IRANIAN JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM)
Year:2009 | Volume:10 | Issue:5 (SN 41)|Papers Count:18

Introduction: To determine the clinical traits of subjects with isolated impaired glucose tolerance (isolated-IGT) defined as fasting plasma glucose (FPG)<100 mg/dl and 2-hour plasma glucose (2h-PG) between 140 mg/dl and 200 mg/dl. Materials and Methods: In this cross-sectional study, we evaluated the data and results of oral glucose tolerance test (OGTT) from 8212 participants of the Tehran Lipid and Glucose Study (4742 women and 3470 men) aged≥20 years, without diabetes. Logistic regression models for having isolated-IGT were developed among 7012 subjects with FPG<100 mg/dl to predict isolated-IGT. Results: The overall prevalence of IGT was 13.6% (n=1120); of these subjects, 59.6% (n=668) were isolated-IGT. In the clinical model, the adjusted odds ratios (OR) for having isolated-IGT were statistically significant for age≥40 years (2.6), hypertension (1.9), overweight (1.7) or obesity (2.2), family history of diabetes (1.3), and female gender (1.2). Adding the lipid profiles to the clinical model increased the area under the receiver-operating characteristics curve (AUC) only slightly (72.5% vs. 71.4%, P=0.001). The other clinical model including waist circumference had similar predictive power compared to the clinical model including female gender (AUC: 71.7 vs. 71.4, P=0.15). Conclusion: This analysis showed that in Tehranian adults with FPG<100 mg/dl, female gender, older age, family history of diabetes, overweight and obesity, and hypertension were significantly associated with a higher likelihood of isolated-IGT; OGTT should hence be recommended in subjects with the above mentioned characteristics.

Introduction: The aim of the present study was to assess the diagnostic accuracy of the modified ATP III and IDF definitions of the metablic syndrome in identifying of insulin resistant individuals by HOMA_IR and to assess levels of agreement between these definitions and insulin resistance. Materials and Methods: The sample consisted of 347 nondiabetic subjects from the TLGS population (140 men and 207 women; aged 27-87 years). The reference standard for insulin resistance was determined by HOMA-IR and insulin resistance was defined as HOMA-IR≥2.5. Results: According to ATP III and IDF criteria 38.9%, 45% had metabolic syndrome respectively. The sensitivity and specificity of ATP III was 52.3% and 65% respectively, and this was 60% and 59% for IDF criteria respectively. Kappa agreement between modified ATP III and IDF with HOMA-IR was 0.14 and 0.15. Based on the area under the receiver operating characteristic curve constructed by counting metabolic syndrome components as recommended by modified ATP III and IDF diagnostic accuracy was fair. When each component of metabolic syndrome measures were considered as continous traits, waist circumference and fasting plasma glucose each separately had diagnostic accuracy equal or grater than at all the metabolic syndrome as a whole by ATP III and IDF criteria. Conclusion: ATP III and IDF definition, have low sensitivities for detecting insulin resistance and there is poor agreement between those criteria and insulin resistance. Measuring just waist circumference and fasting plasma glucose is simpler and may provide greater accuracy for identifying insulin resistance.

Introduction: Syndrome X or metabolic syndrome is a collection of risk factors which can lead to diabetes and cardiovascular diseases and result in death. Considering the important role of oxidative stress in causing the complications of this syndrome, the aim of this study was to investigate the effect of vitamin E supplementation on insulin resistance and associated risk factors in patients with metabolic syndrome. Materials and Methods: A randomized double blind placebo controlled clinical trial with parallel design was conducted on 70 metabolic syndrome patients, 29-57 years old, who were randomly divided into two groups; one using 400 mg vitamin E (n=35), and group 2- given placebos (n=35) for 3 months; 24 hour dietary recalls were completed in the beginning, and end of first, second and third months for each patient. Serum glucose and lipoprotein by enzymatic, Insulin by RIA, uric acid and CRP by colorimetric, insulin resistance by HOMA-IR methods were measured. For statistical analyses, student’s t-test, paired t-test, chi square and ANOVA were used. Results: There was significant difference in systolic and also diastolic blood pressure at the end of study in the vitamin E group compared to initial values (p=0.00, p=0.09 respectively). In this group, systolic blood pressure, serum glucose and triglycerides (TG) had significant decrease at the end of the study compared to the control (p=0.003, p=0.02, p=0.04 respectively). Serum glucose, TG, insulin and insulin resistance had significant differences in the vitamin E group at the end of study compared to the beginning (p=0.03, p=0.01, p=0.03, p=0.04) Serum TG, glucose and insulin were 221.08±59.54, 114.07±9.64, and 8.3±1.6 at the beginning and 197.65±56.77, 101.05±9.7 and 7.48±1.55, respectively at the end of study. Conclusion: In metabolic syndrome patients, 400 mg vitamin E for 3 months had benetical effects on blood pressure, TG, glucose, insulin and insulin resistance.

