IRANIAN JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM)
Year:2007 | Volume:9 | Issue:3 (SN 35)|Papers Count:17

Introduction: Omega 3 fatty acid (03FA) consumption has been shown to reduce risk factors for cardiovascular disease. TYPE 2 diabetes confers an adverse cardiovascular risk profile particularly in women after menopause. The aim of this study was to determine whether a dietary supplement with omega 3 fatty acids affected insulin resistance, glycemic control and cardiovascular risk markers in postmenopausal women with type 2 diabetes. A total of 32 postmenopausal overweight women with diet-controlled type 2 diabetes completed a randomized double blind parallel trial of purified omega 3 fatty acid supplementation (2g/day) versus placebo for 10 weeks. Evaluated were serum triglycerides (TG), HDL-c, total cholesterol (TC) and glucose using the enzymatic method, Insulin by radioimmunoassay and insulin resistance using the Homeostasis Model Assessment method (HOMA-IR) were calculated. Relative to those in the placebo group, TG decreased significantly (P=0.03) in the 03 FA group. 03 FA supplementation had no significant effect on serum LDL-c, HDL-c , glucose and insulin resistance but there was a significant increase in serum insulin and TC in the 03 FA group at the end of study compared to the beginning (P=0.04, P=0.04 respectively). Intake of 2g 03 FA had favorable effects on serum TG and TG/HDL-C, no effect of LDL-C, HDL-C, glucose and insulin resistance but did have an adverse effect on serum insulin and TC. Recommendation of 03FA intake in diabetic postmenopausal women needs further investigation.

Introduction: Hypertension is a major risk factor for cardiovascular and microvascular complications. Recent studies have demonstrated the effectiveness of blood pressure in treatment in reducing the complications of diabetes. The aim of this study is to assess the quality of blood pressure control in type 2 diabetic patient with hypertension.Materials and Methods: We studied data from 602 type 2 diabetic patients who had had at least four regular clinic visits every year for medical care in the outpatient clinics of the Isfahan Endocrinology and Metabolism Research Centre duting the period 1999–2004 years. Blood pressure was measured of a systolic and/or diastolic blood pressure of ³ 130 and/or ³ 80 mmHg by standardized protocols, and hypertension was defined as at least two consecutive measurements within 2 months and/or taking antihypertensive medication.Results: At initial registration the mean age of participants was 57.4±9.3 years, with a mean duration of diabetes of 9.4±4.7 years. Of the patients, 338 (56.2%) who more than four visits per year, had high blood pressure and 13.9 percent of these had a blood pressure ³ 130/80 mmHg at initial registration. Among the 5 years of follow up, hypertensive patients increased to 452 (75%), of whom 24.5% had controlled blood pressure. The mean values of age, BMI, HbA1c, urine albumin and prevalence of retinopathy in controlled hypertensive patients were significantly lower in the uncontrolled.Conclusion: Our findings showed that many type 2 diabetic patients with hypertension have inadequately controlled blood pressure. Effective intervention efforts are needed to improve blood pressure control in these patients.

Introduction: Hyperglycemia is a known a risk factor for cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke. This risk is continuous and graded across the distributions of fasting plasma glucose (FPG), and levels of plasma glucose after an oral glucose challenge. Both fasting and 2-h postchallenge glucose (2hpg) levels contribute to average glycemia, but the relative contributions of fasting and postchallenge hyperglycemia to CVD risk remain uncertain. Considering the high prevalence of cardiovascular disease (CVD) in Tehran, this study was designed to evaluate the effects of difference levels of fasting and postchallenge hyperglycemia in prediction of cardiovascular disease.Materials and Methods: In this cohort study, all participants of the Tehran Lipid And Glucose Study (TLGS) (3694 subjects), aged over 40 years, free from clinical CVD (coronary heart disease, stroke) or medication-treated diabetes were assessed for prediction of incident CVD events. We used the interquartile range (IQR) as a unit of exposure for continuously distributed glycemic measures in predicting CVD risk. Also, the Framingham Risk Score (FRS) was determined in this population at baseline. We recorded the cardiovascular events in 6.1±0.6 years of follow up for all subjects. Finally, we assessed ability of fasting and postchallenge hyperglycemia in prediction of cardiovascular disease.Results: Mean age of the study population was 53.9 years; undiagnosed diabetes in this population was present in 346 (9.3%) of the 346 subjects; 172 (49.7%) had 2hPG  ³ 200mg/dL without FHG. There were 148 CVD events. In separate sex- and CVD risk–adjusted models) hazard ratio (HR) for CVD with fasting plasma glucose (per [14 mg/dL] increase) was 1.15 (95% CI: 1.08–1.22); and HR for CVD per 49 mg/dL increase in 2hPG was 1.23 (95% CI: 1.14–1.33). When modeled together, the HR for FHG decreased to 1.03 (95% CI: 0.93–1.13) and for 2hPG remained significant (95% CI: 1.20, 1.05–1.38).Conclusion: In this study, postchallenge hyperglycemia was an independent risk factor for CVD.

Introduction: There are limited studies concerning the prevalence of gestational diabetes (GDM) in Iran. This study was performed to investigate the prevalence and risk factors for GDM in Isfahan, and to compare the results of selective and universal GDM screening methods.Materials and Methods: In a cross – sectional study conducted between June 2003 and March 2005, GDM universal screening (based on the Carpenter and Coustan criteria) was done for pregnant women between 24 and 28 weeks of gestation, referred to the Isfahan Endocrine and Metabolism Research Center; 1112 pregnant women with no history of diabetes underwent 50 gr glucose challenge test (GCT). Cases with blood sugar ³ 130 mg/dL were considered positive and underwent a 3-hour, 100 gr glucose tolerance test (OGTT); this was also done randomly in some of negative GCT cases.Results: OGTT was performed in 245 GCT – positive cases and 130 women with negative G.C.T, GDM was diagnosed in 67 and 6 women respectively, showing a total prevalence of 6.76% for GDM. Of all pregnant women, 23.2% were classified as a low-risk group, including only 2 diagnosed cases of GDM (2.7% of all GDM cases). Among risk factors, only age, pre–pregnancy BMI and gravidity were significantly correlated with GDM.Conclusion: There is a moderate prevalence of GDM in Isfahan; a selective GDM screening method seems to be more appropriate for this community.

Introduction: Hypotension is the most common acute complication of hemodialysis. To ameliorate symptomatic hypotiension during dialysis, cool temperature dialysate has been recommended. Since reports show that not all patients benefit from cool dialysis, it seems necessary to determine which patients benefit more from cool dialysis. The aim of this study is to investigate the effect of cool dialysis on hemodynamic parameters in diabetic patients; serum nitric oxide levels also were determined to find any possible association.Materials and Methods: Twenty diabetic patients (mean age 63.3±7.5) were included in the study. Each patient was dialyzed twice, once using cool and once using warm dialysate solution. Apart from a change in temperature to 35oC, all other conditions remained the same during the study. Hemodynamic parameters including SBP, DBP, and HR were measured hourly, the number of hypotension episodes was also determined. Oral temperature was measured before and after dialysis. Serum urea and nitric oxide metabolites (NOx) were determined before and after hemodialysis.Results: SBP, DBP, and MAP decreased significantly during warm, as compared to cool, dialysis. Maximum decreases in SBP, DBP, and MAP were seen in the third hour of dialysis and these were 18, 17, and 14 percent for warm and 6, 1, and 4 percent for cool dialysis respectively. HR showed no significant difference between the two groups. Compared to before dialysis, NOx levels decreased significantly in cool and warm conditions after dialysis (59±5 vs. 37±4, and 63±7 vs. 41±5, respectively, P<0.01). Conclusion: Cool dialysis could decrease episodes of hypotension and stabilize hemodynamic parameters in diabetic patients. Mechanisms other than increased serum nitric oxide levels are involved in hemodialysis hypotension in diabetic patients.

