Effectiveness of cognitive-behavioral therapy on nutrition improvement and weight of overweight and obese adolescents: A randomized controlled trial

AimTo assess the effectiveness of a cognitive-behavioral treatment (CBT) program on weight reduction among Iranian adolescents who are overweight.MethodsUsing a randomized controlled trial design, 55 adolescents who were overweight (mean [SD] age = 14.64 [1.69] years; zBMI = 2.18 [0.65]) were recruited in the CBT program and 55 in the treatment as usual (TAU; mean age = 14.88 [1.50]; zBMI = 2.09 [0.57]) group. All the participants completed several questionnaires (Child Dietary Self-Efficacy Scale; Weight Efficacy Lifestyle questionnaire; Physical Exercise Self-Efficacy Scale; Pediatric Quality of Life Inventory; and self-reported physical activity and diet) and had their anthropometrics measured (height, weight, waist and hip circumferences, and body fat).ResultsThe CBT group consumed significantly more fruits and juice, vegetables, and dairy in the 6-month follow-up as compared with the TAU group (p-values <0.001). The CBT group consumed significantly less sweet snacks, salty snacks, sweet drinks, sausages/processed meat, and oils in the six-month follow-up compared with the TAU group (p-values<0.001). Additionally, the waist circumference, BMI, waist-hip ratio, and fat mass were significantly decreased in the CBT group in the six-month follow-up compared with the TAU group (p-values<0.005). The CBT group significantly improved their psychosocial health, physical activity, and health-related quality of life (p-values<0.001).ConclusionThe CBT program showed its effectiveness in reducing weight among Iranian adolescents who were overweight. Healthcare providers may want to adopt this program to treat excess weight problems among adolescents.     

The effects of vitamin D supplementation on lipid profiles and oxidative indices among diabetic nephropathy patients with marginal vitamin D status

AimsDiabetic nephropathy is one of the major microvascular complications of type 2 diabetes which insufficient vitamin D might -have a role in it's incidence. This study evaluated the effects of vitamin D supplementation on lipid profiles and oxidative/anti-oxidative indices in marginal vitamin D status patients with diabetic nephropathy.MethodsFor the current paralleled, randomized, double-blinded, placebo-controlled clinical trial, 50 diabetic nephropathy patients with marginal serum vitamin D were selected. Intervention group received 1,25-dihydroxycholecalciferol (50000 IU/week, n = 25), and placebo group (n = 25) received an identical placebo, for 8 weeks. Lipid profiles (LDL, HDL, TG and TC) and oxidative/anti-oxidative markers (TAC, SOD, CAT, GPX and MDA) were measured.ResultsVitamin D supplementation significantly increased vitamin D status in the intervention group, compared to the control group (P = 0.001). The reductions in the serum levels of TG, LDL and TC were significant (P = 0.04, P = 0.006 and P = 0.02, respectively) in the intervention group. The changes in oxidative/anti-oxidative markers and HDL levels were not significant after intervention.ConclusionIn conclusion, vitamin D supplementation for 8 weeks among diabetic nephropathy patients has beneficial effects on serum vitamin D status and dyslipidemia.     

An investigation of the association between the level of prolactin in serum and type II diabetes

As a hormone secreted from the pituitary gland, prolactin (PRL) plays an important role in increasing beta cell proliferation, stimulating the secretion of insulin, preventing the activities of caspases on pathways that cause apoptosis in the Langerhans' islands, and moderating the immune system in regulating the whole body's sensitivity to insulin. Therefore, PRL level changes in type II diabetes and it can be concluded that PRL can play an important role in metabolic disorders of glucose. The present study is carried out in order to investigate the association between serum levels of PRL and type II DM. Blood samples were taken from 64 females affected by type II diabetes and 70 healthy ones, whose PRL level was measured using electrochemiluminescence (ECL) technique. It was a case-control study, and based on the definition dedicated to each group, subjects were assigned to two groups. The patient group included the subjects with type II diabetes while the control group included healthy samples. Data were analyzed using SPSS software (Mann-Whitney test, t-test, and spearman's rho correlation test). According to the results, PRL concentration in the serum of people affected by type II diabetes (5.32 ± 0.36) was significantly (P?0.05) lower than that of control group (18.38 ± 2.3). The results also showed that in type II diabetes, the level of PRL changes so that the concentration of PRL in the serum of the patients was lower than that of healthy ones. Therefore, PRL concentration in the blood can be related to diabetes.     

Serum pentraxin 3 levels in rheumatoid arthritis patients and its association with disease activity

Aim of the workThis work aimed to evaluate serum pentraxin 3 (PTX3) levels in rheumatoid arthritis (RA) patients and to study the association with the disease activity.Patients and methodsSixty RA patients and 26 matched controls were included. In patients, clinical examination was performed and disease activity score (DAS28) assessed. Serum PTX3, rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured.ResultsThe mean age of the patients was 54.9 ± 11.7 years, and the median (Min–Max) of disease duration was 24 (3.96–60) months and 91.7% were females. The mean DAS28 was 4.16 ± 1.77, the ESR was 38.6 ± 23.03 mm/1st h, CRP was 14.9 ± 8.6 mg/l, RF was 49.6 ± 28.1 IU/ml and the median anti-CCP was 375. Serum PTX3 level was significantly higher in RA patients (2.82 ± 0.48 pg/ml) compared to controls (2.56 ± 0.29 pg/ml) (p = 0.003). There was a significant difference in serum PTX3 level according to the disease activity: remission (2.49 ± 0.16 pg/ml), low (2.61 ± 0.33 pg/ml), moderate (2.90 ± 0.53 pg/ml) and high (3.01 ± 0.51 pg/ml) (p = 0.016). There was a significant correlation between serum PTX3 level with disease activity (r = 0.39, p = 0.002) and CRP (r = 0.49, p < 0.001). There was no significant correlation between serum PTX3 level and the RF (r = 0.25, p = 0.054), anti-CCP (r = 0.18, p = 0.17) and ESR (r = 0.09, p = 0.51). PTX3 and CRP showed a good sensitivity and specificity in predicting RA disease (p = 0.006 and p < 0.001, respectively).ConclusionPTX3 can be considered as a marker of a positive acute phase response and may serve as a potential novel biomarker for detecting RA activity.     

The effect of probiotic supplementation on glycemic control and lipid profile in patients with type 2 diabetes: A randomized placebo controlled trial

AimsThe role of gut microbiota in the pathogenesis of diabetes is increasing; this study investigates the effect of multi-strain probiotics on fasting plasma glucose (FPG), plasma insulin and lipid profile among patients.MethodsThis randomized double blind controlled trial was performed among 60 patients; individuals were randomly assigned into 2 groups of 30 participants in order to take either probiotic supplements or placebo for 6 weeks. The probiotic supplement consisted of 7 viable strains Lactobacillus, Bifidobacterium and Streptococcus. Nutrient intakes were estimated using a 3-day and 24 hour-dietary recall at the beginning and end of study. Fasting blood samples were taken before and after intervention to measure the levels of FPG, plasma insulin and lipid profiles.ResultsWithin group comparisons showed significant decrease and increase in the levels of FPG (P = 0.001) and HDL-C (P = 0.002) in probiotic group, respectively. No significant alterations were observed for within and between group comparisons in the levels of insulin, triglycerides, total cholesterol, insulin resistance and anthropometric measurements, including weight, waist circumference and body mass index (all P > 0.05).ConclusionsThis study showed a significant decrease in FPG level by multi-strain probiotic supplements in within group comparison; though, further studies are needed to confirm results. (IRCT Code: IRCT2013100714925N1).     

Efficacy of l-carnitine supplementation for management of blood lipids: A systematic review and dose-response meta-analysis of randomized controlled trials

Background and aiml-carnitine has an important role in fatty acid metabolism and could therefore act as an adjuvant agent in the improvement of dyslipidemia. The purpose of present systematic review and meta-analysis was to critically assess the efficacy of l-carnitine supplementation on lipid profiles.Methods and resultsWe performed a systematic search of all available randomized controlled trials (RCTs) in the following databases: Scopus, PubMed, ISI Web of Science, The Cochrane Library. Mean difference (MD) of any effect was calculated using a random-effects model.In total, there were 55 eligible RCTs included with 58 arms, and meta-analysis revealed that l-carnitine supplementation significantly reduced total cholesterol (TC) (56 arms-MD: ?8.53 mg/dl, 95% CI: ?13.46, ?3.6, I²: 93%), low-density lipoprotein-cholesterol (LDL-C) (47 arms-MD: ?5.48 mg/dl, 95% CI: ?8.49, ?2.47, I²: 94.5) and triglyceride (TG) (56 arms-MD: ?9.44 mg/dl, 95% CI: ?16.02, ?2.87, I²: 91.8). It also increased high density lipoprotein-cholesterol (HDL-C) (51 arms-MD:1.64 mg/dl, 95% CI:0.54, 2.75, I²: 92.2). l-carnitine supplementation reduced TC in non-linear fashion based on dosage (r = 21.11). Meta-regression analysis indicated a linear relationship between dose of l-carnitine and absolute change in TC (p = 0.029) and LDL-C (p = 0.013). Subgroup analyses showed that l-carnitine supplementation did not change TC, LDL-C and TG in patients under hemodialysis treatment. Intravenous l-carnitine and lower doses (>2 g/day) had no effect on TC, LDL-C and triglycerides.Conclusionl-carnitine supplementation at doses above 2 g/d has favorable effects on patients' lipid profiles, but is modulated on participant health and route of administration.     

Impact of resveratrol supplementation on inflammatory,antioxidant, and periodontal markers in type 2 diabetic patients with chronic periodontitis

BackgroundDiabetes mellitus and periodontal disease are two common and chronic diseases with bidirectional relationship influence public health and quality of life. The aims of this study was to study the impact of resveratrol supplementation in adjunct with non-surgical periodontal therapy on inflammatory, antioxidant, and periodontal markers in patients with type 2 diabetes with periodontal disease.Materials and methodsIn this randomized clinical trial, 43 patients with diabetes and chronic periodontitis were randomly allocated into two intervention and control groups receiving either resveratrol supplements or placebo for 4 weeks. Serum levels of interleukin 6 (IL6), tumor necrosis factor α (TNFα), total antioxidant capacity (TAC) and clinical attachment loss (CAL) as the main index of periodontal marker were measured pre-intervention and post-intervention.ResultsIn the intervention group, the mean serum level of IL6 was reduced significantly (P = 0.039) post-intervention (2.19 ± 1.09 and 1.58 ± 1.06). No significant differences were seen in the mean levels of IL6, TNFα, TAC and CAL between two groups post-intervention.ConclusionsIt is suggested that daily consumption of resveratrol supplement may not change TNFα, TAC and CAL, but it would be beneficial in reducing serum levels of IL6. Therefore, further studies are suggested to investigate the effects of resveratrol supplementation along with NST on periodontal status.     

An update on obesity: Mental consequences and psychological interventions

Besides physical consequences, obesity has negative psychological effects, thereby lowering human life quality. Major psychological consequences of this disorder includes depression, impaired body image, low self-esteem, eating disorders, stress and poor quality of life, which are correlated with age and gender. Physical interventions, mainly diet control and energy balance, have been widely applied to treat obesity; and some psychological interventions including behavioral therapy, cognitive behavioral therapy and hypnotherapy have showed some effects on obesity treatment. Other psychological therapies, such as relaxation and psychodynamic therapies, are paid less attention. This review aims to update scientific evidence regarding the mental consequences and psychological interventions for obesity.     

Effects of vitamin D supplementation on depressive symptoms in type 2 diabetes mellitus patients: Randomized placebo-controlled double-blind clinical trial

AimDiabetes increases the odds of depression and depression is often associated with poor glycemic control and complications of diabetes. Vitamin D is also believed to improve glycemic control and ameliorate depressive symptoms. Therefore, we examined effects of vitamin D monotherapy (without antidepressant drugs) on depressive symptoms in Type 2 diabetic patients with mild to moderate depressive symptoms.MethodsWe conducted 12 weeks, placebo-controlled, double-blind, randomized trial on 68 subjects with T2DM and mild to moderate depressive symptoms. Subjects received 100 μg (4000 IU) vitamin D (n = 32) or placebo (n = 34) daily. Beck Depression Inventory-II (BDI–II–PERSIAN) was applied for assessment of the severity of depression. Depression scores and metabolic profiles were measured at the beginning and end of trail.Resultsafter 3 months of vitamin D supplementation, mean values of 25(OH) D increased from 15.5 ± 8.8 to 32.2 ± 8.9 ng/ml (p-value <0.001) in the vitamin D group. Moreover, BDI-II scores decreased from 15.2 ± 9.6 to 9.8 ± 7.2 (p-value <0.001) in the vitamin D group and 15.5 ± 11.2 to 13.7 ± 11.5 (p-value = 0.03) in placebo group. This decrease in BDI-II scores were significant (27.6% vs 10.8%) compared with placebo (p-value = 0.02). In term of metabolic profiles, mean change in level of Hemoglobin A1c (HbA1c), insulin and triglycerides (TG) were significantly higher in response to the treatment with vitamin D compared to placebo (p-value <0.02).ConclusionsIn conclusion, supplementation of vitamin D in T2DM patients may protect these patients against the onset of major depressive disorder (MDD), with noticeable favorable effects on measures of metabolic profiles.Trial registrationNCT03008057     

Long-term association of nut consumption and cardiometabolic risk factors

Background and aimsLong-term associations between nut consumption and cardiometabolic risk factors are not well known. We investigated the relationship between nut consumption and cardiometabolic risk factors including dyslipidemia, hypertension, diabetes mellitus (DM), and obesity in a cohort of Iranian adults.Methods and resultsThe study was conducted within the framework of the Isfahan Cohort Study on 1387 healthy participants. The participants were followed up for 12 years. A validated food frequency questionnaire was completed, and anthropometric measurements, blood pressure, and fasting serum lipids and blood sugar were evaluated in three phases. Mixed-effects binary logistic regression was applied to examine the associations between nut consumption and cardiometabolic risk factors. The participants were classified according to the tertiles of nut consumption as cut-points, and associations were evaluated between the thirds of nut intake.Subjects in the last third were less likely to have hypercholesterolemia [OR (95% CI): 0.76 (0.60–0.97)], hypertriglyceridemia [OR (95% CI): 0.74 (0.58–0.93)], and obesity [OR (95% CI): 0.79 (0.50–0.98)] but more likely to have DM [OR (95% CI): 1.85 (1.27–2.68)] than those in the first third. However, after adjustment for various potential confounders, the associations remained significant only for obesity [OR (95% CI): 0.67 (0.48–0.94)] and DM [OR (95% CI): 2.23 (1.37–3.64)].ConclusionAfter adjustment for potential confounders, we observed an inverse association for nut consumption and obesity but positive association for DM and nut intake. On the basis of our findings, it is suggested that incorporation of nuts into people's usual diet may have beneficial effects for individuals with lower risk such as subjects without DM.     

Factors associated with therapeutic target achievement in the control of complications in consequence of diabetes: A hospital-based study in west of Iran

Background and aimThe goal of diabetes management is to enhance the performance of the surveillance system to perpetuate optimal blood sugar, blood pressure and cholesterol levels in the normal values. This paper aimed to identify factors associated with therapeutic target achievement in the control of complications in consequence of diabetes.MethodsIn this cross-sectional study, a secondary analysis was performed on data obtained in the surveillance center of patients referred to in Makoo city, West Azerbaijan Province. The main interested variables included Fasting Blood Sugar (FBS), HbA1c, triglycerides, cholesterol, Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL) diastolic and systolic blood pressure, duration of diabetes, family history of diabetes, early and late complications of diabetes, treatment received, history of smoking.ResultsAverage age of the patients with diabetes mellitus, insulin-dependent was 35.43 (SD = 17.25) and in patients of diabetes mellitus 53.37 (SD = 10.89), which was significantly different (p-value = 0.001). Frequency amount of fasting blood sugar in diabetes mellitus, insulin-dependent and diabetes mellitus, type II was 64.30% and 66.0%, respectively. Only 19.0% of patients with diabetes mellitus, insulin-dependent and 13.90% of diabetes mellitus, type II breached to the optimum level of blood glucose control.ConclusionsThis study found that a considerable proportion of subjects with diabetes mellitus, insulin-dependent and diabetes mellitus, type II did not achieve the goals of care guidelines of Iran on secondary prevention of complications related to diabetes, especially vascular complication.     

A comparison of body mass index and percent body fat as predictors of cardiovascular risk factors

BackgroundCardiovascular disease (CVD) is an important cause of global mortality and morbidity. Body mass index (BMI) is the measure of adiposity that is used most frequently in CVD risk algorithms.AimsWe aimed to assess the relationship between several CVD risk factors (RFs) and percent body fat (PBF), and to compare the predictive values obtained using PBF for these cardiovascular RFs with the values obtained using BMI. The CVD RFs included, hypertension (HTN), diabetes mellitus (DM) and the presence of dyslipidemia (DLP).Methods and materialsThe data were derived from the MASHAD study, a cohort study of 9704 volunteers, aged 35–65 years and living in the city of Mashhad. Based on BMI and PBF values, subjects were classified into 4 groups; group 1 (low or normal BMI and PBF, N = 1670), group 2 (low or normal BMI but high PBF, N = 992), group 3 (high BMI and low or normal PBF, N = 837), and group 4 (high BMI and PBF, N = 6245). Chi-square, covariance and logistic regression were used to analyze the data at a significance level of 0.05.ResultsThere was an increasing trend from group 1 to group 4 for the mean values of all CVD RFs and their prevalence. There were significant differences in the frequency of a low HDL-C, this was substantially higher in Group 3 (38.6% in Group 3 versus 12.2% in Group 2); the frequency of a high serum TG (24% in Group 3 versus 9.9% in Group 2) and the frequency of dyslipidemia overall (56.2% in Group 3 and 28.8% in Group 2) (P-value<0.001 for all comparisons). The frequency of hypertension (22.9% in Group 3 versus 16.2% in Group 2) and IFG (8.5% in Group 3 versus 5.0% in Group 2) were also substantially higher in Group 3 compared to Group 2 (P-value<0.001 for both comparisons). All the mean values for the RFs were higher in group 3 from group 2 except HDL-C. When Group 1 was used as a reference and calculated OR of any RF for any group 2–4 rather than group 1, OR for all RF in group 3 was higher from group 2.ConclusionThe differences in frequency, means and OR of RFs between Groups 2 and 3 showed a differential impact of a high BMI or high PBF. Compared to PBF, BMI may be a better predictor for several RFs for CVD.     

Nonalcoholic fatty liver disease is associated with breast cancer in nonobese women

BackgroundGrowing evidence supports that nonalcoholic fatty liver disease (NAFLD) is associated with extrahepatic cancers. Nonalcoholic fatty liver disease (NAFLD) and breast cancer share similar risk factors, including obesity.AimThe aim of this case-control study was to investigate the association between NAFLD and breast cancer.MethodsSubjects who received health screening, including mammography and breast and hepatic ultrasonography simultaneously, were included. Subjects diagnosed with breast cancer were matched with controls. Conditional logistic regression analyses were performed.ResultsAmong 270 breast cancer patients and 270 controls, 81 cancer patients (30.0%) and 54 controls (20.0%) had NAFLD (P = 0.008). NAFLD was significantly associated with breast cancer in multivariate analysis (P = 0.046). When the interaction between obesity (BMI < 25 kg/m² vs. ≥25 kg/m²) and NAFLD in breast cancer patients was examined, a significant effect modification between obesity and NAFLD in breast cancer was noted (P = 0.021). The subgroup analysis showed that NAFLD was significantly associated with breast cancer in the nonobese subgroup (odds ratio 3.04, 95% confidence interval 1.37–4.32, P = 0.002) but not in the obese group (P = 0.163).ConclusionsNAFLD was significantly associated with breast cancer independent of traditional risk factors, and this association existed in the nonobese subgroup but not in the obese subgroup.     

The influence of subclinical hypothyroidism on serum lipid profile,PCSK9 levels and CD36 expression on monocytes

BackgroundProprotein convertase subtilisin/kexin type 9 (PCSK9) is a serine protease and a secreted protein which increases cholesterol levels in plasma via inducing degradation of low-density lipoprotein receptor (LDLR). Cluster of differentiation 36 (CD36) is a member of a family of cell surface proteins in many cells. CD36 is known as fatty acid translocase (FAT) because it imports fatty acids inside cells and participate in triglyceride storage. It has been suggested that PCSK9 regulates CD36 in some tissues.MethodsData and serum levels of TSH, FT4, lipid profile and PCSK9 and the expression of CD36 on monocytes from 40 new untreated patients with subclinical hypothyroidism (SH) and 40 age- sex- and BMI-matched euthyroid controls were analyzed in a cross-sectional study. Then the relationships between these parameters were examined.ResultsPatients with SH had higher TSH, FT4, total cholesterol (TC) and triglyceride (TG) Low-density lipoprotein (LDL) and PCSK9 levels than controls. There were significant and positive correlations between serum TSH levels and lipid parameters except HDL-C. PCSK9 had a significant and negative correlation with FT4. No significant correlation could be found in relation to PCSK9 and CD36.ConclusionsPCSK9 inhibitors are used to reduce blood cholesterol levels as drugs. If it will be proven that PCSK9 can induce CD36 degradation, taking these drugs may have unwanted side effects. This study showed that serum PCSK9 and lipid profile levels increase in patients with subclinical hypothyroidism and there is no relationship between PCSK9 and CD36 in these patients.     

Toll-like receptor (TLR9) -1486 T/C (rs187084) gene polymorphism in Egyptian patients with rheumatoid arthritis

Aim of the workThe aim of the study was to assess the role of Toll-like receptor-9 (TLR9) gene polymorphism in rheumatoid arthritis (RA) and to evaluate its association with disease activity and severity in Egyptian patients.Patients and methodsThe study included 100 RA patients and 100 matched controls. Genotyping of TLR9 -1486 T/C (rs187084) gene polymorphism for all participants was performed. Medical Records-Based Index of Severity (RARBIS), modified Health Assessment Questionnaire (mHAQ), disease activity score (DAS28) and clinical and laboratory parameters of disease activity were assesses in RA patients. Anti-cyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor (RF) were also determined.ResultsThe patients mean age was 43.7 ± 8.9 years and were 73 females and 27 males with mean disease duration of 13.3 ± 6.2 years. The mean DAS28 was 3.5 ± 1.1, RARBIS was 6.6 ± 2.8 and the mHAQ 1.4 ± 0.8. The frequency of the TLR9 TT genotype carriers were significantly higher in RA patients than in controls (27% and 9% respectively). Similarly, the T allele was significantly more frequent in RA patients in comparison to the controls (56.5% and 42% respectively). No significant association was found between the TLR9 genotypes with the gender or the age at disease onset. The clinical and laboratory parameters reflecting disease activity showed no association with the TLR9 genotype. No significant association was found between the TRL9 genotyping with the RARBIS or presence of RF or anti-CCP antibodies.ConclusionTLR9 gene polymorphism -1486 T/C is associated with the increased RA susceptibility in Egyptian patients.