فهرست مطالب

Nutrition and Food Security - Volume:7 Issue: 4, Nov 2022

Journal of Nutrition and Food Security
Volume:7 Issue: 4, Nov 2022

  • تاریخ انتشار: 1401/08/16
  • تعداد عناوین: 15
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  • Shiva Khani, Azadeh Lesani, Hadis Gerami* Pages 420-423

    Dyslipidemia is a crucial risk factor for atherosclerosis , and an abnormal metabolic condition characterized by disorders in lipid profile . Dyslipidemia is a critical yet controllable risk factor in coronary vascular disease (CVD) which cause deaths . Antioxidant activity of sumac fruits against lipid peroxidation and free radicals was reported previously .

  • Masoumeh Jabbari, Tahereh Alsadat Khoubbin Khoshnazar, Arezoo Haghighian-Roudsari*, Farzad Taghizadeh-Hesary, Ali Milani-Bonab Pages 424-436
    Background

    Complications of anti-cancer therapies can lead to inadequate nutrient intake, indigestion and deficiency of nutrients. The present study aims to better understand the nutritional challenges of hospitalized patients with cancer.

    Methods

    The participants were patients referred to the oncology ward of the hospital who were selected by the maximum diversity sampling of patients with various cancers. Semi-structured interviews were conducted to collect data and continued until data saturation with 20 participants. Inductive content analysis was applied to interpret data using MAXQDA 2018 software.

    Results

    The views of hospitalized patients with cancer regarding the nutritional complications were explored in four main themes, including "Inefficiency in patient food management”, “The need for care and support of the treatment team”, “Problems due to the consequences of the disease”, “Patients' strategies in conditions of dissatisfaction with the hospital food environment”. The sub-themes included "Dissatisfaction with the hospital food environment”, “Neglect of patients' specific conditions”, “Problem with the characteristics of hospital food”, “Uncertainty of the responsible person/people”, “Lack of continuous communication between the treatment team and patients”, “Patients’ need to consult with the treatment team”, “Patients’ concerns”, “Disease side-effects”, “Chemotherapy side effect”, and “Dissatisfaction of food and environment".

    Conclusion

    It is necessary to obtain a comprehensive understanding of patients' needs by a treatment team, including physicians, nurses, and nutritionists by establishing appropriate communication with the patients and nutrition education from the time of diagnosis and treatment

    Keywords: Cancer, Hospitalized patient, Nutrition, Phenomenology
  • Ameneh Marzban, Fariba Ramezani-Siakhulak, Vahid Rahmanian*, Maryam Dolatabadi, Abozar Ansari, Mohammad Afkhami Aghda Pages 437-444
    Background

    Since breast milk is one of the ways of transferring toxic elements from the body, breast milk infection in any form can have adverse effects on the development of the baby. This study aims to investigate the effect of education on knowledge, attitude, and practice of breastfeeding mothers about heavy metals transferred by breast milk.

    Method

    In this interventional study, 100 women referring to Abarkooh health centers were selected and randomly divided into case (n = 50) and control (n = 50) groups. The data collection tool was a questionnaire consisting of four parts, including background questions and knowledge, attitude, and practice. Then, eight two-hour classes were held weekly during two months by food health and safety expert in coordination with the test group. At the end of two months after the last training session, the questionnaires were repeated between the two groups (post-test).

    Results

    The mean score of knowledge, attitude, and practice of the mothers in the intervention group after training significantly increased (P < 0.05), while in the control group no significant difference was observed in the variables before and after the intervention. There was a significant difference between mean of knowledge, attitude, and practice in mothers with demographic variables only between knowledge and education level (P < 0.001).

    Conclusion

    The results showed that breastfeeding training program had a positive effect on promoting the knowledge, attitude, and behavior of the mothers. Therefore, it seems that continuous and varied educational programs are required to prevent the occurrence of heavy metal poisoning caused by breast milk and its consequences in infants.

    Keywords: Knowledge, Attitude, Practice, Breastfeeding, Heavy metals
  • Farzaneh Montazerifar*, Mansour Karajibani, Gohar Sedaghat, Shadi Shourestani, Fatemeh Azar Nour, Ahmad Bolouri Pages 445-451
    Background

    Diabetes and obesity are associated with an increased risk of cardiovascular disease. Irisin is a newly recognized peptidic myokine with anti-obesity and anti-diabetic properties. This study aims to investigate the relationship between serum irisin levels with cardiometabolic biomarkers in patients with type 2 diabetes mellitus (T2DM).

