The association between dietary glycemic and insulin indices with incidence of cardiovascular disease: Tehran lipid and glucose study

Background: The present study was conducted to investigate the association of dietary insulin index(II), insulin load(IL), glycemic index(GI), and glycemic load(GL) with the risk of cardiovascular disease(CVD). Methods: This cohort study was conducted within the framework of the Tehran Lipid and Glucose Study on 2198 subjects, aged�19 years old, who were followed-up for a median (IQR) 6.7 (6.1-7.1) years. Dietary GI, GL, II, and IL were calculated using a food frequency questionnaire at the baseline. Multivariate Cox proportional hazard regression models were used to estimate the risk of CVD across quartiles of dietary insulin and glycemic indices. Results: Mean ± SD age of the subjects(44.9 men) was 38.3 ± 13.4 years. During a mean of 2406 ± 417 person-years of follow-up, 76(3.5) new cases of the CVD were ascertained. The mean ± SD of II, IL, GI, and GL of participants were 51.7 ± 6.5, 235.8 ± 90.2, 61.9 ± 7.8, and 202.2 ± 78.1, respectively. After adjusting for the variables of age, sex, smoking, physical activity, daily energy intake, body mass index, diabetes, and hypertension, the hazard ratio (HR) of the highest quartile of dietary GL was 2.77(95CI:1.00-7.69,P for trend:0.033) compared to the lowest one. Also, each one SD increase in the GL score was associated with a higher risk of CVD(RR:1.46;CI:1.00-2.16),P-value = 0.047. However, there was no significant association between the dietary GI, II, and IL and risk for CVD incidence. Conclusions: Our results suggested that a high GL diet can increase the incidence of CVD, whereas high dietary II and IL were not associated with the risk of CVD among adults. © 2020 The Author(s)

The association of insulinemic potential of diet and lifestyle with the risk of insulin-related disorders: a prospective cohort study among participants of Tehran Lipid and Glucose Study

Background: We aim to assess the association of empirical dietary (EDIH) and lifestyle (ELIH) index for hyperinsulinemia with the risk of insulin resistance, hyperinsulinemia, insulin sensitivity, and β-cell dysfunction in Iranian adults. Methods: In this prospective study, a total of 1244 men and women aged � 20 years were selected among participants of the Tehran lipid and glucose study and followed for 3.2 years. Dietary intakes were assessed using a valid semi-quantitative food frequency questionnaire. Dietary and lifestyle insulinemic potential indices were calculated using dietary intake, body mass index, and physical activity information. Multivariable logistic regression was used to estimate the associated risk of a 3-year incidence of insulin-related disorders. Results: The mean ± SD age and BMI of all eligible participants (42.7 males) were 43.0 ± 13.0 and 27.4 ± 4.9 in the study's baseline. After adjusting for all potential confounders, participants in the highest tertile of ELIH score had a greater risk of developing hyperinsulinemia (OR:2.42, 95CI:1.52�3.86, P for trend = < 0.001), insulin resistance (OR:2.71, 95CI:1.75�4.18, P for trend = < 0.001) and insulin insensitivity (OR:2.65, 95CI: 1.72�4.10, P for trend = < 0.001) compared with those in the lowest tertile. However, the risk of incident β-cell dysfunction was lower in individuals with a higher score of ELIH in comparison to those with the lowest score (OR:0.30, 95CI:0.19�0.45, P for trend = < 0.001). Conclusions: Empirical lifestyle index for hyperinsulinemia was directly associated with insulin resistance, insulin insensitivity, and hyperinsulinemia and was inversely associated with β-cells dysfunction. © 2021, The Author(s)

Association of the insulinemic potential of diet and lifestyle with risk of diabetes incident in Tehranian adults: a population based cohort study

