golaleh asghari

The prevalence of overweight, obesity and related complications is increasing rapidly in the world. Also, treating this disease in the presence or absence of co-morbidities has become a challenge. In this article, based on the clinical recommendations of the American Endocrinology Association and the American College of Endocrinology, a comprehensive clinical guide has been written for the stages of treating obese patients and its individualization, and it has been tried to be adjusted as much as possible based on the conditions in Iran.

with a specific search strategy, a complete search was performed in PubMed, Scopus, ISI Web of Science, EMBASE and Google Scholar Cochrane databases. Then, the best clinical guidelines suitable for the Iranian society were selected and using the opinions of specialists and clinical experts, a clinical guideline was prepared for the treatment of obesity in Iranian adults.

In this article, in continuation of the previous article, we answered the questions number 4 to 6 regarding the stages of obesity treatment and its individualization in adults of Iranian society, and presented a total of 60 recommendations in this regard.

In this part of the clinical guide for obesity in Iranian adults, we tried to have a special view on the treatment of these patients and by providing evidence-based recommendations and statements, the treatment process was personalized as much as possible for patients with special conditions so that decision-making in this regard is facilitated for the relevant colleagues in this field.

Considering the increasing and alarming trend of overweight and obesity as well as its related complications, in this study, a comprehensive clinical guide for the medical care of patients with obesity was written based on the clinical recommendations of the American Endocrinology Association and the American College of Endocrinology, and it has been adjusted as much as possible based on the conditions in Iran.

A complete search was performed in the available databases without any restrictions with a specific strategy. Using the opinions of experts in this field, the best clinical guidelines were selected and obesity clinical guidelines were written for Iranian adults. Recommendations were given based on a detailed review of available clinical evidence and considering objective factors.

A total of 1788 references were used and in response to 9 clinical questions, 123 recommendations, including 160 special statements, were provided to determine a comprehensive medical care program for obesity. In this article, we discuss the prevention, screening, diagnosis, benefits and goals of obesity treatment. Questions 6 to 9 regarding obesity treatment steps and its individualization will be published in the next part of the article.

The detailed evidence-based questions and recommendations outlined in this study identify clinical considerations that facilitate decision-making in obese patients from screening and diagnosis to goals of treatment.

Peroxisome proliferator-activated receptor gamma (PPARγ) has recently been studied for its potential influence on the functional response of the human body to exercise. We aimed to investigate the association of habitual physical activity (PA) with PPARγ mRNA level in the visceral and subcutaneous adipose tissues (VAT and SAT) in non-obese and obese non-diabetic adults.

VAT and SAT were obtained from 95 individuals, including 40 non-obese (BMI<30kg/m2) and 55 obese (BMI≥30kg/m2) who underwent elective abdominal surgery (Tehran, Iran, 2012-2015). The assessment of habitual PA was performed by a valid and reliable International PA Questionnaire-long form, and the metabolic equivalent of task (MET) was evaluated. Real-time quantitative reverse transcriptase-PCR evaluated the PPARγ expression in VAT and SAT.

PPARγ expression in both VAT (1.18 vs. 0.37 fold change, P<0.001) and SAT (2.07 vs. 0.29 fold change, P=0.004) among obese subjects was higher than the non-obese group. After controlling for age, sex, and total energy intake, a positive association was found between total METs and PPARγ expression in both VAT and SAT among obese participants (β=0.22, P=0.007 and β=0.12, P<0.001, respectively). Among obese participants, there was a direct association between leisure time-related METs with VAT PPARγ expression (β=0.05, P=0.026). Moreover, in this group, an association was observed between occupation-related METs with PPARγ in both fat tissues (β=0.11, P=0.002 and β=0.17, P=0.013, respectively), and household work-related METs with SAT PPARγ (β=0.21, P=0.011).

High PA as an indispensable part of a healthy lifestyle may exert its beneficial effect by regulating PPARγ expression.

Spexin, a novel neuropeptide with diverse physiological functions, can be a cardiovascular disease risk assessment biomarker. This study investigated the association between serum spexin concentration and cardiovascular risk factors in children and adolescents.