    Methods

    In this comparative cross- sectional study, 80 T2DM patients and 80 control participants (adjusted by age, body mass index (BMI), and physical activity) referring to Bou Ali Hospital in Zahedan, Iran, were enrolled. Serum irisin concentrations, anthropometric, and biochemical parameters were assessed.

    Results

    Serum irisin level was significantly lower in T2DM patients compared to control group. Multiple linear regression analysis revealed that after adjustment for age, irisin was negatively associated with waist circumference (WC, P < 0.01) and waist to height ratio (WHtR, P < 0.01), homeostasis model assessment insulin resistance (HOMA-IR, P = 0.009), triglycerides (TG, P = 0.016), and positively associated with high density lipoprotein cholesterol (HDL-c, P = 0.03) in diabetic patients.

    Conclusion

    The findings suggest that irisin can be used as a marker for predicting of obesity-related cardiometabolic biomarkers, insulin resistance, and incident T2DM.

    Keywords: Irisin, Insulin Rrsistance, Obesity, Cardiometabolic Risk factors, Type 2 diabetes mellitus
  • Mehran Rahimlou, Sara Sohaei, Ammar Salehi-Sahlabadi, Mehran Nouri* Pages 452-463
    Background

    At least 50% of infertile couple's problems are related to male factor infertility and in many patients; nutritional problems have been related to decreased sperm quality. Thus, the present study aims to examine the association of dietary fat and mineral intake with semen quantity and quality.

    Methods

    This cross-sectional study was conducted on 175 infertile men in Isfahan Infertility and Fertility Center, Iran.  Dietary intake of all patients was evaluated by validated Food Frequency Questionnaire (FFQ) and semen analysis was performed by standard protocol. Linear and quartile regression were used to determine the association of dietary fat and mineral intake with semen related factors.

    Results

    There was a positive association between the sperm total count with iron (Fe) (Ptrend = 0.03), zinc (Zn) (Ptrends= 0.02), and selenium (Se) (Ptrend = 0.001). Men in the highest quartile of Zn and alpha-linolenic acid (ALA) had higher sperm density (P < 0.05). Levels of Zn and docosahexaenoic acid (DHA) in participant's diet were also negatively related to DNA damage (Ptrend = 0.01 for Zn and Ptrend = 0.04 for DHA). Higher intake of saturated fatty acid (SFA) was associated with lower sperm density (Ptrend = 0.02) and higher intake of monounsaturated fatty acids (MUFAs) was associated with higher sperm totality (Ptrend = 0.02).

    Conclusion

    In this preliminary cross-sectional study, diets containing higher amounts of Fe, Zn, Se, MUFA, and DHA and lower amounts of SFA were associated with more favourable semen quality parameters.

    Keywords: Male infertility, Semen quality, Minerals, Fats
  • Leila Nateghi* Pages 464-473
    Background

    Many of the most common cancers, such as prostate and breast cancer are due to the presence of harmful agents and compounds in processed foods, including nitrite. In this research the physicochemical, antioxidant, and color properties of sodium nitrite-free sausages containing different concentrations of cochineal pigment alone or in combination with cumin essential oil were studied and compared with the control sample containing sodium nitrite.

    Methods

    The extract of cochineal pigment in concentrations 200 ppm, 400 ppm, and 600 ppm alone or with 0.004 % w/w of essential oil of cumin were added to 40% red meat German sausage and physico-chemical, antioxidant, and color changes of the samples during 1, 10, 20, and 30 days after production (in refrigerator conditions) were compared with the control (without cochineal pigment, essential oil of cumin, and 120 ppm sodium nitrite) sample.

    Results

    The findings of the study showed that this substitution did not have a significant (P > 0.05) effect on physico-chemical properties, and by increasing the concentration of cochineal pigment in the samples, the antioxidant properties of the samples significantly increased. The samples containing 400 or 600 ppm of cochineal pigment with 0.004 %w/w of cumin in the formulation were not significantly different from control sample in terms of antioxidant properties and were selected as superior treatment.

    Conclusion

    It is possible to produce a healthy German sausage without nitrite by using cochineal pigment and cumin essential oil.

