Middle East Research Articles

Knowledge and concern towards endometriosis among Lebanese women: a cross-sectional study

BackgroundEndometriosis is a prevalent disease among women worldwide, including the Middle East. Insufficient knowledge about the disease causes delayed diagnosis which could result in major complications, particularly infertility. Thus, being aware of the symptom’s aids in prompt diagnosis and treatment. Furthermore, no research has been done in Lebanon to assess the Lebanese women’s knowledge about endometriosis.AimTo determine the understanding and concerns of Lebanese women about endometriosis which aids in identifying knowledge gaps and misconceptions so that they can be addressed.MethodsA cross-sectional study was conducted between February and March 2024 among Lebanese females, who completed the authors’ online questionnaire assessing knowledge and concern about endometriosis and its associated symptoms, Multivariable logistic regression analysis was used to explore the relationship between score of knowledge and different characteristics of patients.ResultsA survey of 725 Lebanese women (mean age 32.5 years, SD = 9.5) revealed low knowledge (25.9%) about endometriosis origin, symptoms, and treatment. Over 60% were unaware of endometriosis symptoms, while 9.9% mistakenly believed menstrual cramps indicated the disease. Younger age (< 35 years), higher education (Master’s degree or above), professional occupation, lower pregnancy and live birth rates, and no history of abortion, endometriosis, pelvic inflammatory disease, uterine or ovarian conditions, and pelvic surgeries were significantly associated with greater knowledge of endometriosis.ConclusionLebanese women’s knowledge of endometriosis is limited. This highlights how crucial medical education and awareness initiatives are in addressing the issue in Lebanon. Greater awareness of endometriosis will encourage Lebanese women to seek medical advice and consultation, resulting in earlier detection and treatment.

Double Veto System: Reforming the Veto and Voting Rules in UN Security Council

Abstract: The UN Charter endows the UN Security Council with the authority and responsibility to maintain international peace and security. Given this mandate, the Security Council plays an essential role in addressing transnational and non-traditional security threats. However, the Councils demonstrated inefficiencies have sparked widespread calls for reform, particularly concerning the veto power, which is criticized by nearly all nations except the permanent members. This paper focuses on reforming the veto power of the five permanent members. Through a literature review, this paper summarizes mainstream reform proposals and analyzes the frequency and characteristics of vetoes exercised by the permanent members over the past 24 years. It also examines the differing positions of China and Russia versus the US, the UK, and France on Middle Eastern issues and proposes a feasible reform methoda Double Veto Systemto ensure that the operation of the P5 is based on shared interests, while pioneering new pathways for reform in the UN Security Council.

Recurrent Early Pregnancy Loss and Congenital Thrombophilia: A Prospective Study.

Background/Objectives: This study aims to investigate the role of congenital single nucleotide thrombophilia in young females with early recurrent pregnancy loss (RPL). Methods: We studied 120 pregnant females with RPL and 80 matched females as a control with no RPL. Females were aged ≤ 35 years, had at least two consecutive first-trimester RPLs, and the acquired cause of RPL was excluded. A matched control group of 80 pregnant women with no RPL was studied. Coagulation tests included prothrombin time (PT), partial thromboplastin time (PTT), thrombin time (TT), a Factor XIII functional assay, and detecting IgM and IgG anti-beta2-Glycoprotein I (β2GPI) antibodies by an ELISA. The DNA samples were tested for Factor V Leiden, Factor II G20210A, Methylenetetrahydrofolate reductase (MTHFR C677T, A1298C), FXIII V34L, plasminogen activator inhibitor-1 (PAI-1) 4G/5G, endothelial protein C receptor (EPCR) A4600G, and endothelial protein C receptor (EPCR) G4678C. Results: Of the single nucleotide gene mutations investigated, the most relevant mutations were MTHFR C677T, MTHFR A1298C, heterozygous FXIII Val34Leu, and heterozygous FXIII 1694 C>T. Each of them conferred a statistically significant effect. There was a statistically significant protective role for the endothelial protein C receptor (EPCR) A2/A2, wild FXIII Val34Leu, and heterozygousFXIII1694 C>T. Conclusions: Our findings suggest the important role of congenital single nucleotide thrombophilia mutations in young Middle Eastern women with early RPL, particularly MTHFR mutations and FXIII Val34Leu. We found a protective effect of EPCR A2/A2, wild FXIIIVal34Leu, and heterozygous FXIII1694 C>T. We recommend additional studies to explore detrimental factors and protective factors.

