Background: Understanding factors that influence adolescents’ diet quality and nutritional status is essential, as this life stage shapes long-term health outcomes. Therefore, this study aimed to examine individual, parental, and environmental determinants that significantly predicted dietary quality and nutritional status among adolescents in Padang City, Indonesia.Methods: A cross-sectional study involving 186 adolescents was conducted in Padang City, Indonesia. They were interviewed to assess individual, parental, and environmental determinants. Diet Quality Index for Adolescents (DQI-A) was used to assess dietary quality score and direct anthropometric measurements were performed to assess adolescentnutritional status. Multivariate analysis was applied to identify the most influential variable on DQI-A score (multivariate linear regression) and nutritional status (Multinomial logistic regression).Results: Mean score of DQI-A was 43.7±6.4 and the majority of adolescent had normal nutritional status (65.6%). Diet quality was associated with parental determinants (paternal education) and environmental determinants (availability of healthy and unhealthy food at school, food accessibility and screen time) with β coefficient -5.37 to 4.39. Individual determinants (low physical activity) and parental determinants (maternal education) was associated with higher odds of being underweight with OR 11.04 and 12.98.Conclusion: Dietary quality and nutritional status were shaped by the interaction of individual, parental and the environmental determinants rather than by a single factor. Therefore, comprehensive interventions are needed that simultaneously improve healthy food availability at school, strengthen parental nutritional knowledge, and promote healthier lifestyle behaviours among adolescents.
Sarcopenia, the age-associated decline in skeletal muscle mass and function can be a significant risk in elderly patients by increasing their vulnerability to complications, prolonging hospital stays, and impairing the recovery. Whey protein, due to its rich leucine content and rapid digestibility, has emerged as a promising intervention to counteract muscle wasting in this population. This review synthesized findings from 25 eligible studies published between 2015 and 2025, selected through a rigorous PRISMA-guided search across four major databases of PubMed, ScienceDirect, Cochrane Library, and ProQuest. Included studies encompassed randomized controlled trials, cohort analyses, systematic reviews, and narrative syntheses, with participants aged 60 years and older who experienced critical illness in ICU or postacute settings. The results consistently demonstrated that whey protein supplementation, either alone or as part of multimodal nutritional strategies could contribute to improvements in muscle mass, strength, physical function, and nitrogen balance. Early initiation of whey-based nutrition was particularly beneficial when combined with rehabilitation protocols. However, considerable heterogeneity was observed across studies in terms of protein formulation, dosage, intervention duration, and sarcopenia assessment methods. Despite these variations, the overall evidence supports the clinical utility of whey protein in attenuating sarcopenia progression in critically ill older adults. Further standardized and multicenter trials are warranted to optimize protein dosing, timing, and delivery strategies tailored to this vulnerable population.
Background: Hepatic toxicity of antipsychotic drugs needs to be protected by hepatoprotective medications. This study evaluated the antiinflammatory effect of N-acetylcysteine (NAC) and Royal jelly against hepatotoxicity of fluoxetine in rats.Methods: Thirty adult female rats were divided into five equal groups of 6 rats. Group A was considered negative control. Group B were rats administered orally by fluoxetine (10 mg\kg) to induce hepatotoxicity. Group C were animals pre-treated with oral NAC (200 mg\kg) and then fluoxetine (10 mg\kg). Group D was pre-treated with Royal jelly (150 mg\kg) following the use of fluoxetine (10 mg\kg). Group E was pretreated with oral Royal jelly and NAC following fluoxetine utilization. After completion of 28 days of treatment, the rats were euthanized and a blood sample was collected and evaluated for inflammatory cytokines of tumor necrotizing factor alpha (TNF-α), interleukin-10 (IL10) and oxidative stress biomarkers of malondialdehyde (MDA) and glutathione (GSH) by ELISA.Results: Fluoxetine induced hepatotoxicity and an increase in inflammatory cytokines such as TNF-α. Royal jelly and NAC showed significant anti-inflammatory and antioxidant effects by reduction in inflammatory cytokines and oxidative parameters.Conclusion: Both NAC and Royall jelly were shown to have antioxidant and anti-inflammatory activities, even NAC impact was more than Royal jelly against hepato toxicity induced by fluoxetine.
