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Dehghani Firouzabadi M, Sheikhy A, Poopak A, Esteghamati A, Mechanick JI, Dehghani Firouzabadi F. Challenges to Lifestyle Medicine for Type 2 Diabetes in Iran: A Synoptic Review. Am J Lifestyle Med 2023. [DOI: 10.1177/15598276231167787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Type 2 diabetes (T2D) is a major public health issue in Iran. The principal context for T2D management is the prevention of cardiovascular disease development and progression. These preventive strategies can be enhanced with routine implementation of comprehensive lifestyle modification, guideline-directed medical therapies, and creation of infrastructure that considers social determinants of health, ethnocultural variables, and financial challenges. In this synoptic review, scientific evidence sourced from Iran is analyzed to identify tactics to optimize the lifestyle medicine component of T2D care in Iran. Important evidence-based factors gleaned from the literature were curated into 9 categories: self-care, dietary adherence, mental health, self-comparison, transcultural adaptation, family support and community engagement, physical activity, the global pandemic, and service delivery. These categories were then assigned to 1 of 4 a priori aspects challenging diabetes care in Iran: behavioral factors, belief system, drivers, and implementation. By codifying discussion points and individual tactics, the improvement and optimization of T2D care in Iran can be facilitated. This reductionist model of approaching lifestyle medicine and complex chronic disease such as T2D can be applied to other ethnocultural populations.
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Affiliation(s)
- Mohammad Dehghani Firouzabadi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheikhy
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Poopak
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Jeffrey I. Mechanick
- Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart and the Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fatemeh Dehghani Firouzabadi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Badrooj N, Keshavarz SA, Yekaninejad MS, Mirzaei K. Association between Dietary Inflammatory Index with Bioelectrical Impedance Parameters and Characteristics Health in Overweight/Obese Women: A Cross-Sectional Study. Int J Prev Med 2021; 12:79. [PMID: 34447521 PMCID: PMC8356945 DOI: 10.4103/ijpvm.ijpvm_450_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/25/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Diet quality has been suggested as an important factor in disorders such as obesity and mental health as it controls inflammatory biomarkers. This study aimed to investigate the association between dietary inflammatory index (DII) with bioelectrical impedance parameters and characteristics of health in overweight\obese women. Methods: In this cross-sectional study, we calculated DII for 301 participants from their food frequency questionnaire (FFQ). Body composition was assessed through a multifrequency bioelectrical impedance analyzer (BIA). Depression, anxiety and stress scale-21 (DASS-21) was used to assess the level of characteristics of health. Results: The mean percentage ± SD of fat-free mass (FFM) and fat mass (FM) was 46.81 ± 5.65 and 34.05 ± 8.69, respectively. In this study, 49% (95% CI: 40.8–57.2) of participants had positive DII. Linear regression analysis revealed that FFM (P = 0.004) and total body water (TBW) (P = 0.004) were significantly associated with DII. Conclusions: A significant relationship was found between DII with FFM and TBW in overweight\obese women, supporting the hypothesis that an anti-inflammatory diet is associated with elevated FFM and TBW.