Background: We aimed to assess the associations between insulinemic potential of diet and lifestyle and the risk of diabetes incident, using four empirical indices including the empirical dietary index for hyperinsulinemia (EDIH), the empirical dietary index for insulin resistance (EDIR), empirical lifestyle index for hyperinsulinemia (ELIH), and empirical lifestyle index for insulin resistance (ELIR). Methods: A total of 3734 individuals, aged � 20 years old, who were free of diabetes at baseline (2008�2011), were followed for 6.2 years (2015�2018) to ascertain incident diabetes. The food frequency questionnaire was used to collect dietary intakes at baseline. Odds ratio (OR) of diabetes were calculated across quartiles of EDIH, EDIR, ELIH, and ELIR using logistic regression, which controlled for confounding factors. Results: The mean ± SD age and BMI of individuals (45.1 male) were 40.9 ± 12.0 years and 27.1 ± 4.1 kg/m2, respectively. At the end of follow-up, 253 (6.8 ) diabetes cases were identified. In the multivariable-adjusted model, individuals in the highest quartile of EDIR (1.58;95 CI:1.03�2.44, P for trend = 0.025), ELIH (1.89;95 CI:1.20�2.97, P for trend = 0.004), and ELIR (1.74; 95 CI:1.11�2.72, P for trend = 0.031) had increased the risk of diabetes. However, no significant associations were found between the score of EDIH and diabetes incident. Conclusions: Higher adherence to EDIR, ELIH, and ELIR scores were associated with increased risk of diabetes, while no significant association was found between EDIH score and diabetes incident. © 2021, The Author(s)

A nutrient pattern characterized by vitamin A, C, B6, potassium, and fructose is associated with reduced risk of insulin�related disorders: A prospective study among participants of Tehran lipid and glucose study

Background: Insulin-related disorders, including insulin resistance, insulin insensitivity, and insulinemia, is considered early predictors of major chronic disease risk. Using a set of correlated nutrient as nutrient patterns to explore the diet-disease relationship has drawn more attention recently. We aimed to investigate the association of nutrient patterns and insulin markers� changes prospectively among adults who participated in the Tehran Lipid and Glucose Study (TLGS). Methods: For the present study, 995 men and women aged 30�75 years, with complete information on insulin and dietary intake in survey III TLGS, were selected and followed three years until survey IV. Dietary intakes at baseline were assessed using a valid and reliable food frequency questionnaire (FFQ). Nutrient patterns were derived using principal component analysis (PCA). We extracted five dominant patterns based on the scree plot and categorized them into quartiles. Linear regression analysis was conducted to investigate the association between Nutrient patterns and three-year insulin markers changes, including fasting insulin, HOMA-IR, and HOMA-S. Results: The mean (SD) age and BMI of participants (43.1 male) were 46.2(10.9) year and 28.0(4.7) kg/m2, respectively. The median (IQR, 25, 75) of 3 years changes of insulin, HOMA-IR and HOMA-S were 0.35 (� 1.71, 2.67) mU/mL, 0.25 (� 0.28, 0.84) and � 6.60 (� 22.8, 7.76), respectively. In the fully adjusted model for potential confounders, per each quartile increment of the fifth nutrient pattern, the β coefficients (95 CI) of changes in insulin, HOMA-IR, and HOMA-S were � 0.36 (� 0.62, � 0.10); P value = 0.007, -0.10 (-0.19, -0.01); P value = 0.022, and 1.92 (0.18, 3.66); P value = 0.030, respectively. There were no significant association between other nutrient patterns and insulin related indices. Conclusions: Present study showed that high adherence to a nutrient pattern rich in vitamin A, vitamin C, pyridoxine, potassium, and fructose is inversely associated with 3-years changes in insulin, HOMA-IR, and directly associated with HOMA-S. © 2021, The Author(s)

Nutrient patterns and cardiometabolic risk factors among Iranian adults: Tehran lipid and glucose study

