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Rheumatoid arthritis is a systemic, chronic disease which may increase the risk of osteoporosis. This study was carried out in order to examine the effect of conjugated linoleic acid (CLA) on bone markers in rheumatoid arthritis disease which is the most common autoimmune disease. The present study is a randomized double-blind clinical trial. Subjects included 52 patients with active rheumatoid arthritis who were divided into two groups. Group I received standard treatment plus 2 daily 1.25 g capsules (Containing about 2 g of 9- cis 11- trans isomer and 10- cis 12- trans isomer in ratio of 50 −50 CLA in glycerinated form), Group II received standard treatment plus 2 Placebo 1.25 g capsules containing sunflower oil with high oleic acid. Telopeptides C, osteocalcin, and MMP3 were analyzed by ELISA method, PGE 2 was done by competitive enzymatic immunoassay method, and IGF-1 was analyzed by the IRMA method based on the sandwich method and ALK-P of bone. Before and after the intervention, the questionnaires about general information, nutrition assessment and medical history were filled out by the subjects. Nutritional assessment was done by a 24-h record questionnaire for the three-day diet. The results were analyzed using SPSS software (version 18). Findings: There was no significant difference between the groups in enzyme activity of ALK-P of bone, PGE 2 and MMP3 variables. However, differences between the two groups in terms of activity of telopeptides C, Osteocalcin, and IGF1 were significant ( P  < 0.05). CLA has a potentially beneficial effect on bone markers in patients with rheumatoid arthritis. Therefore, in order to study the effect of CLA on bone health in patients with RA and all patients with autoimmune and bone diseases more studies with longer duration and evaluation of bone mass density are required.

•Waist and hip circumference significantly were decreased in the intervention group, but there wasnot significant differences between two groups.•Body fat percent, low density lipoprotein levels and systolic blood pressure significantly were decreased in the intervention group.•A significant decrease was observed in body fat percent, hip circumference, fasting blood sugar and high density lipoprotein in the intervention group compared to the placebo group. Since, the main cause of death in Rheumatoid arthritis (RA) patients is the presence of type 2 diabetes, abnormal increase in blood lipids, blood pressure and obesity, the aim of this study was to assess the effects of Barberry on the anthropometric indices and metabolic profile in patients with RA. present study was a double-blinded, placebo-controlled randomized clinical trial. 70 active RA patients were randomly allocated into intervention or placebo group Participants received 6 capsules of 500 mg barberry extract or placebo for 3 months. Serum levels of fasting blood sugar (FBS), triglyceride (TG), LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C), systolic and diastolic blood pressure and anthropometric factors were assessed at baseline and at the end of the trial. The results of intervention on 62 patients showed that weight, BMI, and conicity index increased in both groups, but this was significant only in the placebo group (p < 0.001). Waist and hip circumference were decreased in the intervention group and increased significantly in the placebo group (p < 0.001). Body fat percent (p = 0.04), LDL-C (p = 0.05) and SBP (p = 0.02) significantly were decreased in the intervention group. The results showed a significant decrease in body fat percent (p = 0.05), hip circumference (p < 0.001), FBS (p = 0.03) and HDL-C (p = 0.03) in the intervention group compared to the placebo. Conclusions: Overall, the results of this study demonstrated that the extract of Berberis Integerrima had beneficial effects on metabolic profile and anthropometric indices in RA patients.

Background Little information on the effects of Vitamin E on inflammation and immune function in humans is available so we decided to investigate the effect of Vitamin E on this autoimmune disease, as our knowledge for the first time. Objectives This study investigated the effects of Vitamin E on the inflammatory mediators and Immunity factors in adults with active RA Methods In a randomized, double-blind, placebo controlled clinical trial 43 RA patients were randomly divided into 2 groups, each group receiving one of the following daily supplement for 3 months; Group E: 400 mg Vitamin E, Group P: placebo. Cytokines, Citrolinated Antibody (CCP-A)were measured by Elisa method, Vitamin E measured by HPLC. Results After study there were no significant differences between groups in cytokines IL2, IL4, TNFα, IL1β, Il2/IL4, CCP-A, WBC and Neutrophils, Lymphocyte, Monocytes, Eeosinophils numbers.TNFα decreased in 2 groups nonsignificantly, but its reduction was more in group E. IL1β increased in both groups P and E (P=0.004, P=0.041 respectively). IL4 decreased in groups E and P (P=0.07, P=0.068 respectively). ESR, CRP, DAS 28 and GPA decreased in group E (P≤0.05). Conclusions Vitamin E probably can be useful in RA patients. References Venkatraman J, Meksawan K(2002) Effects of dietary omega3 and omega6 lipids and vitamin E on chemokine levels in autoimmune-prone MRL/MpJ-lpr/lpr mice. J Nutr Biochem 13(8), 479. Comstock GW, Burke AE, Hoffman SC, Helzlsouer KJ, Bendich A, Masi AT, Norkus EP, Malamet RL, Gershwin ME(1997) Serum Concentration of alpha tocopherol and carotene and retinol perceding the diagnosis of rheumatoid arthitis and systemic lupus erythmatus. Ann Rheum Dis 56, 323- 5. Edmonds SE, Winyard PG, Gue R, et al.(1997) Putative analgesic activity of repeated oral doses of vitamin E in the treatment of rheumatoid arthritis, Results of a prospective placebo controlled double blind trial. Ann Rheum Dis 56, 649-55. Tidow -Kebritchi S, Mobarhan S (2001). Effects of diets containing fish oil and vitamin E on rheumatoid arthritis. Nutr Rev 59(10), 335-8. Wittenborg A, Petersen G, Lorkowski G, Brabant T(1998) Effectiveness of vitamin E in comparison with diclofenac sodium in treatment of patients with chronic polyarthritis. ZRheumatol 57(4), 215-21. J van Tits L, Demacker P N, Graaf Jde, Lemmers H LH, Anton F (2000)α-Tocopherol supplementation decreases production of superoxide and cytokines by leukocytes ex vivo in both normolipidemic and hypertriglyceridemic individuals. Am J Clin Nutr 71, 458–64. Pallest EG, Schoten EG, Dewaart FG, Fonk HC, Doekes G (1999) Effect 50 and 100 mg vitamin E supplements on Cellular immune function in noninstitutionalized elderly person.American Journal of Clinical Nutrition 69(6),1273-81. Beharka AA, Wu D, Serafini M, Meydani SN(2002) Mechanism of Vitamin E inhibition of Cyclooxygenase activity in macrophages of old mice role of peroxynitrite. Free Radic Biol Med 15, 32(6), 503-11. Disclosure of Interest None Declared