Introduction: While consumption of vegetable and fruit are increasingly being recommended to prevent chronic diseases in dietary guidelines, epidemiologic data on the association between vegetable and fruit intakes and the metabolic syndrome is limited. The aim of this study was to investigate the hypothesis that higher fruit and vegetable intakes reduce metabolic risk factors in Tehranian adults.Materials and Methods: In a cross-sectional study, quartiles of vegetables and fruit consumption were determined using the food frequency questionnaire, for 606 subjects, aged 18-74 years. Blood pressure was assessed according to standard methods and fasting blood samples were taken for biochemical measurements. Hypertriglyceridemia, hypercholestrolemia, high LDL, low HDL and metabolic syndrome were defined according to ATP III guidelines.Results: Mean ±SD consumption of starchy vegetables, vegetables and fruit intake was 50.8±49, 304±179 and 211±147 g/day, respectively. The prevalence of metabolic syndrome was higher among subjects in lower quartiles of fruits (17.2% in first vs 15.4% in fourth quartile, P<0.05). Those in the higher quartile of vegetable intake had higher intakes of fat (31.7±8 in fourth vs 28.5±9 g/day in first quartile), cholesterol (208±13 in fourth vs 153±12 g/day in first quartile), (P<0.05). Significant differences were seen in mean vegetable and fruit intakes across the 3 risk factor groups (0,1-2 and ³ 3 risk factors) after adjustments for fat and saturated fat intakes (310±14, 194±17 in individuals with ³ 3 risk factors vs 364±18, 248±15 g/day in individuals with no risk factors respectively, P<0.05). There was a significant difference in mean fruit intake across the 3 risk factor groups before and after adjustments for fat and saturated fat intakes (P<0.05).Conclusion: Fruit and vegetable intake is inversely associated with the risk of having metabolic syndrome.

Introduction: Obesity is a risk factor for the incidence of hypertension. Waist circumferences (WC) reflect abdominal fat distribution and provide a simple yet effective measure of truncal obesity, WC being correlated to blood pressure. In this study the relation between blood pressure and WC has been evaluated.Materials and Methods: The study is part of the Isfahan Healthy Heart Program (IHHP) and included 7806 persons; demographic data were collected by questionnaires and body weight, height, systolic blood pressure, diastolic blood pressure and WC were measured.Statistical analysis was performed using correlation, logistic regression and general linear regression. Results: In all groups, systolic and diastolic blood pressures were correlated to WC. In younger patients, WC was correlated more with systolic blood pressure (r=0/119 for male and 0.248 for female) (P<0.001); in older people (over 55 years), WC was correlated more too diastolic blood pressure (P<0.001). This effect was independent of BMI, sex, age and daily energy intake.Conclusion: WC which is related to total body fat especially abdominal distribution of fat is correlated positively to systolic and diastolic blood pressure; any increase of WC, even in persons with normal BMI could predict development of hypertension.

Introduction: One of the leading risk factors for various diseases is obesity, a nutritional burden and an independent factor which increases mortality. Patients with chronic bronchiolitis due to mustard gas have low levels of physical activity, owing to respiratory problems, and comorbidities like psychological disorders. The aim of this study was to assess obesity in veterans exposed to chemical warfare agents.Materials and Methods: In a descriptive cross-sectional study, 434 veterans exposed chemical warfare agents, admitted to the chest of clinic of Baqiyatallah Hospital during 2006 were studied. Patients were divided into three age groups as follows: 30-39, 40-49 and 50-59 years. Respiratory symptoms, including dyspnea, cough, sleep fragmentation and bloody sputum, pulmonary function and body mass index (BMI) were assessed in subjects.Results: Mean BMI was 26.4±3.9 kg/m2 in patients, 26.3±4.1 kg/m2 in 30-39, 26.3±3.9 kg/m2 in the 40-49, and 27.1±3.9 kg/m2 in 50-59 year olds. In addition, 32.9%, 35.9%, 32.9% and 17.6% of patients had normal weight, and 54.7%, 61.3%, 64.8% and 82.4% were overweight or obese in all patients, 30-39, 40-49 and 50-59 age groups. BMI was not correlated with the severity of cough, sleep fragmentation, dyspnea, the presence of bloody sputum and respiratory volumes.Conclusion: The prevalence of obesity and overweight in was veterans exposed to chemical warfare agent seem to be higher than in the normal population. Given the importance of obesity, there should be more focus on balancing weight in patients with chronic pulmonary diseases; in this regard, such patients will benefit greatly from collaboration between nutritionists, endocrinologists, pulmonologists and psychologists.

Introduction: The aim of this study was to assess antioxidant status in elite alpine ski racers during six weeks intensive training. Materials and Methods: Subjects included 12 male alpine ski racers (20±5 years) who underwent 6 weeks of intensive training. For red blood cells glutathione content, plasma uric acid and total anti oxidant determination, blood samples were collected before and just after training. Results: Plasma Uric acid concentration (6.5±1.4 mg/dL, 8.3±1.7 mg/dL) and total antioxidant capacity after six weeks intensive training showed statistically significant increases (2.1±0.2 mM, 2.7±0.3 mM). Red blood cell glutathione content also increased after period of training (5.4±0.7 and 6.1±0.9 nmol/mg Hb). Conclusion: Intensive alpine ski training after six weeks can increase total antioxidant capacity of plasma probably by increasing through uric acid and RBC glutathione content.

Introduction: Some studies suggest that magnesium deficiency contributes to the cardiovascular complications associated with diabetes mellitus; hence the present study investigated the effects of long term orally administrated magnesium on isolated denuded aorta contractility in response to KCl and Phenylephrine (Phe).Materials and Methods: Sixty male Wister rats (180–250 g) were divided into two diabetic and two control groups. One group of each received magnesium sulfate in their drinking water, while the two other groups had only tap water. After 8 weeks, thoracic aorta was isolated, cut into 2-3 mm rings, endothelium removed and transferred to an organ bath. The tissue was then exposed to cumulative doses of KCl (10, 20, 40, 60 and 80 mM) and Phe (10-9, 10-8, 10-7, 10-6 and 10-5 M) and contractions were measured by an isometric transducer. During the study period, fasting blood samples were obtained every 2 weeks to measure Plasma Glucose level.Results: Vasoconstrictive responses to KCl and Phe were significantly (p<0.05) higher in the control group as compared to the diabetic groups (p<0.05) and there were no significant differences between Mg-treated and non Mg-treated rats. Maximal contractions to KCl were 2.32±0.23, 2.76±0.19, 1.96±0.11 and 1.84±0.21 and the maximal responses to Phe were 2.94±0.24, 3.38±0.20, 2.24±0.27and 2.61±.27 in the control, Mg-treated control, diabetics and Mg-treated diabetic groups, respectively. No significant differences were found in plasma glucose concentrations between the Mg-treated and non Mg-treated groups.Conclusion: Oral administration of magnesium for 8 weeks has no effect on isolated denuded aorta contractility in diabetic rats.

Introduction: Hyperthyroidism is associated with anemia. Since thyroid hormones, by acting on Na+/K+-ATPase activity and numbers, and also on the lipid composition of the membrane can alter the fragility of red cells, in this study, use compared the osmotic fragility of red cells in hyperthyroid rats to that of controls.Materials and Methods: Forty eight male Wistar rats (body weight, 221±4g) were divided in 4 groups. Group I consumed L-thyroxine (12mg/L in drinking water) for 30 days, group II was the control for group I, group III consumed L-thyroxine for 60 days and group IV was the control group for the group III. At the end of the intervention period, hormonal and biochemical measurements were done in blood samples. To assess the osmotic fragility, red blood cells (RBC) were incubated at 37oC for 30 min in different concentrations of NaCl and the extent of hemolysis was measured by colorimetry of the supernatant. Hemolysis percent was expressed in terms of percent hemolusis in presence of distilled water (100% hemolysis).Results: In this study although hemoglobin, haematocrit, mean corpuscular hemoglobin and mean corpuscular volume in group III were significantly (P<0.05) higher compared to group IV, osmotic fragility did not show any significant difference.Conclusion: The results indicate that hyperthyroidism in rat can not anemia and osmotic fragility of RBCs in hyperthyroid animals do not differ from control groups.

Introduction: Carney Complex is an autosomal dominant syndrome that is defined with different tumors including myxoma in different organs, endocrine tumors and lentiginosis lesions. This is the first case report of this syndrome from Iran.Case: The patient is a 27 year old girl, referred with flank pain. Physical examination revealed hirsutism, truncal obesity, hyperpigmantasion and hypertension; Cushing's syndrome was suggested and confirmed with related classic biochemical tests. She had history of cardiac myxoma during her childhood and had been operated twice.Pituitary microadenoma and right adrenal adenoma were reported on MRI and CT-scan, respectively. Initially laparascopic right adrenalectomy was done; as expected, no remission in signs of Cushing's syndrome was observed after surgery. By laparoscopic adrenalectomy of the other site, Cushing's syndrome resolved. Pathologic report of 1st operation was adrenal adenoma with surrounding pigmented micronodular hyperplasia and of the 2nd one was just pigmented micronodular hyperplasia.Conclusion: We have reported a patient with Carney syndrome along with Cushing's syndrome due to bilateral adrenal hyperplasia and an adenoma in contralateral adrenal and microadenoma of the pituitary as an incidentaloma. This is a new presentation of Carney syndrome.