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Background Structural equation modeling (SEM) is a method used to evaluate linear causal relationships among variables. This study aimed to investigate the direct and indirect effects of serum 25(OH) D on certain cardiovascular risk factors using SEM. Methods An analytical cross-sectional study was conducted in six provinces of Iran. Subjects ( n  = 922), aged 19–65 years, were selected from National Food and Nutrition Surveillance. The assessments were sun-exposure behavior, anthropometric and biochemical measurements. A series of SEM models were tested and the model with the best fit indices was considered for use in the structural part of the model. Based on the literature review of previous theoretical models and supporting bivariate analyses, an overall SEM examined direct or indirect associations among observed and latent variables. We put the demographic, duration of sun exposure, anthropometric and metabolic variables in our model. Results The paths between serum 25(OH) D and BMI were inverse and statistically significant, whereas age showed a positive association with BMI (B = 0.06, p  < 0.001), both direct (st. effect = 0.11, p  = 0.01) and indirect via vitamin D (st. effect = − 0.02, p  = 0.01). The results confirmed that serum 25(OH) D concentration is a predictor for latent variable of lipid profile (B = − 0.13, p  = 0.01) both through direct ( p  = 0.02) and indirect effects via BMI ( p  = 0.01). Conclusion Serum 25(OH) D concentration is a predictor of BMI and also a latent variable of lipid profile via direct and indirect effects. It can also attenuate the harmful effect of age on BMI and lipid profile particularly in women.

Background Both augmented inflammatory reaction and low vitamin D status are associated with depression but the magnitude of their relationships is unclear. This study was, therefore, conducted to evaluate the effects of vitamin D supplementation on serum 25(OH)D concentration, depression severity and some pro-inflammatory biomarkers in patients with mild to moderate depression. Methods An 8-week double-blind randomized clinical trial (RCT) was performed on 56 (18–60 yrs) patients with mild to moderate depression, randomly assigned to intervention (50,000 IU cholecalciferol 2wks −1 ) and control (placebo) groups. Serum 25(OH)D, intact parathyroid hormone (iPTH), interlukin (IL)-1β, IL-6, high-sensitivity C-reactive protein (hs-CRP) and depression severity (Beck Depression Inventory-II) (BDI-II)) were initially and finally assessed. Results At the end point, statistically significant changes were observed only in intervention group as compared with controls including increased 25(OH)D concentration (+ 40.83 ± 28.57 vs. + 5.14 ± 23.44 nmol L −1 , P  < 0.001) and decreased depression severity (-11.75 ± 6.40 vs. -3.61 ± 10.40, P  = 0.003). No significant within- or between group differences were observed in serum IL-1β, IL-6 and hs-CRP concentrations. Conclusion Increased circulating 25(OH)D concentrations following 8-week vitamin D supplementation (50,000 IU 2wks −1 ) resulted in a significant decrease in BDI-II scores in patients with mild to moderate depression. However, this effect was independent of the serum concentrations of the studied inflammatory biomarkers. Trial registration The clinical trial registration code was obtained from the Iranian Registry of Clinical Trials (date of registration: 17/09/2018, registration number: IRCT20170926036425N1) and ClinicalTrials.gov (date of registration: 04/12/2018, registration number: NCT03766074)

Background Dietary Diversity Score (DDS), as a proxy for nutritional adequacy, can be used as a useful tool to assess diet quality, especially in children, due to its low cost and ease of use in comprehensive studies. This study aimed to develop a questionnaire to estimate dietary diversity and also assess the validity of DDS as an indicator of nutritional status among children aged 24 to 59 months in Iran. Methods In addition to the Dietary Diversity Questionnaire (DDQ), which was designed based on the Food and Agriculture Organization (FAO) protocols, two non-consecutive 24-hour dietary recalls were completed for 471 children aged 24–59 months, recruited using random cluster sampling. Nutrient Adequacy Ratio (NAR) for energy, protein, and micronutrients, and the Mean Nutrient Adequacy Ratio (MAR) were calculated. Serum retinol concentration was assayed using High Performance Liquid Chromatography (HPLC). Children’s weights and heights were measured and Height for Age (HAZ), Weight for Age (WAZ), Weight for Height (WHZ), and BMI for Age (BAZ) Z-scores were calculated according to World Health Organization (WHO) criteria in 2006. Pearson correlation analysis was performed to analyze the correlation between DDS and NARs, MAR, anthropometric indicators, and serum retinol. Results The mean age of the children was 42.5 ± 0.47 months. The average DDS was 5.19 ± 0.06. DDS showed a positive association with the NAR of energy, protein, and all micronutrients ( p  < 0.05) except for vitamin K. There was a positive and significant correlation between DDS and MAR ( r  = 0.271; p  < 0.001). In addition, DDS showed a direct, weaker but statistically significant, correlation with serum retinol concentration ( r  = 0.104; p  = 0.026). No significant relationship was found between DDS and children’s growth indicators. Conclusions The designed DDQ can be a valuable tool for examining the adequacy of nutritional intake in Iranian children.

Background Vitamin D deficiency, a common problem among pregnant women, is linked with maternal inflammation, oxidative stress and consequent adverse pregnancy outcomes. The aim of this systematic review was to evaluate the effect of vitamin D supplementation on oxidative stress and inflammatory biomarkers in pregnant women according to the PRISMA guidance. Methods Four databases including PubMed/MEDLINE, Scopus, Web of Science and Cochrane were used for searching papers published until 25 th July 2022. Clinical trials that assessed 25-Hydroxyvitamin D (25(OH)D), inflammatory markers (including high sensitivity C-reactive protein (hs-CRP) and certain cytokines) and oxidative stress markers (including malondialdehyde (MDA), total antioxidant capacity (TAC) and glutathione (GSH)) in pregnant women, were included in this review. The primary search of three databases displayed 21571 records. After removing duplicates and irrelevant articles, 17 eligible RCTs included for more evaluation. Random effect model and Der Simonian-Laird method were used to pool the data of studies. Risk of bias assessed according to version 2 of the Cochrane risk-of-bias tool for randomized trials. Results According to the meta-analysis result, vitamin D supplementation caused a significant increase in the maternal circulating concentrations of 25(OH)D (SMD 2.07; 95%, CI 1.51, 2.63; p  < 0.001), TAC (SMD 2.13, 95% CI 1.04 to 3.23, p  < 0.001) and GSH (SMD 4.37, 95% CI 2.9 to 5.74, p  < 0.001) as well as a significant decrease in the levels of MDA (SMD -0.46, 95% CI -0.87 to -0.05, p  = 0.02). However, it had no significant impact on hs-CRP concentrations (SMD 0.24; 95% CI, -0.55, 1.03; p  = 0.50). Conclusion In the present study, vitamin D supplementation led to increased levels of 25(OH)D, TAC and GSH and also decreased concentration of MDA. Nevertheless, because of low certainty of evidence, these findings have to be declared conservatively. Trial registration Registration code in PROSPERO website: CRD42020202600

Background In this meta-analysis, findings from recent studies on the preventive properties of anthocyanins (ACN) against cardiovascular disease are summarized. Methods MEDLINE, PubMed, Embase, Cochrane Library, and Google Scholar were searched and 2512 studies were found in a preliminary search. After screening of titles and abstracts, 47 studies met the inclusion criteria (randomized clinical trial design and sufficient data of outcomes). Studies were excluded based on the following criteria: incomplete data; obscurely reported outcomes, or lack of control groups; and animal studies. Results The results showed that intervention with ACNs resulted in a significant decrease in body mass index ((MD),− 0.21; 95% CI, − 0.38, − 0.04; P < 0.001) and body fat mass (MD: − 0.3%, 95% CI − 0.42 to − 0.18%, p < 0.001). Pooled data comparing ACN with control showed statistically significant effect on fasting blood sugar and HbA1c. However, the reductions were significantly more in the subjects with type 2 diabetes and in those who used ACN as supplement/extract. The subgroup analysis test showed that there was a significant effect of ACN on triglyceride concentrations, total cholesterol, LDL-C and HDL-C concentrations in all subgroups of participants (with vs. without dyslipidemia at baseline) and intervention type (supplement/extract vs. food). However, we did not observe any significant effect on apo A and apo B concentrations. Conclusions ACN intake in the forms of natural foods and supplements can induce healthy changes in body fat mass, glycemic and lipidemic status and these effects are more prominent in the subjects with above-normal values. This meta-analysis was registered at http://www.crd.york.ac.uk/Prospero (Registration no. CRD42021286466).