    Keywords: Cochineal pigment, Cumin essential oil, Red Mmat, Sausage, Sodium nitrite
  • Fatemeh Toorang, Saba Narmcheshm, Bahareh Sasanfar, Neda Amini, Maryam Hadji, Mahshid Mortazavi, Kazem Zendehdel* Pages 474-483
    Background

    This study investigated the association between vitamins intakes and risk of gastric cancer (GC) among Iranian population.

    Methods

    In this hospital-based case-control study, 178 pathologically confirmed GC patients and 276 healthy controls were interviewed to answer a valid diet history questionnaire. Unconditional logistic regression, in which potential confounders were taken into account, was applied to determine the association of vitamin intakes and odds of GC in total population and in stratums of body mass index (BMI), helicobacter pylori (H-pylori) infection, and smoking.

    Results

    GC was directly associated with vitamin D (OR 1.59; CI 95% 1.07, 2.36) and cobalamin (OR 1.25; CI 95% 1.08, 1.44). Thiamin (OR 0.50; 95%CI 0.30, 0.83), pantothenic acid (OR 0.71; 95%CI 0.58, 0.87), folate (OR 0.99; 95%CI 0.99, 0.99) and vitamin E (OR 0.98; 95%CI 0.96, 0.99) were inversely associated with GC. In 231 H-pylori infected participants, consumption of thiamin (OR 0.3; 95% CI 0.59, 0.86), pyridoxine (OR 0.52; 95%CI 0.31, 0.85), and folate (OR 0.99; 95%CI 0.99, 0.99) reduced GC risk. In H-pylori negative participants, only vitamin E (OR 0.96; 95%CI 0.93, 0.99) reduced the risk and vitamin D (OR 1.99; 95%CI 1.18, 3.36), riboflavin (OR 1.91; 95%CI 1.37, 2.66), pantothenic acid (OR 1.34; 95%CI 1.13, 1.64), biotin (OR 1.03; 95%CI 1.01, 1.05), and cobalamin (OR 1.36; 95%CI 1.13, 1.64) increased the risk. In BMI stratums, only vitamin D (OR 1.81; 95%CI 1.07, 3.08) was associated with the risk of GC among normal weight participants. Vitamin E was associated with lower risk of GC in ever smokers (OR 0.97; 95%CI 0.95, 0.99) and thiamin (OR 0.41; 95%CI 0.19, 0.86) and niacin (OR 0.93; 95%CI 0.87, 0.99) were associated with lower risk in never smokers. Positive associations were observed by increasing vitamin D (OR 2.08; 95%CI 1.12, 3.85) and cobalamin (OR 1.33; 95%CI 1.08, 1.65) in never smokers.

    Conclusion

    This study provided support for a possible protective effect of vitamin E, thiamin, pantothenic acid, and folate on GC risk. Vitamin D and cobalamin intake increased the risk.

    Keywords: Vitamin, Stomach cancer, Nutrition, Dietary Intake, Hospital-based case-control study
  • Ameneh Shirin, Hamid Joveini*, Masoumeh Hashemian, Akram Kooshki, MohammadHassan Rakhshani, Nader Sharifi, Alireza Rohban Pages 484-495
    Background

    Current educational techniques may have a few effects on dietary habits and food preferences in adolescents, so by designing an educational attractive program, nutritional knowledge can be significantly enhanced. This study aims to investigate the effect of a structured educational intervention based on poetry, game, and problem-solving skills on promoting nutritional knowledge, and behavior in primary school students.

    Methods

    This experimental study was conducted on 120 primary school students aged 10-12 years in Sabzevar, Iran, in 2019. The participants were selected through multi-stage random sampling and divided into experimental (EG, n=60) and control (CG, n=60) groups. The data collection tool was a researcher-made questionnaire consisting of three sections (demographic characteristics, nutritional knowledge section, and nutritional behavior section). The validity and reliability of the questionnaire were checked and confirmed. The educational program, including educational poems, a "road to health" game, and problem-solving skills, was designed. The EG received a self-directed educational program. Both groups completed the questionnaires before and one month after the intervention.

    Results

    After the intervention, the mean scores of nutritional knowledge and nutritional behaviors significantly improved in the EG compared to the CG (P < 0.05). Moreover, after the intervention, the mean score of nutritional behavior in the EG significantly improved compared to before the intervention (P < 0.05). The highest percentage in mean scores in the food pyramid groups was related to the consumption of vegetables (27%), consumption of milk and dairy products (26%), non-consumption of low-value snacks (13%), and non-consumption of sugar and candy (11%), respectively.