Is the decline of war a delusion? The long peace phenomenon and the modernization peace – the explanation that refutes or subsumes all others

ABSTRACT The wars in Ukraine and the Middle East, and the China challenge, revive the question of whether the world is becoming more peaceful. Realists’ claim that we told you so compares oranges with cabbage. Today’s world is divided into a “zone of peace”, encompassing all the developed countries, and a “zone of war”, comprising less developed countries. Within the former, interstate wars, civil wars, and the “security dilemma” itself have all disappeared. The Long Peace since 1945 is widely attributed to nuclear deterrence. However, the sharp decrease in war had begun during the 19th century. The effect of industrialization is the greatest lacuna in IR theory. The Malthusian Trap that plagued premodern societies has been broken. Wealth is no longer finite and a zero-sum game. This transformation has made democracies as well as nondemocracies fight much less, and has sharply increased international trade. It underlies both the democratic/liberal and capitalist/trade interdependence peace.

High-performance work systems and employee voice behavior: a sequential mediation analysis

PurposeBased on ability-motivation-opportunity, social exchange, and job demands-resources theories, this research aims to investigate how high-performance work systems (HPWS) are linked to voice behavior through sequential mediating effects of psychological meaningfulness and work engagement in a Middle Eastern context.Design/methodology/approachStructural equation modeling was employed to analyze data obtained from a sample of 538 nurses working in various hospitals located in Palestine.FindingsThe findings show a positive association between HPWS and voice behavior. In addition, the study findings support the sequential mediation of psychological meaningfulness and work engagement on the association between HPWS and voice behavior.Originality/valueThis study is one of the few examining the effect of HPWS on individual-level outcomes in the context of the Middle East. More specifically, our study is the first to test the association between HPWS and voice behavior, especially in this under-researched context. It is also the first to explore the influence of HPWS on voice behavior through sequential mediating pathways of psychological meaningfulness and work engagement.

Profiles in intelligence: an interview with the 17th Chief of Staff of the Israel Defense Forces, Moshe (Bogie) Ya’alon

ABSTRACT During the summer of 2023, I conducted an interview with Moshe (Bogie) Ya’alon, a veteran of over 30 years in key roles within the Israeli Defense Forces. As a leading authority on national security and intelligence, Ya’alon provided critical insights, particularly regarding the intelligence failures of the 1973 Yom Kippur War and how these failures inform present-day security dilemmas. Although this interview was conducted three months before the surprise Hamas attack on 7 October 2023, Ya’alon stressed the significance of lessons from previous conflicts and significant geopolitical developments. He also underscored the importance of cultural and emotional factors in intelligence failures and the dynamics of Israel’s relations with the Five Eyes alliance, offering insights that illuminate some of the challenges Israel would encounter three months later. This interview is part of an ongoing oral history project designed to gather diverse perspectives on intelligence and national security leadership in Israel, enhancing our understanding of the security dilemmas of the Middle East and the world of espionage.

The Relationship between Technology for the Development of Green Finance and Economic Growth: A Comparison Study between Developed and Middle East Countries

The Relationship between Technology for the Development of Green Finance and Economic Growth: A Comparison Study between Developed and Middle East Countries

Revision of a self-assessment tool for research ethics committees in low- and middle-income countries: Incorporation of elements that safeguard participants' rights and welfare.