Background: Metabolic syndrome (MetS) is a multifactorial disorder marked by obesity, dyslipidemia, hypertension, and insulin resistance, which increase the risk of cardiovascular diseases and type 2 diabetes mellitus. Genetic factors, including polymorphisms in the Melanocortin-4 receptor (MC4R) have been linked to its development, especially regarding lipid metabolism and obesity. This study aimed to investigate the association between the MC4R (rs17782313) C/T polymorphism and lipid profile in individuals with MetS compared to healthy controls.Methods: A case-control study was conducted with 150 Iraqi participants including 75 MetS patients and 75 healthy controls. Anthropometric measurements and lipid profile were recorded. Genotypic distribution of the MC4R (rs17782313) polymorphism was analyzed using ARMSPCR. Statistical analyses assessed the correlation between MC4Rpolymorphisms, lipid profile, and risk of MetS.Results: Patients with MetS showed significantly higher BMI, waist circumference, triglycerides, total cholesterol, and low density lipoprotein (LDL) levels when compared to controls. The TT genotype of MC4R (rs17782313) was more prevalent among patients (24%) than controls (12%), associated with increased risk of MetS (OR=2.81, p=0.024). The T allele was also more common in patients (40.7%) than in controls (26%) (p=0.007, OR=1.95).Conclusion: Findings suggest a strong association between MC4R (rs17782313) polymorphism, lipid abnormalities, and MetS. The T allele and TT genotype may serve as genetic markers for increased susceptibility. Further studies are needed to clarify the molecular mechanisms behind therapeutic interventions targeting this receptor
Background: The expansion of the food industry and the rise in food processing have changed dietary habits, leading to concerns about excessive consumption. This study examined the relationship between the intake of ultra-processed foods (UPFs) and the prevalence of diabetes in an adult population in Shiraz, Southern Iran.Methods: Data from 3,285 participants in Employee Health Cohort of the Shiraz University of Medical Sciences were collected between August 2017 and February 2020 and analyzed using logistic regression analysis. The associations, yielding odds ratios with corresponding 95% confidence intervals were determined.Results: The relationship between higher consumption of UPFs and diabetes prevalence did not reach statistical significance. Even after adjusting for potential confounders, including age, gender, body mass index (BMI), educational level, smoking habit, intake of energy drinks, and physical activity did not reveal a significant association.Conclusion: Our findings did not show any statistically significant association between higher consumption of UPFs and diabetes prevalence. Comprehensive judgments require further investigations with more comprehensive study designs, larger sample sizes, and other populations.
Background: Previous meta-analyses have not examined intake thresholds for coconut oil’s effect on glycemic markers. This study addressed that gap by investigating the non-linear relationship between coconut oil consumption and fasting glucose and insulin levels.Methods: PubMed, Scopus, Embase, CENTRAL, ISI Web of Science, and Google Scholar were systematically searched for randomized controlled trials (RCTs) published through August 2025. Eligible studies examined coconut oil’s effect on glycemic markers in adults over at least two weeks. Pooled effect sizes were calculated using a random-effects model, followed by subgroup and sensitivity analyses. Distinct from prior reviews, a restricted cubic spline model was applied to evaluate dose-response patterns.Results: Twelve RCTs with 518 participants were included. Coconut oil intake showed a modest but significant increase in fasting plasma glucose [mean difference (MD): 3.18 mg/dL; 95%CI: 0.22-6.13; I²=90.8%; n=11]. No significant effect was observed on serum insulin (MD: 0.17 µIU/mL; 95%CI: −2.28-2.63; I²=89.1%; n=5). The dose-response analysis revealed a non-linear trend, indicating that moderate consumption of 30-50 grams per day may attenuate glucose elevations compared to lower doses, a novel finding highlighting the need for dosage-specific guidelines (p for non-linearity=0.533).Conclusion: Coconut oil appears to exert a modest effect on fasting glucose, with minimal impact on insulin. The observed non-linear dose-response suggests that moderate intake may offer a more favorable glycemic profile. Further high-quality trials are needed to clarify optimal dosing and clinical relevance.
This narrative review investigated the current evidences on antiinflammatory diets and gut microbiome modulation for depression and anxiety management. Comprehensive literature search identified 127 relevant publications through PubMed, Scopus, and Web of Science until March 31, 2024. The evidences suggested Mediterranean and antiinflammatory diets to be associated with reduced depression risk (33-42% in observational studies) and symptom improvement in randomized trials. Probiotics demonstrated strain-specific benefits, though heterogeneity in formulations complicated the recommendations. Prebiotics showed promising but limited evidences. Proposed mechanisms were presented as gut-brain axis modulation, inflammatory pathway regulation, and microbial metabolite production. Current evidences supported nutritional interventions as adjunctive approaches, though methodological limitations and inconsistent outcome measures necessitated cautious interpretation. Future researches should prioritize standardized interventions, longer follow-up, and personalized nutrition approaches.
