Association of Perceived Stress and Physical Activity Level with Severity of Coronary Artery Disease in Gaza Strip, Palestine: A Cross-Sectional Study

Mohamed Kuhail,Kurosh Djafarian,Sakineh Shab-Bidar,Khalid Jamal Khadoura 대한가정의학회 2022 Korean Journal of Family Medicine Vol.43 No.4

Background: The association between life-event stressors and low physical activity linked to the severity of coro-nary artery disease (CAD) is poorly understood. Therefore, this study aimed to determine the perceived stress sta-tus and physical activity level associated with the severity of CAD.Methods: The study was conducted among 423 patients with newly discovered CAD (both sexes, aged 35–65 years) confirmed by coronary angiography results. CAD severity was classified according to the Gensini score as severe or non-severe. The fasting blood glucose and lipid profiles were also investigated. Anthropometric and brachial blood pressure measurements were obtained. A structured questionnaire including participants’ characteristics, the Per-ceived Stress Scale (PSS-14), and the International Physical Activity Questionnaire were used via face-to-face inter-views. Multivariable binary logistic regression was used to assess the predictors of CAD severity using IBM SPSS ver. 24.0 (IBM Corp., Armonk, NY, USA).Results: Most participants were classified as having severe CAD (63.8%). Adjusting for age, sex, smoking status, sys-tolic blood pressure, body mass index, and history of hypertension, the severity of CAD increased by 9% for a one-score increase in the PSS (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.01–1.14; P=0.030). Moreover, suffi-ciently active (600–1,500 metabolic equivalents [METs]/wk) patients had lower odds of severe CAD (OR, 0.43; 95% CI, 0.23–0.72; P=0.027) than those with insufficient activity. However, no significant association was found between physical activity (≥1,500 METs/wk) and CAD severity.Conclusion: The odds of CAD severity significantly increased with increasing perceived stress score but decreased with sufficient physical activity.

Breakfast-Based Dietary Patterns and Obesity in Tehranian Adults

Zahra Akbarzade,Saba Mohammadpour,Kurosh Djafarian,Cain C. T. Clark,Parivash Ghorbaninejad,Maryam Mohtashami,Sakineh Shab-Bidar 대한비만학회 2020 The Korean journal of obesity Vol.29 No.3

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; P=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; P=0.03). Conclusion: Overall, our results suggest that specific breakfast dietary patterns are associated with increased odds of central obesity in Iranian adults.

The Effects of Nigella sativa Supplementation on Liver Enzymes Levels: a Systematic Review and Meta-analysis of Randomized Controlled Trials

( Neda Azizi ),( Mohammad Reza Amini ),( Kurosh Djafarian ),( Sakineh Shab-bidar ) 한국임상영양학회 2021 Clinical Nutrition Research Vol.10 No.1

The present systematic review and meta-analysis aimed to investigate the effects of Nigella sativa (N. sativa) supplementation on liver enzymes levels including aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Relevant studies, published from inception up to January 2020, were searched through PubMed, Scopus and Google Scholar conducted on randomized controlled trials (RCTs) investigating the effect of N. sativa on serum AST and ALT levels. Meta-analysis was applied using a random-effects model. Eight studies met inclusion criteria (n=281 in the N. sativa and n = 279 in placebo group). This meta-analysis showed that N. sativa supplementation significantly reduced AST level (weighted mean difference [WMD], -8.11 IU/L; 95% confidence interval [CI], -13.6, -2.53; p = 0.004) with significant heterogeneity (I-squared, 95.9%; p < 0.001) while the decrease in ALT level was not statistically significant (WMD, -7.26 IU/L; 95% CI, -15.4, 0.04; p = 0.051) with significant heterogeneity (I-squared, 97.8%; p < 0.001). This meta-analysis suggests that N. sativa supplementation may improve AST levels and ALT levels, however more RCTs with larger sample size are needed to found effects of N. sativa on liver enzymes in patients with non-alcoholic fatty liver disease.

