Flavonoid protection of cardiac cells against ischemia-reperfusion injury

Myocardial ischemia-reperfusion injury occurs following the majority of cardiac events including myocardial stenosis and heart surgeries. As reactive oxygen species are one of the major contributors to ischemia-reperfusion injury, strategies to prevent their effects may be directed towards enhancing the antioxidant capacity of cells. Polyphenols, and in a more specific category, flavonoids are strong antioxidants, while possessing other biological activities such as anti-apoptotic, anti-inflammatory, and vasodilatory effects. I hypothesized that flavonoids are able to reduce ischemia-reperfusion-induced cell death through multiple mechanisms including reduction of oxidative stress and induction of cellular antioxidant enzymes. The hypothesis was tested in in vitro and in vivo phases.In the first phase of the studies, rat embryonic ventricular H9c2 cells were treated with various concentrations of polyphenols with or without ascorbate for 1-3 days before induction of ischemia and reperfusion. Ischemia was induced by exposure of the cells to a non-glucose containing solution bubbled with nitrogen, and reperfusion by returning the regular medium containing the corresponding polyphenols and/or ascorbate. Cell viability measurements using the MTT assay or counting acridine orange-stained cells showed that the best protection against cell death was given by catechin (44-58 %), epigallocatechin gallate (48%), proanthocyanidins (44%), and ascorbic acid (57-92%). A low concentration (10 µM) of catechin was more effective with a long-term (2 days) incubation time (64%), while a higher concentration (50 µM) could exert benefit even after 1 h pre-treatment (98%). Quercetin, resveratrol, cyanidin, and delphinidin displayed almost no protection. In the second part of the in vitro study, H9c2 cells were treated with 350 to 450 µM tert-butyl hydroperoxide for 24 h after pre-incubation with various concentrations of polyphenols with or without ascorbate for either short (1 h) or prolonged (3 days) periods. Unlike in the ischemia-reperfusion experiments, 3 days pre-treatment with polyphenols did not protect and often caused cytotoxicity. In short-term (1 h) pre-treatments, the best protection was obtained with 50 µM quercetin (95%), 50 µM epigallocatechin gallate (66%), and 100 µM catechin (28%). Pre-treatment with ascorbic acid (100 µM) with or without polyphenols did not improve cell survival except in one case where it enhanced cytoprotection by epigallocatechin gallate.The second phase of the studies was performed with isolated rat hearts. Rats were fed diets containing broccoli sprouts (2%), saskatoon berries (5%), or green tea extract (0.25%) for 10 days before induction of global ischemia for 20 min and reperfusion for 2 h. Broccoli sprouts decreased cell death in ischemic-reperfused hearts as assessed by caspase-3 activity (86%) and DNA fragmentation (78 %), attenuated oxidative damage as detected by lower thiobarbituric acid reactive substances (TBARS) (116%) and preserved aconitase activity (82%). Green tea extract prevented apoptosis in hearts as detected by caspase-3 activity (85%), but did not inhibit DNA fragmentation. Berries showed lower TBARS (73%). None of the feedings significantly prevented necrosis as evaluated by the release of lactate dehydrogenase into the coronary effluents, improved coronary flow, or increased heart glutathione.Green tea extract was the only intervention capable of preserving the activity of glutamate cysteine ligase (78%) and quinone reductase (147%) in hearts. The sprouts group was the only group which induced these same enzymes in liver (40 and 44 %, respectively), as it was the only intervention which elevated total liver glutathione (12%). None of the interventions changed heme oxygenase-1 protein levels. Assessment of total polyphenol content revealed that broccoli sprouts had the lowest and green tea extract had the highest amount of polyphenols among the three plant materials, suggesting that the protection exhibited by broccoli sprouts was unlikely to be due to the polyphenols. In conclusion, flavonoids and flavonoid-rich foods can strengthen the cellular ability to fight against oxidative stress. A part of this effect could be due to their direct antioxidant activity, while in prolonged applications they may also activate cellular pathways to promote endogenous antioxidant defences of cells. Application of low doses of flavonoids and consumption of flavonoid-rich plants in long-term ensures their effectiveness while avoiding possible toxicity. However, plants such as broccoli sprouts may have other chemical ingredients bearing biological properties which may help cells to survive states of oxidative stress

Skipping meals and frequency of snack consumption are important eating behaviours related to obesity in hospital employees

