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1.
Effect of dietary anthocyanins on biomarkers of glycemic control and glucose metabolism: A systematic review and meta-analysis of randomized clinical trials.
Fallah, AA, Sarmast, E, Jafari, T
Food research international (Ottawa, Ont.). 2020;:109379
Abstract
Anthocyanins, as natural food colorants, are bioactive substances with several health advantages. In this research, the effects of dietary anthocyanins on biomarkers of glycemic control and glucose metabolism was evaluated through a meta-analysis. The results revealed a significant reduction in levels of fasting blood sugar (FBS; -2.70 mg/dl, 95% CI: -4.70 to -1.31; P < 0.001), 2-h postprandial glucose (2-h PPG; -11.1 mg/dl, 95% CI: -18.7 to -3.48; P = 0.004), glycated hemoglobin (HbA1c; -11.1 mg/dl, 95% CI: -18.7 to -3.48; P = 0.004), homeostasis model assessment of insulin resistance (HOMA-IR; -0.54, 95% CI: -0.94 to -0.14; P = 0.008), resistin (-1.23 µg/l, 95% CI: -2.40 to -0.05; P = 0.041), and plasminogen activator inhibitor-1 (PAI-1; -5.09 µg/l, 95% CI: -9.45 to -0.73; P = 0.022) following administration of anthocyanins, whilst changes in the levels of fasting insulin (0.33 mU/l, 95% CI: -0.18 to 0.85; P = 0.207) and C-peptide (-0.02 µg/l, 95 %CI: -0.20 to 0.16; P = 0.816) was not statistically significant. Consumption of anthocyanins for >8 weeks and at doses >300 mg/day significantly reduced levels of FBS, 2-h PPG, HbA1c, and HOMA-IR. Moreover, anthocyanins administration reduced the levels of FBS, 2-h PPG, HbA1c, and HOMA-IR in type 2 diabetic subjects and HOMA-IR in overweight/obese individuals. Overall, dietary anthocyanins can be used as an adjuvant therapy to improve biomarkers of glycemic control and glucose metabolism specially in diabetic subjects.
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2.
Impact of dietary anthocyanins on systemic and vascular inflammation: Systematic review and meta-analysis on randomised clinical trials.
Fallah, AA, Sarmast, E, Fatehi, P, Jafari, T
Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association. 2020;135:110922
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Plain language summary
Low-grade chronic inflammation contributes to the development of various chronic conditions like diabetes mellitus type2, chronic kidney disease, stroke, atherosclerosis, cardiovascular diseases, and cancer. Anthocyanins, a member of the flavonoid family, are water-soluble pigments that give plants their red-orange to blue-violet colours and have been shown to have antioxidant properties. The aim of this review and meta-analysis of 32 randomised controlled trials was to evaluate the impact of pure anthocyanins or anthocyanin-rich extracts/powders on inflammatory markers. The quality of studies for the meta-analysis was high for the inflammatory markers CRP (C-reactive protein), IL-6, TNF-alpha, adiponectin, and VCAM-1. There was a significant reduction in the pro-inflammatory CRP, IL-6, TNF-alpha and VCAM-1, and a significant increase in the anti-inflammatory adinopectin. Quality of studies was poor for other inflammatory markers evaluated. Higher doses tended to have a bigger positive effect. The authors conclude that anthocyanins may reduce inflammation.
Abstract
Anthocyanins are natural bioactive compounds that have several health benefits. This systematic review and meta-analysis assessed the impact of dietary anthocyanins on markers of systemic and vascular inflammation. Meta-analysis of 32 randomised controlled trials indicated that dietary anthocyanins significantly decreased levels of C-reactive protein (CRP; -0.33 mg/l, 95% CI: -0.55 to -0.11, P = 0.003), interleukin-6 (IL-6; -0.41 ρg/ml, 95% CI: -0.70 to -0.13, P = 0.004), tumor necrosis factor-alpha (TNF-α; -0.64 ρg/ml, 95% CI: -1.18 to -0.09, P = 0.023), intercellular adhesion molecule-1 (-52.4 ng/ml, 95% CI: -85.7 to -19.1, P = 0.002), and vascular adhesion molecule-1 (VCAM-1; -49.6 ng/ml, 95% CI: -72.7 to -26.5, P < 0.001) while adiponectin level was significantly increased (0.75 μg/ml, 95% CI: 0.23 to 1.26, P = 0.004). The levels of interleukin-1β (IL-1β; -0.45 ρg/ml, 95% CI: -3.77 to 2.88, P = 0.793) and P-selectin (-6.98 ng/ml, 95% CI: -18.1 to 4.15, P = 0.219) did not significantly change. Subgroup analyses showed that administration of higher doses of anthocyanins (>300 mg/day) significantly decreased levels of CRP, IL-6, TNF-α, and VCAM-1. The results indicate that dietary anthocyanins reduce the levels of systemic and vascular inflammation in the subjects.
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Effects of pomegranate peel extract and vitamin E on the inflammatory status and endothelial function in hemodialysis patients: a randomized controlled clinical trial.
Jafari, T, Fallah, AA, Reyhanian, A, Sarmast, E
Food & function. 2020;(9):7987-7993
Abstract
Inflammation and endothelial dysfunction are major problems in hemodialysis (HD) patients. This study assessed the effects of an 8 week administration of pomegranate peel extract (PPE) and vitamin E (Vit E) alone or in combination on the biomarkers of inflammation, including C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), and the biomarkers of endothelial function, including intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and P-selectin, in HD patients. In a randomized, double-blind, parallel, placebo-controlled trial, 100 HD patients were randomly divided into 4 equal groups: (a) PPE + Vit E, received 2 pomegranate tablets (each tablet contained 225 mg PPE, equal to 90 mg ellagic acid) + 1 Vit E soft gel (400 IU) daily, (b) PPE, received 2 pomegranate tablets + 1 Vit E placebo soft gel daily, (c) Vit E, received 1 Vit E soft gel + 2 pomegranate placebo tablets daily, and (d) placebo, received 2 pomegranate placebo tablets + 1 Vit E placebo soft gel daily. For group allocation, a stratified block randomization procedure based on sex, age, and HD duration was used. Each intervention product and its placebo had identical shape, color, size, and packaging. Consumption of PPE + Vit E significantly reduced the serum CRP level (mean change: -7.12 ± 4.59 mg l-1, P < 0.001) compared to other groups, while reduced levels of IL-6 (mean change: -2.19 ± 2.33 pg ml-1, P < 0.001), TNF-α (mean change: -2.41 ± 3.21 pg ml-1, P = 0.008), ICAM-1 (mean change: -64.2 ± 111.0 ng ml-1, P = 0.017), and VCAM-1 (mean change: -117.7 ± 177.1 ng ml-1, P = 0.002) were observed compared to the control. There was no significant difference in the P-selectin level among the groups. Consumption of PPE or Vit E alone significantly reduced the CRP level (mean change for PPE: -3.58 ± 5.41 mg l-1, P < 0.001; mean change for Vit E: -3.25 ± 8.29 mg l-1, P = 0.002) compared to the control. As a result, consumption of PPE in combination with Vit E enhanced the inflammatory status and endothelial function in HD patients.
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Effect of Chlorella supplementation on cardiovascular risk factors: A meta-analysis of randomized controlled trials.
Fallah, AA, Sarmast, E, Habibian Dehkordi, S, Engardeh, J, Mahmoodnia, L, Khaledifar, A, Jafari, T
Clinical nutrition (Edinburgh, Scotland). 2018;(6 Pt A):1892-1901
Abstract
BACKGROUND & AIMS The effect of Chlorella supplementation on cardiovascular risk factors of subjects with different health status has not been conclusively studied. Therefore, the efficacy of Chlorella supplementation on cardiovascular risk factors was assessed through a meta-analysis. METHODS A literature search on five electronic databases was performed and related randomized controlled trials (RCTs) published until 15 January 2017 were identified. For each study, the effect size of each outcome was presented as Un-standardized mean difference and 95% confidence interval (CI). The overall effect for each outcome was calculated using random effects model. RESULTS Meta-analysis on 19 RCTs with 797 subjects indicated that Chlorella administration significantly decreased the levels of total cholesterol (TC; -9.09 mg/dl, 95% CI: -12.91 to -5.26, P < 0.001), low-density lipoprotein cholesterol (LDL-C; -8.32 mg/dl, 95% CI: -12.22 to -4.42, P < 0.001), systolic blood pressure (SBP; -4.51 mmHg, 95% CI: -6.53 to -2.48, P < 0.001), diastolic blood pressure (DBP, -1.64 mmHg, 95% CI: -3.28 to -0.01, P = 0.049), and fasting blood glucose (FBG; -4.23 mg/dl, 95% CI: -8.29 to -0.17, P = 0.041) whereas changes in triglycerides (TG; 1.73 mg/dl, 95% CI: -7.25 to 10.70, P = 0.706), high-density lipoprotein cholesterol (HDL-C; 1.54 mg/dl, 95% CI: -2.40 to 5.48, P = 0.443), and body mass index (BMI; -0.23 kg/m2, 95% CI: -0.97 to 0.51, P = 0.545) was not statistically significant. Subgroup analyses based on intervention duration and Chlorella doses revealed that administration of Chlorella for 8 weeks or higher and doses higher than 4 g/day significantly reduced TC, LDL-C, SBP, and DBP levels in the participants. Moreover, Chlorella supplementation significantly reduced TC and LDL-C levels in unhealthy individuals, and also reduced SBP and DBP in hypertensive ones. CONCLUSIONS The results indicated that Chlorella supplementation improved levels of TC, LDL-C, SBP, DBP, and FBG but the changes in TG, HDL-C, and BMI were not satisfactory. More precise RCTs on subjects with different health status is recommended to clarify the effect of Chlorella supplementation on cardiovascular risk factors.