Background: The present study aimed to assess the relation between nutrient patterns and changes in adult anthropometric and cardiometabolic factors. Methods: This study was conducted on 1637 adults participating in the Tehran Lipid and Glucose Study (2005-2008), who were free of cardiovascular diseases and cancer and had completed dietary data. They were followed to the next survey (2008-2011). Dietary intakes were collected and nutrient patterns were obtained. Three year changes in anthropometric and cardiometabolic factors were measured. Results: Five nutrient patterns were extracted. The first pattern was characterized by "plant protein, thiamine, niacin, and minerals including phosphorus, zinc, copper, magnesium, manganese, and selenium". Animal protein, lactose, vitamin D, riboflavine, pantothenic acid, vitamin B12, calcium, phosphorus, and zinc" were loaded in the second pattern. The third and fourth patterns were characterized by "vitamin K, fiber, calcium, iron, manganese, and potassium", and "high correlation with starch, thiamine and folate, and negative correlation with mono and poly unsaturated fatty acids and vitamin E", respectively. The fifth pattern was high in Fructose, vitamins A, C, pyridoxine, and potassium. There was no association between nutrient patterns and 3-year changes in blood pressure and fasting blood glucose; whereas, per each quartile increment of the fifth pattern adjusted for potential confounders, triglyceride change was decreased β = - 3.66, 95% CI (- 6.57, - 0.57); P for trend = 0.014. Conclusion: Present study indicates that nutrient patterns may have an association with cardiometabolic factors, particularly a pattern rich in fructose, vitamins A, C, pyridoxine, and potassium which decreases triglyceride level. © 2020 The Author(s)

Opioids and viral infections: A double-edged sword

Opioids and their receptors have received remarkable attention because they have the ability to alter immune function, which affects disease progression. In vitro and in vivo findings as well as observations in humans indicate that opioids and their receptors positively or negatively affect viral replication and virus-mediated pathology. The present study reviews recent insights in the role of opioids and their receptors in viral infections and discusses possible therapeutic opportunities. This review supports the emerging concept that opioids and their receptors have both favorable and unfavorable effects on viral disease, depending on the type of virus. Targeting of the opioid system is a potential option for developing effective therapies; however caution is required in relation to the beneficial functions of opioid systems. © 2016 Tahamtan, Tavakoli-Yaraki, Mokhtari-Azad, Teymoori-Rad, Bont, Shokri and Salimi

Animal based low carbohydrate diet is associated with increased risk of type 2 diabetes in Tehranian adults

Background: To investigate the association of low carbohydrate diet (LCD) score with the risk of type 2 diabetes among adults. Methods: This cohort study was conducted on 4356 healthy participants aged � 19 years old, who were followed-up for a mean duration of 3 years within the framework of the Tehran Lipid and Glucose Study. LCD score was calculated using a food frequency questionnaire according to intake of carbohydrate, protein, and fat at baseline. Diabetes was defined according to the criteria of the American Diabetes Association. Multivariable logistic regression models, adjusted for potential confounders, were used to estimate risk of diabetes across quartiles of LCD score. Results: Mean ± SD age of the study participants (44.4 men) was 40.5 ± 13.0 years. The median (25-75 interquartile range) of LCD score was 17.0 (12.0-21.0) and after a 3 year follow-up period, 123 (2.8) incident cases of diabetes were ascertained. After adjustment for confounding variables, including age, sex, smoking status, physical activity, total calorie intake, saturated fatty acid, waist circumference, educational level, and family history of diabetes, the multivariable-adjusted ORs (95 CIs) of type 2 diabetes, comparing the highest with the lowest quartiles, were 2.16 (1.16-4.04) for total LCD score (P-value = 0.015), 1.81 (1.06-3.11) for animal-based LCD score (P-value = 0.029), and 1.47 (0.85-2.52) for plant-based LCD score (P-value = 0.160). Conclusion: Our findings suggest that a higher adherence to LCD, mostly with higher intakes of protein and fat from animal-source foods, can increase the incidence of diabetes; however, a plant-based low-carbohydrate dietary pattern is not significantly associated with risk of type 2 diabetes. © 2020 The Author(s)

Dietary and lifestyle inflammatory scores and risk of incident diabetes: a prospective cohort among participants of Tehran lipid and glucose study