    Conclusion

    The educational program based on poetry, game, and problem-solving skills can be practical, attractive, and cost-effective for promoting nutritional knowledge and behavior in adolescents.

    Keywords: Nutritional knowledge, Nutritional behavior, Educational poetry, Problem-solving, Primary students
  • Augustin Nawidimbasba Zeba*, Hermann Zosé Ouedraogo, Alain Hien Pages 496-507
    Background

    The present cross-sectional study was conducted to measure the population attributable risk (PAR) of severe anemia among children aged 6-23 months in the rural district of Kongoussi, in Burkina Faso.

    Methods

    Socio-demographic, clinical, anthropometric, and biological data were collected from children and mothers.

    Results

    In total, 671 children were included in the analysis, 50.4% of whom were male and 97.8% were breastfed. Only 5.8% of the children had adequate complementary feeding, 25.8% were wasted, and 23.5% stunted. Malaria affected about half (50.8%) of children; 39.3% had mild malaria and 11.5% had severe malaria. Children who were no longer breastfed were more likely to have malaria [OR = 3.98 (1.11-14.2), P = 0.022] than those who were breastfed. Fever in the last fortnight [OR = 1.49 (1.07-2.08), P = 0.019], current fever [OR = 4.30 (2.39-7.76), P < 0.001], and presence of splenomegaly [OR = 2.68 (1.54-4.67), P < 0.001] were also positively associated with malaria. Anemia and severe anemia had a prevalence of 96.8% and 24.4%, respectively, and were associated with both mild and severe malaria. Body mass index of mothers [OR = 1.82 (1.06-3.12), P = 0.029], diarrhea in the last fortnight [OR = 1.70 (1.06-2.71), P = 0.027], stunting [OR = 1.54 (1.01-2.34), P = 0.045], and splenomegaly [OR = 2.93 (1.70-5.06), P = 0.045] were other independent factors associated with severe anemia. The PARs of severe anemia due to mild and severe malaria were 22.1% (6.1%-35.4%) and 22.0% (11.6%-27.7%), respectively.

    Conclusion

    Given the high frequency of anemia and severe anemia in this rural malaria-endemic area, interventions are required that consider the important contribution of malaria to anemia and aim to prevent infection.

    Keywords: Malaria, Severe anemia, Children, Impact, Burkina Faso
  • Hamed Rahnavard* Pages 508-511
    Background

    Astaxanthin is widely and naturally distributed in marine animals including, crustaceans, such as shrimp, crabs, and fish, such as salmon and trout.

    Methods

    A total of 20 trout samples were collected from local market and were analyzed for astaxanthin via HPLC-UV. Analyte extraction was done by water, methanol, dichloromethane, and acetonitrile 4.5:85:5:45.5, v/v/v/v.

    Results

    Despite the optimal conditions, analytical property of the method containing lower limit of quantitation (2.00 ng g-1) and upper limit of quantitation (1000 ng g-1), linearity (r2=0.992), and recovery (103%) were acceptable. The results showed the range of 105 ± 0.09 - 875 ± 0.020 ng g-1.

    Conclusion

    The method was successfully used to quantify the target analytes in all trout samples.

    Keywords: Astaxanthin, High performance liquid chromatography, Fish, Upper limit of quantification (ULOQ), lower limit of quantification (LLOQ)
  • Ayodeji Oluwafemi Idowu*, Aduke Oluremi Saliu, Babamotemi Oluwasola Itakorode, Cecilia Nireti Fakorede, Rotimi Olusanya Arise Pages 512-524
    Background

    Exposure of potato tubers to light causes accumulation of glycioalkaloids in the tubers and overdose of glycoalkaoids are associated with some toxicity. This study aims to investigate the effect of consuming sunlight exposed tubers of Irish potato on some selected tissues of rats.

