IRANIAN JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM)
Year:2006 | Volume:8 | Issue:3 (SN 31)|Papers Count:19

Introduction: Serum Low-Density-Lipoprotein Cholesterol has long been used as an important assessment tool to predict the risk of coronary artery diseases, but due to certain limitations in the use of this index, it has been shown recently that Apo lipoprotein B is a better screening tool. Non- HDL cholesterol (total cholesterol minus HDL-C) includes all the lipoprotein particles, which' contain Apo lipoprotein B, and could be a good screening tool for Apo lipoprotein B during CAD assessment and treatment. This study aims at assessing the distribution and correlation of non- HDL-C and related factors in a population of Tehranian children and adolescents. Materials and Methods: The study sample consisted of 4298, 3-19 year-olds, (2019 boys (47%) and 2279 girls (53%)) who had participated in the first phase of the Tehran Lipid and Glucose Study (TLGS), from 1998-2000. Anthropometric and clinical data were collected for analysis. Results: Non-HDL-C levels were higher in girls than in boys of the same age groups, especially among the younger (3-4 year-olds) age groups. Body mass index and waist circumference were positively associated with non-HDL-C. Both non-HDL-C and LDL-C were strongly associated with each other and total cholesterol (r2=0.81 and p< 0.001). Non-HDL-C and LDL-Care were associated with triglycerides, but the strength of this correlation with triglycerides was relatively weaker as compared to that with total cholesterol. Non-HDL-C showed a significant inverse relationship to HDL-C (r2=0.01, p< 0.01). It was also seen that non-HDL-C had a stronger correlation to BMI and body fatness indicies. Conclusion: Population based data on non-HDL-Care now available for children and adolescents, which may help improve the CAD risk assessment and related interventions.

Introduction: Lipoprotein (a) [Lp(a)] is known as an independent risk factor of atherosclerosis and changes in serum level of this molecule and other lipoproteins have been noticed in diabetic patients because the most important cause of death in these patients is related to their cardiovascular disorders. Moreover, patients with IGT (Impaired Glucose Tolerance) are more at risk of cardiovascular disease than the normal population. The main purpose of this study is to comparie Lp (a) serum levels between diabetic patients, patients with IGT and normal controls without any glucose metabolism disturbance. Materials and Methods: In this study, 180 patients (112 females, average age of 51±11 years and 68 males, average age of 54±14 years) were selected and placed in three separate age and sex matched groups (60 patients in each group) as Diabetic, IGT and Control group. After taking clinical history and determining body measurements, serum total cholesterol, triglyceride, HDL-C, LDL-Cand Lp (a) were measured in fasting blood samples.Results: Lp(a) serum levels were not significantly different between the three groups.(DM: 25.4±20.9, IGT: 24±21.4, Control: 24.6±17.9 mg/dL). An increase in serum triglyceride was found in the diabetic patients compared with the controls. (DM: 210.6±91.5, control: 159±71.9 mg/dL; p=0.04). HDL-Clevels showed no significant difference between groups. In addition, HDL-C levels of the all three groups were lower than the recommended range of Coronary Artery Disease prevention. (average range of the three groups: 37.4±8.7 mg/dL) Total Cholesterol and LDL-C serum levels were higher in diabetic patients compared with the controls. (DM: 222.3±35.4vs Control group: 191.7±46.5 mg/dL; p<0.007 and DM: 141.2±32.4vs Control: 119.0±36.6mg/dL; p<0.03). In the IGT group, serum lipids levels were between the levels of the diabetic and control groups; none of these differences were significant. Conclusion: This study shows that Lp (a) serum levels do not change in Diabetes Mellitus and IGT.

Introduction: High Lp(a)level in human serum appears to be associated with increased risk for athero- thrombosis. Pathogenecity of Lp(a) as a risk factor may depend on its lysine binding site [LBS] activity, which imparts a unique function to Lp(a), including a potential to inhibit  ibrinolysis. Lp(a) is present in human plasma in four heterogeneous subspecies: (Lp(a)Lys-, Lp(a) Lys+1, Lp (a)Lys+2, Lp(a)Lys+3). This subclassification is made according to their ability to bind to lysine sepharose. Data available indicate that serum lipoproteins are sensitive to copper-induced oxidation. In this study the effect of copper oxidation on lysine binding site properties of Lp (a) was investigated, to find information about molecular mechanism of Lp (a) in promoting thrombosis and atherosclerosis. Materials and Method: Serum lipids were oxidized in the presence of 15, 30, 50, 75 and 100mm of CuCl2. Lipid oxidation was measured as conjugated diene formation determined by spectrophotometric method at 245 nm. Four species of Lp(a) in the oxidized serum were isolated using affinity chromatography on lysine sepharose. Results: Results showed a concentration dependent increase in all subtypes of Lp(a)Lys+ and a decrease in all subtypes of Lp (a) Lys-. These data suggest that copper ion can induce a chemical modificaton to lipoprotein (a) leading to an increase in LBS activity of Lp(a), and thus, can promote athero- thrombosis.