Background: Inflammation is a precursor of chronic disease, which is affected by lifestyle and dietary habits. Recently empirical dietary inflammatory patterns (EDIP), dietary inflammation scores (DIS), and lifestyle inflammation scores (LIS) were developed to indicate lifestyle and dietary contributions in systemic inflammation. The current study aimed to investigate the associations between these indices and the incidence of diabetes among Tehranian adults. Methods: A total of 4624 individuals, aged 20�75 years, who were free of diabetes at baseline (2008�2011), were followed for 5.71 years (2014�2017) to ascertain incident diabetes. Dietary intakes were collected at baseline using the food frequency questionnaire. The hazard ratio (HR) of diabetes was calculated by Cox proportional hazards regression across quartiles of EDIP, DIS, and LIS, adjusted for potential confounders. Results: The mean ± SD for the age and BMI of the study population (45.1 male) were 40.8 ± 12.7 years and 27.1 ± 4.1 Kg.m2, respectively. At the end of the follow-up, 329 (7.1) diabetes cases were identified. In the multivariable-adjusted model, individuals in the highest compared to the lowest quartile of EDIP (HR = 0.83; 95CI:0.59�1.15, p for trend = 0.286), and LIS (HR = 2.41; 95CI:1.61�3.60, P for trend < 0.001) had increased risk of diabetes. However, no significant associations were found between the score of DIS and diabetes incidents (HR = 0.83; 95CI:0.59�1.15, p for trend = 0.286). Conclusion: Greater adherence to EDIP and LIS scores was associated with a higher risk of diabetes, while no significant association was found between the DIS score and diabetes incident. © 2021, The Author(s)

Spinach consumption and nonalcoholic fatty liver disease among adults: a case�control study

Background: Spinach has high antioxidants and polyphenols and showed protective effects against liver diseases in experimental studies. We aimed to assess the association between dietary intake of spinach and odds of nonalcoholic fatty liver disease (NAFLD) in a case�control study among Iranian adults. Methods: Totally 225 newly diagnosed NAFLD patients and 450 controls, aged 20�60 years, were recruited in this study. Participants� dietary intakes were collected using a valid and reliable 168-item semi-quantitative food frequency questionnaire (FFQ). The logistic regression test was used for assessing the association between total, raw, and boiled dietary spinach with the odds of NAFLD. Results: The mean (SD) age and BMI of participants (53 male) were 38.1 (8.8) years and 26.8 (4.3) kg/m2, respectively. In the final adjusted model for potential confounders, the odds (95 CI) of NAFLD in individuals in the highest tertile of daily total and raw spinach intake was 0.36 (0.19�0.71), P_trend = 0.001 and 0.47 (0.24�0.89), P_trend = 0.008, respectively compared with those in the lowest tertile. Furthermore, in the adjusted analyses, an inverse association was observed between the highest yearly intake versus no raw spinach consumption and odds of NAFLD (OR 0.41; 95% CI 0.18�0.96), P for trend = 0.013. However, there was no significant association between higher boiled spinach intake and odds of NAFLD. Conclusions: The present study found an inverse association between total and raw spinach intake with the odds of NAFLD. © 2021, The Author(s)

Measurement invariance of assessments of depression (PHQ-9) and anxiety (GAD-7) across sex, strata and linguistic backgrounds in a European-wide sample of patients after Traumatic Brain Injury

Background The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) are two widely used instruments to screen patients for depression and anxiety. Comparable psychometric properties across different demographic and linguistic groups are necessary for multiple group comparison and international research on depression and anxiety. Objectives and Method We examine measurement invariance for the PHQ-9 and GAD-7 by: (a) the sex of the participants, (b) recruitment stratum, and (c) linguistic background. This study is based on non-randomized observational data six months after Traumatic Brain Injury (TBI) that were collected in 18 countries. We used multiple methods to detect Differential Item Functioning (DIF) including Item Response Theory, logistic regression, and the Mantel-Haenszel method. Results At the 6-month post-injury, 2137 (738 [34.5%] women) participants completed the PHQ-9 and GAD-7 questionnaires: 885 [41.4%] patients were primarily admitted to the Intensive Care Unit (ICU), 805 [37.7%] were admitted to hospital ward, and 447 [20.9%] were evaluated in the Emergency Room and discharged. Results supported the invariance of PHQ-9 and GAD-7 across sex, patient strata and linguistic background. For different strata three PHQ-9 items and one GAD-7 item and for different linguistic groups only two GAD-7 items were flagged as showing differences in two out of four DIF tests. However, the magnitude of the DIF effect was negligible. Limitation Despite high number of participants from ICU, patients have mostly mild TBI. Conclusion The findings demonstrate adequate psychometric properties for PHQ-9 and GAD-7, allowing direct multigroup comparison across sex, strata, and linguistic background