ABSTRACT Objectives: Despite controversies, no study has systematically summarized findings from earlier studies on the effect of berberine (BBR)–silymarin on liver enzymes. Therefore, the current systematic review and meta-analysis aimed to investigate the effect of berberis aristate and silybum marianum on alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in adults. Methods: Relevant studies, published up to June 2020, were searched through PubMed/Medline, Scopus, ISI Web of Science, EMBASE and Google Scholar. The mean differences and standard deviations were pooled using a random-effects model. The studies’ quality was evaluated using Cochrane Risk of Bias Tool. Out of 80 citations, 5 trials that enrolled 549 participants were included. Results: Berberis aristate and silybum marianum resulted in no statistically significant change in ALT (weighted mean differences (WMD): −0.39 mg/dl; 95% CI: −1.67 to 0.89, P=0.55), and AST (WMD: −0.44 mg/dl; 95% CI: −2.02 to 1.14, P=0.58). We did not find any significant reduction in liver enzymes following BBR–silymarin consumption in adults. Conclusion: Further clinical trials with high quality according to challenges mentioned seem to be helpful to use BBR–silymarin as a supplement for improving liver function. Keywords: Berberis aristate, Silybum marianum, ALT, AST, Meta-analysis

Background: Understanding the association between water consumption and mortality is important for guiding consumers and prioritizing dietary guidelines to reduce the risk. Therefore, in the current study, we conducted a systematic review and dose-response meta-analysis of prospective cohort studies to summarize the association between total water and drinking intake and risk of mortality from all causes and CVD. Method: A comprehensive search was performed on PubMed/Medline, Scopus, and ISI Web of Science up to February 2020. The random effects model was used to calculate pooled effect size (EFs) and 95% confidence interval. Result: Seven prospective cohort studies with a total of 116816 reporting 14754 cases of all-cause mortality and 7611 of CVD mortality, were included in the present meta-analysis. No significant association was found between drinking water intake and all-cause mortality (EFs: 0.82; 95% CI: 0.63-1.08, P=0.65) and CVD mortality (EFs: 0.82; 95% CI: 0.63-1.08, P= 0.16). Total water intake was not associated with all-cause mortality (EFs: 0.95; 95% CI: 0.83-1.09, P=0.47). However, indicating a significant inverse association between total water intake and risk of CVD mortality (EFs: 0.84; 95% CI: 0.77-0.93, P<0.001). Linear dose-response meta-analysis revealed a significant inverse association between total water intake and all-cause mortality by an additional one cup per day (Pooled ES: 0.98; 95% CI: 0.97-0.99, P= 0.001). Furthermore, each additional cup of total water intake per day was associated with a 3% lower risk of death from CVD (Pooled ES: 0.97; 95% CI: 0.96-0.98, P<0.001). Conclusion: High consumption of total water is associated with a lower risk of CVD mortality. However total water intake was not associated with an increased risk of all-cause mortality.

Background: The prevalence of diabetes has been increasing, imposing massive costs on nations. Diet and physical activity are recommended for diabetes management. Evidence suggests theory-based interventions are more efficacious than non-theory approaches. This study aimed to test the effectiveness of an integrated theoretical model-based intervention to encourage compliance for low-fat food consumption, carbohydrate counting, and physical activity in adults with type 2 diabetes. Methods: A 4-week parallel randomized control trial was conducted in Iran. Data were collected using a self-report questionnaire at baseline and 8-weeks post-intervention. This survey assessed the Theory of Planned Behaviour (TPB) constructs of attitude, subjective norm (others’ approval), and perceived behavioural control (PBC). We also assessed risk perceptions (motivational) and planning (volitional) from the Health Action Process Approach (HAPA). Furthermore, weight, body mass index, triglyceride (TG), and LDL-cholesterol were measured. Results: For both low-fat food consumption and physical activity, only planning revealed a significant improvement over time for intervention rather than control participants (F=8.78, p≤0.001 for low-fat vs. F=11.26, p≤0.001 for physical activity). For carbohydrate counting, significant effects were found for behavior (F=4.37, p=0.03), intention (F=8.14, p≤0.001), PBC (F=7.52, p≤0.001), and planning (F=4.54, p=0.03), reflecting improvements over time in the intervention participants compared to controls. Further, the effects of the intervention on behavior were partially mediated via participants’ degree of planning (B=0.10, SE=0.06, CI=0.01 to 0.26). The serum TG level was significantly reduced from pre to post-intervention for intervention rather than for control participants (F=18.69, p≤0.001). Conclusions: This intervention was promising for carbohydrate counting but did not show improvements for low-fat diet nor physical activity. Given the improvement in psychological measures and self-reported behaviour for carbohydrate counting, coupled with the findings for TG, future research is needed to demonstrate longer-term improvements. Current theory-based educational strategies can be adopted for the management of carbohydrate intake in diabetes.

Objective: We aimed to assess the potential association of dietary (DIS) and lifestyle inflammation score (LIS) and their joint association (DLIS) with cardiorespiratory fitness (CRF) in Tehranian adults. Methods: A total of 265 males and females aged 18-70 years (mean ± SD: 36.9 ± 13.3) were entered in the present cross-sectional study. The DIS was calculated by the use of data from 18 anti- and pro-inflammatory dietary components, and the LIS by three non-dietary components including physical activity, smoking status and general adiposity, with higher scores indicating a more pro-inflammatory diet and lifestyle, respectively. The DLIS was calculated by summing the DIS and LIS. CRF was assessed by the Bruce protocol. The odds ratio (OR) and 95% confidence interval (CI) of CRF across tertiles of the DIS, LIS, and DLIS were estimated by logistic regression analysis with considering age, gender, energy intake, marital and education status and occupation as confounders. Results: The DLIS ranged from -2.10 to 0.38 (mean ± SD: -1.25 ± 0.64). In the model that controlled for all variables, the ORs of CRF for the second and third tertiles of the DLIS as compared to the first tertile were 0.42 (95%CI: 0.20, 0.90) and 0.12 (95%CI: 0.05, 0.32), respectively (P-trend <0.001). There was strong inverse association between the LIS and CRF (ORthird vs first tertile: 0.12, 95%CI: 0.05, 0.32). There was no association between DIS and CRF. Conclusion: Having a more inflammatory lifestyle was strongly inversely associated CRF. More research is needed to confirm the present findings.

Abstract Background: We sought to investigate whether adherence to a more plant-based, and less animal-based, diet is associated with visceral adiposity, lipid accumulation product (LAP), and triglyceride-glucose index (TyG) in Iranian adults. Methods: This cross-sectional study was conducted on 270 adults aged between 18-75 years old. We created three plant-based diets. including an overall plant-based diet index (PDI), hPDI, and uPDI based on tertiles regarding the intake of animal- or plant-based food items obtained from a semi-quantitative food-frequency questionnaire. Results: Higher hPDI was significantly associated with lower body mass index (BMI) (P-value = 0.01), lower waist circumference (P-value<0.001), and lower waist-hip ratio (P-value<0.001). A significant increase was found for high-density lipoproteins (HDL) (P-trend <0.001) with a significant decrease for LAP (P-value = 0.03) in those with higher adherence to hPDI. Moreover, greater adherence to PDI was associated with a significant increase in diastolic blood pressure (DBP) (p-value=0.01) and fat free mass (FFM) (p-value=0.01). There were no significant associations between PDIs and TyG and VFA. Conclusion: We found that a higher hPDI score was significantly associated with better anthropometric measurements. A significant increase was found for HDL and a significant decrease was found for LAP on hPDI. However, a higher PDI score was significantly associated with higher DBP and higher FFM.