Background Childhood malnutrition remains a critical public health challenge in low- and middle-income countries, contributing significantly to morbidity and mortality among children aged 2–5 years. This study was undertaken to assess the nutritional status of 2–5 y children and to explore the main determinants of child malnutrition in eight food insecure provinces of Iran. Methods In each province, participants were invited to attend the health house/center to complete the questionnaire on the pre-appointed day. In this study, an android application comprising electronic questionnaires was employed for data collection. Anthropometric, dietary, food security and socioeconomic status (SES) assessments were performed. Structural equation modeling (SEM) was done to assess the structural relationship of malnutrition indicators (z-score of height to age (HAZ), z-score of weight to age (WAZ) and z-score of weight to height (WHZ)) with other variables. Results Overall, 2247 children aged 42.2 ± 0.3 months were enrolled in the study, of whom 1048 (46.6%) were female and 1438 (64%) were urban residents. Based on Z score criteria, 216 (10.1%) of the studied children had less than − 2SD HAZ, 193 (8.4%) had lower than − 2SD WHZ and 188 (8.1%) had lower than − 2SD WAZ. The prevalence rates of stunting, wasting and underweight were not significantly different between boys and girls. Nevertheless, the occurrence of stunting was significantly higher in children residing in rural than in urban areas ( p  = 0.025). SEM analysis revealed that higher SES had a positive relationship with HAZ (0.089), WAZ (0.163) and WHZ (0.109). The effect of SES was greatest on WAZ, indicated by the highest absolute value of a path coefficient. There were specific indirect effects of father’s education on HAZ (0.032, p  = 0.001), WHZ (0.045, < 0.001) and WAZ (0.061, < 0.001) through effect on SES and DDS. SES had a direct effect on DDS (0.202). Conclusions Our findings using SEM approach provided more concrete evidence for the effect of the household’s SES on child’s nutritional status. Nevertheless, we still need to monitor the studied population in the context of our surveillance program to document more conclusive causal associations.

Background Adolescent obesity is linked to a higher risk of becoming obese adults and developing chronic diseases. School-based interventions, focusing on nutritional education and physical activity (PA), are crucial for preventing childhood obesity. This study aimed to evaluate the effectiveness of such interventions using network meta-analysis. Methods We searched PubMed, Scopus, Web of Science, and the Cochrane Library for studies on school-based obesity interventions. Interventions included behavioral, nutritional, and physical activity components. Network meta-analysis (NMA) employed random-effects models, generating network plots. Surface under the cumulative ranking curve (SUCRA) ranked intervention efficacy. Results Sixty-one studies were included. School-based interventions significantly reduced body mass index z-score (z-BMI; mean difference [MD]: − 0.06; 95% CI : − 0.1, − 0.03) and BMI ( MD : − 0.351; 95% CI : − 0.566, − 0.135). NMA indicated that combined interventions, PA + health education (HE) + school policy (SP), were more effective in reducing BMI than HE alone ( MD : − 0.61; 95% CI : − 1.2, − 0.02). SUCRA rankings highlighted PA + HE + SP and PA alone as the most effective interventions in reducing BMI and z-BMI, respectively. Conclusion School-based interventions are effective long-term strategies for managing childhood obesity. Combining PA, HE, and SP showed the highest efficacy in reducing BMI. Meanwhile, intervention duration and parental involvement did not show any significant additional effect, necessitating further prospective studies.