Introduction: Empowerment in individuals with people diabetes is well researched. However, few researchers have focused specifically on the barriers to and facilitators of empowerment in Iranians with diabetes. Understanding the barriers and facilitators that affect the empowerment process could help health professionals to more effectively facilitate self-empowerment. Materials and Methods: A grounded theory research design was used with in-depth interviews to collect the data from a purposive sample of males and females aged 21-73 years. Data were collected between February and July 2007. Themes were identified using the early steps of the grounded theory data analysis. Results: Common barriers to empowerment were similar to other chronic diseases; viZ prolonged stress, negative view about diabetes, ineffective healthcare systems, poverty and illiteracy. Diabetes education, fear of diabetes' complications, and hope for a better future also emerged as being crucial to empowerment. Facilitators specific to Iranians were the concept of the doctor as a holy man, accepting diabetes as God's will and the body as God's gift and support from peers and especially from daughters. Conclusion: Iranians with diabetes describe similar facilitators and barriers to empowerment quite similar to those as people from other countries as well as some specific to Iran. Empowerment is strongly affected by cultural and religious beliefs in Iran. Health professionals with deeper understanding of information about diabetics' lives and sources of strength could facilitate the process.

Introduction: We conducted this controlled trial to investigate whether combined therapy with levothyroxine and liothyronine in primary hypothyroidism, would lead to improvements in general health, quality of life, psychological problems and metabolic changes. Materials and Methods: This study was a double blinded randomized control trial. Patients were invited to participate if they were between the ages of 18 and 60 years, and if they had been receiving treatment for primary hypothyroidism for at least 6 months, including a stable dose of levothyroxine for at least 3 months, and had normal serum thyroid hormone levels. Patients were randomized to receive combined levothyroxine plus liothyronine (patients in this group decreased their usual daily dose of levothyroxine by 50 μg and began taking 6.25 μg of liothyronine twice daily) or to continue their usual dose of levothyroxine. Treatment duration was 4 months. Weight, height, heart rate, blood pressure, total Cholesterol, LDL, HDL, Triglycerides, serum TSH, total T4, and total T3 levels were measured before and after of study. All patients completed the General Health Questionnaire -28 (GHQ-28) before and after the trial. Results: Seventy-one participants were randomized into the 2 groups, and 60 completed the study. In the combined therapy group, serum T4 levels fell and serum T3 levels rose (P<.001), although both levels remained within normal limits. Serum TSH levels were similar in both groups at baseline and at 4 months. There were no differences between weight, heart rate, blood pressure and lipid profiles of two groups. For the GHQ-28, the overall score was similar but the anxiety/insomnia subscale was significantly higher (indicating worse psychological well-being) for combined treatment compared with T4 alone (P=0.037). Conclusion: The only biochemical change was the expected rise in serum T3 levels and fall in serum T4 in the combined therapy group, because the blood samples were drawn only 1-2 hour after the morning dose of liothyronine. In conclusion, we found no evidence that combined T4/T3 replacement, resulted in improved well-being, general health, quality of life and lipid profile compared with T4 alone. T4 should remain the standard treatment for hypothyroidism.

