Dietary Quality among Tehranian Adults in Relation to Lipid Profile: Findings from the Tehran Lipid and Glucose Study

The prevalence of dyslipidaemia has been increasing in developing countries that are undergoing nutrition transition. However, the association of diet quality and lipid profile has not been well-understood in these countries. The aim of the current study was to compare the ability of three diet quality indices 12the Mediterranean diet scale (MDS), healthy eating index-2005 (HEI-2005), and diet quality index-international (DQI-I) in relation to changes in lipid profile between baseline and 6.7 years of follow-up. Baseline data from two 24-hour dietary recalls provided by 469 adults with mean age of 38.7\ub112.3 years, who were participants of the Tehran Lipid and Glucose Study, were analyzed to describe dietary intakes. Data on anthropometry, sociodemography, physical activity, and other lifestyle variables were recorded, and a comparison of baseline and follow-up data revealed changes in the concentrations of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). A general linear model was used in assessing changes in lipid profile depending on adherence to diet quality indices at baseline, after adjustment for age, smoking status, waist-circumference, body mass index, physical activity, and energy intake. A significant interaction was observed between scores and sex, and upon stratification, males in the highest quartile score of the HEI-2005 had significantly lower TG changes than those in the lowest quartile, after adjusting for confounders (-8.8 vs 2.9, p=0.038). No association was apparent in females (-0.2 vs 11.2, p=0.297). In addition, a positive association was found between DQI-I and HDL-C (Q1=0.6 vs Q4=-2.0, p=0.044) in males. In both sexes, all these indices were weakly associated with TC while none was associated with LDL-C. It is concluded: adherence to the HEI-2005 recommendations was weakly associated with reduced TG concentration in an urban Iranian adult population. The MDS and DQI-I were not related to change in lipid profile

Diagnostic Performance of Ultrasonography for Identification of Small Bowel Obstruction: A Systematic Review and Meta-analysis

Introduction: Small bowel obstruction (SBO) is known as a common cause of acute abdominal complaints in the emergency department (ED). The modality of choice for the diagnosis of SBO has not yet been established. This systematic review and meta-analysis aimed to investigate the accuracy of ultrasonography for the diagnosis of SBO. Methods: Systematic search was performed on five electronic databases including Medline, Scopus, Web of Sciences, Embase, and Cochrane Library, and the retrieval period was from the inception of each database to November 2023. The quality of the included studies were investigated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). The pooled values of diagnostic characteristics for ultrasonography were estimated using meta-Disc and Stata statistical software. Results: Twenty-one studies with a total of 1977 patients were included in the meta-analysis. The pooled estimate for sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary ROC curve of ultrasonography for diagnosing SBO were 0.93 (95% CI: 0.91–0.95), 0.8 (95% CI: 0.77–0.83), 5.69 (95% CI: 3.64–8.89), 0.1 (95% CI: 0.07–0.16), 83.51 (95% CI: 18.12–182.91) and 0.96, respectively. Conclusion: The findings of this meta-analysis showed that the utilization of ultrasonography holds promise as a diagnostic imaging for SBO with high accuracy. However, additional worldwide studies are essential to get more evidence on the value of ultrasonography for the diagnosis of SBO

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation

Effects of Iron Salts on Demineralization and Discoloration of Primary Incisor Enamel Subjected to Artificial Cariogenic Challenge versus Saline Immersion

Aim: This study aimed to assess the effects of iron salts on the demineralization and discoloration of primary incisor enamel subjected to artificial cariogenic challenge (ACC) versus saline immersion. Methodology: In this in vitro experimental study, 90 primary incisors were evaluated in 10 groups (n = 9). Five groups were subjected to ACC, and the other five were immersed in saline. Ferrous sulfate, ferrous fumarate, ferrous ammonium citrate, and ferrous gluconate were added to both saline and cariogenic solutions. The solutions were refreshed every 48 h. After 14 days, the teeth were removed from the media and their demineralization was inspected via scanning electron microscopy (SEM). Energy-dispersive X-ray spectroscopy (EDX) was also performed. The color of the specimens was measured at baseline and after the intervention using the Vita Shade Guide. Results: Data were analyzed by the Kruskal–Wallis test, one-way ANOVA, and Tukey’s test. The color change of specimens subjected to ACC was greater than the color change of those in saline (p = 0.083). The teeth subjected to ACC showed greater iron uptake than did those in saline (p = 0.023). SEM assessment revealed a regular pattern of enamel prisms, with some broken prisms and superficial cracks in the teeth immersed in saline. The teeth subjected to ACC showed numerous fractures and cracks, which were greater in the ferrous sulfate group. Conclusions: Immersion in ACC increased the structural porosities and led to greater iron uptake and, consequently, higher discoloration. The maximum structural changes and subsequent staining were noted in the ferrous sulfate group, followed by ferrous ammonium citrate, ferrous fumarate, and ferrous gluconate

Adsorption and safe immobilization of Sr ions in modified zeolite matrices

Abstract In the present study, an Iranian natural zeolite (Sabzevar region) was evaluated as a natural adsorbent for the elimination and immobilization of strontium ions from an aqueous solution. For improving the adsorption efficiency of strontium ion, the zeolite surface was modified by the Schiff base ligand of bis (2-hydroxybenzaldehyde)1,2-diaminoethane (H2L). The natural zeolite and zeolite/H2L were characterized using Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD), X-ray fluorescence (XRF), BET and scanning electron microscope (SEM). Analysis of the natural zeolite showed that the zeolite is from the type of clinoptilolite and has a crystalline structure with the specific surface area 29.74 m2/g. The results showed that strontium adsorption onto modified zeolite increases compared to unmodified zeolite from 64.5% to 97.2% (at pH = 6). The effective parameters pH, adsorbent dosage, initial concentration of strontium ions, contact time, temperature, and interfering ions, were studied and optimized. The maximum adsorption efficiency was confirmed by modified zeolite and found to be 97.5% after 60 min of equilibrium time at pH 6, 0.05g as adsorbent dosage, and at 25 °C. Adsorption of strontium was confirmed by Langmuir model with maximum adsorption capacity of 10.31 mg/g. Kinetic studies showed that the adsorption of strontium ions on the adsorbent follows pseudo-second-order (PSO) model. Also, the thermodynamics of the adsorption process indicated that the adsorption of strontium on zeolite/H2L is an endothermic and spontaneous process, and the adsorption mechanism is a combination of physical and chemical adsorption. Finally, to manage the secondary waste generated from the adsorption process, strontium ions were immobilized in a zeolite structure. The results showed that the stabilization is well done with the thermal preparation process. After thermal treatment at 25–900 °C, modified zeolite satisfactorily retains strontium during back-exchange tests with NaCl solution. According to the results, the amount of strontium released from the adsorbent phase decreases from 52.6 to 1.6% with increasing heat treatment temperature

Dietary Quality among Tehranian Adults in Relation to Lipid Profile: Findings from the Tehran Lipid and Glucose Study

The prevalence of dyslipidaemia has been increasing in developing countries that are undergoing nutrition transition. However, the association of diet quality and lipid profile has not been well-understood in these countries. The aim of the current study was to compare the ability of three diet quality indices−the Mediterranean diet scale (MDS), healthy eating index-2005 (HEI-2005), and diet quality index-international (DQI-I) in relation to changes in lipid profile between baseline and 6.7 years of follow-up. Baseline data from two 24-hour dietary recalls provided by 469 adults with mean age of 38.7±12.3 years, who were participants of the Tehran Lipid and Glucose Study, were analyzed to describe dietary intakes. Data on anthropometry, sociodemography, physical activity, and other lifestyle variables were recorded, and a comparison of baseline and follow-up data revealed changes in the concentrations of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). A general linear model was used in assessing changes in lipid profile depending on adherence to diet quality indices at baseline, after adjustment for age, smoking status, waist-circumference, body mass index, physical activity, and energy intake. A significant interaction was observed between scores and sex, and upon stratification, males in the highest quartile score of the HEI-2005 had significantly lower TG changes than those in the lowest quartile, after adjusting for confounders (-8.8 vs 2.9, p=0.038). No association was apparent in females (-0.2 vs 11.2, p=0.297). In addition, a positive association was found between DQI-I and HDL-C (Q1=0.6 vs Q4=-2.0, p=0.044) in males. In both sexes, all these indices were weakly associated with TC while none was associated with LDL-C. It is concluded: adherence to the HEI-2005 recommendations was weakly associated with reduced TG concentration in an urban Iranian adult population. The MDS and DQI-I were not related to change in lipid profile

Dietary antioxidants and liver enzymes in Rafsanjan, a Region in Southeast Iran

Abstract Oxidative stress has been considered the main contributor to liver injury. Dietary antioxidants would be expected to improve liver function. The hepatoprotective effects of antioxidants are controversial. In the present study, the associations of some dietary antioxidants and the levels of serum liver enzymes were examined. This cross-sectional study was conducted using the Rafsanjan Cohort Study (RCS) data as a population-based prospective cohort which is a part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN). A total of 9942 participants aged 35–70 years old were included in this study. Among this population, 4631 (46.59%) were male, and 5311 (53.42%) were female. Dietary intakes were collected by a validated food frequency questionnaire (FFQ) with 128 items. Aspartate transaminase (AST), Alanine transaminase (ALT), γ-glutamyl transferase (GGT), and Alkaline phosphatase (ALP) were measured by a biotecnica analyzer. Dichotomous logistics regression models were used to investigate the association between the elevated liver enzymes and intake of dietary antioxidants using crude and adjusted models. In the adjusted model, in subjects with higher consumption of Se, Vit A, Vit E, β-carotene, α-carotene, and β-cryptoxanthin, the odds ratios of elevated ALP were decreased compared to the reference group (ORs 0.79 (0.64–0.96), 0.80 (0.66–0.98), 0.73 (0.60–0.89), 0.79 (0.64–0.96), 0.78 (0.64–0.95), 0.80 (0.66–0.98), and 0.79 (0.64–0.98), respectively). Subjects with higher consumption of Se, Vit A, Vit E, and provitamin A carotenoids (β-carotene, α-carotene, β-cryptoxanthin) showed decreased odds of elevated ALP. These findings support the hypothesis that Se, Vit A, Vit E, and provitamin A carotenoids may be associated with improvements in ALP and act as suppressors against the development of liver injury

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000–17

Abstract Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation

Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17

Abstract Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers’ understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage