Dietary inflammatory index in relation to the progression of hepatic steatosis and liver fibrosis: evaluation by elastography/Fibroscan

One of the proposed mechanisms by which nutrition influences the progression of hepatic steatosis to fibrosis is inflammation. The study investigated how the inflammatory potential of the diet affects the risk of liver damage in patients with nonalcoholic fatty liver disease (NAFLD), a condition where fat accumulates in the liver. This cross-sectional study included 170 outpatients with newly diagnosed NAFLD. This study used a device called Fibroscan® to measure the degree of liver fibrosis, which is the scarring of the liver tissue due to chronic inflammation. The study also used a tool called the Dietary Inflammatory Index (DII) to measure the inflammatory potential of the diet based on the intake of different foods and nutrients. In the findings of the study, patients with more severe fat accumulation in the liver (hepatic steatosis) had higher DII scores, meaning they had more inflammatory diets. The study also found that higher DII scores were associated with higher weight and body mass index (BMI). One standard deviation (SD) increase in DII scores was associated with a 0.29 kilopascal (95% CI: 0.10-0.44; P-value 0.001) increase in the mean liver stiffness, an indicator of liver fibrosis. The study concluded that patients with higher DII scores had a higher risk of developing liver fibrosis than those with lower DII scores, even after adjusting for confounding factors (odds ratio: 5.89; P-value: 0.001). The study suggested that eating less inflammatory foods may help prevent or slow down the progression of hepatic steatosis and liver in patients with NAFLD.

Association of plant-based dietary patterns with the risk of type 2 diabetes mellitus using cross-sectional results from RaNCD cohort

The prevalence of type 2 diabetes mellitus (T2DM) is increasing in middle- and low-income countries, and this disease is a burden on public health systems. Notably, dietary components are crucial regulatory factors in T2DM. Plant-based dietary patterns and certain food groups, such as whole grains, legumes, nuts, vegetables, and fruits, are inversely correlated with diabetes incidence. We conducted the present study to determine the association between adherence to a plant-based diet and the risk of diabetes among adults. We conducted a cross-sectional, population-based RaNCD cohort study involving 3401 men and 3699 women. The plant-based diet index (PDI) was developed using a 118-item food frequency questionnaire (FFQ). Logistic regression models were used to evaluate the association between the PDI score and the risk of T2DM. A total of 7100 participants with a mean age of 45.96 ± 7.78 years were analysed. The mean PDI scores in the first, second, and third tertiles (T) were 47.13 ± 3.41, 54.44 ± 1.69, and 61.57 ± 3.24, respectively. A lower PDI was significantly correlated with a greater incidence of T2DM (T1 = 7.50%, T2 = 4.85%, T3 = 4.63%; P value < 0.001). Higher PDI scores were associated with significantly increased intakes of fibre, vegetables, fruits, olives, olive oil, legumes, soy products, tea/coffee, whole grains, nuts, vitamin E, vitamin C, and omega-6 fatty acids (P value < 0.001). After adjusting for confounding variables, the odds of having T2DM were significantly lower (by 30%) at T3 of the PDI than at T1 (OR = 0.70; 95% CI = 0.51, 0.96; P value < 0.001). Our data suggest that adhering to plant-based diets comprising whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea/coffee can be recommended today to reduce the risk of T2DM.

The burden of colorectal cancer attributable to dietary risk in Middle East and North African from 1990 to 2019

The incidence of colorectal cancer (CRC) is increasing in low- and middle-income countries. This study aimed to estimate the burden of CRC attributable to nutritional risk in the Middle East and North Africa (MENA) region. The GBD 2019 methods were used to estimate age-standardized mortality rates (ASMRs) and disability-adjusted life-years (DALYs) in 2019 and over the past three decades. We evaluated the 30-year trend in DALYs and mortality rates from nutrition-related risks of CRC, from 1990 to 2019 by sex and age groups in 21 countries in the MENA region. The rate of DALYs/100,000 due to diet-related risks for CRC in 2019 was 79.71 (95% UI: 56.79, 98.44) and 65.16 (95% UI: 45.86, 80.95) in men and women, respectively. The percent changes of DALYs/100,000 in men and women were 8.15% and 2.50%, respectively, between 1990 and 2019. The percent changes in ASMRs in men and women were 8.32% and 3.44%, respectively. The highest DALYs and ASMRs were observed in both sexes in the age group 75-79 years and above. The highest percent changes in DALYs/100,000 and ASMRs were observed between 1990 and 2019 in Afghanistan, Egypt, Iran, Iraq, Lebanon, Libya, Morocco, Palestine, Qatar, Saudi Arabia, Sudan and Yemen. DALYs and ASMRs attributed to dietary risk for CRC increased in 21 countries in the MENA region from 1990 to 2019. A modified diet with more fiber, dairy products and less red meat intake is a highly recommended strategy for prevention CRC.

Association between dietary inflammatory index and musculoskeletal disorders in adults

This research investigated how the Dietary Inflammatory Index (DII) related to musculoskeletal issues in adults. It used a cross-sectional design with a sample of 3477 female and 3572 male participants aged 35 to 65 from the Ravansar Non-Communicable Diseases cohort study in western Iran. The DII is calculated from a Food Frequency Questionnaire (FFQ) to measure dietary intake. Musculoskeletal disorders including back pain, back pain/stiffness, joint pain, and joint pain/stiffness were evaluated by the RaNCD cohort study physician using a standard questionnaire. Logistic regression analysis examined the association between DII and musculoskeletal disorders. The findings demonstrated a positive association between higher DII scores and back pain/stiffness (OR 1.32, 95% CI 1.04-1.73, P = 0.047). Furthermore, DII displayed a significant association with a heightened odd to joint pain (OR 1.26, CI 1.10-1.46) when compared to those with lower DII scores (Q3 vs. Q1). After adjusting for cofounding factors, the Q3 DII quintile participants showed a 44% higher odd of experiencing joint pain/stiffness (OR 1.44, CI 1.01-2.05, P = 0.047). However, the study found no significant association between back pain and DII (P > 0.05). In conclusion, the research suggests that consuming a pro-inflammatory diet might be linked to developing musculoskeletal issues in adults.

The effects of propolis supplementation on high-sensitivity C-reactive protein, testosterone hormone, and metabolic profile in women with polycystic ovary syndrome: A randomized, triple-blinded, placebo-controlled clinical trial

One of the most prevalent ovulation disorders is polycystic ovarian syndrome (PCOS). According to the anti-inflammatory and beneficial effects of propolis, this triple-blind controlled trial was designed to evaluate the effect of propolis on metabolic factors, high-sensitivity C-reactive protein, and testosterone in women with PCOS. Recruited patients from the gynecologist clinic were randomized based on a stratified permuted four-block randomization procedure to supplement with propolis tablets, two tablets/day (500 mg propolis/day) (n = 30) or identical placebo tablets (n = 30) for 12 weeks in 2021 until 2022. Data were collected using a demographic questionnaire, blood samples, and a checklist to record the measured parameters. A total of 57 patients completed the trial. ANCOVA test showed that hip circumference (HC)) p = 0.03), fasting insulin (p = 0.007), homeostatic model assessment for insulin resistance (p = 0.004), testosterone (p = 0.004), and low-density lipoprotein (LDL)/high-density lipoprotein (HDL) (p = 0.02) were significantly decreased in the propolis versus the placebo group after adjustment for confounders. Although fasting blood glucose (p = 0.04) decreased significantly in the propolis group compared to the placebo, after adjusting for confounders, significance was lost (p = 0.09). Supplementation with propolis elicited positive effects on fasting insulin and insulin resistance, in addition to reducing the testosterone level, LDL/HDL, and HC, in PCOS women.

Glycemic index, glycemic load, dietary inflammatory index, and risk of infertility in women

The dietary glycemic load (GL) indicates the quantity and quality of carbohydrates, which can affect ovulation and fertility by controlling insulin sensitivity. Also, past studies confirm the role of the dietary inflammatory index (DII) in many diseases, including metabolic syndrome and cardiovascular disorders, so it may be related to reproductive health. This case-control study aims to study the association between glycemic index (GI), GL, and DII with infertility in women. This study was conducted on 300 infertile women in the case group and 300 fertile women in the control group in Kermanshah, Iran. Food intake was evaluated using FFQ, and using NUTRITIONIST IV software programs, GI and GL values were determined. DII was computed as well using FFQ data. Physical activity was assessed using IPAQ-SF. The association between GI, GL, and DII with infertility was evaluated using a logistic regression test, using STATA version 14 software. The results showed that the DII, GI, and GL were higher in the case group compared to the control group ([p = .009], [p = .0001], and [p = .0007], respectively). The increase in GI, GL, and DII caused an increase in infertility factors, and consequently enhanced chance of infertility ((adjusted odd ratio [OR] 2; 95% confidence interval [CI], 1.16, 3.45), (OR 3.68; 95% CI, 1.99, 6.82), and (OR 1.7; 95% CI, 0.97, 2.95), respectively). The present study indicated that the chance of infertility is higher in women who follow a diet with high GI, GL, and DII. Therefore, a positive association may be present between GI, GL, and DII with infertility.

