Vol 2, No 3 (Summer 2016)


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    In this issue of the Journal, a cross-sectional study Mirzaei et al., found a positive association between adherence to the Mediterranean diet and bone density in postmenopausal women. They also reported an inverse association between the Western dietary pattern which is high in oil and butter, refined grain, organ meat, sugar, pickles, legume and soy, potato, salt and flavor, high fat dairy and starchy vegetables and bone density in postmenopausal women (1). It must be kept in mind that this study was in postmenopausal women. The result cannot be generalized to other population.
    Considering the population pyramid in Iran (2), it seems that it is changing from the young population to old people. Therefore, age-related diseases will be a major concern in the country over the next few years. Amongst age-related disease are bone-related disorders. Due to their huge burden to the healthcare system, as well as possible disabilities associated with these conditions, prevention of age-related bone disorders is of great importance, in particular in Iran which has increasing old populations. To achieve this, dietary intakes of Iranians, especially during their adolescence to adulthood, should be taken into account. In terms of dietary investigations in this field, nutritional epidemiologists offer the application of dietary pattern approach to identify diet-disease relations. In the above-mentioned study, Mirzaei et al., have used this approach to find the association between diet and bone density. The results are interesting in terms of focusing on bone health using the dietary pattern approach. The notable finding was that adherence to the Mediterranean diet is positively associated with bone density. Although this finding is not novel, limited data are available suggesting the beneficial effects of Mediterranean diet in non-Mediterranean countries. The effects of the Mediterranean diet on human health have been shown in numerous studies. Adherence to the Mediterranean diet was associated with reduced risk of several chronic diseases including obesity, cardiovascular disease, and some cancers (3,4). It has also been associated with better quality of life (5). A recent meta-analysis showed that adherence to Mediterranean diet was associated with a reduced risk of fractures and with a higher mean bone mass density (BMD) (6). Besides Mediterranean diet, the authors have also reported an inverse relationship between Western diet and bone mass density. Consumption of foods greatly loaded in the western dietary pattern has previously been shown in relation to bone health (7). Almost all publications in this regard have consistently indicated the detrimental effects of western dietary patterns on bone health. This might be attributed to the increased acidity of urine they cause by their ingredients (8). By the way this phrase is not usually used in a scientific text, policy makers in the countries should be aware of the relationship of several foods and dietary patterns with age-related disorders and apply findings from these investigations in their policy making process. Based on findings of the mentioned study, it seems that consumption of Mediterranean dietary pattern should be encouraged in Iran and greater efforts should be done to make people aware of the detrimental effects of western dietary pattern on bone health.
    In conclusion, it is suggested to design large-scale prospective studies focusing on dietary determinants of bone health in Iran. Although small studies, including the one we discussed, are available, no nationwide investigation is available in the country indicating the effect of environmental factors, including diet, on bone health.

Original Article(s)

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    : Bone discordance considered a new challenge to a diagnosis of osteoporosis, especially among postmenopausal women, there are many causes have been proposed for the occurrence of this phenomenon. This study was conducted to investigate the relation between major dietary patterns and bone discordance in postmenopausal women.
    Methods: In this cross-sectional study, 258 postmenopausal women completed demographic data from June 2015 to February 2016. Dietary intake was assessed with a validated food frequency questionnaire (FFQ). Dietary patterns were created by PCA method from 25 food groups. Dual-energy x-ray absorptiometry (DXA) was performed on lumbar (L2-L4) and hip for cases.
    Results: Three major dietary patterns were identified by using factor analysis based on baseline intake data: Unhealthy, Mediterranean and Western diet. After analysis, we found 55.41% were concordance and 44.56% (4.26% were in the major discordance group of participants were discordance. We found participants who were in discordance group were younger, and obese participants were more talented to be in the major discordance group. We found an inversely relationship between unhealthy dietary pattern and hip and lumbar Z score, while there was a positive relationship between Mediterranean dietary pattern and hip BMD. No associations were found between dietary pattern and bone discordance.
    Conclusion: This study concluded that bone discordance was directly related to obesity. Obese and younger women were at risk of bone discordance. Unhealthy and a Mediterranean dietary pattern were negatively and positively related to bone density among postmenopausal women


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    Objective: To evaluate the association of breakfast intake with micro and macro nutrients intake, dietary diversity score (DDS), food group consumption and body mass index (BMI) in girl students.
    Methods & Procedures: A total of 384 female students (aged 15 to 19 years) were recruited from high-schools of Tehran using stratified sampling. Information regarding frequency of breakfast consumption was collected by asking questions on a three-point scale of “always”, “sometimes” and “never”. Physical activity and DDS were measured by International Physical Activity Questionnaire (IPAQ), Dietary Diversity Questionnaire (FAO-2013), respectively. In addition, weight, height and waist circumference (WC) were measured and body mass index (BMI) was calculated as weight (kg) per height squared (m2).
    Results: In the present study, 49.5% of girls always consumed breakfast; 34.4% sometimes and 16.1% never consumed breakfast. Skipping breakfast was significantly associated with higher BMI and weight dissatisfaction (p≤0.05). Adolescents who were daily consumers of breakfast had higher intake of energy and carbohydrate (p˂0.05). They had also higher intake of saturated fatty acids, cholesterol, linoleic acid, folate, manganese and fluoride after adjustment for energy intake (p˂0.05). After adjustment for energy and BMI, DDS was significantly higher for adolescents with daily breakfast consumption compared to other groups(p=0.03). Further, percentage of participants consuming egg, milk and dairy, fruits and vegetables rich in vitamin A was higher in daily breakfast eaters compared to other groups (p˂0.05).
    Conclusion: Eating breakfast may associate with higher diet quality as well as weight control in female adolescents.

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    Background: Red/processed meats are suggested to increase risk of prostate cancer (PCa). We examined the link between unprocessed red meat, processed meat, fish and poultry consumption with risk of PCa.
    Methods: In this hospital based, case–control study, a total of 50 patients with prostate cancer and 100 controls underwent face-to-face interviews. Logistic regression analysis, were used to examine the relation between unprocessed red meat, processed meat, fish and poultry consumption and risk of PCa.
    Results: It was observed that a significant positive association between consumption of total meat and risk of PCa (above median vs. below median: OR = 4.6, 95%CI 1.7-12.5). A significant positive association between organ meat (above median vs. below median: OR=3.1, 95%CI =1.3-7.6) and processed meat (above median vs. below median: OR=2.5, 95%CI =1.0-6.1) and risk of PCa was observed (p<0.05). Positive association between beef and mutton consumption and risk of PCa wasn’t significant (p =0.762). Fish consumption were also negatively associated with risk of PCa (above median vs. below median: OR = 0.07, 95%   CI =0.02-0.2) (p<0.05). The association between poultry consumption and risk of PCa, wasn’t significant (p =0.083).
    Conclusions: The results of the present study suggest that high consumption of processed meat and organ meat might be positively associated with an increased risk of PCa in Iranian men. Furthermore, fish consumption might be a protective factor for PCa in Iranian men.

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    Objectives: The aim of this study was to investigate the effect of branched-chain amino acids (BCAA) supplementation on lactate dehydrogenase, creatine kinase and total antioxidant capacity after a session of exhaustive strength exercise.
    Method: Twenty four men rock climbers aged 27 to 37 from Tehran province were randomly assigned to two groups of 12 subjects (amino acids, placebo). Five ml of blood was taken from all subjects in three stages: 30 post-exercise hours post-exercise. The subjects participated in a session of intense physical activity (70% repetition maximum resistance movements) and then the supplementation group received BCAA at the rate 6 g per day for 14 days. The placebo group received Maltodextrin capsules during this time. A day after completing the course, the subjects were once again present in the same location as the one in the pre-test and post-test was performed on all subjects. An independent t test at p < .05 was conducted to analyze the data.
    Results: The results showed that the use of BCAA has a significant impact on creatine kinase and lactate dehydrogenase before, immediately, and 24 hours post-exercise (p>0.05), but it has no significant impact on total antioxidant capacity (p<0.05). conclusion : According to the results, it can be said that BCAA may be useful in reducing the release of lactate dehydrogenase enzymes and creatine kinase.

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    Background: This study aimed to determine the differences in plasma total antioxidant capacity between metabolic syndrome patients and those without metabolic syndrome with normal weight, overweight, and obesity.
    Methods: A case-control study was carried out among 146 men and women (aged 20-55 years) in Endocrinology Center of Tehran University of Medical Sciences. The case group included overweight/obese subjects with metabolic syndrome and the two control groups were weight-matched subjects without metabolic syndrome and normal weight subjects without metabolic syndrome. Total antioxidant capacity was determined using the colorimetric method.
    Results: Waist circumference and total antioxidant capacity of the case group were significantly higher than that of both control groups ((p<0.001) for both). There was no significant difference between normal and overweight/obese control groups in total antioxidant capacity level (p=0.53).
    Conclusion: Oxidative stress presumably is an important factor in the pathology of metabolic syndrome and total antioxidant capacity may be responsible for defense against oxidants.

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    Background: Disease related malnutrition (DRM) has been an important problem in all health care settings for many years and is associated with an increased risk of adverse clinical outcomes. Nutritional interventions with ONS are associated with fewer numbers of hospital admissions and shorter duration of hospital stay.
    Objective: The objective of the present study was to investigate the knowledge and attitude of medical specialists regarding ONS prescribing practices.
    Methods: A total sample of 120 medical specialists were recruited from two hospitals in northeastern Iran. Sixty medical specialists from Imam Reza Hospital and sixty medical specialists from Ghaem Hospital were randomly selected. A questionnaire was administered by face-to-face interview to each participant.
    Results: Only a small number of medical specialists reported the use of screening tools to ascertain whether a patient requires ONS. Both medical specialists in Imam Reza (44%) and Ghaem (36.8%) hospitals reported increased prescription of ONS in recent years. Only 38.5% of the medical specialists said that they would monitor the patient after prescribing ONS. Only 32.9% of medical specialists stated that they have received training on use of ONS in the past. Around 41% of medical specialists stated that they have no idea about the calorie content of a standard 200 mL carton of ONS.
    Conclusion: The results of the present study raise concerns regarding the appropriateness of current ONS transcriptions among hospitalized patients. Therefore, there is a need for targeted educational interventions for medical specialists in order to promote the use of ONS in hospitalized patients.

Review Article(s)

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    Background: Several studies have investigated the effect of quericitn supplementation on serum C - reactive protein (CRP). However, results were inconsistent. This systematic review and meta-analysis was designed to assess the effect of quercetin supplementation on CRP levels in randomize control trials (RCTs).
    Method: We searched PubMed and Scopus up to July 2016 to identify RCTs investigating the effect of quercetin on serum CRP. Meta-analysis was performed using either a fixed-effects or random-effect model according to I² statistic. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated for net changes in CRP levels.
    Results: Seven trials with eight data sets and 346 participants met the inclusion criteria. There was no significant differences for CRP reduction between subjects with quercetin supplementation and placebo control [WMD, 0.01 mg/L; 95% CI: -0.18 to 0.21, p =0.88] with significant heterogeneity (I²=48.9%; p=0.05). Subgroup analyses showed that dose, duration and country were not the potential sources of heterogeneity.
    Conclusion: Our results suggest that quercetin supplementation does not reduce serum CRP. Further large and well-designed studies are necessary to confirm this conclusion.