Introduction: The effect of thyroid hormones on all stages of the development of central nervous system has been documented in different studies. Postpartum thyroiditis (PPT) is associated with high titers of TPO-Ab during pregnancy. Thyroid autoimmunity in pregnancy results in reduction of serum free thyroxin level, even in the presence of normal thyroid function. This study was conducted to evaluate the effect of PPT on the thyroid function and cognitive development of the offspring.Materials and Methods: In this prospective cohort study, conducted between December 2007 and March 2008, children born to mothers who had developed postpartum thyroiditis after delivery and those mothers who had not, were included in this study. Blood and urine samples were obtained from all children and blood samples were drawn from their mothers. All children underwent 7 cognitive tests in a clinical psychology laboratory. Results: We enrolled 124 children for the study, 55 cases (children of mothers with PPT) and 69 controls (children of mothers without PPT). Average age of cases was 9.5±1.4 and in controls was 9.4±0.1 (P=0.2). No difference was noted between the two groups for baseline characteristics which might have affected their neurodevelopment. Mean scores for total IQ, performance IQ, and verbal IQ in cases and controls were as follows: 115±10 vs. 116±12, 113±11 vs. 116±12, and 113±12 vs. 113±13, respectively (P=0.5). There was no difference between the results of the other tests (CPT, WCST, PRM Test, SWM Test, MFVP Test, SOC) in the two groups. No difference was noted between the thyroid function of the two groups. Conclusion: Prevalence of goiter, thyroid function, cognitive development, and intelligence quotient of children born to mothers who later develop postpartum thyroiditis are similar to those of normal children. Postpartum thyroiditis in mother is not a threat for the newborn. 

Introduction: Thyroid nodules are common and surgery is the usual treatment. One of the common complications after thyroid surgery is keloid formation in front of the neck which is an important cosmetic problem. Nodular goiter is a common disorder of thyroid and its common treatment is surgery. Considering the fact that with clinical evaluation and FNA, the risk of malignancy in these cases is low; a non aggressive approach to this complication is necessary. This study aims to evaluate of the effectiveness of percutaneous laser photocoagulation (PLP) in reducing the volume of benign thyroid nodules. Materials and Methods: In this case-controlled clinical trial, 39 female euthyroid patients with solitary solid benign thyroid nodules were enrolled; 18 patients were treated with ultrasound guided percutaneous laser photocoagulation, and 21 patients were included in the control group. PLP was performed by diode surgical laser with 1-3 watt output for 123-1019 seconds. All patients were followed up for 3 months. Results: After PLP, mean nodule volume decreased from a baseline value of 26.3±23 mL to 15.1±13 at 3 months. Mean nodule volume reduction in comparison with baseline was 42.72%. Compressive symptoms showed relative decrease. No serious complication was seen, nor was any keloid or scar observed in the front of the neck. Conclusion: PLP can be a minimally invasive effective alternative treatment for symptomatic benign solitary solid thyroid nodules in patients not suitable for surgery.

Introduction: Correct interpretation of ultrasonographic measurement of thyroid volume in goiter surveys depends on the availability of valid reference criteria from iodine sufficient populations. There is a lack of consensus of opinions on universal reference values for thyroid volume. Our objective was to describe thyroid volume measured by ultrasonography in Tehranian schoolchildren who had been living in an iodine sufficient area their entire life. Materials and Methods: This cross-sectional study was performed on 464 schoolchildren, aged 7-15 yr in Tehran, fifteen years after distribution of iodized salt. Data were collected on age, sex, weight, and thyroid size was ascertained by palpation and ultrasonography. Results: The prevalence of goiter was 2.3% by palpation. All goitrous subjects had grade 1 goiter; thyroid volumes determined by ultrasonography were comparable in boys and girls of all ages. The best predictors of thyroid volume were age, weight, and body surface area. The median thyroid volumes of Tehranian schoolchildren in this study were lower in all age groups compared with our previous 2001 study and updated provisional WHO/ICCIDD reference values. Conclusion: Tehranian schoolchildren currently living in an iodine sufficient area, where they have spent their entire lives, have smaller thyroid glands than recommended international references. Existing values for universal thyroid volume reference ranges should be re-considered.