The relationship of dietary inflammatory index and dietary patterns with premenstrual syndrome among women in Kermanshah: An analytical cross-sectional study

Premenstrual syndrome (PMS) is a common psychological condition that occurs continuously during the luteal phase of the menstrual cycle. Potential factors in this syndrome comprise the central nervous system, hormones, genetic background, and nutritional indicators. Little is known about foods or eating patterns that may be associated with this syndrome, yet nutritional factors can be considered in strategies for the management of PMS. The current study purposed to investigate the relationship between PMS and dietary inflammation index as well as PMS and food patterns. The present cross-sectional study was conducted on 125 women and girls aged 20-46 years who experienced symptoms of PMS. The inclusion criteria included cooperation and consent to enter the study, a body mass index of 18.5-25 kg/m², no underlying disease, no use of contraceptives or antidepressants, and no use of multivitamin or mineral supplements. In the first stage of this study, participants' height, weight, waist circumference, and hip circumference were measured. In the second stage, eating habits were examined using a semiquantitative Food Frequency Questionnaire. This study found a significant correlation between glycemic load quintiles as well as between energy and macronutrient intake and the dietary inflammatory index; however, it revealed a direct correlation between PMS and both Western-mixed dietary and high-salt-high-sugar dietary patterns. Moreover, the Western food pattern was found to have a direct correlation with dietary inflammatory index, and the healthy food pattern had an inverse correlation with this index. This study showed that PMS symptoms are more severe with the consumption of high-salt-high-sugar or a Western-mixed food dietary pattern. It seems that an imbalance in hormones and neurotransmitters can affect the metabolism of proteins, carbohydrates, and fats. Also, some foods, such as vegetables, and low-fat and high-fiber diets reduce plasma estrogen levels and the duration of PMS symptoms.

The effect of low dietary inflammatory index score formula on inflammatory, metabolic, and clinical outcomes in critically ill traumatic brain injury patients: A single-blind randomized controlled pilot study

In traumatic brain injury (TBI) patients, a complex cascade of inflammatory responses are frequently observed following trauma. Numerous dietary agents have long been found to have potential in modulating inflammatory responses. This pilot study, designed an enteral formula with low inflammatory properties based on the dietary inflammatory index (DII®) and evaluated its effect on inflammatory and metabolic factors in critically ill TBI patients. This single-blind randomized controlled pilot study was conducted at the Neurosurgical ICU of Shahid Kamyab Hospital (Mashhad, Iran). A total of 20 TBI patients were randomly assigned to receive either low-DII score or standard formula at the intensive care unit (ICU). The primary outcomes of the study included clinical status, inflammatory biomarkers, APACHE II, SAPS II, SOFA, and NUTRIC scores. The trial groups did not differ significantly in baseline values. Following 14 days of intervention, there was a statistically significant decrease in the APACHE II, SAPS II, and NUTRIC scores and a significant increase in the GCS score in the low-DII score formula group compared to the standard formula group. Over 2 weeks, high sensitivity C-reactive protein (hs-CRP) values of -2.73 (95% CI: -3.67, -1.79) mg/dL in the low-DII score formula group versus 0.65 (95% CI: -0.29, 1.58) mg/dL in controls were obtained. Moreover, the length of hospital stay was longer for the standard formula group than for the low-DII score formula group. The low-DII score formula improves inflammatory factors (serum hs-CRP) and metabolic biomarkers (LDL-c and FBS). Furthermore, clinical outcomes, including the length of hospital stay and disease severity, appear to be enhanced.

Application of machine learning in predicting non-alcoholic fatty liver disease using anthropometric and body composition indices

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, which can progress from simple steatosis to advanced cirrhosis and hepatocellular carcinoma. Clinical diagnosis of NAFLD is crucial in the early stages of the disease. The main aim of this study was to apply machine learning (ML) methods to identify significant classifiers of NAFLD using body composition and anthropometric variables. A cross-sectional study was carried out among 513 individuals aged 13 years old or above in Iran. Anthropometric and body composition measurements were performed manually using body composition analyzer InBody 270. Hepatic steatosis and fibrosis were determined using a Fibroscan. ML methods including k-Nearest Neighbor (kNN), Support Vector Machine (SVM), Radial Basis Function (RBF) SVM, Gaussian Process (GP), Random Forest (RF), Neural Network (NN), Adaboost and Naïve Bayes were examined for model performance and to identify anthropometric and body composition predictors of fatty liver disease. RF generated the most accurate model for fatty liver (presence of any stage), steatosis stages and fibrosis stages with 82%, 52% and 57% accuracy, respectively. Abdomen circumference, waist circumference, chest circumference, trunk fat and body mass index were among the most important variables contributing to fatty liver disease. ML-based prediction of NAFLD using anthropometric and body composition data can assist clinicians in decision making. ML-based systems provide opportunities for NAFLD screening and early diagnosis, especially in population-level and remote areas.

Effect of propolis on mood, quality of life, and metabolic profiles in subjects with metabolic syndrome: a randomized clinical trial

Metabolic syndrome (MeS) is a common multifaceted disorder. Plants contain antioxidant bioactive compounds, which are beneficial to improve the health condition of patients with MeS. Propolis is a hive natural product that is composed of various constituent. We aimed to assess the effects of Iranian propolis as a natural and safe agent on indicators of MeS, quality of life and mood status in individuals with MeS. In total, 66 interested eligible patients recruited to the present study. Participants were randomly assigned to consume a tablet at dose of 250 mg of propolis extract, twice daily for 12 weeks or placebo. Propolis supplementation could lead to a significant reduction in waist circumference (WC), increase in physical functioning, general health and the overall score of SF-36 compared with placebo group (P-value < 0.05). However, no significant differences were observed regarding other anthropometric indices and biochemical parameters between two groups (P-value > 0.05). The current study indicated that propolis can be effective in decreasing WC and improving physical health and quality of life, while had no significant effects on other components of MeS among subjects with this syndrome. Clinical trials registration Iran Registry of Clinical Trials.ir IRCT20121216011763N49, registration date 23/12/2020.

The Potential Effect of Royal Jelly on Biomarkers Related to COVID-19 Infection and Severe Progression

Royal jelly is a yellowish to white gel-like substance that is known as a "superfood" and consumed by queen bees. There are certain compounds in royal jelly considered to have health-promoting properties, including 10-hydroxy-2-decenoic acid and major royal jelly proteins. Royal jelly has beneficial effects on some disorders such as cardiovascular disease, dyslipidemia, multiple sclerosis, and diabetes. Antiviral, anti-inflammatory, antibacterial, antitumor, and immunomodulatory properties have been ascribed to this substance. This chapter describes the effects of royal jelly on COVID-19 disease.

Relationship between the Mediterranean diet and risk of hepatic fibrosis in patients with non-alcoholic fatty liver disease: A cross-sectional analysis of the RaNCD cohort

Background

Despite evidence supporting the beneficial effects of the Mediterranean diet (MedDiet) on hepatic steatosis in subjects with non-alcoholic fatty liver disease (NAFLD), the relationship of the MedDiet with hepatic fibrosis is as yet unclear. The aim of the present study was to explore this association in Iranian adults with NAFLD.

Methods

This cross-sectional study included 3,325 subjects with NAFLD from the Ravansar Noncommunicable Disease (RaNCD) cohort. Dietary intake data were collected by a validated food frequency questionnaire (FFQ). The MedDiet score was computed based on a nine-point scale constructed by Trichopoulou et al. Fatty liver index (FLI) and fibrosis-4 (FIB-4) index were used to predict hepatic steatosis and fibrosis in the population. Multivariate regression models were applied to determine associations.

Results

Subjects in the highest tertile of MedDiet score had a higher platelet and a lower weight, total cholesterol (TC), LDL-c, and FLI than those in the lowest tertile (p-value < 0.05). Adherence to the MedDiet was associated with a 7.48 (95%CI: 5.376 to 9.603; p-value: 0.001) × 10³/μl; -0.417 (95%CI: -0.819 to -0.014; p-value: 0.042) kg, -2.505 (95%CI: -3.835 to -1.175; p-value: 0.001) mg/dl; and -1.93 (95%CI: -2.803 to -1.061; p-value: 0.001) mg/dl change in platelet, weight, TC, and LDL-c for each SD increase in the score, respectively. A significant linear trend was observed in odds of hepatic fibrosis across the tertiles of the MedDiet score (P-trend: 0.008). This linear trend was attenuated but remained significant after the adjustment of the relevant confounders (P-trend: 0.032). Adherence to the MedDiet was independently associated with about 16% lower odds of having hepatic fibrosis in patients with NAFLD for each SD increase in the score.

Conclusion

Adherence to the MedDiet characterized by a high intake of whole grains, fruits, vegetables, legumes, nuts, and fish was associated with a lower risk of having hepatic fibrosis in patients with NAFLD. Further studies are required to elucidate the causal relationship of observed association in individuals of all ages, ethnicities, and etiologies of hepatic steatosis.

Ginger as an anticolorectal cancer spice: A systematic review of in vitro to clinical evidence

Ginger and its derivatives have been shown to be effective in the prevention and treatment of cancer. We undertook a systematic review to answer the question of whether ginger has a role in modifying the biomarkers of cancer in cell culture conditions and on colorectal cancer in randomized clinical trials. We performed a comprehensive search of the literature from Scopus, Embase, Web of Science, PubMed, Cochrane central register of controlled trials, and Cochrane database of systematic reviews. At first, all 12 papers studied the effect of ginger or its derivatives on cell culture conditions. The results of cell culture studies show that ginger has a powerful role in inducing apoptosis. In the second part, five studies of clinical trials were analyzed. By analyzing antitumor markers of clinical trials, ginger increased some anticancer markers but performed poorly in inducing some anticancer markers. This systematic review showed that the consumption of ginger extract has the potential to prevent and treat colorectal cancer but this ability is weak.

Association between dietary inflammatory index scores and the increased disease activity of rheumatoid arthritis: a cross-sectional study

Background

Diet plays an important role in regulating inflammation, which is a hallmark of rheumatoid arthritis (RA). Our aim was to investigate the association between the Dietary Inflammatory Index (DII) scores and RA activity.

Methods

This cross-sectional study was conducted on 184 patients with RA in rheumatology clinic in Kermanshah city, Iran, in 2020. RA was diagnosed according to the criteria of the 2010 American College of Rheumatology/ European League against Rheumatism. The overall inflammatory potential of the diet was extracted from a validated 168-item food frequency questioner (FFQ) using the DII. RA disease activity was assessed using Disease Activity Score 28 (DAS-28) scores. Logistic regression and one-way ANOVA/ ANCOVA were conducted.

Results

Individuals in the highest DII quartile had the significantly higher odds of positive C-reactive protein than those in the lowest quartile of the DII scores (OR 4.5, 95% CI 1.16 – 17.41, P = 0.029). A statistically significant downward linear trend in fat-free mass and weight were observed with increasing the DII quartiles (P = 0.003, P = 0.019, respectively). Patients in the highest DII quartile had higher DAS-28 scores than those in the first quartile (Mean difference: 1.16, 95% CI 0.51 – 1.81, P < 0.001) and second quartile of the DII scores (Mean difference: 1.0, 95% CI 0.34 – 1.65, P < 0.001).

Conclusion

Our results indicated that reducing inflammation through diet might be one of the therapeutic strategies to control and reduce the disease activity in RA patients.

The Relationship between Major Dietary Patterns and Disease Activity of Rheumatoid Arthritis

AIM

Rheumatoid arthritis is an inflammatory illness characterized by persistent and systemic inflammation. There is just a little amount of research on nutrition and RA progression. The goal of this research is to see whether there's a link between main eating trends and RA activity.

METHODS

In Kermanshah, Iran, 183 individuals with RA were studied in cross-sectional research. The American College of Rheumatology's 2010 criteria were used to diagnose RA. The disease activity score 28 and nutritional information from a reliable 147-item food frequency questionnaire were used to assess RA activity. Factor analysis was used to extract dietary patterns.

RESULTS

The researchers discovered three main eating trends, which they named. Individuals in the highest tertile of a high protein anti-inflammatory dietary pattern that emphasizes consumption of dairy products, red meats, white meats, vegetables oils, condiments, vegetables and fruits as well as low in salts and refined grain had lower DAS-28 scores than those in the first tertiles (T3 = 2.09 ± 0.14 vs. T1 = 3.75 ± 0.13; P-value = 0.001) after controlling for potential confounders. Patients in the top tertile of the low fiber dietary pattern had higher DAS-28 scores than those in the bottom tertile (T3 = 3.40 ± 0.15 vs. T1 = 2.95 ± 0.15; P-value = 0.036) than those in the bottom tertile.

CONCLUSION

This research found an inverse connection between RA activity and adopting a high-protein anti-inflammatory dietary pattern. Furthermore, adopting a low-fiber dietary pattern may be linked to increased RA disease activity. To confirm such a relationship, further research is needed in the future.

The efficacy of curcumin-piperine co-supplementation on clinical symptoms, duration, severity, and inflammatory factors in COVID-19 outpatients: a randomized double-blind, placebo-controlled trial

BACKGROUND

COVID-19 pandemic has made the disease a major global problem by creating a significant burden on health, economic, and social status. To date, there are no effective and approved medications for this disease. Curcumin as an anti-inflammatory agent can have a positive effect on the control of COVID-19 complications. This study aimed to assess the efficacy of curcumin-piperine supplementation on clinical symptoms, duration, severity, and inflammatory factors in patients with COVID-19.

METHODS

Forty-six outpatients with COVID-19 disease were randomly allocated to receive two capsules of curcumin-piperine; each capsule contained 500 mg curcumin plus 5 mg piperine or placebo for 14 days.

RESULTS

Mean changes in complete blood count, liver enzymes, blood glucose levels, lipid parameters, kidney function, and c-reactive protein (CRP) were not significantly different between the two groups. There was a significant improvement in health status, including dry cough, sputum cough, ague, sore throat, weakness, muscular pain, headache, and dyspnea at week 2 in both curcumin-piperine and placebo groups (P value < 0.05); however, the improvement in weakness was more in the curcumin-piperine group than with placebo group (P value 025).

CONCLUSION

The present study results showed that curcumin-piperine co-supplementation in outpatients with COVID-19 could significantly reduce weakness. However, in this study, curcumin-piperine co-supplementation could not significantly affect the other indices, including biochemical and clinical indices.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20121216011763N46 . 2020-10-31.

Probiotic supplementation: A prospective approach in the treatment of COVID-19

Background: Despite strategies based on social distancing, the coronavirus disease 2019 (COVID-19) expands globally, and so far, many attempts have been made to achieve effective treatment for patients with COVID-19. This disease infects the lower respiratory tract and may lead to severe acute respiratory syndrome coronavirus (SARS-CoV). COVID-19 also can cause gastrointestinal infections. Therefore, COVID-19 patients with gastrointestinal symptoms are more likely to be complicated by SARS-CoV. In this disease, acquired immune responses are impaired, and uncontrolled inflammatory responses result in cytokine storms, leading to acute lung injury and thrombus formation. Probiotics are living microorganisms that contribute to the health of the host if administered in appropriate doses. Aim: This study aimed to provide evidence to show the importance of gut dysbiosis in viral disease, especially COVID-19. Therefore, we have focused on the impact of probiotics consumption on preventing severe symptoms of the disease. Methods: We have entirely searched SCOPUS, PubMed, and Google Scholar databases to collect evidence regarding the relationship between probiotics and viral infections to expand this relationship to the COVID-19. Results: It has been shown that probiotics directly counteract SARS-CoV in the gastrointestinal and respiratory tracts. Moreover, probiotics suppress severe immune responses and prevent cytokine storms to inhibit pathologic inflammatory conditions in the body via modulation of immune responses. Conclusion: According to available evidence based on their antiviral and respiratory activities, using probiotics might be an adjuvant therapy to reduce the burden and severity of this disease.

Effects of propolis supplementation on irritable bowel syndrome with constipation (IBS-C) and mixed (IBS-M) stool pattern: A randomized, double-blind clinical trial

Background

Recent evidence indicates that propolis can modulate gastrointestinal (GI) function. This trial aims to assess the efficacy of propolis supplementation on the severity of irritable bowel syndrome (IBS) symptoms.

Methods

This clinical trial was conducted on 56 subjects with IBS diagnosed by Rome IV criteria. Eligible subjects were randomly assigned to receive either 900 mg/day of propolis or matching placebo tablets for 6 weeks. The IBS symptom severity scale (IBS‐SSS) was used to evaluate IBS severity in five clinically applicable items.

Results

After adjusting anxiety scores, a significant reduction was observed in the overall score of IBS symptoms (−98.27 ± 105.44), the severity of abdominal pain (−24.75 ± 28.66), and the frequency of abdominal pain (−2.24 ± 3.51) with propolis treatment as compared to placebo (p‐value < .05). Patients in the propolis group were 6.22 times more likely to experience improvement in IBS symptoms than those in the placebo group (95% CI: 1.14–33.9; p‐value: .035). There was no significant change in anthropometric measurements and dietary intakes in both groups (p‐value > .05).

Conclusions

Our results showed that propolis supplementation might have a beneficial effect on constipation subtype of IBS (IBS‐C) and mixed subtype of IBS (IBS‐M) severity by reducing the severity and frequency of abdominal pain in patients with irritable bowel syndrome (IBS).

Optimal cut‐off points of fat mass index and visceral adiposity index associated with type 2 diabetes mellitus

Background

Indices, based on anthropometrics with or without non‐anthropometric components, are predictive of cardio‐metabolic outcomes. Fat mass index (FMI) is similar to BMI except measured fat mass replaces body weight. The visceral adiposity index (VAI) combines anthropometric measures with lipid measurements TG/HDL. The relationship of these indices to incident type 2 diabetes (T2DM) has not been established. Therefore, we have evaluated the predictive power and optimal cut‐off points of FMI, and VAI with T2DM in a cross‐sectional population study.

Methods

These population‐based cross‐sectional study comprised 8411 adults aged 35–65 years using data from the Ravansar Non‐Communicable Diseases (RaNCD) cohort. VAI and FMI were defined as previously published. Optimal cut‐off points for association with incident T2DM were determined from receiver‐operating curves (ROC).

Results

The optimal cut‐off point for VAI was 4.86 (AUC: 0.673; 95% CI: 0.65–0.69) and FMI 9.3 (AUC: 0.57; 95% CI: 0.55–0.59), and for T2DM in our study population. The odds ratios (OR) for T2DM were nearly identical, for VAI 1.098 (95% CI: 1.08–1.11) and for FMI 1.08 (95% CI: 1.05–1.10).

Conclusions

In the current population study, VAI and FMI were weakly associated with T2DM. Therefore, it seems that anthropometric measures are unlikely to be strong mediators of T2DM compared to historical and other factors in the population studied.

We found that VAI had more predictive power to diagnose T2DM than FMI.

A systematic review and meta-analysis of preclinical and clinical studies on the efficacy of ginger for the treatment of fatty liver disease

Fatty liver disease (FLD) is the most common chronic liver disease worldwide. The pathogenesis of this disease is closely related to obesity and insulin resistance. Ginger has hypolipidemic and antioxidant effects and acts as an insulin sensitizer. This study aims to evaluate the effect of ginger supplementation on the fatty liver. A comprehensive search of Medline/PubMed, Embase, Scopus, Web of Science/ISI, and Cochrane databases was conducted without time or language restrictions. Eighteen eligible studies were identified, including 17 in-vivo experiments in quantitative analysis and 3 clinical trials in qualitative analysis. The present study provides comprehensive evidence of the efficacy of ginger to improve the liver levels of cholesterol (-5.60 mg/g), triglycerides (TG, -4.28 mg/g), malondialdehyde (-3.16 nmol/mg), catalase (CAT) (3.35 nmol/mg), superoxide dismutase (SOD, 3.01 U/mg), serum levels of alanine aminotransferase (ALT, -2.85 U/L), aspartate aminotransferase (AST, -0.98 U/L), TG (-4.98 mg/dL), low-density lipoprotein (LDL, -3.94 mg/dL), total cholesterol (TC, -3.45 mg/dL), high-density lipoprotein (HDL, 1.27 mg/dL), and fasting blood sugar (FBS, -2.54 mg/dL). Ginger administration may reduce many clinical aspects of FLD by several mechanisms, including insulin-sensitive effects, stimulating the expression of antioxidant enzymes, reducing the generation of reactive oxygen species (ROS), having antidyslipidemic activities, and reducing hepatic fat content. However, future clinical trials are essential to investigate the clinical application of ginger in this area.

Dietary Intake in Relation to the Risk of Reflux Disease: A Systematic Review

Gastroesophageal reflux disease (GERD) is a chronic condition which has a high global prevalence. Dietary intake is considered to be a contributing factor for GERD. However, scientific evidence about the effect of diet on the risk of GERD is controversial. This systematic review was conducted to address this issue. A comprehensive structured search was performed using the MEDLINE, Scopus, and Web of Science databases up to August 2020, in accordance with the PRISMA statement. No restrictions were set in terms of language, time of publication, or study location. Study selection and data abstraction was conducted independently by two authors, and risk of bias was assessed using a modified Quality in Prognosis Studies Tool. Eligible studies evaluating the impact of food and dietary pattern on GERD were included in qualitative data synthesis. After excluding duplicate, irrelevant, and low quality studies, 25 studies were identified for inclusion: 5 case-control studies, 14 cross-sectional studies, and 6 prospective studies. This review indicates that high-fat diets, carbonated beverages, citrus products, and spicy, salty, and fried foods are associated with risk of GERD.

Major dietary patterns in relation to muscle strength status among middle-aged people: A cross-sectional study within the RaNCD cohort

Grip strength in midlife can predict physical disability in senior years. Recent evidence shows the critical role of nutritional status on muscle function. We aimed to elucidate whether adherence to a particular dietary pattern would be associated with abnormal muscle strength among middle-aged people. In this cross-sectional study, a semiquantitative Food Frequency Questionnaire was used to assess the dietary intake of 2781 participants in the Ravansar Non-Communicable Chronic Disease (RaNCD) cohort. Major dietary patterns from 28 main food groups were extracted using principal component analysis. Binary logistic regression was used to determine the association between the tertiles of the major dietary patterns and muscle strength status. Two major dietary patterns were identified: the "mixed dietary pattern" that heavily loaded with fruits, vegetables, nuts, dairies, sweets, legumes, dried fruits, fish, red meat, butter, whole grains, natural juices, poultry, pickles, olive, industrial juice, egg, processed meat, and snacks and "unhealthy dietary pattern" that heavily loaded by fats, sugar, refined grains, soft drink, salt, organ meat, tea, and coffee. Adherence to the mixed dietary pattern (OR = 1.03, 95% CI = 0.8-1.33, P for trend = 0.77) and the unhealthy dietary pattern (OR = 1.01, 95% CI = 0.79-0.13, P for trend = 0.89) did not associate with abnormal muscle strength. This study suggests that the dietary pattern involving the consumption of healthy and unhealthy food does not have an effect on muscle strength in middle-aged adults.

Arctigenin, an anti-tumor agent; a cutting-edge topic and up-to-the-minute approach in cancer treatment

Today, herbal-derived compounds are being increasingly studied in cancer treatment. Over the past decade, Arctigenin has been introduced as a bioactive dibenzylbutyrolactone lignan which is found in Chinese herbal medicines. In addition to anti-microbial, anti-inflammatory, immune-modulatory functions, Arctigenin has attracted growing attention due to its anti-tumor capabilities. It has been shown that Arctigenin can induce apoptosis and necrosis and abolish drug resistance in tumor cells by inducing apoptotic signaling pathways, caspases, cell cycle arrest, and the modulating proteasome. Moreover, Arctigenin mediates other anti-tumor functions through several mechanisms. It has been demonstrated that Arctigenin can act as an anti-inflammatory compound to inhibit inflammation in the tumor microenvironment. It also downregulates factors involved in tumor metastasis and angiogenesis, such as matrix metalloproteinases, N-cadherin, TGF-β, and VEGF. Additionally, Arctigenin, through modulation of MAPK signaling pathways and stress-related proteins, is able to abolish tumor cell growth in nutrient-deprived conditions. Due to the limited solubility of Arctigenin in water, it is suggested that modification of this compound through amino acid esterification can improve its pharmacogenetic properties. Collectively, it is hoped that using Arctigenin or its derivates might introduce new chemotherapeutic approaches in future treatment.

Polycyclic aromatic hydrocarbons in grilled foods from Kermanshah province

Grilling is one of the most traditional ways of cooking foods, especially meat, which can produce a number of carcinogenic compounds. This study was to identify the pattern of kebab consumption and its PAHs among a selection of the Iranian population. Kebab consumption pattern were assessed using a validated questionnaire. A sample of three types of popular kebabs, including Koobideh (minced meat), Barg (crushed meat pieces), and Juje (chopped chicken pieces), was collected from each restaurant and then transferred to a laboratory to measure PAHs. The median benzo[a]pyrene concentrations (7.85 μg/kg) and the sum of benzo[a]pyrene, chrysene, benzo[a]anthracene, and benzo[b]fluoranthene concentrations (15.74 μg/kg) were higher than the maximum level imposed by the Commission of the European Communities. A significant relationship between Barg kebab prepared with charcoal and the amounts of anthracene, benzo[a]anthracene, dibenzo[a,h]pyrene, and benzo[g,h,i]perylene was found. The highest PAHs produced in samples prepared with charcoal was dibenzo[a,h]pyrene.

Cinnamon: A Promising Natural Product Against COVID-19

COVID-19 is a pandemic and acute respiratory disease. Every day, all around the world, researchers are endeavoring to find effective or potential adjuvant therapies. Studies illustrate that essential oils from cinnamon and derivatives such as cinnamaldehyde and cinnamic acid possess numerous biological activities. In this paper, we have reviewed the possible mechanisms of cinnamon on the inflammatory cascade as a potential alternative therapy to decrease oxidative stress and inflammation in COVID-19 patients.