Evaluating the quality of research ethics committees (RECs) is crucial but challenging due to the difficulty of developing meaningful quality measures. Recently, commentators assessed ten quality instruments for RECs, including the Research Ethics Committee Quality Assurance Self-Assessment Tool developed for RECs in the Arab Middle East. They identified several missing items in this tool regarding safeguarding participants' rights and welfare. To address these gaps, we aimed to redesign the tool. Using the Delphi method, we involved 15 REC chairs to provide feedback and recommendations for a revised tool. This process led to a modified instrument that incorporated the missing items and additional elements regarding the monitoring of research conduct (an essential oversight function of RECs), and the independence of the RECs from institutional and external influences. We conclude that the revised tool effectively addresses the quality of RECs by including elements relevant to participant outcomes, board deliberations, and participant protection. The added focus on ethics oversight enhances its robustness, significantly impacting participants' rights and welfare.

Intercultural Adaptive Communication Competence (Case Study on Afghan Refugee in Indonesia)

The arrival of refugees to Indonesia for temporary refuge is a phenomenon that has occurred for a long time and has not been resolved until now. Families from Middle Eastern countries, especially Afghanistan, who were affected by the war chose to make Indonesia their second country for safety. After they settled in Indonesia, they were required to adjust or enter the adaptation phase. In terms of culture and language, Indonesia is clearly different from their home country and this is a challenge for refugees. This study uses a qualitative ethnographic method approach, where data is taken from interviews with selected refugees who live together in the South Tangerang area. Interviews were analyzed based on the concept of five competencies in cross-cultural communication initiated by Michael Byram. The results of the study stated that refugees match with competencies during their adaptation in communication after relocation to Indonesia.

The influence of accent on the evaluation of trust-building efforts during conflict.

The Israeli-Palestinian conflict has been an ongoing source of violence in the Middle East, claiming the lives of tens of thousands of people. As of late violence has escalated, with this year being one of the deadliest years in the conflict in decades. Therefore, now more than ever finding ways to bridge divides is essential to reduce the human suffering associated with the conflict. In this study we evaluated the impact of an important element of communication: accent. We demonstrate that the accent through which trust-building initiatives are communicated can inadvertently sway public opinion regarding their benefits. Jewish-Israelis listened to the same trust-building proposal communicated by a Palestinian delegate with varying degrees of Palestinian Arabic-accented Hebrew. When the same proposal came from a Palestinian delegate with a heavier accent, Jewish-Israelis thought this proposal was significantly worse for Israel than when it was offered by a Palestinian delegate who spoke Hebrew with no detectable, non-native accent. This effect was explained by differences in how the Palestinian delegate was judged depending on his accent. When the delegate spoke with heavier, Arabic-accented Hebrew, he was judged more harshly than when he spoke Hebrew with no such accent, which in turn reduced how favorably Jewish-Israelis evaluated the proposed measures. Our findings show that the way in which trust-building measures are communicated can shape how they are received and thus has direct implications for diplomatic efforts.

Brief Overview of MERS: Middle East Respiratory Syndrome

Middle East Respiratory Syndrome (MERS) is a zoonotic disease caused by MERS-CoV, a beta coronavirus with a mortality rate of approximately 35%. The disease exhibits a wide range of clinical symptoms, from mild respiratory issues to severe conditions like multi-organ failure and pneumonia. Person-to-person transmission has led to significant hospital and community outbreaks, underscoring the urgent need for effective infection control measures. This study explores MERS-CoV's epidemiology, pathogenesis, and transmission dynamics, aiming to enhance understanding of its replication, spread, and control strategies due to limited pharmaceutical interventions. A comprehensive review of current literature was conducted, focusing on epidemiological data, genetic characteristics, and transmission patterns across affected regions, including the Middle East, Asia, Africa, and North America. Findings indicate that MERS-CoV originated from recombination events in the spike protein of African dromedaries and spread to the Arabian Peninsula via camels. The virus affects not only humans but also domestic animals like sheep, cattle, horses, and pigs, with global transmission facilitated by travelers, resulting in outbreaks in Asia and North America. Despite extensive research, no effective vaccines, antiviral drugs, or immune therapies control MERS-CoV. The findings emphasize the high pandemic potential of MERS-CoV due to its mortality rate and lack of effective treatments, highlighting the need for strict infection control and further research into viable therapeutic options.