Little information about the effects of conjugated linoleic acids (CLAs) on inflammation and immune function in humans is available. This study investigated the effects of CLAs, with and without Vitamin E on immunity and inflammatory parameters in adults with active rheumatoid arthritis (RA). In a double-blind clinical trial, 78 patients were randomly divided into four groups, each group receiving one of the following daily supplement for 3 months; group C: 2.5 g CLAs, group E: 400 mg Vitamin E, group CE: CLAs plus Vitamin E, group P: Placebo. Cytokines, matrix metalloproteinase 3 (MMP-3) and citrullinated antibody (CCP-A) were measured by ELISA method and Vitamin E by high-performance liquid chromatography. Consider statistical methods there were no significant differences between groups in cytokines interleukin-2 (IL-2), IL-4, tumor necrosis factor-α (TNF-α), IL-1β, IL-2/IL-4, CCP-A white blood cells and neutrophils, lymphocyte, monocytes, and eosinophils numbers. TNF-α decreased in all groups, but its reduction was significant in group CE. IL-1β increased in groups P (P = 0.004) and E (P = 0.041) but the difference between group P and CE was significant. IL-4 decreased in groups C, CE and E (P = 0.03, P = 0.03, P = 0.07 respectively). IL2 did not change significantly within groups. CCP-A increased in groups P (P = 0.035) and E (P = 0.05), while it decreased in groups CE (P = 0.034). CCP-A and MMP-3 decrease were significant between groups P and CE. MMP-3 reduction was significant in group CE. Co-supplementation CLAs and Vitamin E may be effective in the level of inflammatory markers in RA patients.

Background Depression is more common in diabetic patients, with a 1.5-fold increased risk of death. Melissa officinalis ( M. officinalis ) have anti-diabetic and anti-depression activities. The study aimed to determine the efficacy of M. officinalis extract on depression, anxiety, and sleep quality in patients with type 2 diabetes with depressive symptoms. Methods In this double-blind clinical trial, 60 volunteer patients (age range 20–65 years) with type 2 diabetes mellitus with symptoms of depression were randomized into the intervention (received 700 mg/day hydroalcoholic extract; n  = 30) or control group (received 700 mg/day toasted flour; n  = 30). Dietary intake, physical activity, anthropometric indices, FBS (Fasting blood sugar), hs-CRP(High-sensitivity C-reactiveprotein), depression, anxiety, and sleep quality were determined at the beginning and end of the study. Depression and anxiety were assessed by Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI), respectively; sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Results Sixty participants received M. officinalis extract or placebo, of which 44 patients completed the 12-week double-blind clinical trial. After 12-week the mean change of depression and anxiety scores were statistically significant between the two groups ( p  < 0.001 and p = 0.04, respectively), but no significant differences were observed in FBS, hs-CRP, anthropometric indices, sleep quality, and blood pressure.In the intervention group, there was a significant decrease in depression and anxiety severity( p  < 0.001 and p  = 0.01, respectively) at the end of the study compared to the baseline. Trial registration All protocols in this study were followed in accordance with the Helsinki Declaration (1989 revision). Ethical approval for this study was obtained from the Iran University of Medical Sciences Ethics committee (IR.IUMS.FMD.REC 1396.9413468004; research.iums.ac.ir). The study was registered at the Iranian Registry of Clinical Trials (IRCT201709239472N16); Registration date: 09/10/2017.

BACKGROUND According to previous studies, probiotic and prebiotic supplementation have desirable effects on glycemic parameters. Thus far, the effect of supplementation on the glycemic parameters and adipokines in non-alcoholic fatty liver disease (NAFLD) has not been assessed. Therefore, the aim of this study was to determine the effects of supplementation with probiotic and prebiotic on adiokines and glycemic parameters in the patients with NAFLD. METHODS In the present randomized, double-blind, placebo-controlled trial, 89 patients with NAFLD were randomly divided into three groups to receive one probiotic capsule + 16 g/d maltodextrin (probiotic group) or 16 g/d oligofructose powder + one placebo capsule (prebiotic group), and one placebo capsule + 16 g/d maltodextrin (control group) for 12 weeks. All the subjects in the study were advised to follow the weight loss diet and physical activity recommendations during the intervention. Fasting blood samples were taken at baseline and after the intervention to measure leptin, adiponectin, insulin, and fasting blood sugar. RESULTS At the end of the study, serum concentrations of leptin, insulin, and HOMA-IR decreased significantly in the probiotic and prebiotic groups compared with the control group. Despite the changes within the groups, serum concentrations of adiponectin did not change significantly between the three groups. Also, fasting blood sugar did not change between the groups, but decreased in the prebiotic group. Quantitative insulin-sensitivity check index (QUICKI) increased significantly in probiotic and prebiotic groups compared with the control group. CONCLUSION Probiotic and prebiotic supplementation along with lifestyle intervention has a favorable impact on glycemic parameters and leptin levels compared with lifestyle intervention alone.

To determine the effectiveness of nutrition education intervention based on Pender's Health Promotion Model in improving the frequency and nutrient intake of breakfast consumption among female Iranian students. The quasi-experimental study based on Pender's Health Promotion Model was conducted during April-June 2011. Information (data) was collected by self-administered questionnaire. In addition, a 3 d breakfast record was analysed. P < 0·05 was considered significant. Two middle schools in average-income areas of Qom, Iran. One hundred female middle-school students. There was a significant reduction in immediate competing demands and preferences, perceived barriers and negative activity-related affect constructs in the experimental group after education compared with the control group. In addition, perceived benefit, perceived self-efficacy, positive activity-related affect, interpersonal influences, situational influences, commitment to a plan of action, frequency and intakes of macronutrients and most micronutrients of breakfast consumption were also significantly higher in the experimental group compared with the control group after the nutrition education intervention. Constructs of Pender's Health Promotion Model provide a suitable source for designing strategies and content of a nutrition education intervention for improving the frequency and nutrient intake of breakfast consumption among female students.

Many studies have investigated the possible role of reactive oxygen species in the etiology and pathogenesis of Rheumatoid Arthritis (RA). The aim of this study was to investigate the activities of some antioxidants in RA patients. In this case-control study, 59 RA patients and 60 healthy sex and age-matched controls were selected. Vitamin E and Beta-carotene were determined using HPLC. Erythrocytes glutathione reductase (GR) activity was measured spectrophotometrically, and malondialdehyde (MDA) was determined by colorimetric method. Arylesterase activity (AEA) was measured by Phenylacetate. The clinical data were determined by a rheumatologist, medical history and filling the questionnaire by interview. Statistical analyses were carried out using the SPSS software. In patients with RA, serum MDA level was significantly higher and plasma concentration of vitamin E, Beta-carotene and GR activity, were significantly lower than healthy control (P< 0.001). AEA activity differences between two groups were non-significant. Oxidative stress may play an important role in the inflammation and pathogenesis of RA.

Background Type 1 diabetes is a main health burden with several related comorbidities. It has been shown that endothelial function, vascular structure, and metabolic parameters are considerably disrupted in patients with type 1 diabetes. Omega-3 as an adjuvant therapy may exert profitable effects on type 1 diabetes and its complications by improving inflammation, oxidative stress, immune responses, and metabolic status. Because no randomized clinical trial has examined the effects of omega-3 consumption in children and adolescents with type 1 diabetes; the present study aims to close this gap. Methods This investigation is a randomized clinical trial, in which sixty adolescents with type 1 diabetes will be randomly assigned to receive either omega-3 (600 mg/day) or placebo capsules for 12 weeks. Evaluation of anthropometric parameters, flow-mediated dilation (FMD) as an endothelial function marker, carotid intima-media thickness (CIMT) as a vascular structure marker, proteinuria, biochemical factors including glycemic and lipid profile, blood urea nitrogen (BUN), creatinine, high-sensitivity C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR), as well as blood pressure will be done at the baseline and end of the trial. Also, dietary intake and physical activity will be assessed throughout the study. Statistical analysis will be performed using the SPSS software (Version 24), and P < 0.05 will be considered statistically meaningful. Discussion It is hypothesized that omega-3 supplementation may be beneficial for the management of type 1 diabetes and its complications by reducing inflammation and oxidative stress and also modulating immune responses and glucose and lipid metabolism through various mechanisms. The present study aims to investigate any effect of omega-3 on patients with type 1 diabetes. Ethical aspects This trial received approval from Medical Ethics Committee of Iran University of Medical Sciences, Tehran, Iran (IR.IUMS.REC.1400.070). Trial registration Iranian Registry of Clinical Trials IRCT20210419051010N1 . Registered on 29 April 2021