    Methods

    Freshly harvested tubers of Solnum tuberosum were purchased from a farmland and were randomly grouped into five groups. Groups 1- 4 consisted of tubers exposed to sunlight (including visible and invisible light e.g. ultraviolet) for a period of 1, 2, 3, and 4 week(s), respectively, while group 5 served as the control and consisted of freshly harvested tubers of Irish potato that have not been exposed to sunlight. The glycoalkaloids content was determined in both the non-exposed (control) and sunlight exposed tubers. Thereafter the tubers were formulated as diet and administered to rats. Biochemical analyses on serum lipid profile, enzymes of selected tissues (serum, liver, and kidney) and lipid peroxidation were carried out.

    Results

    The results showed that the total glycoalkaloids content of the exposed sunlight groups (230, 250, 270, and 300 mg/kg fresh weight, respectively) significantly increased compared to the control group (100 mg/kg fresh weight). A significant reduction (P < 0.05) in activities of alanine aminotransferase, aspartate aminotransferase and a significant upsurge (P < 0.05) in alkaline phosphatase activity was observed in the selected tissues of sunlight-exposed potato tuber animal groups compared to the (non-exposed) group. Lipid peroxidation assessment revealed a significant upsurge (P < 0.05) in malondialdehyde formation and a mild alteration in serum lipid profile.

    Conclusion

    The study concluded that consumption of sunlight exposed Solanum tuberosum tubers may pose a threat on vital organs of the body irrespective of duration of exposure.

    Keywords: Solanum tuberosum, Glycoalkaloids, Alanine aminotransferase, Aspartate aminotransferase, Lipid peroxidation
  • Andisheh Norouzian Ostad, Zahra Dehnavi, Hossein Farshidi, Ali Jafarzadeh Esfahani, Soudabeh Behrooj, Teamur Aghamolaei, Abdoulhossain Madani, Roghayeh Ezati Rad, Farkhondeh Razmpour* Pages 525-535
    Background

    There is limited evidence regarding the risk factors and nutritional patterns in patients with premature coronary artery disease (PCAD). This study aims to investigate the relationship between different dietary patterns and risk factors in patients with PCAD.

    Methods

    This cross-sectional study was conducted on PCAD patients, including men younger than 55 years and women younger than 65 years, who underwent coronary angiography in the Angiography Department of the Shahid Mohamadi Hospital, Bandar Abbas, Iran. Anthropometric and clinical examination, demographic questionnaires, and containing dietary intake and physical activity questionnaires were filled for all participants.

    Results

    The most prevalent risk factors for obstructive PCAD in the 65 selected patients were family history of coronary artery disease (CAD) (73%), hypertension (52%), and overweight/obesity (50%). Daily consumption of hydrogenated fats (P = 0.008) and high-fat milk (P < 0.001) were significantly higher in obstructive PCAD patients compared to non-obstructive and non-PCAD patients. Daily consumption of fruits was significantly higher in non-obstructive and non-PCAD patients compared to obstructive PCAD patients (P = 0.039).

    Conclusion

    Family history of CAD, hypertension, and obesity were found to be the most common risk factors among obstructive PCAD patients.  According to the findings, increased consumption of high-fat milk and hydrogenated fats may increase the risk of PCAD, whereas, daily consumption of fruits may reduce the risk of PCAD.

    Keywords: Coronary artery disease, Premature coronary artery disease, Risk factors, Dietary patterns
  • Masha Shirani*, Zohreh Ghaem Far, Milad Bagheri, Mehran Nouri Pages 536-547
    Background

    Infertility affects about 15% of the population and male factors only are responsible for ~25–30% of cases of infertility. Oxidative stress is an imbalance between the production of free radicals and the capacity of the body to counteract their harmful effects through neutralization by antioxidants. This study aims to access the relationship between non-enzymatic dietary antioxidant capacity and male infertility.

    Methods

    In this cross-sectional study, 270 infertile men aged 18-55 years were selected from Isfahan province in 2018. Semen assessment was performed according to the fifth edition of the WHO laboratory manual and a 168-item food frequency questionnaire (FFQ) questionnaire was used to determine the amount of dietary intakes of participants. P-value < 0.05 was considered statistically significant.

    Results

    There were no significant association between sperm parameters and dietary total antioxidant capacity (DTAC) tertiles in the crude model and after adjustment for potential confounders. The participants in the highest tertile of DTAC had a higher risk of abnormal density and motility in crude model (OR=1.30; 95% CI: 0.65, 2.59; P = 0.46 and OR=1.69; 95% CI: 0.83, 3.44;
    P = 0.99) and risk of abnormal density decreased in the adjusted model (OR=0.99; 95% CI: 0.39, 2.50; P = 0.99) and (OR: 1.43; 95% CI: 0.51, 4.01;
    P = 0.5).