     Obesity is an epidemic nutritional disease caused mainly by excessive dietary intake and/or insufficient exercise. The purpose of this study was to investigate associations between a number of demographic characteristics and eating habits with prevalence of overweight and obesity in hospital employees. The study was cross-sectional performed on employees of Namazi Hospital in Shiraz, Iran. Subjects were selected from different departments of the hospital. Demographic characteristics, eating habits, and exercise were questioned by interview. Overweight and obesity was defined as a body mass index ≥ 25 kg/m2. The rate of overweight/obesity was 30.2%. Among demographic characteristics, only age (OR=5.6 for older ages, p=0.001) and sex (OR=0.4 for females, p=0.04) were significantly associated with overweight/obesity. Skipping breakfast was not associated with overweight/obesity, but skipping meals (OR=2.8, p=0.08) and consuming ≥ 3 snacks per day (OR=0.2, p=0.05) had associations with it, although non-significantly. Performing ≥ 60 min/day (but not ≥ 45 min/day) exercise was associated with a lower risk of overweight/obesity (OR=0.1, p=0.01). The association between exercise and overweight/obesity existed in both sexes, but the association between skipping meals and obesity was present only in females (OR=3.8, p=0.05). Females skipped meals especially breakfast more frequently than males (p=0.001) but snack consumption and exercise was not statistically different between the two sexes. Eating 3 meals and at least 3 snacks per day and performing 1 hour or more exercise may be introduced as helpful strategies in prevention of obesity.

The Effect of Phytoestrogens on Cognitive Function and Alzheimer’s Disease

Dementia is a neurodegenerative disorder that leads to a significant cognitive loss. It was shown that the rise in life expectancy and the number of elderly people in the community led to an increasing trend in incidence and prevalence of Alzheimer’s disease. Several studies reported that nutritional factors can affect the development and rate of the disease. Food strategies and lifestyle may be effective in prevention of Alzheimer’s development. Phytoestrogens are non-estradiol compounds with a diphenolic and heterocyclic structure. Phytoestrogens have potential to bind to estrogen receptors and exhibit biological properties of estrogen.They are estrogen receptor modulators, acting as estrogen agonists or antagonists. Through binding to estrogen receptors, phytoestrogens may increase survival, growth, and plasticity of brain cells. One of the most important effects of phytoestrogens is improvement of visual-spatial memory. Acting as estrogen, phytoestrogens promote the cognition and memory through improvement of endothelium vasodilatation and increase supplying blood to brain cells. In addition, phytoestrogens possess antioxidant capacity which may prevent neurodegenerative diseases when passing through the blood-brain barrier. The use of phytoestrogens and their dietary sources such as soybeans can be beneficial in prevention of Alzheimer’s disease

Associations between Western and Mediterranean-type dietary patterns and depression in adults in Shiraz

Background and aims: Depression is a growing public health problem in the world. In this study we investigated the relationship between dietary patterns and depression in adults aged 20-50 years living in Shiraz, Iran. Methods: In a cross-sectional study, 416 subjects (180 men and 236 women) aged 20 to 50 years were selected by stratified multistage random sampling. Dietary intakes were assessed using a semi-quantitative food frequency questionnaire. Depression information was collected by Depression, Anxiety and Stress Scale (DASS) questionnaire. Three major dietary patterns were extracted by factor analysis: vegetable, Western, and Mediterranean-type dietary patterns. Regression analysis was used for association between dietary pattern and depression. Results: A strong positive significant association was observed between Western dietary pattern and depression. Also there was a negative significant association between Mediterranean-type dietary pattern and depression. These associations remained statistically significant even after adjustments for demographic characteristics, physical activity, smoking, body mass index, and energy intake. No association was found between vegetable dietary pattern and depression. Conclusion: The results showed that there was a relationship between dietary patterns and depression. However, clinical trials are needed to clarify whether a causal relationship between diet and mood disorders can be established

Undesirable Knowledge and Practice of Mothers about Under 2 Years Old Children Nutrition are Related to Socio- Economic Factors in Shiraz, Southern Iran