A search was conducted to collect studies between January 2007 and March 2021 in the PubMed, Embase, and Scopus databases. The keywords "neuropeptide Q" and "spexin," along with keywords related to diabetes, inflammation, metabolic syndrome, and cardiovascular disease, were used for the search.

A total of 11 full-text articles were included in the study. In six of the studies, the spexin level was lower in obese children and adolescents than in normal-weight individuals, and the difference was significant in four of them (p <0.05). An inverse relationship was observed between spexin and insulin resistance in six of the studies; however, no correlation was found between spexin and glucose in the studies. The results were contradictory regarding inflammation, but the positive correlation of spexin with anti-inflammatory agents showed the anti-inflammatory effects of this neuropeptide. Five of the studies investigated the relationship between spexin and cardiovascular diseases such as hypertension, and three of them showed a positive role for spexin in cardiovascular health. Also, one of the studies examined the effect of spexin on metabolic syndrome and confirmed the protective role of spexin.

It seems that this neuropeptide positively affects metabolic status, especially weight control and insulin resistance, in children and adolescents.

There is controversy over the association between habitual physical activity and incidence of chronic kidney disease (CKD). The aim of this research was to investigate the association between physical activity and incidence of CKD in a population-based cohort study.

In Tehran Lipid and Glucose Study (TLGS) a prospective investigation was performed in 4226 individuals (1872 males and 2354 females) with no known CKD who were followed-up for six years (from phase 3 (2005-2007) to phase 5 (2012-2015). Baseline physical activity was accessed, and the metabolic equivalent of task (MET) hours per week was calculated. Glomerular filtration estimation (eGFR) was done using Modification of Diet in Renal Disease (MDRD) and CKD was determined as eGFR <60 ml/min/1.73 m2. Logistic regression was used to evaluate the association between CKD and MET categories by reporting odds ratio (OR) and 95% confidence intervals (95%CI).

The average MET values in males and females were 913 and 638 min/week, respectively. The incidence of CKD was 10.7% in men and 15.4% in women. After adjusting for potential confounders, men with high physical activity had a 30% (95% CI: 0.51-0.95) lower risk of incident of CKD than those with light physical activity (P=0.012). There was no significant association between levels of physical activity and CKD in women (P=0.059).

In this study, higher physical activity levels were associated with lower risk of CKD among men.

Although high blood pressure is an important risk factor for chronic kidney disease (CKD), it remains unclear whether diet can still influence the risk of CKD in adults with high blood pressure.

This study aimed at investigating the association between major dietary patterns and the incidence of CKD in adults with high blood pressure.

In this cross-sectional study, we recruited 1,521 subjects aged ≥ 27 years with high blood pressure and with preserved estimated glomerular filtration rate at baseline, who participated in the fourth examination survey of the Tehran Lipid and Glucose Study. The principal component analysis was performed to derive dietary patterns. High blood pressure was defined as systolic blood pressure ≥ 120, diastolic blood pressure ≥ 80, or the current use of antihypertensive drugs. Multiple logistic regression analysis was applied to investigate the association between the dietary pattern scores and CKD risk.

After 3.6 years of follow-up, the incidence of CKD was 16.8%. Three dietary patterns were produced by using factor analysis, including the Western, the healthy, and the traditional Iranian dietary patterns. The healthy and the traditional Iranian dietary patterns were not related to the risk of CKD, but scoring on the Western dietary pattern was associated with enhanced odds of CKD, after being adjusted for relevant confounders (odds ratio: 2.12; 95% confidence interval: 1.19 - 3.76).

Results of this study provided evidence that a high score on the Western dietary pattern was associated with an increased risk of CKD in adults with high blood pressure.

Adipose tissue affects body hemostasis by secreting a variety of proteins named adipokines. Plasma levels of apelin decreases after exercise; however, the evidence on gene regulation in adipocytes is rare. The aim of this study was to investigate the association of daily physical activity and applein gene expression and its serum levels in visceral and subcutaneous adipose tissues in non-obese and morbid obese subjects.

In this cross-sectional study, samples of visceral and subcutaneous adipose tissues were collected from patients (64) undergoing abdominal surgery. Data on physical activity was gathered using a valid and reliable International Physical Activity Questionnaire (IPAQ) and the metabolic equivalent (MET) was calculated. Apelin expression in fats was evaluated using the qRT-Real Time PCR method.

Mean age for non-obese and morbid obese groups was 45.6 and 39.6 years, and total physical activity was 1093 and 894 (MET), respectively. The expression of apelin was significantly higher in subcutaneous fat in morbid obese subjects, compared to non-obese adults (P=0.038). After controling age, waist circumference and insulin levels, total MET was significantly associated with subcutaneous adipose tissue (β=0.519 and β=0.395) in both, the non-obese and obese groups. Among obese individuals, occupational-related activity was associated with apelin expression in subcutaneous adipose tissue (β=0.391).

The association of physical activity and adipose tissue gene expression in non-obese and obese individuals indicates the positive effects of active lifestyles on adipokines secreted from adipose tissues.

Snack consumption is associated with cardiovascular disease (CVD) risk factors in children and adolescents. The aim of this study is to investigate the association of snack consumption and carotid intima media thickness (CIMT) among overweight and obesity children and adolescents.

In this cross sectional study, a total of 339 participants, aged 6 to 13 years with the body mass index Z score ≥1 enrolled in this study. Data on anthropometric measurements, pubertal status, and CIMT were documented. Food intakes of participants were measured by a valid and reliable food frequency questionnaire (FFQ). Linear and logistic regression were estimated. 

Mean age of study participants was 9.3 years and with 68.4% of obesity. After controlling for confounders, including age, sex, energy intake, puberty status, physical activity, and body mass index, one SD increase in intake of nuts decreased the CIMT, by 0.126 mm (P value=0.019). Moreover, participants in the last tertile of nuts intake had 63% lower risk of high CIMT in comparison with those who consumed less than 1.74 serving/wk of nuts (P for trend=0.006). When nuts intake was replaced by the sweet unhealthy snacks the CIMT decreased by 0.15 mm.

Our findings emphasize the positive impact of nuts consumption as a healthy snack on subclinical stages atherosclerosis. Clinical trial studies could examine the effect of different kinds of nuts consumption on CIMT and complications of CVD risk factors.

Omentin, an adipokine, with anti-inflammatory effects reduces insulin resistance, and can hence, play an important role in prevention of cardiovascular disease and diabetes. The present study aimed to investigate the association of plasma and dietary fatty acids with gene expression of omentin in visceral and subcutaneous adipose tissues.

Visceral and subcutaneous adipose tissues and fasting blood samples were obtained from 50 obese and 47 non-obese participants, who had undergone elective abdominal surgery. Dietary intakes were assessed using a food frequency questionnaire. Relative gene expression of omentin in visceral and subcutaneous adipose tissues was measured by Real-Time PCR and plasma fatty acids were measured using gas chromatography.

Omentin gene expression in visceral adipose tissue was higher in non-obese participants, compared to obese ones; however, no difference was found in subcutaneous adipose tissue. A significant direct association was observed between omentin gene expression in visceral adipose tissue with dietary monounsaturated fatty acid (MUFA) (P=0.011, β=0.394) in obese subjects and the plasma omega 6: omega 3 ratio (P=0.029, β=0.385) in non-obese subjects after adjustment for confounders. No association was observed between omentin gene expression in subcutaneous adipose tissue and plasma and dietary fatty acids.

Dietary intakes of MUFA in obese participants and plasma omega 6: omega 3 ratio in non-obese ones were directly associated with omentin gene expression in visceral adipose tissue. Therefore, higher omentin gene expression by increasing dietary MUFA may be related to improvement of obesity and its associated comorbidities.

Considering that herbal medicines are commonly used for treatment or management of type 2 diabetes, the aim of this study was to determine the knowledge, attitude, and practice (KAP) of patients with diabetes regarding herbal products. A cross-sectional study was conducted on 421 patients with diabetes who referred to the Iran Diabetes Association in Tehran, Iran in 2014. The KAP of participants on herbal products were determined by a pre-designed questionnaire containing close ended questions. The participnats' age Mean ± SD was 38.0 ± 20.6 years. Of 421 participants, 163 used some type of herbal products during the past year for controlling diabetes. Of these patients, 40 to 60% did not have knowledge about the possibility and desirability of using herbs along with or instead of the anti-diabetic chemical drugs. However, 71% of patients believed that they could not use herbal products without physician's prescription. Participants had a negative attitude towards using herbal products instead of conventional drugs, especially without the physician's prescription (40–60% of patients). Among users of herbal products, 53.0% believed that these products caused no side effects. One-third of patients used herbal products at least once a month for controlling or treating their disease. Most participnats (64.4%) informed their physiciens about consumingherbal drugs and 15.8% had self-prescribed use of these herbal products. Our findings indicated that nearly a third of patients with diabetes used herbal remedies and most of them considered these products safe. However, more than half of the patients informed their physician about using herbal medicines.

Zinc, an essential trace element, plays a key role in many biological human body functions. Se-rum zinc concentration is the most widely used indicator of zinc status for general populations. Considering the limited data available on seasonal fluctuation of serum zinc concentration, we aimed at determining seasonal variations in serum zinc concentrations of Tehranian adults. The current study was conducted within the framework of the Tehran Lipid and Glucose Study, on 4698 subjects, aged ≥20 years. Serum zinc samples of subjects were obtained from all four seasons over three years (from 2009 to 2011); samples of similar seasons over three years were placed in one group and the geo-metric means of serum zinc concentration of four seasons were compared to determine possible seasonal varia-tions. Participants with mean age 46.3 yr and geometric mean of serum zinc concentration 116.3 μg/dl, were studied for almost three years through four seasons. Serum zinc concentrations in spring and summer were significantly higher than those in autumn and winter (112.2 and 114.4 vs. 106.7 and 104.8 μg/dl; P<0.001, re-spectively). Moreover, monthly serum zinc concentration of all subjects differed, with the lowest and highest levels found in October and August (98.5 vs. 122.7; P<0.001). This study demonstrates the difference in serum zinc concentration in Iranian adults of both gen-ders in different months and seasons during the year.

Dietary amino acids have been associated with blood pressure (BP) in previous studies; we conducted this study to examine the association between dietary branched chain amino acids (BCAAs) and the incidence of hypertension among participants of the Tehran Lipid and Glucose Study (TLGS). Analyses were conducted on 4,288 participants aged 20–70 years, who were free of hypertension at baseline (2008– 2011) and were followed for 3 years (2011–2014) to ascertain incident hypertension. Dietary intakes of BCAAs including, valine, leucine, and isoleucine were collected at baseline using the food frequency questionnaire (FFQ). Odds ratio (OR) of hypertension were determined by logistic regression across quartiles of BCAAs, adjusted for sex, age, smoking status, physical activity, body mass index (BMI), diabetes, and some dietary factors. The mean ± standard deviation for age and BMI of participants (41.9% men) were 39.7 ± 12.8 years and 26.9 ± 4.6 kg/ m2 , respectively. The median intakes of total BCAAs, valine, leucine, and isoleucine was 17.9, 5.5, 7.8, and 4.5 percentage of total amino acids intake, respectively. We documented 429 (10%) hypertension incident cases. The multivariable adjusted OR for the highest vs lowest quartiles of BCAAs was 1.54 (95% confidence interval (CI):1.03–2.32; P for trend = 0.05); furthermore, the OR (95% CI) of hypertension for the highest vs the lowest quartile of valine was 1.61 (1.10–2.36; P for trend = 0.009) in the fully adjusted model. However, we found no significant association between leucine and isoleucine with incidence of hypertension. Findings indicated that higher BCAA intake, in particular valine, is associated with higher risk of incident hypertension.

Context: In recent decades, investigations have been focused on the definition, incidence and predictors of metabolic syndrome (MetS) in Iranians. This study aimed to review systematically investigations on MetS, conducted among the Tehran lipid and glucose study (TLGS) participants. Evidence Acquisition: Literature on MetS documented by TLGS studies published from 2000 to 2017 were searched using Pubmed and Scopus database in English language with a combination of following keywords: Metabolic syndrome, TLGS. The harmonized definition of MetS was confirmed, based on the estimated cut point of waist circumference (WC) ≥ 95 cm for both genders in Iran. The incidence rate was 550.9/10000 person/years, lower among women (433.5/10000) than men (749.2/10000). The prevalence of abdominal obesity, high triglycerides (TG), low high density lipoprotein cholesterol (HDL-C), high blood pressure (BP), and high fasting blood glucose (FBG) was 30, 46, 69, 34, and 12%, respectively. The prevalence of MetS in adolescents was 10.1% with no significant difference between boys and girls (10.3% in boys and 9.9% in girls). A strong association of WC (OR: 2.32, CI: 2.06 - 2.59) and TGs (OR: 1.95, CI: 1.65 - 2.11) with development of MetS was found. In adolescent boys, WC had the highest OR for MetS risk. WHO-defined MetS was a significant predictor of total and cardiovascular mortality both in men (HR: 1.66, CI: 1.23 - 2.24; HR:1.93, CI: 1.26 - 2.94) and women (HR: 2.01, CI: 1.39 - 2.88; HR:2.71, CI: 1.44 - 5.09). Our results indicate high incidence of MetS in Tehranian adults and adolescents; high WC also appears to be a strong predictor of MetS. All definitions of MetS predicted cardiovascular disease.

Context: Genetic and environmental factors contribute to the incidence of metabolic syndrome (MetS). This study aimed to review all findings of studies conducted in framework of the Tehran lipid and glucose study (TLGS) regarding the association of dietary factors with cardio-metabolic risk factors. Evidence Acquisition: All English-language studies were searched using PubMed and Scopus databases from 2000 to 2017. Finally, 105 relevant papers were included in this review. Whole grains, legumes, nuts and healthy dietary patterns (DPs) reduced risk of MetS, while white rice, salty/sweet snacks increased this. The western DP had a significant interaction with APOC3, APOA1 and MC4R polymorphisms in relation to MetS. After 6.5 years of follow-up, odds of reaching menarche ≤ 12 years was significantly higher in girls with higher intakes of milk, calcium, magnesium, and phosphorous. Among children and adolescents, higher adherence to the dietary approaches to stop hypertension (DASH)-style diet decreased the risk of abdominal obesity, whereas increased adherence to the western DP could contribute to general and abdominal obesity. A three-year follow-up of adult participants showed that higher intakes of phytochemical-rich foods were inversely related to development of insulin resistance. Higher adherence to the healthy DPs was associated with the reduced risk of hyperlipidemia and hypertention. Nutrition interventions postponed rise in the prevalence of MetS. The DASH diet resulted in weight reduction compared to control diet. Higher adherence to healthy food choices was associated with reduced odds of MetS, abdominal obesity, dyslipidemia and hypertension. The western DP accentuated the association of polymorphisms with MetS.

Context: The high prevalence of chronic diseases can be prevented or managed by specific changes in lifestyle patterns of individuals of which dietary factors is emphasized. The objective of this study was to review all findings of the Tehran Lipid and Glucose Study regarding validity and reliability of food frequency questionnaire (FFQ), evaluating dietary quality and association of dietary factors in relation to diabetes, dysglycemia, cardiovascular (CVD) and chronic kidney disease (CKD). Evidence Acquisition: Related documents were searched through PubMed and Scopus databases, in English language from 2000 to 2017. Finally, 52 relevant documents were eligible for inclusion in this review. The FFQ proved to be an acceptable tool for assessing nutrient and food group intakes and rank individuals accurately according to the levels of their dietary intakes. After 8 years of follow-up, the western dietary pattern (DP) was fairly stable but there was instability of traditional Iranian DP. DPs of over two-thirds of Tehranian populations were not in accordance with the dietary recommendations. Higher dietary scores of variety and healthy DPs were also associated with reduced odds of dysglycemia. The main dietary factor related to increased risk of CVD in our population was western DP. Patterns of amino acid intakes may contribute to the development of CVD. Higher intakes of several micronutrients and macronutrients, DPs and some vegetables decrease the risk of CKD. In conclusion DPs of most Tehranian adults need improvement. This review showed that higher adherence to healthy food choices was associated with reduced odds of dysglycemia and CVD. Dietary sources of renal-protective nutrients should be encouraged among the general population.

Hypertension is one of the main risk factors of cardiovascular diseases, and recent studies have been investigating the association of dietary amino acids with blood pressure. This study aimed to determine the association of dietary glycine with blood pressure.
For the present study, conducted on 2612 participants, aged 35-70 years, who had participated in the fourth phase of the Tehran Lipid and Glucose Study (2008-2011) were followed up to the fifth phase (2011-2014). At baseline, participants, who were free of hypertension, cardiovascular diseases, and cancer and had complete documented anthropometric, clinical and dietary data entered the study. Dietary glycine information was collected, using a valid and reliable food frequency questionnaire. Incidence of hypertesion was ascertained after three years of follow up, using logistic regression to assess the associations between incidence of hypertension and tertiles of glycine intake, adjusted for potential confounders.
The mean±SD age of participants (42.1% men) was 47.1±8.3 years. During 3 years of follow-up, 365 cases (14%) of hypertension developed. The OR of the highest tertile of glycine intake was 0.69 (95% CI: 0.49-0.96; P for trend: 0.04), compared to the lowest, after adjusting for potential confounders.
Our results indicate an inverse association between higher glycine intake and incidence of hypertension.

Diet quality indices are unique approach to studying relations between diet and disease. Our objective was to investigate the relationship between healthy eating index (HEI) and risk of multiple sclerosis (MS).
We recruited 68 subjects with MS and 140 control subjects in a case-control study. Dietary intake was collected using a valid and reliable food frequency questionnaire. The HEI was calculated. Logistic regression was used to evaluate the relationship between HEI score and MS, after adjustment for season of the birth, daily amount of imposed stress, total energy intake, and age.
in comparison to controls, Cases had lower scores of total HEI (68.4vs 72.5 ; P = 0.04), vegetable (7.5vs 8.8; P = 0.006), fruit (6.3vs 8.0; P = 0.02), and Food variety (8.0vs 10; P = 0.008).when comparing the highest and the lowest quintiles of HEI ,We observed a significant decreasing trend in the risk of MS (p- for trend=0.04 ). Although insignificant (p- value>0.05), MS risk was reduced when comparing each quintile to the reference quintile (OR = 0.95, 95% CI: 0.37–2.38), (OR = 0.62, 95% CI: 0.24–1.62), (OR = 0.36, 95% CI: 0.12–1.14). ), (OR = 0.38, 95% CI: 0.13–1.19), respectively.
Our study suggests that a high quality diet assessed by HEI may decrease the risk of MS.

Our aim was to evaluate the association between dietary serine intakes and hypertension incident.
We used the data of 4287 subjects aged 20-70 years, who participated in the fourth phase of Tehran Lipid and Glucose Study (2008-2011) and were followed up to the fifth phase (2011-2014). At baseline, the participants were free of hypertension, cardiovascular diseases, and cancer. Serine dietary data were collected through a valid and reliable food frequency questionnaire. Incidence of hypertension was identified after three years of follow up. To investigate the association of serine intake and incidence of hypertension, multivariable adjusted models of logistic regression were used, and odds ratios (ORs) across quartiles of serine were reported.
After three years of follow up, 429 (10%) incident cases of hypertension were ascertained. The OR of the highest quartile of serine intake was 1.43 (95% CI: 1.05-1.95; P for trend: 0.03) compared to the lowest adjusted for age and sex. After further adjustment for body mass index (BMI), diabetes status, physical activity, smoking status, and dietary intake of energy, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, calcium, magnesium, sodium, potassium and fiber, the OR of the highest vs. the lowest quartile of serine intake was 1.70 (95% CI: 1.18-2.44; P for trend=0.005).
These findings suggest that dietary serine intake may be directly associated with the risk of hypertension incident.

Few studies have investigated the relationship between vitamin D deficiency and diabetic neuropathy. Present study aimed to investigate the effect of vitamin D in the treatment of diabetic peripheral neuropathy.
In this semi-experimental trial, 30 diabetic subjects aged over 35 years with peripheral neuropathy with serum levels of vitamin D less than 30ng/ml, were sequentially selected. The NSS questionnaire (Neuropathy Symptom Score) used to determine the severity of the symptoms of diabetic neuropathy (subjective data) and NDS questionnaire (Neuropathy Disability Score) used for symptoms of neuropathy (objective information). Participants were treated by 50,000 IU/week of oral vitamin D for 10 weeks.
30 patients with mean age of 60.1 years, including 10 (33%) men, were studied. 83.3% had serum vitamin D deficiency (under 20ng/mL) and 16.7% had serum vitamin D insufficiency (20-30ng/mL). Mean (± standard deviation) serum vitamin D levels was 14.37±5.86 ng/mL. Seventy percent of participants showed a significant decrease in NSS scores (p=0.02), as well as declining in mean of their scores (p Prescription of vitamin D for 3 months improved the symptoms of diabetic neuropathy in diabetic patients regarding NSS; however, NDS showed no changes in the examinations of participants.

Considering the incrediblly high incidence of obesity in adolescents, in this study, we have examined the association of DASH diet with 3-year body mass index change and risk of obesity in Tehranian adolescents.
This population based cohort study included 629 adolescents (aged 10 to 18 years) from the Tehran Lipid and Glucose Study (TLGS). Dietary data were collected using a valid and reliable food-frequency questionnaire. Anthropometric measures were assessed both at baseline and end of follow up. In adolescents, obesity was defined as body mass index ≥ 95th percentile for age and sex according to national reference curves.
Mean±SD for age and DASH score at baseline were 14.1±2.5 years and 24.1±4.2, respectively. Also, the mean±SD of body mass index gain and risk of incident obesity was 1.7±2.6 kg/m2 and 12% after 3 years follow up, respectively. After adjustment for potential confounding variables, higher DASH diet score and lower dietary intakes of sweet beverage were inversely associated with 3-year changes in body mass index (P A DASH- style dietary pattern is associated inversely with 3-year body mass index changes and risk of incident obesity in adolescents.

To investigate the association between major dietary patterns and the incidence of chronic kidney disease (CKD) over a 3.6 year follow up in adults with high blood pressure.
This cohort study was conducted on 1521 prehypertensive and hypertensive subjects, aged ≥ 27 years, without CKD at baseline, who participated in the fourth phase (2009-2012) of the Tehran Lipid and Glucose Study. Dietary data were collected using a valid food frequency questionnaire. Principal component analysis was performed to derive dietary patterns. Anthropometrics and biochemical measurements were obtained. CKD was defined as estimated glomerular filtration rate (eGFR) The mean age of participants was 46.32±11.59 years. After 3.6 years of follow-up, 255 (16.8%) cases of CKD occurred. Three dietary patterns were identified, the western, healthy and the traditional Iranian patterns. After adjustment for relevant confounders, subjects in the highest, compared to the lowest quartile category of the Western dietary pattern score, had a higher risk of CKD (OR: 2.12; 95% CI: 1.19-3.76). Neither the healthy nor the traditional dietary patterns were significantly associated with incidence of CKD.
Adherence to the Western dietary pattern is associated with increased risk of CKD in adults with high blood pressure.

Introduction. The objective was to examine whether dietary acid load was associated with chronic kidney disease (CKD) in adults.
Materials and Methods. The cross-sectional analyses included 4564 participants, aged 20 years and older, who participated in the 4th phase of the Tehran Lipid and Glucose Study and had complete dietary and serum creatinine data. Dietary data were obtained from using a 147-item food-frequency questionnaire. Dietary acid load was calculated as the potential renal acid load (PRAL). Anthropometrics, blood pressure, and fasting plasma glucose, and lipids were measured. Chronic kidney disease was defined as an estimated glomerular filtration rate (GFR) less than 60 mL/min/1.73 m2 calculated using the Modification of Diet in Renal Disease equation. Risk of CKD was obtained in quartiles of PRAL with logistic recreation.
Results. The mean dietary PRAL of the participants was -22.0 mEq/d. After adjustment for age, sex, and body mass index, the odds ratio for CKD in the highest compared to the lowest quartile of PRAL was 1.38 (95% confidence interval [CI], 1.02 to 1.83). After additional adjustment for energy intake and smoking, the odds ratio for CKD in the 4th quartile of PRAL compared to the 1st was 1.42 (95% CI, 1.06 to 1.91). In the final model, after additional adjustment for dietary intake of total fat, carbohydrate, dietary fiber, fructose, sodium, diabetes mellitus, and hypertension, the risk of CKD in the highest dietary PRAL category, compared to the lowest, increased by 42%.
Conclusions. After adjusting for possible confounding factors, we found that higher PRAL (more acidic diet) was associated with higher prevalent CKD in Iranian adults.