    Conclusion

    In this cross-sectional study there was no significant relationship between semen parameters and DTAC tertiles in the crude and adjusted model. Therefore, it is required to conduct more research studies to determine the clear benefits and risks of antioxidant therapy for infertility.

    Keywords: Antioxidants, Semen analysis, Male infertility, Phytochemical index
  • Azam Ahmadi Vasmehjani, Fatemeh Yaghoubi, Zahra Darabi, Nooshin Abdollahi, Zohreh Sadat Sangsefidi, Mahdieh Hosseinzadeh* Pages 548-561
    Background

    Quercetin is one of the main flavonoids, overall distributed in plants. The antioxidant capacity of quercetin is several times vitamin E and glutathione. This systematic review and meta‐analysis of randomized controlled trials were performed to determine the effect of quercetin on oxidative stress (OS) markers.

    Methods

    A literature search was conducted in PubMed, ISI Web of Science, Scopus, and Google Scholar to February of 2021. Meta-analysis was conducted on 8 eligible RCTs containing a total of 668 participants. The weighted mean difference (WMD) with 95% confidence intervals (CIs) was calculated for a pool effect size of Malondialdehyde (MDA), Total Antioxidant Capacity (TAC), and Ferric Reducing Ability of Plasma (FRAP). Subgroup analyses were performed based on intervention duration and dosage. The heterogeneity of studies was examined by Cochran's Q test and I-squared (I2) statistic.

    Results

    Effect sizes from 668 participants based on the random effect model showed that quercetin supplementation had no significant effect on TAC and MDA compared to the control group. The analysis illustrated that quercetin supplementation significantly increased FRAP in adults (WMD = -0.159 mmol/l, 95% confidence interval (CI):-0.178, -0.141, P ≤ 0.001).

    Conclusions

    The finding of the current study showed that quercetin supplementation had no significant effect on TAC levels, although it significantly increased FRAP levels in adults. Also, MDA level did not markedly change. It has needed to conduct clinical trials with more quality and bigger sample sizes to verify the positive impact of quercetin on stress oxidative marker.

    Keywords: Quercetin, Oxidative stress, Malondialdehyde, Total antioxidant capacity, Ferric reducing ability of plasma
  • Fatemeh Yaghoubi, Zahra Darabi, Azam Ahmadi Vasmehjani, Zohreh Sadat Sangsefidi, Mahdieh Hosseinzadeh* Pages 562-574
    Background

    This systematic review and meta‐analysis of randomized controlled trials (RCTs) was conducted to determine the effect of dark chocolate on C-Reactive Protein (CRP) levels as one of the inflammatory factors.

    Methods

    A literature search was conducted in PubMed, ISI Web of Science, Scopus, and Google Scholar up to April of 2020. The registration number of study in PROSPERO was CRD4202020072, which was conducted over 5 eligible RCTs containing a total of 330 participants. The weighted mean difference (WMD) with 95% confidence intervals was calculated for the pool effect size of CRP. The heterogeneity of studies was examined by Cochran's Q test and I-squared (I2) statistic.

    Results

    Effect sizes from 330 participants based on random effect model showed no effect between consumption of dark chocolate on CRP levels compared to the control group (WMD: 0.01 mg/dl; 95% CI: −0.19, 0.22 mg/dl; P = 0.89; Cochran's Q test, Q statistic = 21.97; P < 0.001; I2 = 81.80%). The results of subgroup analysis based on intervention duration and dosage showed no significant effect on CRP levels (WMD = 0.05 mg/dl, 95% CI: −0.30, 0.42 mg/dl; P = 0.76).  Meta-regression for the intervention duration (slope: −0.0033, 95% CI: −0.0089, 0.0022; P = 0.24) and dosage (slope: 0.00006, 95% CI: −0.0036, 0.0037; P = 0.97) indicated no significant relationship with the mean difference of CRP.

    Conclusion

    The results of the present meta-analysis showed that consuming dark chocolate had no significant effect on the CRP level. More clinical trials are required with higher quality and bigger sample sizes to verify the positive impact of dark chocolate on the reduction CRP level.

    Keywords: Dark chocolate, CRP, Inflammation