Iranian Journal of

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The incidence and prevalence of type2 diabetes mellitus is increasing worldwide. Many believe that type 2 diabetes mellitus is a disease that can be prevented by appropriate interventions in individuals at high risk for the disease. A number of studies have therefore looked at primary prevention during the past decade. Iran’s diabetic population of approximately 2 million people and the warning by the World Health Organisation that diabetes is on the rise in developing countries make the primary prevention of diabetes mellitus in Iran doubly important. Researchers have been increasingly focusing on identifying the risk factors for type 2 diabetes and, through these, appropriate strategies to prevent the rapidly growing incidence of this disease in the population at risk. Genetic predisposition (a positive family history), insulin resistance, obesity, impaired glucose tolerance, a history of gestational diabetes mellitus, physical inactivity and an unsuitable diet are among the most important recognised risk factors for type 2 diabetes other factors have also been found to contribute. Most of the available research has evaluated the effect of behavioural or lifestyle modification, in the form usually of dietary education and increased physical activity, in the primary prevention of type 2 diabetes. The second most common approach has been pharmacological manipulation. The information available indicates that type 2 diabetes will come to be considered as a preventable disease within the next decade. The weight of research behind this problem will undoubtedly discover even more effective methods of preventing type 2 diabetes in the near future than behavioural/lifestyle modification.

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Concept of dietary patterns is new in the filed of nutritional epidemiology. However, it has not been focused to the extent that foods or nutrients have been considered. Although, identifying the association between nutrients and foods intake with chronic diseases is valuable yet, recent evidences have shown that the clinical trials that have used nutrients are not too successful to indicate the effects of that nutrient on the disease risk. On the other hand, the studies used dietary patterns have shown the significant effects on disease risk. Therefore, using dietary patterns analysis is an efficient method to identify diet-disease relations. However, it should be kept in the mind that dietary patterns are different across gender, ethnics, cultures and regions. It is, therefore, recommended that investigators in different countries need to assess their own community dietary patterns and emphasize on these patterns when trying to reduce chronic disease risk. The current study has been conducted to review the studies that have assessed the association of dietary patterns and chronic disease risk.

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Background: Diabetes is one of the chronic diseases need continual medical care and self care education, and nutritional therapy account as an integral part of dietary management. This study carried out to investigate the effect of diabetes dietary counseling on quality of life in type II diabetic patients.
Methods: As a Randomized Clinical Trial, 144 patients with type II diabetes aged 35-65 years were recruited from patients referred to Imam Hossein Hospital dietary clinic and randomly assigned in case and control groups. A dietary schedule consisting 50-60% carbohydrate, 10-20% protein and less than 30% fat was prescribed at the first orally in a 30-minute counseling session then in written form for case group, while the control group was left without any intervention. The quality of life score was estimated in both groups via using the Short-form 36-Item (SF-36), before dietary counseling and one mouth after the dietary counseling, and the quality of life score between both groups were compared. The data were analyzed using SPSS software. Results: Average age was 52.1±10 years. Before dietary counseling, the quality of life among 46% of subjects was assessed to be poor and 52% claimed their health status poorer than the last year. Independent-Samples T-Test with P<0.05 revealed significant difference in weight, systolic blood pressure, diastolic blood pressure, blood sugar before and after breakfast, blood cholesterol and triglyceride, after dietary counseling in both groups. Also, this test with P<0.05 revealed significant difference in the quality of life score in general and in each dimensions, after dietary counseling in both groups. Paired-Samples T-Test revealed significant increase in the quality of life score in general and in each dimensions on pre and post dietary counseling in case group, but didn’t observe in control group. Conclusion: According to the results, it was revealed that dietary counseling can promote the quality of life in patients with type II diabetes in all dimensions. So, it seems dietary counseling program is essential in prevention and decrease of type II diabetes complications.

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Background: There are no available reports indicating the effects of Dietary Approaches to Stop Hypertension (DASH) eating plan on insulin resistance, inflammation and oxidative stress among pregnant women with gestational diabetes mellitus (GDM) We aimed to investigate the effects of DASH diet on insulin resistance, serum hs-CRP and biomarkers of oxidative stress among pregnant women with GDM. Methods: This randomized controlled clinical trial was performed among 32 pregnant women diagnosed with GDM at 24-28 weeks' gestation. Subjects were randomly assigned to consume either the control (n=16) or DASH diet (n=16) for 4 weeks. The DASH diet was rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats, total fats, cholesterol, refined grains, and sweets, with a total of 2400 mg/d sodium. The control diet contained 40-55% of its energy as carbohydrates, 10-20% as proteins and 25-30% as total fats. Fasting blood samples were taken at baseline and after 4 weeks of intervention to measure fasting plasma glucose (FPG), serum insulin and hs-CRP, HOMA-IR, plasma total antioxidant capacity (TAC) and total glutathione levels (GSH). Results: Consumption of DASH diet, compared to the control diet, resulted in decreased FPG (-7.62 vs. 3.68 mg/dL P=0.02), serum insulin levels (-2.62 vs. 4.32 µIU/ml, P=0.03) and HOMA-IR score (-0.8 vs. 1.1 P=0.03). Increased concentrations of plasma TAC (45.2 vs. -159.2 mmol/L P<0.0001) and GSH (108.1 vs. -150.9 µmol/L P<0.0001) were also seen in the DASH group compared with control group. We failed to find a significant difference in mean changes of serum hs-CRP levels between the two diets. Within-group comparisons revealed a significant reduction in plasma TAC and GSH levels in the control diet, while a significant rise in these biomarkers in the DASH diet. Conclusion: In summary, consumption of DASH diet in pregnant women with GDM had beneficial effects on FPG, serum insulin levels, HOMA-IR score, plasma TAC and total GSH levels. The effects of this dietary pattern on pregnancy outcomes need to be investigated in future studies.

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Background: Physiological stress may affect eating habits and also foods intake may alter the physiological stress. According to the reports of high levels of serum cortisol as a stress biomarker in type 2 diabetic patients the aim of this study was to investigate the relationship between dietary patterns and serum cortisol concentration in type 2 diabetic patents. Methods: This cross-sectional study was conducted on 241 type 2 diabetic patients in 2013. Major dietary patterns were obtained by factor analysis. Serum cortisol was measured at 8 am. Serum cortisol level was compared among tertiles of dietary patterns using ANCOVA adjusted for confounders (age, sex, BMI, and fasting blood glucose). Linear regression analysis was performed to assess the association between serum cortisol and scores of dietary patterns. Results: Three major dietary patterns were identified as Western, healthy and healthy like. None of the variables age, waist circumference, body mass index, physical activity level, duration of diabetes and fasting blood glucose was significantly associated with serum cortisol. After adjustment for confounders, no statistically significant difference was found in mean serum cortisol among tertiles of dietary patterns or no statistically significant association between serum cortisol and dietary patterns scores. Mean serum cortisol was 12.95±5.10 nmol/L which was in normal range. Conclusion: This study showed that in type 2 diabetic patients, normal levels of serum cortisol were not associated with the adherence to Western, Healthy and Healthy like dietary patterns.

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Background: Existing studies show that a poor diet has an effect on the progression of non-alcoholic fatty liver disease (NAFLD). The aim of the present study was to systematically summarize the results of studies on the relationship between dietary intakes and NAFLD. Methods: A review of Scopus, PubMed, Cochrane Library, Magiran, Medlib and SID databases and theses in the National Library of the Islamic Republic of Iran was conducted to identify epidemiological studies concerning NAFLD, food groups and dietary patterns. Cross-sectional, case-control and cohort studies with documented in English were selected for this systematic review. Duplication, topic, type of study, study population, variables examined and quality of data reporting of articles were evaluated. Results: Of 2128 articles found in the initial search, 33 were reviewed in full-text of these 6 articles were included in the systematic review. The literature review showed patients with NAFLD consumed more red meat, fats and sweets and less whole grains, fruits and vegetables. The Western dietary pattern was positively associated with the risk of NAFLD and adherence to the Mediterranean diet was negatively correlated to hepatic steatosis. Conclusion: The results of the systematic review indicate that different dietary intakes may be associated with development of NAFLD and its related factors. Due to limited research documented on this topic, further prospective studies are recommended.

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Background: The higher dietary acid load may affect blood pressure, blood sugar levels, and insulin levels. The purpose of this systematic review study is to examine the relation of dietary acid load with blood pressure and blood glucose.
Methods: We searched in PubMed, Google Scholar, Scopus and Medline up to July 2016, using the keywords "dietary acid load", "serum glucose", "insulin resistance" and "hypertension ". 12 studies (6 cross-sections, 5 cohorts and 1 intervention) were included in this systematic review.
Results: Out of eleven articles related to blood pressure, three studies showed a significant relationship between dietary acid load scale and hypertension. Three studies found only a significant association between dietary acid load and systolic blood pressure, while other studies did not show any significant correlation between dietary acid load and systolic or diastolic blood pressure. Moreover, in relation to blood glucose control, among eight studies, one study demonstrated a significant relationship between increasing dietary acid load and the incidence of diabetes. One study reported a significant relation of dietary acid load with fasting blood glucose and glycosylated hemoglobin concentration. In addition, two studies indicated a significant correlation between increased dietary acid load and insulin resistance, but other studies not revealed a meaningful relationship.
Conclusion: Since most studies suggest a significant association between increased dietary acid load and higher blood pressure, therefore it seems which dietary acid load can effect on blood pressure. The results of the investigation of the relationship between dietary acid load with glucose, insulin levels or diabetes have many contradictions. According to limited studies in this field, there is a need to further trial or prospective studies regarding the dietary acid load and the incidence of diabetes, insulin levels, and other blood glucose markers.
 

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Background: Interleukin-6(IL-6) and Tumor Necroes Factor-alpha (TNF-α) are secreted by adipose tissue and are potential regulators of low grade inflammation and metabolic disorders in Obesity Type 2 Diabetes (OT2D). hence, present study examined the effects of interval training with different diet on low grade inflammation and some of metabolic indexes in OT2D.
Methods: forty-five  OT2D men were randomly assigned into a High intensity interval training(HIIT) plus  normal diet group (ND+H), low carbohydrate diet plus   HIIT group(LC+H)   or  HIIT plus   low fat diet group(LF+H) that involved adherence to a 1200-1500 kcal/day(ND+H: 28% fat, 54% carb and 18% protein; LC+H: 42% fat, 40% carb and 18% protein; LF+H: 20% fat, 62% carb and 18% protein) while participating in a supervised HIIT (3 d/week for 12 weeks). Anthropometrics, physiologic features and fasting blood samples were obtained at 0, 8(8 weeks diet only), 16, 20(12 weeks HIIT plus diet) and 24(4 weeks diet only) weeks.
Results: Maximum Oxygen Consumption (VO2max) after 24 weeks of intervention, the LC + H group (P = 0.001, F = 2.195) and LF + H group (P = 0.014, F = 3.548) showed a significant decrease Compared to the pre-test, this decrease was not observed in the ND + H group. The decrease in IL-6 index with other variables (except for maximum oxygen consumption) showed a significant relationship, but the VO2max index had a significant reverse relationship [for LC + H group (p = 0.001, r = -0.54); For LF + H group (p = 0.019, r = -0.41 =), they showed IL-6. In line with changes in IL6, there was a significant difference in TNF-α index in all stages of the study. After 24 weeks of intervention, the LC + H group (P = 0.001, F = 5.541) and LF + H group (p = 0.001, F = 9.654) had a significant reduction compared to the pre-test , But this decrease was not observed in the ND + H group. Significant increase in VO2peak with significant decreases in insulin, HOMA-IR and HbA1c was observed in all groups. Also, there was a significant decrease in IL-6 and TNF-α in LC + H and LF + H groups. Changes in IL-6 and TNF-α showed an inverse association with peak oxygen consumption. Pearson's analysis revealed meaningful relationships between changes in lipid profiles with peak oxygen consumption. VO2peak significant increases in all groups with significant decreases in insulin, HOMA-IR and HbA1c in all groups. Also, IL-6 and TNFα significant decreases in LC+H and LF+H groups. Changes in IL-6 and TNFα significantly Inverse correlated with VO2peak.  Pearson analysis revealed significant correlations between changes in lipid profile to VO2peak.
Conclusion: Results support contentions that diet and exercise affects low grade inflammatory and fitness, lipid and glycemic profiles that changes in IL-6 and TNF-α be correlated with some of these changes.
 

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Background: Inflammation is one of the main causes of obesity and type 2 diabetes due to obesity and can increase metabolic disorders. Because exercise and diet are effective in reducing inflammation, Hence, Present Study Examined the Effects Of 24 Weeks Interventions On IL-6 Index Changes in Obesity Type 2 Diabetic Men: Influenced by HIIT And Diet Regimes
Methods: In this study, 70 men (Obese Type 2 Diabetic Patients) were randomly assigned into 7 groups (4 groups in different diet plus HIIT intervention and 3 groups only in different diet) that involved adherence to a 1,200 kcal/day for 1 week until 1,900 kcal/d diet for 24 weeks while participating in a supervised HIIT (12 week) followed with 4 weeks primarily diet regimes. Diet regimes consist of standard diet (50% CHO, 32% fat), low carbohydrate diet (25% CHO, 57% fat; 70% of 57% fat was unsaturated fat), low fat diet (67% CHO, 15% fat) and high fat (25% CHO, 57% fat; 50% of 57% fat was saturates fat), while protein was 18% for all groups. Anthropometrics and physiologies parameters, Body composition and fasting blood samples were obtained at 0, 4, 8, 14, 20 and 24 weeks. Data were analyzed by repeated measures analysis, one-way ANOVA test. Data are presented as mean±SD changes from baseline.
Results: results indicated that between differences times wasn’t show significant different (F (5,315) =3.66; P=0.002; η2=0.055).  also results demonstrated that within groups changes interactions don’t show significant different (F (5,315) =1.61; P=0.025; η2=0.133). This results also revelated that maximum increase and decrease of IL-6 was in high fat diet (28.09±19.80) and low CHO+HIIT (-28.89±25.13) after 24 weeks interventions. maximum increase and decrease of IL-6 was in high fat diet (26.74±25.33) and low fat +HIIT (-32.11±29.17) After 12 weeks HIIT + diet interventions.
Conclusion: Results support contentions that different diet regimes and exercise were selectively affects Pro Inflammatory markers and that changes in low CHO and low fat plus HIIT and low CHO meals plus with HIIE may be benefit for obese type 2 diabetic patients

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Background: This review study aims to shade light on the effects of carrying out interventions and policies in order to reduce the incidence and prevalence of non-communicable diseases (NCDs) and their behavioral risk factors (i.e., unhealthy diet, insufficient physical activity and smoking) and strategies and approaches to reduce their attributed burden.
Method: In this research, the documents and reports available in the Ministry of Health, developed action plans, recommendations of national and international organizations, evidence gathered from monitoring and evaluations and the "National Action Plan and Control of Non-Communicable Diseases and Related Risk Factors in the Islamic Republic of Iran, 2015-2025" were investigated with respect to  each of the three main risk factors of NCDs, including unhealthy diet, insufficient physical activity, and smoking (harmful consumption of alcohol has been reviewed in another article). Each risk factor has been discussed separately in the sections describing the current situation, policies and implemented interventions, findings, and future plans.
Results: The implemented interventions and policies to achieve the goals stated in the "National Action Plan and Control of Non-Communicable Diseases and Related Risk Factors in the Islamic Republic of Iran, 2015-2025" in the field of unhealthy nutrition, resulted in revising the food standards. Interventions in the field of physical activity have caused a 1.5% reduction in the relative prevalence of sedentary behavior in the society. Our research also revealed that interventions in the field of tobacco consumption have led a total decrease of 7.44% among Iranian people over 18 years of age, but a decrease in the use of hookah is not recorded, and its consumption has increased by 28% in 2021 compared to 2011.
Conclusion: According to the findings, the goals stated in the aforementioned document have not been fully achieved, so new interventions and policies should be used by those involved.

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Background: Animal studies have shown maternal low/ high-calorie diet during pregnancy can alter metabolism of offspring through change in Sirtuin 1 (SIRT1) expression, as a metabolic sensor. However, there is no study on the effects of isocalorie diet. Herein, effects of two isocalorie diets with different amounts of fat were assessed on SIRT1 gene and protein level in the liver of male and female offspring.
Methods: The control group received AIN93G diet. In this diet, 16% and 64% of total calorie were prepared from fat and carbohydrate, respectively. The intervention group received high fat AIN93G diet contained 48% and 32% of calorie from fat and carbohydrate, respectively. In both diets, fat was prepared from soy oil. Diets were isocaloric and 20% of total calorie was provided from protein. Mothers categorized to one of these diets and offspring received the control diet after weaning (3 weeks after the birth).
Results: SIRT1 gene and protein levels were lower in male and female offspring born from mothers received high-fat diet than the controls (p<0.001).
Conclusion: Change in maternal dietary fat, without increase in calorie, effects on gene and protein levels of SIRT-1 in the liver of next generation. 

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Background: Leptin and adiponectin are adipokines produced by fat cells and play an important role in obesity. The purpose of this study was to compare the effect of low-calorie diet (LCD) and exercise (Exe) on leptin and adiponectin in middle-aged and elderly adults with overweight and obesity.
Methods: A systematic search was conducted in PubMed, Web of Science, SID, Magiran, and Google scholar databases for English and Persian articles published until August 2023. The effect size and 95% confidence interval (CI) were calculated using the random effect model.
Results: The results of 25 studies with 2063 middle-aged and elderly people with overweight and obesity showed that the combination of exercise and diet compared to exercise alone causes a significant decrease in serum leptin [SMD=-0.4, P=0.001], and a significant increase in serum adiponectin [SMD=0.17, P=0.02] in middle-aged and elderly adults with overweight and obesity. Also, findings showed that the diet compared to exercise alone causes a decrease in serum leptin [SMD=-0.16, P=0.1], and a significant increase in serum adiponectin [SMD=0.05, P=0.7] in middle-aged and elderly adults with overweight and obesity. Also, diet compared to exercise alone does not cause a significant change in serum leptin [SMD=-0.11, P=0.2], and serum adiponectin [SMD=0.02, P=0.8] in middle-aged and elderly adults with overweight and obesity. Conclusion: It is suggested that middle-aged and elderly people to achieve hypoleptinemia and hyperadiponectinemia, use a combination Include exercise training and low-calorie diet in your lifestyle.

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Background: The Actinobacteria and Bifidobacterium population, which are the beneficial intestinal bacteria, was compared between pregnant women with gestational diabetes (GDM) and healthy-one, and their relationship with the amount of dietary macronutrients was investigated.
Methods: Fifty pregnant women with GDM, who were identified in the 24-28 weeks of pregnancy, based on the oral glucose tolerance test, and 50 healthy pregnant women with normal results were selected. Stool samples were collected. Bacterial DNA was extracted and 16S rRNA gene amplification was done by qPCR method, using universal bacterial primers. Food information was collected using a food frequency questionnaire.
Results: In total, Actinobacteria phyla (p=0.02) and Bifidobacterium (p=0.001) significantly lower in the pregnant women with GDM than the normoglycemic. Adjusting to the all factors and grouping, age (p=0.02), and education (p=0.04) showed a significant effect on the gut Actinobacteria population. Higher daily calorie intake decreased the intestinal Actinobacteria population by 11.1 times (p=0.01). Dietary carbohydrate and fat showed a positive effect on the gut Actinobacteria (p=0.02 and p=0.003, respectively). Dietary cholesterol showed a negative effect on the Bifidobacterium population (OR= -0.54, p=0.02).
Conclusion: Increase in dietary carbohydrates and fat with an emphasis on mono- and poly-unsaturated fatty acids, decrease in daily calorie intake and cholesterol lead to increase in the Actinobacteria and Bifidobacterium, as the beneficial gut bacteria.