Background: Milk is a widely consumed food product, and contamination with heavy metals poses a significant public health concern due to their potential toxicity and bioaccumulation. This study assessed heavy metal contamination in raw and pasteurized cow’s milk in Shahrekord, Iran.Methods: Seventy nine bovine milk samples, including raw and pasteurized milk collected across warm and cold seasons were enrolled. Elemental concentrations of mercury (Hg), cadmium (Cd), lead (Pb), and arsenic (As) were quantified using inductively coupled plasma optical emission spectrometry (ICP-OES).Results: Hg was the predominant contaminant detected in 10.13% of samples with concentrations ranging from 8.47 to 31.70 µg/L. Warmseason pasteurized milk exhibited the highest contamination (35%) with a mean concentration of 25.19±7.96 µg/L. Only 1.3% of samples contained detectable levels of Cd. Among the 39 pasteurized samples, 2.6% of samples were contaminated with Cd, corresponding to one sample collected during the warm season (1 out of 20; 5%). No Pb or As was detected in any of samples.Conclusion: Hg represented the main heavy-metal risk in milk samples of Shahrekord, Iran particularly in pasteurized products during warmer months. The sporadic occurrence of Cd highlighted the potential localized contamination, while the absence of Pb and As indicated low environmental burden. These findings underscore the need for milkspecific regulatory limits, seasonally adaptive monitoring programs, and strict control of feed and processing inputs to ensure consumer safety.
Background: Insulin resistance (IR) is a detrimental common condition related to type 2 diabetes mellitus and different metabolic diseases. The common indices are the homeostasis model assessment of insulin resistance (HOMA-IR) and triglyceride glucose (TyG) index. This study analyzed IR markers and lipid profile in patients in Baghdad, Iraq.Methods: A cross-sectional study from March 7 2024 to June 1st 2024 was performed at Nutrition and Obesity Center in Al-Kindy Hospital, Baghdad, Iraq enrolling 100 participants (81 females and 19 males) aged between 18-60 years. They were categorized into obese and non-obese groups based on their BMI values. BMI, fasting blood glucose, fasting insulin and lipid profile (total cholesterol, triglycerides, LDL-C, and HDL-C) and HbA1C were determined and analyzed.Results: HOMA-IR index detected 38% of IR individuals, while TyG index verified 51%. BMI was shown to be correlated too (p=0.0001, p=0.033, respectively). For lipid profile, LDL-C and total cholesterol were inversely related to HOMA-IR index (p=0.048, p=0.163, respectively). HDL-C had inverse relationship with HOMA-IR (p=0.014), and triglyceride had a positive correlation with HOMA-IR (p=0.190). TyG revealed a positive correlation with total cholesterol and triglyceride (p=0.0006, p=0.0001, respectively). The correlation between TyG index and LDL was positive, and forTyG and HDL was negative (p=0.105, p=0.179, respectively).Conclusion: TyG index was superior to HOMA-IR with a stronger positive correlation to the BMI marker too. Lipid profile revealed a weak relationship with HOMA-IR ant TyG indices.
Background: Web-based food frequency questionnaires (FFQs) can overcome the limitations of paper-based questionnaires by allowing for complex skip patterns, portion size estimation based on food images, and real-time error checking. The aim of this study was to compare webbased and interview-administered FFQs in evaluation of dietary intake, using 24-hour recalls as the gold standard.Methods: A total of 3,000 subjects were recruited from participants in the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) Cohort Study. Participants were 35-65 years old. Nutritional assessment was conducted using a validated semi-quantitative FFQ consisted of 65 food items. Subjects were allocated to either the web-based FFQ or the interview-administered FFQ groups. Participants completed the web-based FFQ online, while the interview-administered FFQ and 24- hour recalls in paper format. They were completed by trained health professionals through face-to-face interviews.Results: In both groups, females comprised the majority, representing 66.2% and 63.9% of the web-based FFQ and interview-administered FFQ populations, respectively. A significant correlation was observed between FFQ results and daily intake estimates obtained from 24-hour recalls in both the web-based and interview-administered groups, though the correlation was stronger for the interview-administered FFQ.Conclusion: The stronger correlations observed for the interviewadministered FFQ may be attributed to the fact that paper questionnaires were completed with the assistance of trained interviewers.
Background: The increasing rates of obesity among young adults, particularly college students, have become a significant public health concern. Dietary habits, especially the consumption of trans fatty acids (TFAs) were shown to be correlated with an increase in obesity among populations undergoing lifestyle changes. Therefore, this study aimed to assess the dietary intake of TFAs and their association with obesity among a specific group of college students at the University of Jordan, Amman, Jordan.Methods: In a cross-sectional study, 400 students were recruited through convenience sampling, from both genders aged 18-35 years, representing undergraduate and postgraduate students at the University of Jordan, Amman, Jordan. Dietary TFA intake was assessed using a semiquantitative food frequency questionnaire (FFQ).Results: The mean daily dietary intake of TFAs and the percentage of TFAs of total energy varied significantly among different body mass index (BMI) categories, including obese, overweight, and normal, with values of 2.67, 2.31, and 1.76 g/day and 1.2%, 1.0%, and 0.8%, respectively. The mean BMI increased significantly across TFA intake quartiles including 22.68±3.0 kg/m², 25.67±4.9 kg/m², 28.81±3.7 kg/m², and 30.61±5.3 kg/m², respectively. TFA intake level was significantly and positively associated with obesity risk [RR: 4.71 (3.15-7.03), p<0.001].Conclusion: Higher intake of TFAs was positively linked to an increase in BMI among university students. These findings highlight the need for nutritional awareness regarding dietary TFAs intake and unhealthy eating habits in this population.
Background: Type 2 Diabetes Mellitus (T2DM) is a major global health issue that requires integrated management strategies. Indigenous dietary practices and physical activity may offer culturally relevant and sustainable interventions. This study aimed to assess the effect of local food-based dietary recommendations (FBR), alone and in combination with physical exercise (PE), on glycemic control in patients with T2DM.Methods: In a quantitative study and employing a pre-post experimental design, 69 participants were enrolled and randomly assigned to three groups of FBR (n=24), FBR together with physical exercise (FBR+PE) (n=24) and standard care control (n=21). The intervention lasted 4 weeks and the pre- and post-intervention assessments were dietary adherence, physical activity compliance, and glycemic control parameters (fasting blood glucose, 2-h postprandial glucose, and glycated albumin).Results: The FBR and FBR+PE groups showed an increase in dietary intake adherence to several nutrients. The FBR+PE group exhibited significant improvement in all glycemic control parameters after the intervention period. Notably, the combined intervention group exhibited a significantly greater reduction in glycated albumin level when comparedto the control and FBR-only groups.Conclusion: Integrating local FBR with physical activity could enhance glycemic control in T2DM and can be a promising strategy for management of culturally relevant diseases.
Skin cancer remains a significant global health challenge, with ultraviolet (UV) radiation-induced oxidative stress playing a pivotal role in the pathogenesis. Antioxidants exhibit potent free radical scavenging properties that mitigate UV-induced DNA damage and inflammatory responses. This narrative review critically examined the role of dietaryand topical antioxidants in the prevention, treatment, and dermatological care of skin cancer. Here, we conducted a comprehensive search across major medical databases for all research types. The search employed the keywords of antioxidants, oxidative stress, skin cancer, skin neoplasms and skin care. Dietary antioxidants were shown to be associated with reduced incidence and progression of various skin cancers, highlighting the importance of nutritional strategies in primary prevention. Topical antioxidants, formulated in dermatological preparations, offer localized protection by enhancing the endogenous defense mechanisms and improving repair processes of the skin post-UV exposure. In conclusion, the adjunctive use of antioxidants may improve treatment outcomes and reduce adverse effects of conventional therapies. In skin cancer survivors, sustained antioxidant therapy may contribute to improved skin health, reduced recurrence risk, and enhanced quality of life. Despite promising findings, heterogeneity in study designs and antioxidant formulations necessitates further researches to establish standardized guidelines.