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Vitamin D ameliorates systolic but not diastolic blood pressure in patients with type 2 diabetes: Results from a meta-analysis of randomized controlled trials.
Jafari, T, Fallah, AA, Rostampour, N, Mahmoodnia, L
International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition. 2018;(1-2):90-99
Abstract
Inconsistent findings have been reported regarding the effects of vitamin D on blood pressure in patients with type 2 diabetes (T2D). This study aimed to evaluate the subject through a meta-analysis. A computerized literature search on five databases was performed and randomized controlled trials (RCTs) published until March 2016 were identified. The eligibility criteria for articles to be selected were parallel-group RCTs in which consumption of a kind of vitamin D was compared with placebo in patients with T2D. Un-standardized mean difference and its corresponding 95 % confidence interval (CI) was calculated from the effect sizes by using random effects model. Studies comparing intervention group (received vitamin D) with control group (received placebo) were enrolled in meta-analysis. Meta-analysis on 26 studies with 1789 type 2 diabetic subjects showed that vitamin D significantly reduced systolic blood pressure (SBP; -0.97 mmHg, 95 % CI: -1.94, -0.001, P = 0.050), but not diastolic blood pressure (DBP; -0.10 mmHg, 95 % CI: -0.22, 0.02, P = 0.087). Subgroup analyses showed that administration of vitamin D in patients with baseline serum 25-hydroxy vitamin D < 50 nmol/l and baseline SBP < 140 mmHg significantly reduced SBP. Moreover, the patients who received vitamin D without Ca co-supplementation showed significant reduction in SBP. Vitamin D doses (≤ 2000 or > 2000 IU/day) and method of vitamin D application (Supplementation or food fortification) did not affect the blood pressure. This study demonstrated that vitamin D improved SBP in type 2 diabetic patients. Therefore, this vitamin can be considered as an adjuvant therapy in these patients.
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The association between mercury levels and autism spectrum disorders: A systematic review and meta-analysis.
Jafari, T, Rostampour, N, Fallah, AA, Hesami, A
Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements (GMS). 2017;:289-297
Abstract
BACKGROUND & AIMS The relationship between mercury and autism spectrum disorders (ASD) has always been a topic of controversy among researchers. This study aimed to assess the relationship between ASD and mercury levels in hair, urine, blood, red blood cells (RBC), and brain through a meta-analysis. METHODS A systematic search was performed in several databases including PubMed, ISI Web of Science, Cochrane register of controlled trials, Google Scholar, Scopus, and MagIran until June 2017. Case-control studies evaluating concentration of total mercury in different tissues of ASD patients and comparing them to the healthy subjects (control group) were identified. Necessary data were extracted and random effects model was used to calculate overall effect and its 95% corresponding confidence interval (CI) from the effect sizes. RESULTS A total of 44 studies were identified that met the necessary criteria for meta-analysis. The mercury level in whole blood (Hedges=0.43, 95% CI: 0.12, 0.74, P=0.007), RBC (Hedges=1.61, 95% CI: 0.83, 2.38, P<0.001), and brain (0.61ng/g, 95% CI, 0.02, 1.19, P=0.043) was significantly higher in ASD patients than healthy subjects, whereas mercury level in hair (-0.14mg/g, 95% CI: -0.28, -0.01, P=0.039) was significantly lower in ASD patients than healthy subjects. The mercury level in urine was not significantly different between ASD patients and healthy subjects (0.51mg/g creatinine, 95% CI: -0.14, 1.16, P=0.121). CONCLUSIONS Results of the current meta-analysis revealed that mercury is an important causal factor in the etiology of ASD. It seems that the detoxification and excretory mechanisms are impaired in ASD patients which lead to accumulation of mercury in the body. Future additional studies on mercury levels in different tissues of ASD patients should be undertaken.