This study was undertaken to determine the relationship between food security and individual dietary diversity score (IDDS). This population-based cross-sectional study was conducted on 200 non-diabetic individuals aged ≥40 years, selected randomly from the Tehran Lipid and Glucose Study. Household food security was measured using a validated United States Department of Agriculture (USDA) 18-item questionnaire and IDDS using a valid and reliable 147-item food frequency questionnaire based on five food groups of the Food Guide Pyramid. Overall, 48.5% of the study subjects had high, 36.0% had borderline, and 15.5% had low food security. Significant inverse correlations were observed between the scores for food security, diversity of fruits and vegetables, and total IDDS. Food secure group had significantly higher total IDDS (4.74 ± 1.40 vs. 5.15 ± 1.28, P = 0.033) and score for diversity of fruits (1.48 ± 1.40 vs. 1.68 ± 1.28, P = 0.030) as compared to the food insecure group. After adjusting for covariates, higher food security score was associated with lower total IDDS (regression coefficient for a 1-unit difference in diversity score = -0.130, P = 0.040), and score for diversity of fruits (regression coefficient for a 1-unit difference in diversity score = -0.182, P = 0.010). The results showed an inverse relationship between food security score and dietary diversity score. Intake of different fruits is associated with higher food security.

Multiple Sclerosis (MS) is the most prevalent autoimmune disease of the central nervous system, and it has been suggested that nutrition might play a role in the etiology of MS. This study was aimed to evaluate the relationship between MS risk and intake of some macro- and micro-nutrients in Tehran (Iran). In this hospital based, case-control study, a total of 60 newly diagnosed patients with MS and 140 controls underwent face-to-face interviews. Information regarding the usual dietary intake of each individual in the past year was collected by using a valid and reliable 168-item semi-quantitative food frequency questionnaire. Multivariate logistic regression was used to estimate the odds ratios and 95% confidence intervals. Inverse significant associations were observed (P< 0.05) between the intake of protein (OR=0.19; 95% CI: 0.04-0.76) and micro-nutrients such as vitamin B1 (OR=0.10; 95% CI: 0.02-0.53), vitamin B2 (OR=0.15; 95% CI: 0.04-0.50), cobalamin (OR=0.13; 95% CI: 0.04-0.38), vitamin C (OR=0.20; 95% CI: 0.07-0.58), vitamin A (OR=0.23; 95% CI: 0.09-0.59), vitamin D (OR=0.28; 95% CI: 0.11-0.72), vitamin E (OR=0.15; 95% CI: 0.05-0.41), β-carotene (OR=0.38; 95% CI: 0.15-0.97), zinc (OR=0.05; 95% CI: 0.01-0.27), magnesium (OR=0.12; 95% CI: 0.03-0.47) and calcium (OR=0.23; 95% CI: 0.08-0.67) and the risk of MS. The results suggest that intake of some macro- and micro-nutrients might be associated with reduced risk of MS. It seems promising that intake of nutrients at least in the dietary reference levels may decrease the risk of MS.

Regarding to the impact of childhood and adolescence obesity on incidence of most of chronic adulthood diseases, determination of the predictors of obesity can play an important role in human health. Therefore, the objective of the present study was to compare body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR) and skinfolds as predictors of percentage body fat (PBF) and diagnosis of excess adiposity in Iranian adolescents. In this cross-sectional study, all anthropometric measurements and PBF using the bioelectrical impedance analysis of 133 adolescents (65 boys and 68 girls), aged 10-18 years, were taken. Linear regression and receiver operating characteristic (ROC) analysis were used to analyze the data, adjusting for potential covariates including sex, age, and pubertal stage. BMI explained 67% of between-subject variance in PBF and R2adj of models revealed that prediction of PBF by BMI was better than other indices (P< 0.001). The AUC value for BMI to differentiate between the excess adiposity and normal PBF was 0.92 (P< 0.001), which was significantly higher than those for WC, WHR, and WHtR (P< 0.05). The performance of BMI is better than other anthropometric indices in predicting PBF and diagnosing excess adiposity in Iranian adolescents.