Background: Non-alcoholic fatty liver disease (NAFLD), now known as metabolic dysfunction-associated steatotic liver disease (MASLD), is the most common chronic liver disorder globally. It is closely linked to obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome. Dietary factors and micronutrient status may influence its development and progression. Magnesium (Mg), an essential mineral involved in glucose and lipid metabolism, has been suggested as a potential modulator of NAFLD, although the evidence remains inconclusive. This narrative review aimed to summarize experimental, observational, and interventional studies published since 2000 that have explored the relationship between Mg intake and NAFLD.Results: Preclinical studies indicated that Mg deficiency contributes to mitochondrial dysfunction, oxidative stress, and hepatic lipid accumulation, while supplementation may reduce inflammation and fibrosis. Observational studies showed a negative association between Mg intake and NAFLD risk, although, findings vary among different populations. Randomized controlled trials were limited and demonstrated mixed results, with some revealing improvement in liver enzymes and lipid profile, while others illustrated no significant benefits.Conclusion: While there is biological plausibility and initial data supporting a potential protective role of Mg in NAFLD, the current evidence did not establish a causal relationship. Larger, well-designed clinical trials are needed to determine whether Mg supplementation could be an effective preventive or therapeutic approach in NAFLD.
Background: Dyslipidaemia is widely recognized as a major risk factor for development of cardiovascular diseases. In India, it affects approximately 25-30% of the urban and 15-20% of the rural population. Among the various strategies available to manage this condition, dietary intervention plays an indispensable role. With this in mind, the present study was undertaken to assess the impact of a specially developed mixture enriched with nutraceuticals, alongside tailored nutritional counselling, on individuals diagnosed with dyslipidemia.Methods: A nutraceutical-enriched mixture was formulated and standardized for the study. In addition, nutritional visual aids including standardized dietary plans were developed to support dietary modification. Using these aids, tailored nutritional counselling was provided for participants to assist them individually in managing dyslipidemia. The study involved two equal groups including an experimental group (n=30) and a control group (n=30). The experimental group received the developed nutraceutical-enriched mixture in combination with tailored nutritional counselling over a period of six months.Results: The nutritional intervention involving the developed nutraceutical-enriched mixture and tailored nutritional counselling led to a highly significant improvement in total cholesterol, LDL cholesterol, and triglyceride levels among the subjects.Conclusion: The combination of a nutraceutical-enriched mixture and tailored nutritional counselling was illustrated to be effective in managing dyslipidaemia among the study subjects.
Background: Diet-related health problems are on a rising trend due to widespread ingestion of sugar-sweetened drinks, especially by adults in developing countries. Many factors can influence people’s food choices and consumption. This study assessed sugar-sweetened beverage consumption among adults admitted to hospitals in Nasiriyah, Iraq.Methods: A descriptive cross-sectional study from August 20, 2024 to January 20, 2025 using non-random convenient sampling was conducted in four hospitals in Thi-Qar Governorate, Iraq enrolling 384 participants.Results: Most participants (50.0%) were 18-27 years old. Totally, 31.3% of subjects drank carbonated soft drinks two to three times per week; while a significant proportion (66.9%) consumed hot beverages more than five times a week. However, half of the participants (49.7%) fell into the fair (moderated) consumption score, with only 22.9% having a healthy consumption score and 27.3% had an unhealthy score. However, significant links were noted for age groups, educational level, socioeconomic status, and body mass index (BMI).Conclusion: This study showed that more than half of the individuals consumed sugar-sweetened beverages moderately. Age, educational level, socioeconomic status, and BMI of the participants were significantly correlated to consumption of sugar-sweetened beverages.
Background: Nutrition is crucial for boosting the performance, muscular power, and size of older adults. The current research’s objective was to explore the link between the risk of sarcopenia and a high-protein diet score among Iranian elderly population.Methods: Two groups of a case group of 80 elderly individuals and a control group of 80 elderly subjects aged 65 years or older in Iran were enrolled. The recommendations of the Asian Working Group for Sarcopenia were applied to diagnose sarcopenia. To assess dietary intake, a food frequency questionnaire with 168 items was applied. There were three distinct kinds of high-protein diets created. Using logistic regression, the link between the risk of sarcopenia and high-protein diet scores was analyzed.Results: Each point rise in all high-protein diet scores (low-carbo, low-fat, and high-protein diet [odds ratio (OR)=0.638, 95% confidence interval (95%CI): 0.551-0.739; low-fat, high-carb, and high-protein diet: OR=0.856, 95%CI: 0.813-0.902; high-fat, low-carb, and high-protein diet: OR=0.828, 95%CI: 0.757-0.907)] was linked to a lower chance of developing sarcopenia in the crude model. However, in the adjusted models, no association was identified between and all high-protein diet scores and sarcopenia odds.Conclusion: The current case-control study did not find any significant correlation between high-protein dietary intake and the risk of sarcopenia.