Background: The assessment of mother's knowledge and practice about child nutritional requirement is important in identification of the education needs. This research was conducted to assess the knowledge and practice of mothers about nutrition of children under 2 years of age and its relationship with socioeconomic factors in Shiraz health care centers, southern Iran. Methods: In this descriptive-analytic cross-sectional study, 201 mothers with at list one under 2 years old child were selected by systematic random sampling from health centers in Shiraz, southern Iran. Knowledge and practice of mothers about the type and time of providing supplementary foods for the infants were assessed using a validated questionnaire via face to face interview. Also demographic and socioeconomic information were asked. Pearson correlation coefficient and ANOVA tests were used for data analysis. All analyses were performed using SPSS version 19. Results: According to the findings of this study, 11.4% of mothers had a low level of knowledge and 29.4% of them had a desirable practice. We observed significant relationship between knowledge and job (P=0.002) and level of education ( P<0.001), also between practice and job (P=0.01) and level of education (P=0.046). we observed that mother's knowledge has significant positive correlation with mother's practice (r=0.6, P=0.001) Conclusion: Since the knowledge of high percentage of mothers was moderate, and a high percentage of them had undesirable practice, continuing overall effort to increase mother's nutritional knowledge and practice in order to prevention of infants malnutrition seems to be necessary

Age at Menarche and its Nutrition-Related Factors among School Girls in Shiraz, Southern Iran

Background: Menarche is an important period in the health of adolescent girls, and different factors, including genetic and environmental factors affect the age of menarche. The aim of the present study was to determine the age at menarche and its nutrition-related factors in school girls in Shiraz, southern Iran. Methods: In a cross-sectional study, 481 adolescent girls aged 10-13 years were enrolled based on a two-stage cluster random sampling. Weight, height and body mass index (BMI) were assessed. Z-scores for weightfor- age (WAZ), height-for-age (HAZ), and BMI-for-age (BMIZ) were determined based on World Health Organization standards. Associations between food intake and anthropometric measures and menarche age and also between anthropometric measures and menarche age were tested using Pearson correlation and linear regression, respectively Results: Mean age at menarche was 12.27±0.73 years. A significant correlation was observed between the age of menarche and cheese, dairy, legume, and egg consumption. Logistic regression analyses showed z-scores significantly for WAZ (-0.64, -0.24), HAZ (-0.70, -0.37), and BMIZ (-0.59, -0.16) as strong predictors for age at menarche. Conclusion: HAZ, WAZ, and BMIZ and consumption of cheese, dairy, legume, and egg had significant inverse associations with menarches’ age

The Diagnostic Value of Anthropometric Characteristics of Ilium for Sex Estimation Using Pelvic Radiographs

Background: Sex estimation is an essential part of forensic identification. This study was conducted on the Iranian people to determine pelvic bones anthropometric characteristics.Methods: Radiography of 180 pelvic bones (90 males and 90 females) was studied. We measured the height of ilium, inter-acetabular distance, acetabular diameter, the greatest breadth of the pelvis, breadth of pelvic inlet, and the presence of the beaklike bony extension in both sexes.Results: We found a significant difference between men and women regarding their mean height of ilium, acetabular diameter, inter-acetabular distance, breadth of the pelvic inlet in all studied X-rays. The highest accuracy for sex estimation was related to the height of ilium (77%). The prevalence of the beaklike bony extension was 43% in the studied population, 70% in males and 18% in females.Conclusion: When human skeletal remains containing pelvic bones are available, standard radiographic images along with other findings can be helpful in predicting the sex.                                                     

Research Paper: Using Subpubic Angle in Sex Determination and Stature Estimation: An Anthropometric Study on Iranian Adult Population

Background: Pelvic bone has important sex determining features. However, anthropometric reference values vary by study population. This study aimed to determine the accuracy of subpubic angle for sex determination and height estimation in Iranian adults.Methods: In this study, the subpubic angle in the digital pelvic radiographs of 325 Iranian adults (199 males and 126 females) and their standing heights were measured. Then, the relation of subpubic angle with sex and stature was evaluated. Results: The mean(SD) subpubic angle of the studied population was 116.3 (23.7) degrees. Subpubic angle was significantly wider (P&lt;0.001) in females [140.5(14.3) degrees] compared to males [101.0(13.3) degrees]. Moreover, we observed a significant decrease (P&lt;0.001) in females’ subpubic angle with an increase in age. A significant reverse correlation (P&lt;0.01) was also observed between the subpubic angle and height (r=0.416). Conclusion: This study showed that the mean subpubic angle in Iranian adults is different from the average in other populations. Our reference values can be used in forensic identification

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions