sprint tests, the 5-jump test (5JT), and the Y-balance test (YBT). Analyses of the whole sample showed significant correlations between all CODAT measures (CODATwb and CODATb, respectively) and sprint 5-m (r = 0.72, < 0.001; r = 0.52, < 0.01), sprint 20-m (r = 0.54, < 0.03; r = 0.45, < 0.05), jump (r = -0.62, < 0.01; r = -0.64, < 0.01) and balance (r = -0.50, < 0.01; r = -0.83, < 0.001) performances. Correlations were significantly different between player positions (defender, midfielder and striker). When examining the entire sample, the single best predictor of CODATwb was performance in the 5-m test with an explained variance of 52% ( < 0.001). For CODATb, the Y-balance performance explained 68% of the variance of performance ( < 0.001). In conclusion, soccer coaches and fitness trainers are advised to improve players' CoD using neuromuscular training that mimic crucial match actions. Meanwhile, CoD testing and training should be designed in line with the demands of playing position.
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http://dx.doi.org/10.3390/ijerph17228360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7696160PMC
November 2020

Dietary intake of polyphenols and total antioxidant capacity and risk of prostate cancer: A case-control study in Iranian men.

Eur J Cancer Care (Engl) 2020 Nov 11:e13364. Epub 2020 Nov 11.

Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology, Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Prostate cancer (PCa) is one of the leading causes, globally, of cancer-related mortality. Previous studies have reported an inverse relationship between some food items or dietary patterns and prostate cancer risk. Polyphenols, as antioxidant and anti-inflammatory dietary components, have been associated with a reduced risk of PCa, whilst dietary indices such as total antioxidant capacity are good predictors of PCa risk.

Objective: The purpose of this study was to conduct a case-control study on the association between polyphenol intake and DTAC (dietary total antioxidant capacity) and PCa risk in men.

Method: 205 hospital-based controls and 97 newly diagnosed PCa patients were asked about their dietary intakes using a validated questionnaire. The polyphenol contents (flavonoids, lignans, stilbenes and phenolic acids) of foods and beverages were calculated. TAC was obtained using a comprehensive database consisting of the total antioxidant content of more than 3000 food and beverages. Logistic regression was used to determine the odds ratios (OR), with 95% confidence intervals (CI), of PCa according to categories of polyphenol intake and TAC.

Results: When comparing the highest and the lowest tertile of total polyphenol (OR: 0.12; 95% CI: 0.03-0.41), lignans (OR: 0.14; 95% CI: 0.04-0.41), phenolic acids (OR: 0.18; 95% CI: 0.05-0.57) and some flavonoid subgroups intake including flavan-3-ols (OR: 0.24; 95% CI: 0.08-0.67), flavanones (OR: 0.10; 95% CI: 0.03-0.31) and flavones (OR: 0.33; 95% CI: 0.12-0.87), we observed a significant decreasing trend in the risk of PCa (p for trend<0.05).

Conclusion: The results suggest that the consumption of some polyphenols can significantly reduce the risk of PCa.
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http://dx.doi.org/10.1111/ecc.13364DOI Listing
November 2020

Cardiorespiratory fitness is positively associated with both healthy and western dietary pattern in Iranian middle-aged.

Int J Vitam Nutr Res 2020 Nov 4:1-10. Epub 2020 Nov 4.

School of Nutritional Sciences and Dietetics, Department of Community Nutrition, Tehran University of Medical Sciences, Tehran, Iran.

: The association between dietary patterns and cardiorespiratory fitness (CRF) is not well established. : We sought to investigate association between a posteriori dietary pattern and CRF in middle-aged adults. : Adults (n = 276), aged 20-74 years, who were residents of Tehran, Iran were recruited. Diet was assessed by using a validated 168-item semi-quantitative food frequency questionnaire. Principal component analysis was used to derive dietary patterns. Socio-economic status, anthropometric measures, body composition, and blood pressure were recorded. CRF was assessed by using a graded exercise treadmill test. Analysis of variance and linear regression models were used to discern the association between dietary patterns and CRF. : Higher scores of the healthy dietary pattern had no association with VO (p = 0.13 After controlling for potential confounders, VO was positively associated across tertiles of healthy dietary patterns (p < 0.001). Higher adherence to the "mixed" dietary pattern was inversely related to VO (p < 0.01). After adjusting for confounders, the significant association disappeared (p = 0.14). Higher scores of the "Western" dietary pattern was not associated with VO (p = 0.06). However, after controlling for potential confounders, VO was positively associated with the "Western" dietary pattern (p = 0.01). A positive linear association between the "healthy" dietary pattern and CRF for the total sample (R = 0.02; p < 0.01) were presented. : Overall, our findings suggest that higher adherence to a "healthy" and "Western" dietary pattern was positively associated with CRF. However, further studies are required to examine and clarify the causal relationship between dietary patterns and CRF.
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http://dx.doi.org/10.1024/0300-9831/a000685DOI Listing
November 2020

The association of plant-based dietary patterns with visceral adiposity, lipid accumulation product, and triglyceride-glucose index in Iranian adults.

Complement Ther Med 2020 Sep 20;53:102531. Epub 2020 Aug 20.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran. Electronic address:

Background: We sought to investigate whether adherence to a more plant-based, and less animal-based, diet is associated with visceral adiposity, lipid accumulation product (LAP), and triglyceride-glucose index (TyG) in Iranian adults.

Methods: This cross-sectional study was conducted on 270 adults aged between 18-75 years old. We created three plant-based diets. including an overall plant-based diet index (PDI), hPDI, and uPDI based on tertiles regarding the intake of animal- or plant-based food items obtained from a semi quantitative food-frequency questionnaire.

Results: Higher hPDI was significantly associated with lower body mass index (BMI) (P-value = 0.01), lower waist circumference (P-value<0.001), and lower waist-hip ratio (P-value<0.001). A significant increase was found for high density lipoproteins (HDL) (P-trend <0.001) with a significant decrease for LAP (P-value = 0.03) in those with higher adherence to hPDI. Moreover, greater adherence to PDI was associated with a significant increase in diastolic blood pressure (DBP) (p-value = 0.01) and fat free mass (FFM) (p-value = 0.01). There were no significant associations between PDIs and TyG and VFA.

Conclusion: We found that a higher hPDI score was significantly associated with better anthropometric measurements. A significant increase was found for HDL and a significant decrease was found for LAP on hPDI. However, a higher PDI score was significantly associated with higher DBP and higher FFM.
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http://dx.doi.org/10.1016/j.ctim.2020.102531DOI Listing
September 2020

The association between dietary acid load and muscle strength among Iranian adults.

BMC Res Notes 2020 Oct 9;13(1):476. Epub 2020 Oct 9.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Iran. No 44, Hojjat-dost Alley, Naderi St., Keshavarz Blvd, Tehran, Iran.

Objective: There is limited evidence regarding the association between dietary acid load and muscle strength. Thus, in this study, we investigated the association between dietary acid-base load indices and muscle strength among Iranian adults.

Results: This cross-sectional study was conducted on 270 Iranian adults, aged 18-70 year. Dietary acid load indexes, were calculated by using a validated 168-item semi-quantitative food frequency questionnaire (FFQ). Muscle strength was measured by a digital handgrip dynamometer. There was a significant increase in mean muscle strength of left-hand (MSL), muscle strength of right-hand (MSR) and the mean of the MSL and MSR (MMS) across tertiles of Potential Renal Acid Load (PRAL), Net Endogenous Acid Production (NEAP), and Dietary Acid Load (DAL). Significant linear relationships between PRAL and; MSL (β = 0.24, p < 0.001), MSR (β = 0.23, p < 0.001) and MMS (β = 0.24, p < 0.001), between NEAP and MSL (β = 0.21, p < 0.001), MSR (β = 0.19, p = 0.002), and MMS (β = 0.20, p = 0.001) and between DAL and MSL (β = 0.25, p < 0.001), MSR (β = 0.23, p < 0.001) and MMS (β = 0.24, p < 0.001), were attenuated after controlling for potential confounders. However, the nonlinear relationship between dietary acid load indicators and muscle strength were significant (p < 0.001 for all).
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http://dx.doi.org/10.1186/s13104-020-05309-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547515PMC
October 2020

The association between animal flesh foods consumption and semen parameters among infertile Iranian men: a cross-sectional study.

Nutr J 2020 10 6;19(1):113. Epub 2020 Oct 6.

Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Previous studies have demonstrated the association between dietary patterns and semen quality indicators, but research on the possible association between animal flesh foods consumption and semen quality is limited. Therefore, this study was conducted to investigate the association between animal flesh foods consumption with semen quality.

Methods: In this cross-sectional study, 400 newly-identified (< 6 months) infertile men, as diagnosed by an andrologist, were recruited into the study. Dietary intake was assessed by using a semiquantitative Food Frequency Questionnaire. The total meat consumption was defined as the sum of red meat, poultry, fresh fish, canned fish, processed meats, and organ meats in the diet. A linear mixed model was used to assess the relationship between meat consumption and semen quality indicators of participants.

Results: Consumption of canned fish was inversely related to sperm immotility. Compared with the men in the lowest quartile of canned fish intake, those in the highest quartile had a lower sperm immotility [lowest quartile: 52.5%; (95% CI: 47-57) vs 47.4%; (95% CI: 43-51) P-trend = 0.026]. Similarly, a trend toward an inverse significant association between fresh fish intake and sperm immotility was observed (P-trend = 0.074). In contrast, fresh and canned fish intake was unrelated to other outcomes of sperm quality (P-trend > 0.05). No association was found between consumption of processed red meat, red meat, poultry, and organ meat, and semen quality indicators (P-trend > 0.05).

Conclusions: We found that consumption of canned fish is associated with a lower percentage of immotile sperm, whilst a high consumption of fresh fish increased the percentage of immotile sperm in Iranian infertile men. Further studies are recommended in this regard.
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http://dx.doi.org/10.1186/s12937-020-00633-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541170PMC
October 2020

Higher Dietary Acid Load Is Associated With an Increased Risk of Calcium Oxalate Kidney Stones.

J Ren Nutr 2020 Sep 24. Epub 2020 Sep 24.

Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch, Islamic Azad University, Tehran, Iran. Electronic address:

Objectives: Diet-dependent net acid load may influence the risk of kidney stone formation by affecting calcium and citrate excretion. However, to date, little research has investigated the relationship between dietary acid load and kidney stones. Therefore, this study sought to assess whether a diet high in potential acid load was related to the risk of calcium oxalate stone formation.

Methods: This case-control study was conducted on 430 participants (including 215 newly diagnosed patients with calcium oxalate stones and 215 controls matched for sex and age). Dietary intake was assessed using a validated food frequency questionnaire over the preceding year. Dietary acid load was estimated based on the potential renal acid load (PRAL) and net endogenous acid production (NEAP). The association between dietary acid load indices and kidney stone was examined using multivariable logistic regression.

Results: Mean PRAL (standard error) was significantly lower in cases versus controls (-5.3 ± 1.3 vs. -1.7 ± 1.3, P = .048). Corresponding values for NEAP were 39.4 ± 0.8 and 41.8 ± 0.8, respectively (P = .032). After adjustment for potential confounders, the odds ratios (95% confidence intervals) of calcium oxalate stones in the top tertile of PRAL and NEAP were 1.45 (0.89-2.38, P = .136) and 1.88 (1.14-3.09, P = .013), respectively. Adjustment for potassium and protein in 2 separate models did not substantially change the results.

Conclusions: A diet high in potential acid load, measured by NEAP, was associated with higher risk of calcium oxalate stone formation, independent of potassium and protein intake. Prospective longitudinal studies are warranted to confirm the veracity of our results.
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http://dx.doi.org/10.1053/j.jrn.2020.08.012DOI Listing
September 2020

Physical behaviors and fundamental movement skills in British and Iranian children: An isotemporal substitution analysis.

Scand J Med Sci Sports 2021 Feb 10;31(2):398-404. Epub 2020 Oct 10.

Centre for Intelligent Healthcare, Coventry University, Coventry, UK.

Although the relationship between fundamental movement skills (FMS) and physical behaviors has been established, differences between countries are scarcely explored. The impact of the whole physical behavior composition, in relation to FMS, has yet to be investigated in 9-11 y children. The aims were to investigate the associations of substitution of physical behaviors with FMS score and to compare traditional linear regression and compositional data analysis and compare between England and Iran. Measures included accelerometer-derived activity (sleep (SL), sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) and FMS, using the TGMD-2, in 119 children (64 boys) from Iran (mean (±SD) age: 9.8 ± 0.3 y; BMI of 18.2 ± 3.3 kg/m ) and 139 (61 boys) children from England (mean (±SD) age: 9.5 ± 0.6 y; BMI of 17.7 ± 3.1 kg/m ). Isometric log-ratio multiple linear regression models were used to discern the association between FMS and the mean activity composition, and for new compositions, where fixed durations of time were reallocated from one behavior to another, while the remaining behaviors were unchanged. In physical behaviors as a composition, FMS was significantly associated in both ethnicities. English children responded significantly positively to adding 5 or more minutes LPA at the expense of SB (FMS unit change from 0.05 [0.01, 0.09] at 5 minutes to 0.72 [0.01, 1.34] at 60 minutes). Adding 10 minutes or more of SL, at the expense of SB, was associated with a significant, positive change in FMS in all children. Investigation is needed to understand the composition of SB and its potential influence on FMS development.
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http://dx.doi.org/10.1111/sms.13837DOI Listing
February 2021

Pistachios and cardiometabolic risk factors: A systematic review and meta-analysis of randomized controlled clinical trials.

Complement Ther Med 2020 Aug 15;52:102513. Epub 2020 Jul 15.

Nutrition and Metabolic Disease Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Electronic address:

Background: Previous experimental studies have reported that pistachios can elicit positive effects on lipid profile, blood pressure, and inflammation; however, a meta-analysis of the available evidence has yet to be performed.

Objective: the aim of this study was to conduct systematic review and meta-analysis of the effect of pistachio enriched diets on cardiometabolic risk factors, such as weight, BMI, blood pressure, serum lipids, blood glucose, and inflammatory biomarkers.

Design: A literature search was carried out for RCTs in medical databases, including PubMed/MEDLINE, Scopus, and Cochrane databases, with no time limitation up to August 2019, and conducted in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines.

Results: 11 RCTs, with 506 participants, that reported the effect of pistachios consumption on cardiometabolic risk factors were included in this systematic review and meta-analysis. Our findings indicated that pistachios consumption significantly reduced FBS (WMD: -3.73, 95 % CI: -6.99, -0.46, I = 99 %), TC/HDL (WMD: -0.46, 95 % CI: -0.76, -0.15, I = 95 %), LDL/HDL (WMD: -0.24, 95 % CI: -0.38, -0.11, I = 96 %), HbA1C (WMD: -0.14, 95 % CI: -0.26, -0.02, I = 60 %), Insulin (WMD: -2.43, 95 % CI: -4.85, -0.001, I = 58 %), SBP (WMD: -3.10, 95 % CI: -5.35, -0.85, I = 63 %), and MDA (WMD: -0.36, 95 % CI: -0.49, -0.23, I = 0%). Importantly, we did not observe adverse effects of pistachios consumption on BMI or blood pressure.

Conclusion: This systematic review and meta-analysis demonstrates that pistachios consumption can elicit a beneficial effect on some cardiometabolic risk factors. All previous clinical studies are well designed but some points have still remained unclear including the effects of different pistachios dosages on cardio metabolic risk factors and efficacy of pistachios consumption in preventing endothelial dysfunction. Further examination is required to determine the effect of pistachios consumption on further endothelial function risk factors.
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http://dx.doi.org/10.1016/j.ctim.2020.102513DOI Listing
August 2020

Breakfast-Based Dietary Patterns and Obesity in Tehranian Adults.

J Obes Metab Syndr 2020 Sep;29(3):222-232

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

Background: Breakfast is an important meal of the day that contributes to an overall healthy dietary pattern, better nutrient intake, and diet quality. This study sought to investigate the relationship between breakfast patterns and general and central obesity among middle-aged adults.

Methods: In this cross-sectional study of 840 apparently healthy women and men, aged 20-59 years, we assessed usual dietary intake by means of three 24-hour dietary recalls and we took anthropometric measurements. Dietary patterns were subsequently identified by factor analysis. To assess the association between breakfast composition and central and general obesity, logistic regression analysis was performed.

Results: We identified three major dietary patterns by factor analysis: the "bread and grains, meat products, and coffee" dietary pattern, the "sweets, tea and coffee" dietary pattern, and the "fruits, vegetables, and eggs" dietary pattern. Those people in the third tertile of the "sweets, tea and coffee" dietary category had a greater chance of having central obesity (odds ratio, 1.80; 95% confidence interval, 1.25-2.59; =0.001). Moreover, higher adherence to the "bread and grains, meat products, and coffee" pattern increased the chance of central obesity (odds ratio, 1.67; 95% confidence interval, 1.47-1.97; =0.03).

Conclusion: Overall, our results suggest that specific breakfast dietary patterns are associated with increased odds of central obesity in Iranian adults.
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http://dx.doi.org/10.7570/jomes20042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539348PMC
September 2020