The Association between Dietary Antioxidant Quality Score and Cardiorespiratory Fitness in Iranian Adults: a Cross-Sectional Study

( Hossein Shahinfar ),( Mahshid Shahavandi ),( Aliyu Tijani Jibril ),( Kurosh Djafarian ),( Cain C. T. Clark ),( Sakineh Shab-bidar ) 한국임상영양학회 2020 Clinical Nutrition Research Vol.9 No.3

The association between dietary antioxidant quality score (DAQS) and cardiovascular risk factors such as low cardiovascular fitness (CRF) and elevated blood pressure (BP) has rarely been investigated. To investigate the association between DAQS, CRF, and BP. This cross-sectional study was conducted on 270 adult subjects living in Tehran, Iran. Dietary intake was evaluated using a validated food frequency questionnaire. The DAQS was calculated using antioxidant-nutrient intake. Socio-economic status, anthropometric measures, and BP were recorded by a trained interviewer, using standard methods. A significant increase was found in maximal oxygen uptake (p value = 0.01) across tertiles of DAQS. After adjusting for confounders, the association remained unchanged (p value = 0.02). Participants in the highest tertile of DAQS had higher systolic BP (SBP) (p value = 0.01) and diastolic BP (DBP) (p value = 0.03), although adjustment for confounding factors attenuated the results (p value = 0.3 for DBP and p value = 0.6 for SBP). Our results revealed that higher DAQS is associated with better CRF in Iranian adults. Further studies are needed to establish the veracity of our results.

Vitamin D and The Gut Microbiota: a Narrative Literature Review

( Hadith Tangestani ),( Hossein Khosravi Boroujeni ),( Kurosh Djafarian ),( Hadi Emamat ),( Sakineh Shab-bidar ) 한국임상영양학회 2021 Clinical Nutrition Research Vol.10 No.3

Recently several studies have attempted to investigate the association between vitamin D and microbiota. However, studies have reported inconsistent results. This narrative review aimed to investigate the potential association between vitamin D and microbiota population in the gut by pooling together the results from observational studies and clinical trials. We considered animal and human studies in this field. Several studies have shown the correlation of vitamin D deficiency with microbiota. Furthermore, interventional studies were emerging that vitamin D change the microbiota composition in which leads to an increase in beneficial bacteria, such as Ruminococcaceae, Akkermansia, Faecalibacterium, and Coprococcus while decreases in Firmicutes. Vitamin D could change the microbiota toward decreasing in Firmicutes and increasing in Bacteroidetes. At genera level, vitamin D may connect to some genera of Lachnospiaceae family (e.g., Blautia, Rosburia, Dorea, and Coprococcus). It seems that adequate level of vitamin D is an important factor in improving the composition of the gut microbiota. More studies are needed to confirm possible underling mechanisms.

The Association of Dietary Phytochemical Index with Metabolic Syndrome in Adults

( Fatemeh Dehghani Firouzabadi ),( Ahmad Jayedi ),( Elaheh Asgari ),( Mena Farazi ),( Zahra Noruzi ),( Kurosh Djafarian ),( Sakineh Shab-bidar ) 한국임상영양학회 2021 Clinical Nutrition Research Vol.10 No.2

In this study, we assessed the association between the dietary phytochemical index (DPI) and metabolic syndrome (MetS) among adults in a cross-sectional study. We enrolled 850 adult men and women aged 18-65 years who had been referred to health centers in Tehran, Iran. The DPI was calculated based on 8 components including fruits, vegetables, legumes, whole grains, soy products, nuts, seeds, olive, and olive oil. The odds ratio (OR) and 95% confidence interval (CI) of the MetS across quartiles of the DPI were calculated using the logistic regression analysis, adjusting for age, energy intake, marital status, education status, occupation, smoking status, physical activity, and body mass index. The mean age of participants was 44.7 ± 10.7, of whom 69% were women. The prevalence of MetS was 30.5%. The mean score of DPI in women and men was 36.2 ± 26.8 and 33.7 ± 24.7, respectively. There was no significant association between DPI and odds of MetS in men (OR_{fourth vs. first quartile}, 1.57; 95% CI, 0.64-3.84) and women (OR_{fourth vs. first quartile}, 0.86; 95% CI, 0.50-1.49) in the fully adjusted model. There was an inverse association between DPI and increased risk of central obesity in women (OR_{fourth vs. first quartile}, 0.54; 95% CI, 0.29-1.00; p trend = 0.03). There was no significant association between DPI and other components of the MetS in men and women. Finally, we observed no significant association between the DPI and the odds of MetS. However, the finding suggests that having a phytochemical-rich diet can be inversely associated with abdominal obesity.