BackgroundSome evidence suggests indirect ameliorating effects of vitamin D in diabetes via adiponectin and sirtuins. This study aimed to evaluate the effects of daily intake of vitamin D-fortified yogurt drink, either with or without added calcium, on serum adiponectin, sirtuins (SIRT)1 and 6.MethodsBriefly, 75 adults aged 30–60 years from both sexes with type 2 diabetes were randomly allocated to one of the three groups: (i) D-fortified-yogurt drink (DY; containing 1000 IU vitamin D and 300 mg calcium), (ii) Ca+D-fortified-yogurt drink (CDY; containing 1000 IU vitamin D and 500 mg calcium) and (iii) plain yogurt drink (PY; containing no detectable vitamin D and 300 mg calcium). All assessments were performed initially and after 12 weeks.ResultsA significant within-group increment in serum adiponectin concentrations was observed in both DY and CDY groups (+60.4 ± 8.6, +57.5 ± 6.4 µg/L, respectively; p < 0.001 for both). The concentrations of SIRT1 and SIRT6 had a significant within-group increment only in the CDY group (p = 0.003, p = 0.001 respectively). Being in CDY group was more favorable predictor of improvement in SIRT6 concentrations. Changes of 25(OH)D were a significant predictor of changes of adiponectin. However, this association disappeared following adjustment for changes of SIRT1. In contrast, the association between changes of 25(OH)D and HbA1c remained significant even after adjustment for SIRT1.ConclusionsDaily consumption of vitamin D-fortified yogurt drink for 12 weeks resulted in an increase in circulating concentrations of SIRT1 and SIRT6 in T2D subjects and D+Ca-fortified yogurt drink was more in favor of SIRT6 increment.

Background The management of transplantation-related complications in acute leukemia patients has become increasingly important at the bedside. Limited clinical investigations have been conducted regarding high-dose oral magnesium supplementation. In this study, the effects of oral magnesium citrate will be investigated. Magnesium’s role in preventing adverse transplantation outcomes, including graft-versus-host disease (GVHD), will be examined through its inhibitory effects on inflammatory pathways and cytokine production. Methods This randomized, double-blind clinical trial will be conducted at Taleghani Hospital in Tehran, Iran. Fifty patients admitted to the bone marrow transplantation ward will be enrolled based on eligibility criteria. Participants will be randomly allocated using permuted block randomization into two groups ( n  = 25 each): neutropenic diet with magnesium supplementation or neutropenic diet with placebo. In the intervention and placebo groups, 420 mg of magnesium citrate or placebo will be administered for 3 weeks, respectively. Patient assessment will be conducted using consent forms, general questionnaires, three-day 24-h food recalls, and laboratory tests including inflammatory factors such as Interleukin-6 (IL-6), Tumor necrosis factor-alpha (TNF-α), Erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Statistical analysis will be performed based on the intention-to-treat principle. Discussion This protocol aims to be one of the first to implement an oral magnesium supplementation program in a double-blind randomized controlled trial, assessing both inflammatory markers and clinical outcomes in acute leukemia patients undergoing Allo-HSCT. Trial registration Iranian Registry of Clinical Trials. IRCT20240812062726N1. URL of trial registry record: https://irct.behdasht.gov.ir/trial/78589 . Registered on 17 September 2024.

IntroductionPeri-trochanteric fractures, common among the elderly with osteoporosis, pose significant morbidity and mortality risks. These fractures are increasing due to the ageing population, with Nordic countries seeing a high incidence. They present challenges for orthopaedic surgeons and can lead to functional decline and high medical costs. Hip fractures have severe consequences, including pain, immobility and increased mortality. Managing wound care is complex, involving various healing phases. Trehalose, a disaccharide with antioxidant and anti-inflammatory properties, has shown promise in wound healing and other health conditions. Studies suggest its potential benefits in reducing inflammation and aiding wound healing in peri-trochanteric fracture patients, but more research is needed to confirm its clinical effectiveness in humans.Methods and analysisThe study is a double-blind, placebo-controlled randomised clinical trial aiming to evaluate the effect of trehalose consumption on patients with peri-trochanteric fractures. The study will include 64 patients meeting specific inclusion criteria and will assess inflammatory markers and wound healing at different time points. Patients will be divided into two groups, one receiving trehalose and the other receiving a placebo for 12 weeks. Various measurements and assessments will be conducted, including biochemical assays, wound assessments, anthropometric measurements and dietary intake evaluations. Data analysis will be performed using SPSS software, and statistical tests will be used to compare outcomes between the intervention and control groups.Ethics and disseminationThe Ethics Committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.RETECH.REC.1403.191).Trial registration numberIranian Registry of Clinical Trials. IRCT20180404039188N5. URL of trial registry record: https://irct.behdasht.gov.ir/trial/77572. Registration date: 7 July 2024.