Effect of curcumin-pipeine supplementation on clinical status, mortality rate, oxidative stress, and inflammatory markers in critically ill ICU patients with COVID-19: a structured summary of a study protocol for a randomized controlled trial

Objectives

This study aims to investigate the efficacy of curcumin-piperine co-supplementation on oxidative stress factors, clinical symptoms, and mortality rate in patients with coronavirus (COVID-19) admitted to the intensive care unit (ICU).

Trial design

This study is a randomized, placebo-controlled, double-blind, parallel-arm clinical trial.

Participants

The study participants will be recruited from patients admitted to the ICU of Al-Zahra hospital with a definitive diagnosis of COVID-19. The inclusion criteria are aged between 20 and 75 years, confirmation of COVID-19 based on the PCR test, and admitted to the ICU. The exclusion criteria include the present use of parenteral nutrition support, a history of underlying diseases such as congenital disorders, immune diseases, renal and hepatic insufficiency, and pancreatitis, a history of sensitivity to herbal remedies such as turmeric and pepper, and regular use of anticoagulant drugs such as warfarin. This study will be performed in the Al-Zahra hospital, an academic hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran.

Intervention and comparator

Sixty eligible patients will be randomly assigned, in a 1:1 ratio, to receive curcumin-piperine capsules (three capsules/day; each capsules containing 500 mg curcumin plus 5 mg piperine; in total 1500 mg curcumin and 15 mg piperine/daily) for seven days (n=30) or matching placebo capsules (three capsules/day; each capsules containing 505 mg maltodextrin; totally 1515 mg, maltodextrin/ daily) for same duration (n=30). Capsules will be administered after oral or enteral feeding at 9, 15 and 21 o’clock.

Main outcomes

The primary outcome is the time from initiation of supplementation (curcumin-piperine or placebo) to normalization of fever, respiratory rate, and blood oxygen saturation. The secondary outcomes are the mortality rate, length of stay in ICU, temperature, levels of blood oxygen saturation, ventilator dependency, respiratory rate, levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), levels of liver markers (ALT, AST, LDH), and levels of kidney function markers (BUN, Creatinine).

Follow up

All of the parameters will be assessed at baseline and end of the study (7 days intervention). In addition, the rate of mortality will be collected after 4 weeks (28 days’ mortality in the ICU, 4 weeks follow up).

Randomisation

Eligible patients will be randomly assigned to either the intervention group (Curcumin-piperine) or the control group (Placebo). Randomization sequences will be generated using an electronic table of random numbers to allocate the included participants into either control or intervention groups (in a 1:1 ratio) using the stratified block randomization method. Stratification was conducted according to sex (male and female), with a block size of four. The allocation sequences will be prepared by an independent statistician and will be kept inside sealed, opaque, and consecutively numbered envelopes. Participants, investigators, nurses, and physicians will be unaware of the trial-group assignment.

Blinding (masking)

This study is a double-blind clinical trial (participants, investigators, nurses, and physicians). The curcumin-piperine and placebo supplements will be similar in the terms of texture, taste, color, odor, and weight. Both tablets will be provided in containers that are completely identical in weight, shape, labeling, and packaging. All participants, investigators, nurses, and physicians will be unaware of the trial-group assignment.

Numbers to be randomised (sample size)

The sample size is estimated at 60 participants, including 30 patients in the intervention group and 30 patients in the placebo group.

Trial Status

The protocol is Version 2, registered on May 13, 2021. Recruitment began May 20, 2021, and is anticipated to be completed by September 20, 2021.

Trial registration

This trial has been registered in Iranian Registry of Clinical Trials (IRCT) with the title of “Evaluation of the effect of curcumin-piperine supplementation in patients with coronavirus admitted to the intensive care unit (ICU): a double-blind clinical trial study”. IRCT registration number is IRCT20121216011763N52. The registration date was May 13, 2021.

Full Protocol

The full protocol is attached as an additional file, accessible from the Trials website (File 1). In the interest of expediting the dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05372-9.

The effect of food ration bar enriched with β-alanine, L-arginine, and Nigella sativa on performance and inflammation following intense military training: A double-blind randomized clinical trial

BACKGROUND

There are growing interests in using dietary supplements to improve athletic performance. This study aimed to evaluate the effect of the food ration bar enriched with β-alanine, L-arginine, and Nigella sativa on athletic performance and inflammation following intense military training.

METHODS

This double-blind, randomized, controlled clinical trial was conducted on 54 new cadets. Eligible participants were randomly assigned in a 1:1 ratio to receive food ration bars enriched with arginine (2 g/day), β-alanine (2 g/day), and Nigella sativa (2 g/day) or nonenriched food ration bars during a 2-week military training. Aerobic and anaerobic performances were evaluated by the Cooper and RAST tests, respectively.

RESULTS

A significant increase in anaerobic powers (min, mean, and max) and a significant reduction in fatigue index were observed in the intervention group as compared to the control group, even after the adjustment for confounding factors. Also, increased levels of hs-CRP and TNF-α following military training were significantly lower in the intervention group as compared to the control group (hs-CRP: 0.55 ± 0.1 versus 2.43 ± 0.1 mg/L; p-value: 0.01; TNF-α: 0.12 ± 0.04 versus 0.62 ± 0.04 pg/ml; p-value: 0.03). No significant changes were observed in VO2 max in both groups.

CONCLUSIONS

Our results showed that the combination of β-alanine, L-arginine, and Nigella sativa can improve anaerobic performance and reduce inflammation following intense physical activities. Further studies with long-term duration are needed to confirm the cumulative/synergic effects of these ingredients in trained and nontrained subjects.

Effect of propolis supplementation on athletic performance, body composition, inflammation, and oxidative stress following intense exercise: A triple-blind randomized clinical trial

BACKGROUND

Emerging evidence indicates that propolis as a novel potential antioxidant has unique benefits. This study aimed to evaluate the effect of propolis on oxidative stress, inflammation, body composition, and athletic performance in healthy active subjects.

METHODS

This clinical trial was conducted on 54 male military cadets. Eligible subjects were randomly allocated to receive a single dose of 450 mg propolis twice daily for four weeks or a matching placebo containing microcrystalline cellulose. Cooper 12-min run test and running-based anaerobic sprint test were performed to measure aerobic and anaerobic performance. Blood samples were obtained immediately after Cooper's test to evaluate oxidative stress and inflammation status. Fat mass and fat-free mass were analyzed using bioelectrical impedance.

RESULTS

Mean changes in fat mass, fat-free mass, anaerobic powers, fatigue index, and VO2 max did not differ significantly between the two groups after the adjustment for baseline values (P-value>0.05). A significant change was observed in plasma levels of IL-6 (-1.43 ± 0.11pg/mL), total oxidant status (-3.9 ± 0.2µmol/L), total antioxidant capacity (164 ± 12 µmol/L), malondialdehyde (-0.52 ± 0.03µmol/L), oxidative stress index (-0.45 ± 0.04), and glutathione (48.72±2µmol/L) in the propolis group compared with the placebo group after the adjustment for baseline values and weight changes (P-value<0.05). Although IL-10 concentrations had no significant changes in both groups, the ratio of IL-6/IL-10 significantly reduced in the propolis group compared with the placebo group (-0.174 ± 0.015 versus. 0.051 ± 0.014; P-value: 0.041).

CONCLUSIONS

Our results indicated that propolis might have beneficial effects on oxidative stress and inflammation following intense activities in healthy male subjects.

Effect of garlic powder supplementation on blood pressure and hs-C-reactive protein among nonalcoholic fatty liver disease patients: A randomized, double-blind, placebo-controlled trial

Based on the anti-inflammatory and antihypertensive properties of garlic, the current study was designed to evaluate the garlic powder effects on blood pressure and high-sensitivity C-reactive protein (hs-CRP) among Nonalcoholic Fatty Liver Disease patients (NAFLD). This randomized, double-blind, placebo-controlled trial study was conducted on 110 patients with NAFLD. The patients were randomly divided into 2 groups, receiving two tablets of either 400 mg garlic or placebo daily for 15 weeks. At baseline and the end of the study, blood pressure and hs-CRP were determined. Of 110 patients enrolled in the trial, 98 subjects were included in the final analysis. After the intervention, systolic blood pressures (SBP) (mean: -7.89; 95%CI:‒11.39 to -4.39 mm Hg), diastolic blood pressure (DBP) (mean: -5.38; 95%CI: -7.77 to -3 mm Hg), and Mean Arterial Pressure (MAP) (mean: -6:95%CI: -8.4 to -3.6 mm Hg) decreased significantly in the garlic group as compared to the placebo group. Also, the percentage of reduced hs-CRP was significantly higher in the intervention group compared with the control group (mean: -16.1; 95%CI: -32.7 to -0.53; p = .035). Moreover, a positive correlation was observed between the percentage change in hs-CRP and percentage changes in SBP (r = 0.221; p = .029), DBP (r = 0.166; p = .012), and MAP (r = 0.210; p = .038). Garlic supplementation can be a safe and potentially adjunct treatment to reduce blood pressure and the risk of cardiovascular disorders in patients with NAFLD.

Effect of Nigella sativa oil extract on cardiometabolic risk factors in type 2 diabetes: A randomized, double-blind, placebo-controlled clinical trial

The objective of this study was to determine the effects of Nigella sativa oil extract on cardiometabolic risk factors in people with type 2 diabetes (T2D). A randomized, controlled, clinical trial was conducted on 43 patients with T2D (23 women and 20 men; aged 53.5 ± 7.4 years). The intervention group (N = 23) received two 500-mg per day soft gel capsules containing Nigella sativa oil extract and the control group (N = 20) received two identical placebo soft gel capsules containing sunflower oil per day for the same period, 8 weeks. Pre- and post-intervention cardiometabolic risk factors were measured. Compared with the placebo, the N. sativa oil significantly decreased FBS (p = .03(, HbA1c (p = .001), total cholesterol (p = .04), TG (p = .003), LDL-c (p = .001), BMI (p < .001), waist circumference (p < .001), SBP (p = .001), and DBP (p = .002). HOMA-IR (p = .51) and HDL-c (p = .91) did not change significantly following Nigella sativa supplementation. Nigella sativa oil exerted beneficial effects on glycemic control, serum lipid profile, blood pressure, and body weight among people with T2D. Further long-term trials in the future may help confirm the current therapeutic benefits of Nigella sativa in T2D.

Curcumin and cancer; are long non-coding RNAs missing link?

Despite significant signs of progress in cancer treatment over the past decade, either cancer prevalence or mortality continuously grow worldwide. Current anti-cancer agents show insignificant effectiveness, followed by serious side effects. It is important to find new, highly efficient pharmacological agents to increase cancer patients' clinical outcomes. Curcumin, a polyphenolic compound, has gained growing attention because of its anti-cancer properties. Curcumin can hinder the development, migration, and metastasis of cancer cells. The anti-cancer effects of curcumin are principally attributed to the regulation of several cellular signaling pathways, including MAPK/PI3K/Akt, Wnt/β-catenin, JAK/STAT, and NF-ĸB signaling pathways. Furthermore, curcumin can affect the expression and function of tumor-suppressive and oncogenic long non-coding RNAs (lncRNAs). In this study, we briefly reviewed the modulatory effect of curcumin on dysregulated tumor-supportive and tumor-suppressive lncRNAs in several cancers. It is hoped that a better understanding of curcumin's anti-cancer properties would pave the way for the development of a therapeutic approach in cancer.

A comprehensive review of long non-coding RNAs in the pathogenesis and development of non-alcoholic fatty liver disease

One of the most prevalent diseases worldwide without a fully-known mechanism is non-alcoholic fatty liver disease (NAFLD). Recently, long non-coding RNAs (lncRNAs) have emerged as significant regulatory molecules. These RNAs have been claimed by bioinformatic research that is involved in biologic processes, including cell cycle, transcription factor regulation, fatty acids metabolism, and-so-forth. There is a body of evidence that lncRNAs have a pivotal role in triglyceride, cholesterol, and lipoprotein metabolism. Moreover, lncRNAs by up- or down-regulation of the downstream molecules in fatty acid metabolism may determine the fatty acid deposition in the liver. Therefore, lncRNAs have attracted considerable interest in NAFLD pathology and research. In this review, we provide all of the lncRNAs and their possible mechanisms which have been introduced up to now. It is hoped that this study would provide deep insight into the role of lncRNAs in NAFLD to recognize the better molecular targets for therapy.

Food Insecurity and Preeclampsia: A Case-Control Study

Background: Household food insecurity is defined as the limited or uncertain access to adequate and safe food or limited ability to obtain food in a socially acceptable manner. Preeclampsia is a severe case of high-risk pregnancy, which endangers the health of women across the world, especially in developing countries. The current study aimed to use the nutritional deficiencies theory in pathogenesis of preeclampsia and determine the correlation between food insecurity and preeclampsia. Methods: This case-control study was conducted on 100 women with preeclampsia and 200 normal pregnant women with the gestational age of 20 weeks. Participants were selected via purposive sampling according to the eligibility criteria. Data were collected using the USDA questionnaire for food insecurity, socioeconomic data, and demographic data through interviews. Results: The findings indicated that the frequency of food insecurity was significantly higher in the preeclampsia women than the healthy women (71% vs. 21%; P < 0.001). Logistic regression indicated that the risk of preeclampsia was six times higher among pregnant women in the unsafe food status group than those in safe food status group [odds = 6.4; 95%CI: 3.3-12.4; P < 0.001]. Among the studied variables, socioeconomic status, history of stillbirth, history of preterm delivery, and ethnicity were significantly associated with preeclampsia during pregnancy (P < 0.05). In addition, women with low socioeconomic status were twice at the higher risk of preeclampsia compared to those with favorable socioeconomic status [odds = 2.7; 95%CI: 1.1-6.2; P = 0.01]. Conclusion: The current study indicated that the prevalence of food insecurity was high in Iranian women with preeclampsia, especially those with a history of preterm labor, history of stillbirth, low socioeconomic status, or non-Persian.

The Use of Curcumin for the Treatment of Renal Disorders: A Systematic Review of Randomized Controlled Trials

Chronic kidney disease (CKD) is one of the significant causes of morbidity and mortality worldwide, which could develop and progress to end-stage renal disease. Increased inflammation and reduced antioxidant capacity commonly occur in CKD and hemodialysis patients. Curcumin is a natural bioactive compound with antioxidant and anti-inflammatory properties. This systematic review was undertaken with the main aim of assessing the effects of curcumin/turmeric supplementation on renal diseases based on clinical trials. A comprehensive search was performed in PubMed/MEDLINE, Scopus, ISI Web of Science, and Google Scholar from inception up to April 6, 2020 to identify clinical trials assessing the effects of curcumin or turmeric alone, or in combination with other herbs or nutrients on renal diseases. Twelve studies met the eligibility criteria. These randomized controlled trials (RCTs) comprised 631 patients with either chronic kidney diseases (CKD), hemodialysis, diabetic proteinuria and nephropathy, and lupus nephritis. Curcumin/turmeric supplementation had favorable effects on renal diseases, particularly in terms of inflammation and oxidative stress. However, with the exception for proteinuria, their impact on clinical parameters, such as blood urea nitrogen, creatinine, glomerular filtration rate (GFR), and serum albumin, was weak and not significant. No serious adverse effects were reported following curcumin/turmeric supplementation. Within the limitations of this review, it can be concluded that curcumin/turmeric supplementation might have some beneficial effects on inflammatory and oxidative stress parameters of patients but no considerable positive impact on clinical outcomes of kidney diseases, apart from proteinuria.

Effects of curcumin-piperine co-supplementation on clinical signs, duration, severity, and inflammatory factors in patients with COVID-19: a structured summary of a study protocol for a randomised controlled trial

Objectives

This study aims to investigate the efficacy of curcumin-piperine co-supplementation on disease duration, severity and clinical symptoms, and inflammatory mediators in patients with coronavirus (COVID-19).

Trial design

This is a randomized, placebo-controlled, double-blind, parallel arm clinical trial.

Participants

All patients aged 20-75 years with the diagnosis of Covid-19 based on the PCR test. The exclusion criteria will include an age less than 20 and more than 75 years, current use of warfarin or other anticoagulant drugs, and the presence of sensitivity to herbal products such as turmeric and pepper.

This study will be conducted in academic hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran.

Intervention and comparator

Fifty outpatients will be randomly allocated in a ratio of 1:1 to receive a capsule of curcumin-piperine containing 500 mg curcumin plus 5 mg piperine or matching placebo containing 505 mg maltodextrin twice a daily, after lunch and dinner, over a period of 2 weeks. Similarly, 50 inpatients who are admitted to hospital wards excluding intensive care unit (ICU) will be randomly assigned in a ratio of 1:1 to receive a capsule curcumin-piperine or matching placebo (provided by the Sami Labs company) twice a daily, after lunch and dinner, over a period of 2 weeks.

Main outcomes

The main outcomes of this study are the efficacy of curcumin-piperine on coronavirus disease’s clinical symptoms, duration, severity, and inflammatory mediators after 2 weeks of curcumin-piperine co-supplementation.

Randomisation

Randomization sequences will be generated with the use of a random-number table with a permuted block design (block size of 4) and stratification according to the gender variable (male vs. female). These sequences will be prepared by an independent statistician and will be kept in opaque, sealed, numbered envelopes which will be opened only at the time of enrollment. The allocation ratio in intervention and control groups is 1:1. Researchers and all patients will be unaware of the study-group assignment until the completion of data analyses.

Blinding (masking)

This study is a double-blind clinical trial (participant, researcher). The curcumin-piperine and placebo supplements are packaged in similar numbered drug containers, and the researcher and all patients will be unaware of the study assignment until the end of the study.

Numbers to be randomised (sample size)

The calculated total sample size is 100 patients, with 25 patients in each group.

Trial Status

The protocol is Version 2.0, May 24, 2020. Recruitment began May 4, 2020, and is anticipated to be completed by April 19, 2021.

Trial registration

This trial has been registered by the title of “Effect of curcumin-piperine co-supplementation on disease duration, severity and clinical signs, and inflammatory factors in patients with coronavirus (COVID-19): A randomized, double-blind, placebo-controlled clinical trial study” in the Iranian Registry of Clinical Trials (IRCT) with code “IRCT20121216011763N46”, https://www.irct.ir/trial/47529. The registration date is May 4, 2020.

Full protocol

The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-020-04924-9.

The effect of propolis supplementation on clinical symptoms in patients with coronavirus (COVID-19): A structured summary of a study protocol for a randomised controlled trial

OBJECTIVES

This study aims to assess the effect of propolis supplementation on clinical symptoms in patients with coronavirus (COVID-19).

TRIAL DESIGN

This is a Double-Blind, Placebo-Controlled, Parallel Arm, Randomized Phase ΙΙ Clinical Trial.

PARTICIPANTS

Patients with the confirmed COVID-19 based on the PCR test are eligible to participate in the trial if they are 18 to 75 years of age and have no history of the current use of warfarin or propolis supplement and presence of sensitivity to bee products. Patients will be recruited from the Al-Zahra hospital in Isfahan city, Isfahan, Iran.

INTERVENTION AND COMPARATOR

Participants (N=40) in the intervention group will receive an identical propolis tablet (containing 300 mg Iranian green propolis extract) three times a day for a period of 2 weeks. Participants (N=40) in the control group will receive an identical placebo tablet (containing 300 mg microcrystalline cellulose) three times a day for 2 weeks. All tablets are prepared by the Reyhan Naghsh Jahan Pharmaceutical Co., Isfahan, Iran.

MAIN OUTCOMES

The main outcomes are changes in the coronavirus disease's clinical symptoms including duration and severity from baseline to the end of 2 weeks.

RANDOMIZATION

Eligible patients will be randomly allocated in a 1:1 ratio to the intervention or control group. Randomization will be performed on the basis of permuted block sizes of 4 and will be stratified according to sex categories. Randomization sequences will be prepared by the trial's pharmacist with the use of random-number tables.

BLINDING (MASKING)

The trial-group assignment will be concealed from all participants, clinicians, and investigators throughout the trial. To ensure blinding, randomization sequences will be kept in identical, opaque, sealed, sequentially numbered envelopes. Only the trial's pharmacist has access to the randomization list. Also, the placebo tablet will be similar to the propolis tablet in terms of texture, taste, color, odor, and weight. Both tablets will be provided in containers that are completely identical in weight, shape, labelling, and packaging.

NUMBERS TO BE RANDOMIZED (SAMPLE SIZE)

The calculated total sample size is 80 patients, with 40 patients in each group.

TRIAL STATUS

The protocol is Version 1.0, October 10, 2020. Recruitment began August 22, 2020, and is anticipated to be completed by March 21, 2021.

TRIAL REGISTRATION

The name of the trial register: The effect of propolis supplementation on clinical symptoms in patients with coronavirus (COVID-19): A randomized, double-blind, placebo-controlled clinical trial. IRCT registration number: IRCT20200802048267N1 . Date of trial registration: 20 October 2020, retrospectively registered.

FULL PROTOCOL

The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting the dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

Major dietary patterns and food groups in relation to rheumatoid arthritis in newly diagnosed patients

BACKGROUND

Evidence suggests that dietary patterns might act as environmental triggers in the development of chronic disorders such as rheumatoid arthritis (RA). However, data regarding the relationship between food patterns and RA are still limited and conflicting. In the current study, the authors aim to evaluate a link between major dietary patterns and RA in new case patients.

METHODS

This study was conducted in a case-control manner on 50 patients with newly diagnosed RA and 100 healthy individuals living in Mashhad, Iran. The individuals' dietary intake was assessed using a validated food frequency questionnaire (FFQ). The major dietary patterns were identified using factor analysis based on data from FFQ. Multivariable-adjusted logistic regression models were used to measure the associations between patterns and RA.

RESULTS

Three major dietary patterns were identified. High-level adherence to Western pattern had a positive association with RA (multivariable-adjusted OR tertile 3 vs. 1:1.95; 95% CI: 1.09-3.92; p-trend: .046), while the healthy pattern was inversely related to RA (multivariable-adjusted OR tertile 3 vs. 1:0.12; 95% CI: 0.03-0.44; p-trend: .001). No significant association was observed between the traditional pattern and RA.

CONCLUSIONS

Our findings revealed that people with dietary behaviors close to the Western dietary pattern are more likely to develop the disease. However, adhering to healthy and well-balanced dietary patterns rich in whole grains, low-fat dairies, white meats, eggs, fruits, vegetables, tea, and vegetable oils was found to be inversely correlated with the risk of RA.

Protective effects of propolis on hepatic steatosis and fibrosis among patients with nonalcoholic fatty liver disease (NAFLD) evaluated by real-time two-dimensional shear wave elastography: A randomized clinical trial

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, while no drugs have been approved for its treatment. The pieces of evidence indicate that propolis as a novel anti-inflammatory agent might be a promising candidate to treat NAFLD. We aimed to evaluate the efficacy of propolis on hepatic steatosis and fibrosis in patients with NAFLD. This randomized clinical trial was conducted on 54 patients with NAFLD. Patients were randomly assigned to receive propolis tablets at a dose of 250 mg twice daily for 4 months or placebo. The improvement in hepatic steatosis and fibrosis was evaluated using two-dimensional shear wave elastography. Improvement in the hepatic steatosis was significantly higher in the propolis group than the placebo group, even after adjustment for baseline value and changes in weight, energy intake, and physical activity (odds ratio [OR]: 5.67; 95% confidence intervals [CI]: 1.41-22.8; p = .014). A significant reduction was observed on the liver stiffness in the propolis group (-0.65 ± 0.56 kPa; p = .001), whereas it increased in the placebo group (0.27 ± 0.59 kPa; p = .037). Also, the intake of propolis significantly decreased high-sensitivity C-reactive protein (hs-CRP) levels compared with the placebo group (-0.371; 95%CI: -0.582 to -0.16 mg/L; p = .01). Changes in serum levels of fasting blood sugar, alanine aminotransferase, aspartate aminotransferase, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, cholesterol, and triglyceride did not differ significantly between the two groups (p > .05). There was no significant improvement in insulin resistance in both groups (p > .05). Propolis seems to have protective effects on hepatic steatosis and fibrosis and to reduce the serum levels of hs-CRP in patients with NAFLD.

A systematic review of preclinical studies on the efficacy of propolis for the treatment of inflammatory bowel disease

Propolis is a resinous substance produced by bees from plants. There has been some evidence indicating that propolis may be a candidate for the treatment of inflammatory bowel disease (IBD) because of its potent antioxidant properties and ability to modulate immune response and gut microbiome. The objective of this systematic review was to investigate the role of propolis in the treatment of IBD, emphasizing possible mechanisms underlying the anti-inflammatory properties of it. Searches were performed in ISI, PubMed/Medline, Scopus, EMBASE, and Cochrane Library databases up to March 2020. According to the studies examined in this review, the administration of propolis can be useful in attenuating many aspects of clinical, macroscopic, and histological features of colitis in animal models. The efficacy of propolis in the treatment of IBD might be attributed to its potent antioxidants and anti-inflammatory activities. Propolis may also be involved in the modulation of the gut microbiota and in the improvement of the intestinal mucosal barrier function. The major mechanism of action is most likely to be mediated via the prevention of some transcriptional factors and associated proteins. However, future studies are warranted to investigate the clinical utility of propolis as a candidate in the treatment of IBD.

Does propolis affect the quality of life and complications in subjects with irritable bowel syndrome (diagnosed with Rome IV criteria)? A study protocol of the randomized, double-blinded, placebo-controlled clinical trial

BACKGROUND

Irritable bowel syndrome (IBS) is one of the most frequent and recurrent gastrointestinal diseases. However, up to now, no pharmacological agent has been approved to treat IBS. Emerging evidence showed that inflammation has a vital role in enhancing nervous system sensitivity and perception of abdominal pain in subjects with IBS. Propolis is an herbal substance with a broad spectrum of antioxidants, anti-inflammatory, and prebiotic properties, which might exert beneficial effects to reduce the severity of IBS. The current clinical trial aims to evaluate the efficacy of propolis supplementation on IBS.

METHODS

This single-center, randomized, double-blind, placebo-controlled clinical trial will be performed to evaluate the effect of propolis supplementation in adult patients with IBS diagnosed with Rome IV criteria. Fifty-two eligible patients will randomly be allocated to receive a propolis tablet (450 mg, containing 100 mg polyphenol compounds) or identical placebo, twice daily for 6 weeks. The primary outcome of the trial is an improvement in IBS severity from baseline to the sixth week of intervention. The secondary outcomes include the change in weight, waist circumference, and IBS quality of life. We will use the paired sample t test or Mann-Whitney U test for the within-group comparison and independent sample t test or Wilcoxon rank-sum and chi-square test or Fisher's exact test for the between-group comparison. Besides, a multivariable-adjusted mean effect will be computed using the ANCOVA test.

DISCUSSION

We hypothesize that propolis supplementation would be useful for treating IBS through its antioxidants, anti-inflammatory, and prebiotic properties. This trial will show the results of propolis supplementation, whether positive or negative, on IBS. If the current trial confirms our hypothesis, propolis supplementation can be a new choice in adjunctive therapy of IBS.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20190708044154N1. Registered on 26 December 2019. Updated on 13 February 2020. https://en.irct.ir/trial/40983 SPONSOR: Tabriz University of Medical Sciences, Tabriz, Iran.

Depression Relationship with Dietary Patterns and Dietary Inflammatory Index in Women: Result from Ravansar Cohort Study

BACKGROUND AND AIMS

Chronic inflammation is thought to have a major role in the pathophysiology of depression. Diet has been shown to modulate the inflammatory state, thus emphasizing its potential as a therapeutic role in depression. But, little is known about the relationship between dietary intake and depression. The current study aimed to investigate the relationship between major dietary patterns, a dietary inflammatory index (DII) score, and depression among women.

METHODS AND MATERIALS

This cross-sectional study included 4630 women aged 35-65 years using baseline data from the Ravansar Non-Communicable Diseases (RaNCD) cohort study in Western Iran. Diet was evaluated using a validated 125-item food frequency questionnaire (FFQ) to determine DII scores and dietary patterns. Traditional, healthy, and unhealthy dietary patterns were extracted using factor analyses.

RESULTS

A significant upward trend in the odds of depression was observed across the tertiles s of DII scores (P-trend: 0.019). After the adjustment for possible risk factors, a high adherence to an unhealthy dietary pattern was associated with a higher risk of depression than a low adherence (OR: 1.63; 95% CI: 1.1-2.4). A high adherence to a healthy dietary pattern was associated with the lower odds (OR: 0.61; 95% CI: 0.04-0.92). Among the main food groups, a high intake of eggs and refined grains was associated with a higher risk of depression.

CONCLUSION

In women, a refined grain dietary pattern is a risk factor for depression, whereas a healthy dietary pattern is protective. We have also shown that adherence to a pro-inflammatory diet was significantly associated with depression. Adherence to a dietary pattern with high intakes of dairy products, seafood, red meats, nuts, vegetables, fruits, flavor, and vegetable oils and diets with low inflammatory properties were associated with a lower risk of depression in women.

Therapeutic Effects of Garlic on Hepatic Steatosis in Nonalcoholic Fatty Liver Disease Patients: A Randomized Clinical Trial

BACKGROUND AND AIMS

Emerging evidence suggests that garlic (Allium sativum L.) and its bioactive components can mitigate hepatic steatosis by the modulation of hepatic lipid metabolism. We aimed to assess the efficacy of the garlic administration on hepatic steatosis in patients with NAFLD.

PATIENTS AND METHODS

This clinical trial was conducted on adult patients with ultrasound-diagnosed NAFLD. Eligible participants were randomly assigned, with the use of the stratified blocked procedure, to receive 800 mg garlic or placebo for 15 weeks. The primary outcome was the improvement in the hepatic steatosis diagnosed by ultrasound technique after 15 weeks of intervention.

RESULTS

A total of 110 patients underwent randomization, and 98 patients completed the trial. Twenty-four (51.1%) patients in the garlic group achieved improvement in the hepatic steatosis compared to eight (15.7%) patients in the placebo group with the relative risk of 5.6 (95% CI: 2.17 to 14.5; P=0.001), which remained significant after adjusting for baseline value of hepatic steatosis. There were significant reductions in weight and serum ALT, AST, FBS, Hb A1C, total cholesterol, LDL-cholesterol, and TG concentration with the garlic intake compared to placebo (P<0.05). The results were also significant after adjusting for weight change, energy intake, and physical activity. No serious adverse effects were observed with the garlic intake.

CONCLUSION

The intake of garlic powder was accompanied by a significant improvement in the hepatic steatosis and comorbidity related to this condition among subjects with NAFLD.

Dietary patterns in relation to hepatic fibrosis among patients with nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is a multifactorial disorder that can progress to fibrosis. Several dietary patterns have been associated with histological features of NAFLD. However, little is known about the association between dietary patterns and hepatic fibrosis.

PURPOSE

The current study aimed at identifying the relationship between major dietary patterns and hepatic fibrosis among patients with NAFLD.

SUBJECTS AND METHODS

This cross-sectional study included 170 eligible subjects with NAFLD. Diet was evaluated using three 3-day dietary records during a 1-month period. Hepatic fibrosis was diagnosed using Fibroscan. Western, Iranian, and healthy dietary patterns were extracted using factor analysis.

RESULTS

After adjustment for other risk factors, adherence to a Western dietary pattern was associated with the higher odds of fibrosis (OR: 4.21; 95% CI: 1.63-8.31), whereas adherence to a healthy dietary pattern was associated with the lower odds of fibrosis (OR: 0.26; 95% CI: 0.10-0.49). Among main food groups, high intake of red meat, hydrogenated fats, and soft drinks was associated with the higher risk of fibrosis, whereas tea and coffee consumption had a protective role in hepatic fibrosis independent of other risk factors.

CONCLUSION

The adherence to a healthy dietary pattern characterized by high intake of low-fat dairies, white meat, nuts, vegetables, fruits, and vegetable oils combined with coffee and tea consumption might be helpful in the nutritional strategies against hepatic fibrosis.

High Dose Vitamin D Supplementation Is Associated With a Reduction in Depression Score Among Adolescent Girls: A Nine-Week Follow-Up Study

Although vitamin D deficiency is known to be a risk factor for some psychological disorders, there have been few studies on the effects of vitamin D supplementation on their symptoms. Depression and aggression are common mental disorders and are associated with disability and disease burden. We aimed to evaluate the effectiveness of high-dose vitamin D supplementation on depression and aggression scores in adolescent girls. Nine hundred forty adolescent girls received vitamin D₃ at a dose of 50,000 IU/week for 9 weeks. Anthropometric parameters and blood pressure were measured using standard protocols at the baseline and at the end of the study. Depression score was evaluated using the Beck Depression Inventory-II and aggression was evaluated using the Buss-Perry Aggression Questionnaire at baseline and at the end of the study. Comparison among the four categories of depression score (normal, mild, moderate, and severe) revealed no significant differences in demographic and anthropometric parameters at baseline. After 9 weeks of vitamin D supplementation, there was a significant reduction on mild, moderate, and severe depression score. However, vitamin D supplementation had no significant effect on aggression score. Our results suggest that supplementation with vitamin D may improve depressive symptoms among adolescent girls, as assessed by questionnaire, but not aggression score. Formal, larger, randomized controlled studies are required to confirm this effect on cases with different degrees of depression.

Effect of garlic powder consumption on body composition in patients with nonalcoholic fatty liver disease: A randomized, double-blind, placebo-controlled trial

Background:

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease that is becoming a public health problem in recent decades. Obesity and overweight play a key role in NAFLD pathogenesis. Thus, weight loss (especially body fat mass) is one component of therapeutic strategies in NAFLD. Results from experimental studies have shown that garlic (Allium sativum L.) can reduce body weight and body fat mass. However, the effect of garlic on body fat mass and weight in the human population, which is addressed in this study, is still obscure.

Materials and Methods:

In this clinical trial, 110 subjects with NAFLD were randomly assigned to the intervention or the control group. The intervention group received two garlic tablets (containing 400 mg of garlic powder) daily while the control group received placebo tablets. Dietary intake and physical activity of participants were obtained by a validated questionnaire. Body composition was measured by bioelectrical impedance analysis. Data were analyzed using SPSS software version 16.

Results:

In the intervention group, significant reductions were observed in body weight and body fat mass (P < 0.05). We also observed a significant reduction in body weight in the control group, but there were no significant changes in total body water and lean body mass in both groups (P > 0.05). In the intervention group, the percentage change in body weight was significantly greater than the control group (−2.6 vs. −0.7, P = 0.02). No serious side effects associated with the intervention were reported.

Conclusion:

Our trial suggests that garlic supplemfrom experimental studies have shown thatentation can reduce body weight and fat mass among subjects with NAFLD.