Association of Vitamin D status with Visceral Adiposity Index and Lipid Accumulation Product Index among a Group of Iranian People

( Elham Bazshahi ),( Sanaz Pourreza ),( Mahtab Ghanbari ),( Zeinab Khademi ),( Mohammad Reza Amini ),( Kurosh Djafarian ),( Sakineh Shab-bidar ) 한국임상영양학회 2021 Clinical Nutrition Research Vol.10 No.2

There is a growing body of evidence linking vitamin D and its antiadipogenic activity with body composition. The aim of this study was to investigate the association between vitamin D levels, visceral adiposity index (VAI), and lipid accumulation product index among a group of Iranian people. This cross-sectional study was conducted with 270 Iranian adults. Body composition was measured via bio-impedance analysis. The 25-hydroxyvitamin D [25(OH)D] was also measured using the enzyme-linked immunosorbent assay method. The VAI and lipid accumulation product index were calculated. Multiple linear and logistic regression after controlling for confounder was used to report the results. Multiple linear regression showed that serum 25(OH)D levels were positively correlated with age (crude: β ± standard error [SE] = 0.23 ± 0.06, p ≤ 0.001; model I: β ± SE = 0.18 ± 0.05, p = 0.002) and percent body fat (crude: β ± SE = 0.10 ± 0.04, p = 0.02). Binary logistic regression analysis showed a higher chance of greater percent body fat and lipid accumulation product index in the crude model (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.13-3.72 for percent body fat and OR, 2.07; 95% CI, 1.14-3.76 for lipid accumulation product index), which disappeared after adjusting for covariates. Adults with higher vitamin D levels had higher scores of percent body fat and lipid accumulation product index. More longitudinal studies are needed to confirm these results.

Association of Dietary Patterns with Visceral Adiposity, Lipid Accumulation Product, and Triglyceride-Glucose Index in Iranian Adults

( Mohammad Reza Amini ),( Hossein Shahinfar ),( Nadia Babaei ),( Samira Davarzani ),( Mojdeh Ebaditabar ),( Kurosh Djafarian ),( Cain C. T. Clark ),( Sakineh Shab-bidar ) 한국임상영양학회 2020 Clinical Nutrition Research Vol.9 No.2

In the present study, we sought to examine the association between dietary patterns (DPs) and visceral adiposity, lipid accumulation product (LAP), and triglyceride-glucose index. This cross-sectional study was conducted on adults aged between 18-45 years old who lived in Tehran, Iran, between February 2017 and December 2018 (n = 270). DPs were derived using principal component analysis. We used analysis of variance to examine differences in continues variables across tertiles of major DPs. Subsequently, for the modeling of these relationships, and also considering the possible effect of the confounding factors, multivariate regression was used. Three DPs were identified: healthy pattern, mixed pattern, and western pattern, respectively. Compared with individuals in the lowest category of mixed pattern, those in the highest category had lower fasting blood sugar (96.26 ± 11.57 vs. 101 ± 28.66, p = 0.01). A significant association was found between healthy pattern, after adjustment for potential confounders, and odds of LAP; such that individuals in the top category of healthy pattern score were 71% less likely to have a high LAP compared with those in the lowest category (odds ratio, 0.29; 95% confidence interval, 0.10-0.81). We found that adherence to a healthy DP was associated with decreased LAP. To confirm the veracity of these findings, more studies should be conducted.

Effects of a Psychobiotic Supplement on Serum Brain-derived Neurotrophic Factor Levels in Depressive Patients: A Post Hoc Analysis of a Randomized Clinical Trial

( Nazanin Heidarzadeh-rad ),( Hülya Gökmen-özel ),( Asma Kazemi ),( Negin Almasi ),( Kurosh Djafarian ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2020 Journal of Neurogastroenterology and Motility (JNM Vol.26 No.4

Background/Aims Psychobiotics are probiotics or prebiotics that, upon ingestion in adequate amounts, yield positive influence on mental health via microbiota-gut-brain axis regulation to modulate the circulating cytokines, chemokines, neurotransmitters, or neurotrophins levels. We have recently shown that a psychobiotic combination (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175; CEREBIOME) significantly improved depression symptoms in patients with depression. Recent animal data suggest the influence of the gut microbiota on brain-derived neurotrophic factor (BDNF), which was shown to correlate with antidepressant response in depressive patients. Therefore, we conducted this exploratory post hoc analysis of BDNF levels to clarify the mechanism of action of this psychobiotic in our cohort. Methods Our study was a double-blind, randomized controlled trial of patients with low-to-moderate depression receiving either a probiotic combination, prebiotic or placebo. From the 110 patients randomized in the trial, 78 were included in this post hoc analysis (probiotic, n = 28; prebiotic and placebo, n = 25). We compared serum BDNF levels from participants at baseline and endpoint, and assessed the Pearson correlation between depression severity and BDNF levels for each intervention. Results We found that post-intervention BDNF levels were significantly different between groups (P < 0.001). Furthermore, BDNF levels increased significantly in the probiotic group compared to both the prebiotic (P < 0.001) and placebo groups (P = 0.021), which inversely correlated with depression severity compared to placebo (ANOVA/ANCOVA, P = 0.012; Pearson, r = -0.79, P < 0.001). In the prebiotic group, BDNF levels reduced but not significantly compared with placebo group (P > 0.05). Conclusion Eight-week supplementation with B. longum and L. helveticus in depressive patients improved depression symptoms, possibly by increasing BDNF levels. (J Neurogastroenterol Motil 2020;26:486-495)

Association of Nutrient Patterns and Their Relation with Obesity in Iranian Adults: a Population Based Study

( Mohammad Reza Amini ),( Farhang Djafari ),( Fatemeh Sheikhhossein ),( Habib Yarizadeh ),( Sina Naghshi ),( Mahshid Shahavandi ),( Nastaran Payandeh ),( Zahra Akbarzade ),( Kurosh Djafarian ),( Sakin 한국임상영양학회 2021 Clinical Nutrition Research Vol.10 No.1

In the present research, we have evaluated the association between patterns of nutrient intake and obesity. The present cross-sectional study recruited 850 adults aged between 20-59 years old. Dietary intakes were assessed with three 24-hour recalls. As well, data on anthropometric measures were collected. General obesity was specified as body mass index ≥ 30 kg/m2. Factor analysis was conducted, and followed by a varimax rotation, was performed to extract major nutrient patterns. Our analysis identified three major nutrient patterns: The first nutrient pattern was characterized by the high consumption of saturated fatty acids (SFAs), protein, vitamins B₁, B₂, B₆, B₅, B₃, B₁₂, Zinc, and iron. The second nutrient pattern was rich in total fat, polyunsaturated fatty acids, monounsaturated fatty acids, SFAs, oleic acid, linolenic acid, zinc, vitamin E, α-tocopherol, and β-carotene. The third one was greatly loaded with protein, carbohydrate, potassium, magnesium, phosphorus, calcium, vitamin C, and folate. Women in the third quintile of the first pattern were less likely to be generally obese in the fully adjusted model (odds ratio, 0.44; 95% confidence interval, 0.25-0.75). None of the other nutrient patterns had a significant association with obesity, even after adjusting for confounders. Adherence to a nutrient pattern rich in water-soluble vitamins was significantly associated with a greater chance of general obesity among women. Further studies in other populations, along with future prospective studies, are required to confirm these findings.