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Affiliation(s)
- Negin Badrooj
- Department of Nutrition Science, Faculty of Science and Medical Technology, Islamic Azad University, Sciences and Research Branch, Tehran, Iran
| | - Seyed Ali Keshavarz
- Department of Nutrition Science, Faculty of Science and Medical Technology, Islamic Azad University, Sciences and Research Branch, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), PO Box 14155-6117, Tehran, Iran
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Sedaghat G, Montazerifar F, Keykhaie MA, Karajibani M, Shourestani S, Dashipour A. Effect of pre-meal water intake on the serum levels of Copeptin, glycemic control, lipid profile and anthropometric indices in patients with type 2 diabetes mellitus: a randomized, controlled trial. J Diabetes Metab Disord 2021; 20:171-177. [PMID: 34178828 DOI: 10.1007/s40200-020-00724-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022]
Abstract
Background Water pre-load affects insulin secretion by altering the level of copeptin (C-terminal component of the arginine vasopressin hormone (AVP)) and preventing obesity by reducing food intake. Aims The present randomized controlled trial (RCT) aimed to investigate the effects of pre-meal water intake on type 2 diabetes Mellitus (T2DM). Materials and methods In this study, 40 patients with T2DM were randomly assigned to two intervention groups for 8 weeks; a) drinking 1 liter of water per day before each main meal (PW group)., and b) no water consumption before any meal (NPW group). At the beginning and at the end of the study, blood samples were taken to assess glycemic indices, lipid profile, copeptin and anthropometric indices. Results Pre-meal water intake was associated with lower energy intake, BMI, waist circumference (WC) and greater weight loss, in compared with the controls (P < 0.0001) after 8 weeks. At the end of the trial, the concentrations of fasting blood sugar (FBS) (P < 0.0001), triglyceride (TG) (P < 0.05), low-density lipoprotein cholesterol (LDL-C) (P < 0.05) and copeptin (P < 0.05) were significantly reduced following water drinking before meals. Conclusion To sum up, the present study revealed that pre-meal water intake is associated with lower BMI, body weight, WC, FBS, TG, LDL-C and copeptin levels in patients with T2DM.
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Affiliation(s)
- Gohar Sedaghat
- Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Farzaneh Montazerifar
- Pregnancy Health Research Center, Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mahmood Ali Keykhaie
- Genetics of Non-Communicable Disease Research Center, Department of Internal, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mansour Karajibani
- Health Promotion Research Center, Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Shadi Shourestani
- Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Dashipour
- Cellular and Molecular Research Center, Department of Food and Technology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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Vatandoost A, Azadbakht L, Morvaridi M, Kabir A, Mohammadi Farsani G. Association between Dietary Inflammatory Index and Risk of Cardiovascular Diseases Among Firefighters. Int J Prev Med 2020; 11:133. [PMID: 33088461 PMCID: PMC7554439 DOI: 10.4103/ijpvm.ijpvm_256_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 06/18/2020] [Indexed: 11/04/2022] Open
Abstract
Background Diet has an important role in systemic inflammation and development of cardiovascular diseases (CVD). Dietary Inflammatory Index (DII) is a new tool for evaluating the inflammatory potential of the diet. Firefighting is one of the most important occupations with stressful situations and high rates of CVD. In this study, we aimed to investigate the association between dietary inflammatory index (DII) and risk of cardiovascular diseases (CVD) among firefighters. Methods Two hundred and seventy-three male firefighters aged 18-50 years in various regions of Tehran participated in this cross-sectional study. Assessment of anthropometric, blood pressure, and biochemical parameters including glucose, total cholesterol, triglyceride, high-density lipoproteins (HDL-C), low-density lipoproteins (LDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and high-sensitivity C-reactive protein (hs-CRP) was done in all firefighters. A validated semi-quantitative questionnaire (168 items) was used for assessment of DII. Results HDL (P-value = 0.03) and hs-CRP (P-value = 0.05) were significantly higher in third tertile of DII scores than first. After adjustment for confounding factors, there was no significant difference in means (P-value >0.05). The association between DII and hs-CRP was not significant (P-value >0.05). Conclusions Participants in higher DII scores intake less polyunsaturated fatty acids (PUFAs), monounsaturated fatty acids (MUFAs), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and some antioxidant. The association between hs-CRP and DII was not significant among firefighters.
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Affiliation(s)
- Aniseh Vatandoost
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Azadbakht
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Morvaridi
- Paramedical School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
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Modarresi M, Gholami S, Habibi P, Ghadiri-Anari A. Relationship between Self Care Management with Glycemic Control in Type 2 Diabetic Patients. Int J Prev Med 2020; 11:127. [PMID: 33088455 PMCID: PMC7554595 DOI: 10.4103/ijpvm.ijpvm_207_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/27/2020] [Indexed: 11/04/2022] Open
Abstract
Background The purpose of this study was to investigate the relationship between self-care management and HbA1c level of the patients with type 2 diabetes in YAZD. Methods This study was a cross-sectional study. The number of 376 diabetic patients referred to the Diabetes Research Center in Yazd entered the study. The data collection tool was a summary of Diabetes Self Care Activity questionnaire (SDSCA), which was collected through interviews with patients. Data analysis was performed using SPSS software V 16 and kruskalwallis and independent sample t tests. Results The results showed that of 376 patients, 218 (%58) were women and 158 (%42) were male. The mean age of the participants in the study was 54.5 ± 10.9 years old and the mean duration of the disease was 9.53 ± 8.39 years. The mean HbA1C in the patients was 7.93% ± 1.38%. The mean of BMI was 28.93 ± 6 kg/ m2. The mean of self-care score in the patients under study was 30.53 ± 11.4. There was a significant relationship between the mean of self-care score, BMI, age and HbA1C (P value <0.05). Conclusions According to the results of the study, it can be concluded that the level of self-care in patients with controlled diabetes mellitus (HbA1C <7%) is more than patients with uncontrolled diabetes mellitus (HbA1c ≥9%).
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Affiliation(s)
- Mozhgan Modarresi
- Yazd Cardiovascular Research Center, Afshar Hospital, Social Determinant of Health Research Center Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Somaye Gholami
- Diabetes Research Center Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Parnian Habibi
- Medical Student Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Akram Ghadiri-Anari
- Department of Internal Medicine, Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Honarvar B, Banakar M, Hassani N, Movahednezhad Y, Gheibi Z, Bagheri Lankarani K. From Iceberg of Pre-diabetes to Poor Glycemic Control in Diabetics: An Elderly Based Study in Shiraz, South of Iran. Int J Prev Med 2019; 10:171. [PMID: 32133089 PMCID: PMC6826672 DOI: 10.4103/ijpvm.ijpvm_161_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/01/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Delay in diagnosis of diabetes mellitus (DM) in older adults is more catastrophic than other age groups. This study investigated the prevalence of pre-diabetes, DM, and glycemic control in the elderly. Methods: In this cross-sectional study, a sample of 412 older adults >60 years from Shiraz, Iran, were recruited through a multistage cluster random sampling. Demographic, clinical, and laboratory information were collected by interview, physical examination, and reviewing the medical records. Data were analyzed using SPSS 20. Results: Mean age was 68.1 ± 6.2 years and female-to-male ratio was 1.1. Out of all, 137 (33.2%) were diagnosed as diabetic including 128 (31%) as known cases and 9 (2.2%) as new cases of DM, whereas 275 (66.7%) were diagnosed as new cases of pre-diabetes. Multivariable analysis showed that low level of education (OR = 5.2, 95% CI: 1.5–16.6), hyperlipidemia (OR = 3.5, 95% CI: 2.1–5.8), liver disease (OR = 3.1, 95% CI: 1.4–6.9), and hypertension (HTN) (OR = 1.9, 95% CI: 1.1-3.2) were the most common predictors of DM in the elderly, respectively. Out of all diabetics, 33.6% had FBS >130 mg/dL and 25.5% had HbA1c >8%, whereas these figures were ≥100 mg/dL and ≥5.7% in 36.7% and 21.4% of pre-diabetics, respectively. Conclusions: The pre-diabetic elderly were mostly undiagnosed, while one-third to one-fourth of DMs had poor glycemic indices. These figures show the need for pre-diabetes and diabetes screening in the elderly, especially in those with low level of education, hyperlipidemia, liver disease, or HTN. Furthermore, regular monitoring of glycemic indices in the diabetic and pre-diabetic elderly is recommended.
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Affiliation(s)
- Behnam Honarvar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Banakar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazi Hassani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yasaman Movahednezhad
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Gheibi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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