Reconceptualising Security-development Paradigm: A Critical Analysis of Chinese ‘Development Peace Model’ in the Middle East

In recent years, China has emerged as a significant player in the intersection of international security and development in the Middle East. This development coincides with a decline in the enduring dominance of the US in the region’s security and development affairs. In contrast, China has pursued a cautious, impartial and novel concept of zero enemy policy with regional states. While existing research has explored Chinese economic engagement in the Middle East, literature focusing on the ‘Development Peace Model’ in relation to the Belt and Road Initiative (BRI) remains limited. This article aims to provide a critical analysis of how China’s pursuit of a multi-polar world order, based on principles of neutrality and partnership for promoting stability through the ‘Development Peace Model’, offers an alternative approach to ‘Liberal Democratic Peace’ in the Middle East. Furthermore, the article examines why Middle Eastern states are receptive to China’s ‘Development Peace Model’ as they seek to address their economic crises.

Abstract 4120131: Absence of standard modifiable risk factors (SMuRF-less) among 5002 Middle Eastern patients with atherosclerotic cardiovascular disease: (Interim analysis from the Jo-SMuRF Study)

Introduction: A growing number of patients develop atherosclerotic cardiovascular disease (ASCVD) despite the absence of standard modifiable risk factors i.e. hypertension (HTN), type 2 diabetes (T2D), dyslipidemia (DSL), and cigarette smoking (SMuRF-less). There is scarcity of studies on prevalence and clinical profiles of SMuRF-less patients in the Middle Ease (ME). Aim: To study the prevalence and clinical features of ME patients with ASCVD who are SMuRF-less vs. those with ≥ 1 SMuRFs, presence of other risk factors and utilization of secondary preventive medications in the 2 groups, and one year survival. Methods: Clinical details of adult patients with ASCVD who participated in 5 previous registries were analyzed according to the absence or presence of ≥ 1 SMuRFs. Results: Of the 5002 patients included in the analysis, 676 (13.5%) were SMuRF-less and 4326 (86.5%) had ≥ 1 SMuRFs. Prevalence of the 4 SMuRFs in the whole cohort was 53.5% HTN, 47.8% T2D, 40.2% smoking, and 37.5% DSL, and the SMuRF group was 61.9%, 55.2%, 46.5%, and 43.4%, respectively. Compared with the SMuRFs group, patients in the SMuRFless group were younger (mean age 52±11.4 years vs. 56.3±11.5 years, respectively, p&lt;0.001) and more likely to be women than men (38.6% vs. 27.9%, p&lt;0.0001). Furthermore, SMuRF-less patients had lower mean body mass index, and less prevalence of metabolic syndrome, heart failure, and family history of ASCVD. Utilization of secondary cardiovascular prevention medications was significantly less in the SMuRF -less group than those with SMuRFs; dual antiplatelet therapy (36.4% vs. 69.5%), statins (66.3% vs. 87.4%), B blockers (57.5% vs. 70.5%), and renin-angiotensin inhibitors (35.2% vs. 55.3%, respectively, all p&lt;0.001. Of the subgroup with one year follow up after percutaneous coronary intervention (N=2641), mortality rate was not different in the 2 groups; 1.4% vs. 1.8%, p=0.98. Conclusions: In this first study of SMuRFs in ASCVD patients in the Middle East, SMuRF-less patients account for nearly 14% of the studied cohort. These patients were younger, had less comorbid disease, received less guidelines-recommended prevention medication, and had same one year event rate compared with patients who have SMuRFs.