Background: Digital addiction, characterized by excessive interaction with digital devices, poses risks to adolescents’ health behaviors, especially nutrition-related habits. This study aimed to investigate the mediating role of health responsibility in relation to digital addiction and nutrition-related health behaviors among secondary school femalestudents in Karbala, Iraq.Methods: A descriptive correlational study was conducted in Karbala, Iraq, including 368 female students from 13 schools who were selected through simple and systematic random sampling methods. Data collection used a structured questionnaire consisted of sections on demographic characteristics, digital addiction, health behaviors related to nutrition, and health responsibility. Reliability and analysis were confirmed by a pilot study (Cronbach’s alpha=0.85).Results: Moderate level of digital addiction (53.5%), health responsibility (55.2%), and healthy behaviors related to nutrition (73.6%) were observed. Regression analysis revealed that health responsibility could negatively predict digital addictive behaviors (β=-0.143, p=0.006) and positively influenced nutrition-related health behaviors (β=0.585, p=0.000).Conclusion: This study provided empirical evidences to support the promotion of health responsibility as a preventive measure for digital addiction and the promotion of healthy eating behaviors. There is a needto promote health responsibility through targeted educational programs, parent engagement, and awareness campaigns that address digital addiction and nutrition.
Whole grain consumption plays a crucial role in promoting public health, with particular importance for the growth and long-term health of children. This review aimed to summarize and highlight the anthropometric, cardiometabolic, and gut microbiota-related health benefits of whole grain intake in children and adolescents. This is a narrative review with a focus on English-language articles that have been published up until January 2024. Included studies in this review were selected from reputable databases, specifically PubMed, Scopus, Web of Science, and Google Scholar due to their comprehensive and diverse collection of relevant literature for analysis. Even though there are large knowledge gaps in this topic concerning children, current observational and interventional studies acknowledge these mentioned health benefits in children and adolescents. Moreover, it appears that the health advantages of whole grain intake in children are more significant in cardiometabolic and gut microbiota health indices than in anthropometric ones. Improved cardiometabolic outcomes, particularly about lipid metabolism, and more favorable gut microbiota diversity are the notable health benefits reported in the examined studies. In conclusion, this review underscores the need for greater awareness and encouragement to integrate whole grains into the diets of children and adolescents to reap the associated health-protective effects. Yet, we suggest further research for better clarity and stronger evidence due to the sparsity and vagueness of the existing studies.
Background: Enhanced Recovery after Surgery (ERAS) protocols are designed to improve perioperative care and postoperative recovery; however, implementation varies across hospitals. Data on ERAS use in colorectal surgery in Tehran hospitals are limited. This study evaluated ERAS implementation in colorectal surgery, focusing on nutrition, surgery, and anesthesia-related components.Methods: This observational cross-sectional study was conducted in Tehran hospitals from June 2024 to February 2025. Patients undergoing colorectal surgery were included. Using a questionnaire based on the latest ERAS protocols, designated hospital staff assessed protocol implementation from admission to discharge. Completed questionnaireswere included in the final analysis.Results: Low anterior resection (LAR) was the most frequent procedure (25.5%), while abdominoperineal resection (APR) was the least common method. Significant differences were observed between public and private hospitals in 9 of 24 items including patient introduction to ERAS protocols (74.2%), admission timing (74.3%), preadmission counseling (100% private), regional anesthesia use (0% private), preferred analgesia route (74.8%), initiation of oral fluids (100% private), oral diet (100% private), early mobilization (100% private), and urinary catheter removal timing (73.6%). The remaining 15 items showed no significant differences. Eight ERAS elements, including fasting duration modification, carbohydrate loading, preoperative pain control, intrathecal analgesia, gum chewing, intraoperative temperature monitoring, chronic pain prevention, andileus prevention, were absent in all hospitals.Conclusion: This study provided a comprehensive evaluation of ERAS protocol implementation in colorectal surgeries in Tehran, revealing substantial gaps. Disparities between public and private sectors highlight the need for targeted interventions to improve adherence.