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Effects of vitamin D on serum lipid profile in patients with type 2 diabetes: A meta-analysis of randomized controlled trials.
Jafari, T, Fallah, AA, Barani, A
Clinical nutrition (Edinburgh, Scotland). 2016;(6):1259-1268
Abstract
BACKGROUND & AIMS The effect of vitamin D on lipid profile in type 2 diabetic patients is controversial. This meta-analysis aimed to assess the effect of vitamin D on serum total cholesterol (TC), triglycerides (TG), low-density lipoproteins (LDL), and high-density lipoproteins (HDL) of these patients to elucidate the subject. METHODS Seven databases were searched and randomized controlled trials (RCTs) assessed the effect of vitamin D on lipid profile published until November 2015 were identified. Un-standardized mean difference and its corresponding 95% confidence interval (CI) was calculated from the effect sizes by using random effects model. RESULTS We found 2220 articles in our systematic search, after exclusion of un-related studies we enrolled 17 studies comparing intervention group (received vitamin D) with control group (received placebo) in the meta-analysis. Vitamin D significantly reduced serum TC (-3.74 mg/dl, 95% CI: -7.13 to -0.34, P = 0.031), but serum TG did not show significant reduction (-4.90 mg/dl, 95% CI: -15.11-5.31, P = 0.347). Results confirmed the significant lowering effect of vitamin D on LDL in patients with T2D (-2.55 mg/dl, 95% CI: -4.83 to -0.26, P = 0.029), but change in serum HDL was negligible (-0.72 mg/dl, 95% CI: -1.27 to -0.17, P = 0.010). Subgroup analyses showed that the baseline serum 25-hydroxy vitamin D of patients, vitamin D dosage, intervention duration, and the method of vitamin D application influence the effect of vitamin D on lipid markers. CONCLUSION This study demonstrated that vitamin D improved serum levels of TC, TG, and LDL in patients with T2D but changes of serum HDL was not satisfactory.
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Effects of vitamin D-fortified low fat yogurt on glycemic status, anthropometric indexes, inflammation, and bone turnover in diabetic postmenopausal women: A randomised controlled clinical trial.
Jafari, T, Faghihimani, E, Feizi, A, Iraj, B, Javanmard, SH, Esmaillzadeh, A, Fallah, AA, Askari, G
Clinical nutrition (Edinburgh, Scotland). 2016;(1):67-76
Abstract
BACKGROUND & AIMS Low levels of serum 25-hydroxy vitamin D (25(OH)D) are common in type 2 diabetic patients and cause several complications particularly, in postmenopausal women due to their senile and physiological conditions. This study aimed to assess the effects of vitamin D-fortified low fat yogurt on glycemic status, anthropometric indexes, inflammation, and bone turnover in diabetic postmenopausal women. METHODS In a randomized, placebo-controlled, double-blind parallel-group clinical trial, 59 postmenopausal women with type 2 diabetes received fortified yogurt (FY; 2000 IU vitamin D in 100 g/day) or plain yogurt (PY) for 12 weeks. Glycemic markers, anthropometric indexes, inflammatory, and bone turnover markers were assessed at baseline and after 12 weeks. RESULTS After intervention, in FY group (vs PY group), were observed: significant increase in serum 25(OH)D and decrease of PTH (stable values in PY); significant improvement in serum fasting insulin, HOMA-IR, HOMA-B, QUICKI, and no changes in serum fasting glucose and HbA1c (significant worsening of all indexes in PY); significant improvement in WC, WHR, FM, and no change in weight and BMI (stable values in PY); significant increase of omentin (stable in PY) and decrease of sNTX (significant increase in PY). Final values of glycemic markers (except HbA1c), omentin, and bone turnover markers significantly improved in FY group compared to PY group. Regarding final values of serum 25(OH)D in FY group, subjects were classified in insufficient and sufficient categories. Glycemic status improved more significantly in the insufficient rather than sufficient category; whereas the other parameters had more amelioration in the sufficient category. CONCLUSIONS Daily consumption of 2000 IU vitamin D-fortified yogurt for 12 weeks improved glycemic markers (except HbA1c), anthropometric indexes, inflammation, and bone turnover markers in postmenopausal women with type 2 diabetes. TRIAL REGISTRATION www.irct.ir (IRCT2013110515294N1).