The Middle East as a Natural Laboratory to Advance Our Understanding of Global Hyper-Arid Drylands

The Middle East as a Natural Laboratory to Advance Our Understanding of Global Hyper-Arid Drylands

Bystander Response and Out-of-Hospital Cardiac Arrest Outcomes (Bro. Study) in 3 Gulf Countries: Protocol for a Prospective, Observational, International Collaboration Study.

: Globally, there is significant variation in the out-of-hospital cardiac arrest (OHCA) survival rate. Early links in the chain of survival, including bystander cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator at the scene, are known to be of crucial importance, with strong evidence of increased survival rate with good neurological outcomes. The data from the Middle East are limited and report variable rates of bystander CPR and survival. It is crucial to get prospective, reliable data on bystander response in these regions to help plan interventions to improve bystander response and outcomes. This international collaborative study aims to describe the characteristics, including bystander interventions and outcomes, of OHCAs brought to hospitals enrolled in the study from Abu Dhabi, United Arab Emirates; Doha, Qatar; and Muscat, Oman. It also aims to describe the strength of the association between bystander response and OHCA outcomes, including the return of spontaneous circulation, survival to hospital admission, survival to discharge, and good neurological outcome at discharge in the local context of low bystander CPR rates. This multicenter, prospective, noninterventional observational study (Bro. Study) will be conducted at the emergency departments of 4 participating tertiary care hospitals in 3 countries. The data will be collected prospectively according to the Utstein style (a set of internationally accepted guidelines for uniform reporting of cardiac arrests) on demographic variables (age, sex, nationality, country, participating center, and comorbidities), peri-cardiac arrest variables (location, witnessed or not, bystander CPR, use of automated external defibrillator, time of emergency medical services arrival, initial rhythm, number of shocks, and time of prehospital CPR), and outcome variables (return of spontaneous circulation, survival to discharge, and neurological outcome at discharge and 3 months). Univariate and multivariate analysis with logistic regression models will be used to measure the strength of the association of bystander interventions with outcomes using SPSS (version 22). Data collection began in November 2023 and will continue for 2 years, with publication expected by early 2026. Bystander response to an OHCA is critical to a favorable outcome. The reliable, baseline bystander CPR data will be a cornerstone in the team's next planned projects, which are to qualitatively identify the barriers to bystander CPR, conduct a scoping review of community interventions in the Gulf and other Asian countries, and design and implement strategies to help improve the bystander CPR rate in the community. DERR1-10.2196/58780.

Trading Community Analysis of Countries' Roll-On/Roll-Off Shipping Networks Using Fine-Grained Vessel Trajectory Data.

Roll-on/roll-off vessels (RO/RO vessels) are playing an increasingly critical role in international automobile transport, facilitating the efficient movement of vehicles and heavy machinery across continents. Despite this growing significance, there is still limited research specifically focused on the RO/RO shipping network and its impact on global trade. This paper studies the global RO/RO shipping network using AIS data on RO/RO vessels collected from 2020 to 2023. We construct a method based on the complex network theory and the graph feature extraction method to quantitatively assess the features of the RO/RO shipping network. This method assesses the complexity, sparsity, homogeneity, modularity, and hierarchy of the RO/RO shipping network across various ports and countries and employs the graph convolutional neural network (GCN) model to extract network features for community detection. This process enables the identification of port clusters that are frequently linked to RO/RO vessels, as well as regional transport modes. The paper's findings support these conclusions: (1) From 2020 to 2023, the number of nodes in the RO/RO shipping network increased by 22%, primarily concentrated in African countries. The RO/RO shipping network underwent restructuring after the pandemic, with major complex network parameters showing an upward trend. (2) The RO/RO shipping network is complex, with a stable graph density of 0.106 from 2020 to 2023. The average degree increased by 7% to 4.224. Modularity decreased by 6.5% from 0.431 in 2022 to 0.403, while the hierarchy coefficient rose to 0.575, suggesting that post-pandemic, community routes have become more diverse, reflecting the reconstruction and maturation of the overall network. (3) The model yielded a silhouette coefficient of 0.548 and a Davies-Bouldin index of 0.559 using an improved automatic feature extraction method. In comparison between 2020 and 2023, the changes in the two indicators are small. This shows that GINs can effectively extract network features and give us results that we can understand for community detection. (4) In 2023, key communities divide the RO/RO shipping network, with one community handling 39% of global routes (primarily Europe-Asia), another community handling 23% (serving Asia-Pacific, Africa, and the Middle East), and a third community managing 38% (linking Asia, Europe, and South America).

Tracing the path to sustainable governance: CSR committees as mediators of board impact on ESG performance in the MENA region

Purpose This study aims to explore the mediating role of corporate social responsibility (CSR) committees in the relationship between board characteristics and environmental, social and governance (ESG) performance, specifically within the Middle East and North Africa (MENA) region. Design/methodology/approach Based on a panel of 178 firms spanning 2015–2022, the analysis uses Baron and Kenny’s (1986) mediation approach, supplemented by structural equation modeling (SEM) path analysis for robustness. Findings The findings demonstrate that CSR committees play a significant mediating role in the impact of board size, expertise and gender diversity on ESG performance. Furthermore, the study confirms the direct, positive influence of both board characteristics and the presence of CSR committees on ESG performance, underscoring their strategic importance in fostering sustainability in this regional context. Practical implications The findings highlight the strategic importance of diversifying and enhancing board skills to improve ESG performance. Companies are encouraged to recalibrate their governance frameworks to leverage the mediating influence of CSR committees and promote sustainable business practices. Social implications By demonstrating the positive effect of CSR committees on ESG performance, this study aligns with global trends in responsible business conduct and highlights the importance of corporate governance in addressing environmental and social challenges. This alignment is critical for achieving sustainable development goals and reinforcing stakeholder trust in the region. Originality/value This research provides novel empirical insights into the mediating effect of CSR committees within the MENA region, offering a unique contribution to the discourse on corporate governance and sustainability. By highlighting region-specific governance dynamics that shape ESG outcomes, it deepens the understanding of effective governance practices.

Assessing Post-Vaccination Seroprevalence and Enhancing Strategies for Lumpy Skin Disease Vaccination in Korean Cattle.

Lumpy skin disease (LSD), caused by the LSD virus (LSDV), a dsDNA virus of the genus Capripoxvirus, represents a significant cross-border infectious threat, particularly impacting cattle and water buffaloes through transmission by blood-feeding insects. Traditionally endemic to Southern Africa, LSD has rapidly spread over the past decade through the Middle East to Eastern Europe and China, reaching Korea in October 2023. This outbreak prompted a nationwide vaccination campaign, addressing both the disease's severe economic impact and its status as a notifiable disease under the World Organisation for Animal Health. This study assesses the seropositivity of the LSD vaccine in cattle across four Korean provinces 2-3 months post-vaccination, aiming to inform improvements in biosecurity and vaccination strategies. Overall, 30.59% of the cattle tested (1196 out of 3910) exhibited positive antibody responses, comparable to international post-vaccination findings. Analysis further revealed differences in the antibody positivity between farm types and management practices. Specifically, farms where vaccines were administered by veterinarians showed no significant difference in antibody positivity between Korean native cattle and dairy cattle, regardless of the presence of restraint facilities. However, on farms where vaccinations were conducted by the owners, dairy cattle demonstrated a higher seropositivity (43.30 ± 33.39%) compared to Korean native cattle (21.97 ± 20.79%) in the absence of restraint facilities. Further comparisons underscored the impact of restraint facilities on vaccination efficacy, with dairy farms generally achieving higher antibody positivity (29.43 ± 30.61%) than farms with Korean native cattle (23.02 ± 23.33%) (p < 0.05), suggesting that consistent vaccine delivery methods enhance immunogenic responses. Contrarily, no significant difference was noted in antibody positivity between large- and small-scale farms, indicating that farm size did not notably impact the effectiveness of the vaccinator. These findings emphasize that while current vaccines are sufficiently inducing immunity, enhancing vaccination strategies, particularly through trained personnel and improved restraint facilities, is crucial. This study's insights into the impact of vaccination and farm management practices provide valuable guidance for refining LSD control measures in Korea and potentially other affected regions.