Introduction: A population based cross-sectional survey was conducted to determine prevalence of hypertension in the adult population of Semnan province. Materials and Methods: The study was conducted from September 2005 until February 2006, using a multistage cluster sampling method to select a representative sample. A total of 3799 adults, aged 30-70 years, were examined. Two blood pressure measurements were obtained by trained observers using a standard sphygmomanometer after a 5 minute seated rest. Information on history of hypertension and use of antihypertensive medication was obtained using a standard questionnaire. Body mass index (BMI) and waist to hip circumference were determined. Fasting blood sample was drawn for measurement of glucose, total cholesterol and triglycerides. Results: Prevalences of hypertension in men and women were 24.1% and 24.7%; respectively. In both sexes, prevalence of hypertension increased with age. No significant difference was found in prevalence of hypertension in rural (24.1%) and urban (24.8%) regions. Among hypertensive subjects, 40.6% were aware of their hypertension (men: 30%; women: 49.7%, P<0.001), only 25.5% were taking antihypertensive medication (men: 19.5%; women: 30.6%; P<0.001) and 41.2 % had their blood pressure controlled (men: 41%; women: 42.3%). In 93.7% of men and 97.2 % of women with hypertension, at least one other cardiovascular risk factor was present and its prevalence was increased in both genders with age. Finally, gender (OR: 1.28 in men), diabetes (OR: 1.86), obesity (OR:1.7), high triglycerides (OR:1.3), high cholesterol (OR: 1.3), and abdominal obesity (OR: 1.79) were positively associated with hypertension (P<0.001). Conclusion: Hypertension was present in one-fourth of the population. Majority of hypertensive subjects in this region still remain undetected and control of hypertension is also inadequate. This calls for urgent prevention and control measures for hypertension in Semnan province.

Introduction: There are evidences suggesting associations between serum Cu, Zn/Cu, Fe and ferritin and hyperlipidemia. Considering the increasing prevalence of hyperlipidemia, the objective of this study was to determine and compare serum Zn, Zn/Cu, Fe and ferritin status in normo- and hyperlipidemic men. Materials and Methods: This cross-sectional study investigated 96 adult men divided into three groups (32 persons in each group) according to their lipid profiles (hypercholestrolemic, hypercholestrolemic+hypertriglyceridemic, normolipidemic). For all subjects, 10cc samples of fasting venous blood samples were obtained. Serum lipids and iron were measured using the enzymatic method. Serum levels of copper and zinc were measured by atomic absorption spec, and ferritin by Elisa. Dietary intakes were estimated using a 24-hr recall and 2 days dietary records. Dietary data were analyzed using the food processor ΙΙ software. Statistical analyses were performed using SPSS software. Results: Iron intake was considerably higher in the hypercholestrolemic+hypertriglyceridemic group, compared to normolipidemic subjects (28.9±1.6 mg vs 23.2±1.8 mg, p<0.05). Iron serum levels in the hypercholesterolemic (99.3±2.9mg/dL) and hypercholestrolemic+hypertriglyceridemic (122±5.8 mg/dL) groups were significantly higher than healthy males (85±9.3 mg/dL) (p<0.05). There were no differences between the other variables among study groups. Conclusion: Considering the changes of iron status in the hyperlipidemic group in this study, it is recommended that serum and dietary status of iron shoud be evaluated in these individuals.

introduction: Osteoprosis is a well recognized health hazard for women who are the main group at risk. This study assessed the relative risk factors of osteoprosis in women referring to the Chamran Hospital densitometry center during the year 1386, with the aim of designing a formula to estimate the severity of osteoprosis based on its risk factors. Materials and Methods: This cross sectional analytic study used the data of outpatients (n=1047) who visited the Bone Densitometry Center of Chamran Hospital during the year 1386. Information was gathered using questionnaires, completed face to face; and the cases underwent Dexa densitometry of the hip and vertebras. The data were analysed with SPSS software. Results: Of the patients, 73% were menopausal; the average and standard deviation of age and weight was 54.5±(10.3), 69.5±(10.8) and the average and standard deviation of T-score of hip and lumbar spine was -1.88±(1.08), -1.04±(1.05). After assessment, the precipitating factors of osteoprosis of hip were age, menopause, time of menopause, history of fracture, history of taking calcium supplements and dosage, number of deliveries, and duration of breast feedings. The preventing factors were weight, OCPs, exercise, (p<0.05) being significant; the percipitating factors in vertebras were age, menopause, time of menopause, diabetes, history of fracture, history of calcium supplement usage and dosage, number of deliveries, timing of breast feeding and the preventing factor was weight, (p=<0.05) being significant. Using the use of stepwise regression analysis, a minimal mathematical model for predicting of bone density of hip and lumbar spine was formulated. Then the mathematical model of hip in the form of clinical decision rule (CDR) was validated with less number of independent cases. Conclusion: Using the method mentioned, along with clinical findings and history, persons at risk of osteoporosis can be identified and early prevention and treatment are possible. This can also prevent unnecessary expenses of diagnostic procedures for people without the risks of osteoprosis.

Introduction: Ghrelin is a gut hormone predominantly produced by the stomach and, to a lesser extent, by other regions of the gastrointestinal tract. Ghrelin circulates in the bloodstream in two different forms: acylated (or n-octanoylated) and unacylated (or des-octanoylated or des-acylated). The purpose of this study was to examine the effect of 12 weeks training on plasma acylated ghrelin concentrations and gastrocnemius muscle mRNA expression in male rats. Materials & Methods: Twenty adult Wistar male rats (8 weeks old, 280±20 g) were used. Animals were randomly divided into experimental (EX, n=10, V=34m/min) and control (n=10) groups. Training groups were given exercise on a motor-driven treadmill (0% grade, 60min, and 5 days/week for 12 weeks). Gastrocnemius was excised and frozen in liquid nitrogen for extraction of ghrelin; mRNA and plasma acylated ghrelin, were measured. Results: Plasma acylated ghrelin was significantly (P<0.01) higher in high intensity trained rats. Also muscle mRNA expression was higher in trained rats compared to control rats. Conclusion: Data indicate that higher ghrelin mRNA expression in muscle and higher plasma acylated ghrelin levels could be attributed to metabolic changes (muscle glycogen and ATP depletion are less in endurance trained species). A higher plasma acylated ghrelin in the present study might be attributed to liver and skeletal muscle glycogen and ATP deficiency and incomplete energy sources recovery after the last exercise session along with overnight fast. Lower muscle glycogen levels, as we observed in the present study, might be considered as stimuli for this elevated plasma acylated ghrelin in trained rats.

Introduction: Central obesity is a common complication of glucocorticoids which is associated with insulin resistance. In some studies, thiazolidinediones have decreased central obesity in type 2 diabetic patients. The purpose of this study was to investigate the effect of pioglitazone on glucocorticoid induced central obesity in rats. Materials and Methods: Forty Sprague-Daily rats were divided into 2 groups, with 10 male and 10 female rats in each. In group 1, methylprednisolone succinate 5 mg/kg was injected 3 times per week and pioglitazone 30 mg/kg/day was given. In group 2, only methylprednisolone succinate was administered. After 3 weeks, the rats were sacrificed and visceral fat was removed, and the weight of visceral fat, abdomen circumference and total body weight in the 2 groups were compared. Results: The weight of animals was not different significantly; however animals given pioglitazone had less visceral fat (7.32±2.60 vs 11.95±2.76 gr P<0.001) and lower abdominal circumference (11.92±1.20 vs 14.98±1.74 cm P<0.001). Conclusion: Pioglitazone has antagonistic effect on glucocorticoid induced central obesity.

Introduction: Gama amino butyric acid (GABA) is the major inhibitory neurotransmitter in the mammalian nervous system. Pancreatic beta cells in islets of Langerhans express GABA at the levels comparable to those encountered in the central nervous system. The concentrations of GABA and the number of GABA secreting cells, decrease in diabetic patients and experimental diabetes models. Reports on effects of GABA on insulin secretion have been controversial. In this study we investigated whether or not GABA administration in an animal diabetes model can change insulin and glucagon secretion and improve diabetic symptoms.Materials and Methods: Seven-week old CD1 mice were used. For inducing diabetes, 40 mg/kg of streptozotocin (STZ) was given intraperitoneally for 5 days. Two months after diabetic induction, animals were divided into two groups, one receiving 200 mmol of GABA, while the other group received phosphate buffer solution (PBS) for two and half months. Results: After 42 days, the glucose concentration in the GABA treated group decreased significantly compared to the untreated group and the first day. After two and half months, water consumption in the GABA treated group decreased significantly in comparison to the control group. Plasma insulin level increased significantly (0.989±0.67 vs 0.779±0.11) while plasma glucagon level decreased significantly (91.71±4.52 vs 130.07±18.78). Glucose tolerance test in the GABA group returned to normal levels. Conclusion: GABA administration by regulation of insulin and glucagon secretion could help treat some diabetic symptoms, and could possibly be used in the future as a therapeutic tool in diabetes.