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The association between serum selenium and gestational diabetes mellitus: a systematic review and meta-analysis.
Askari, G, Iraj, B, Salehi-Abargouei, A, Fallah, AA, Jafari, T
Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements (GMS). 2015;:195-201
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Abstract
BACKGROUND Results of the studies about association between serum selenium concentration and gestational hyperglycemia are inconsistent. Some studies have demonstrated that women with gestational diabetes mellitus (GDM) have lower Se concentrations while contrary results are reported in other studies. AIM: The aim of this study is to compare the serum Se concentration in women with GDM and normoglycemic pregnant women via a systematic review and meta-analysis. METHODS A computerized literature search on four databases (PubMed, Cochrane register of control trials, Scopus and Google scholar) was performed from inception through August 2013. Necessary data were extracted and random effects model was used to conduct the meta-analysis. RESULTS Six observational studies (containing 147 women with GDM and 360 normoglycemic pregnant women) were found, which had compared serum Se concentration in women suffering from GDM with normal pregnant ones. Our meta-analysis revealed that serum Se concentration was lower in women with GDM compared to normoglycemic pregnant women (Hedges=-1.34; 95% CI: -2.33 to -0.36; P<0.01). Stratified meta-analysis demonstrated that concentration of Se in the sera of women with GDM was lower than normal pregnant women both in second and third trimesters, but the result was not significant in second trimester (second trimester: Hedges=-0.68; 95% CI: -1.60-0.25; P=0.15, third trimester: Hedges=-2.81; 95% CI: -5.21 to -0.42; P<0.05). It was also demonstrated that serum Se status was lower in pregnant women with impaired glucose tolerance (IGT) compared to normoglycemic pregnant women (Hedges=-0.85; 95% CI: -1.18 to -0.52). CONCLUSION The available evidences suggest that serum Se concentration is significantly lower in pregnant women with gestational hyperglycemia compared to normal pregnant women.
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Parenteral immunonutrition in patients with acute pancreatitis: a systematic review and meta-analysis.
Jafari, T, Feizi, A, Askari, G, Fallah, AA
Clinical nutrition (Edinburgh, Scotland). 2015;(1):35-43
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BACKGROUND & AIMS Acute pancreatitis is a systemic immunoinflammatory response to auto-digestion of the pancrease and peri-pancreatic organs. Patients with acute pancreatitis can rapidly develop nutritional deficiency; hence nutritional support is important and critical. Sometimes parenteral nutrition (PN) is inevitable in acute pancreatitis. Due to immunosuppressive and inflammatory nature of the disease, it seems that immunonutrients like glutamine and omega-3 fatty acids (ω-3 FAs) added to parenteral formulas may improve the conditions. We conducted a meta-analysis to evaluate the effects of parenteral immunonutrition on clinical outcomes (infectious complications, length of hospital stay (LOS) and mortality) in patients with acute pancreatitis. METHODS A computerized literature search on four databases (PubMed, Cochrane, ISI Web of Science, and Iran Medex) was performed to find all the randomized controlled trials (RCTs) assessed the effects of parenteral immunonutrition in acute pancreatitis. Necessary data were extracted and quality assessment of RCTs was performed with consensus in the study team. Fixed effects model was used to conduct the meta-analysis. RESULTS One hundred and ninety four references were found via our search in which 7 articles matched our criteria for enrolling the meta-analysis. Parenteral immunonutrition significantly reduced the risk of infectious complications (RR = 0.59; 95% CI, 0.39-0.88; p ≤ 0.05) and mortality (RR = 0.26; 95% CI, 0.11-0.59; p ≤ 0.001). LOS was also shorter in patients who received immunonutrition (MD = -2.93 days; 95% CI, -4.70 to -1.15; p ≤ 0.001). CONCLUSION Immunonutrients like glutamine and ω-3 FAs added to parenteral formulas can improve prognoses in patients with acute pancreatitis.