Prevalence and Clinicopathological Features of Autoimmune Metaplastic Atrophic Gastritis in the Eastern Province of Saudi Arabia: A Regional Study.

Introduction. Autoimmune metaplastic atrophic gastritis (AMAG, also termed autoimmune gastritis) is a chronic gastritis of autoimmune pathogenesis. Although its clinical and pathological features are well-documented in many countries, data from Middle Eastern populations remain scarce. This study examined the prevalence of AMAG in gastric specimens from the region, specifically from Saudi Arabia. Methods. We conducted a retrospective review of the pathology database of gastric specimens with a diagnosis of AMAG between 2020 and 2023. Detailed clinical, endoscopic, and pathological features of identified features were described. Result. Of the 978 gastric biopsies received, 17 patients were diagnosed with AMAG. The cohort comprised 11 women (64.7%) and 6 men (35.3%), presenting at a median age of 50 years (range: 32-85). Clinical manifestations varied widely, from abdominal pain (n = 6), dyspepsia (n = 2), symptomatic anemia with significant vitamin B12 deficiency (2 of 17) to asymptomatic/incidentally diagnosed patients (5 of 17). The tissue samples showed varying histological characteristics, with some showing lymphoplasmacytic infiltrate, mucosal atrophy, and hyperplasia of enterochromaffin-like cells. Conclusion. The observed prevalence of AMAG in our study aligns with global averages reported for other populations. The diverse clinical presentations highlight the need for awareness of findings in AMAG in gastric biopsies to ensure appropriate clinical management.

Abstract 4132159: Dietary Intake of Niacin and Risk of Cardiovascular Mortality in The Golestan Cohort Study

Introduction: Recent studies have linked niacin metabolism with vascular inflammation and cardiovascular disease (CVD); however, the association is still inconclusive regarding dietary intake, and the findings may not be generalizable to various populations. In this longitudinal study within a Middle Eastern population, we aimed to assess the relationship between dietary intake of B vitamins, including niacin, and the risk of CVD mortality. Methods: Our study utilized data from the Golestan Cohort Study, which has tracked 50,045 participants aged 40-75 years since 2004. We excluded subjects who reported extreme total energy intake or had a positive history of cancer, CVD, or diabetes at baseline. Vitamin B intake estimations including thiamin, riboflavin, niacin, pyridoxamine, folate, and cobalamin intake were derived from the baseline food frequency questionnaire, noting that supplement use was uncommon in this cohort. To adjust for calorie intakes, we employed the nutrient density method. Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for cardiovascular mortality, using the lowest quintile of intake as the reference group for vitamins and adjusting for potential confounders. Results: We analyzed 42,456 subjects with a mean age of 51.5 ± 8.7 years at baseline. During 579,339 person-years of follow-up (median: 14.1 years), 3,065 CVD deaths were recorded. The median dietary intake of niacin was 25.3 mg/d (Recommended Dietary Allowance = 14-16 mg/d). We observed significant associations between niacin intake (HR Q5 vs. Q1 = 1.13, 95% CI = 1.01-1.26, P trend &lt;0.05) and CVD mortality. When niacin was modeled as a continuous linear variable, it was associated with a greater risk of CVD mortality (HR = 1.05, 95% CI = 1.01-1.09) per 2 mg/1000Kcal/d increase. None of the other B vitamin intakes evaluated were associated with CVD mortality in this population. Conclusion: These findings suggest that among B vitamins, only dietary niacin intake was positively associated with CVD mortality. Further confirmation in larger studies is needed.