Introduction: Diabetes a major threat fo public health today and deaths resulting from its later complications such as diabetic foot, have increased alarmingly, causing physical and emotional problems and disability for diabetic patients. The current strategy for prevention of diabetic foot prevention is health education. This study was conducted to assess effects of educational interventions based on the HBM model used in food care by type 2 diabtetic patients. Materials and Methods: This is an interventional study in which 108 type 2 diabetic patients attending the the Kermanshah diabetic centre participated. They were randomly divided into the case and control groups. For data collection by interview a questionnaire consisting of 59 questions arranged in 5 sections including the demographic HBM model parts (perceived susceptibility, perceived severity, perceived benefits, perceived barriers) and also cues of action foot care at home (self-reporting) and the checklist section was used. Reliability and validity of this questionnaire was confirmed before the study. Educational interventions based on HBM model were implemented in three 60 minute-sessions after completion of questionnaires and the data was again collected after one month. Results: Findings showed means for knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, mean grades were at average levels and whereas the foot care mean grade was below average. After intervention, however, the results demonstrated that knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, action and checklist mean grades in type 2 diabetic patients increased significantly in the case group. Discussion: The findings of this study showed that foot care increased when knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, elevated. These study results confirm the effectiveness and influence of the use of the HBM model in foot care by type 2 diabetic patients.

Introduction: Obesity in children is a major health problem and parents can play an important role in its prevention and treatment. However, some parents are unaware of the problem and believing that their obese children are healthy do not participate in any related preventive or educational programs. The aim of this study is to assess parental perception of obesity in children aged 6-12 years and to evaluate the effect of education could have on this. Materials and Methods: This study has been conducted in two stages (stage 1, descriptive and second stage, experimental). Weight, length, and body mass index were calculated in children aged 6-12 years. Then 300 children with BMls higher than those standard for sex and age were selected as obese. Questionnaires for each child were completed by one of the parents. Parents that believed their obese children were not overweight, were divided into two groups, randomly. One group was educated about obesity during four, 2-hour sessions whereas the other group were not. After two months, questionnaires were completed by both groups and compared. Results: Findings of the study showed 41/3% obese children are girls and 58/7% are boys. Among parents of obese children, 23/3% believed that their obese children were not overweight and after education, 94/3% became aware of their child's obesity and overweight. In this study, there was no relationship between the mother's job or the child's sex and the mother's perception. Conclusion: Present beliefs of parents regarding obesity and overweight in children need to be assessed in communities and educational programs conducted if necessary.

Introduction: Different results have been reported on the association between metabolic syndrome (MS) and cardiovascular diseases (CVD).The aim of this study is to determine the role of the Adult Treatment Cholesterol Program (ATP Ill) and International Diabetes Federation (IDF) definitions of metabolic syndrome in predicting CVD. Material and Methods: In this cohort study, all individuals aged over 40 yrs, phase I participants of the TLGS, with no histories of CVD were selected. Based on the APTIII and IDF criteria of the MS syndrome, they were divided into those with and those without the condition. All of the subjects were followed for a mean duration of 4.9±0.8 years for occurrence of CVD. The predictive ability of different definitions of the MS was evaluated in different regression models that included only the MS (model 1) and were also adjusted for age, sex, family history of premature CVD and smoking (model 2), serum LDL(model 3) and other components of the MS (model 4). Results: There were 3777 individuals' aged 54±10 years; 1536 (41%) where normal according to the both criteria of the MS and 1714 (45%) and 1900 (50%) subjects had MS according to the ATP III and IDF criteria respectively. New CVD occurred in 143 individuals (3.7%). In our study, the MS was the predictor of CVD in the first three models according to ATP III and IDF criteria; however, in model 4, none of the definitions of MS predicted CVD. After calculation of the area under the curve (AUC) for model 2 and 3, it was observed that the power of the ATP III criteria in model 2 for prediction of CVD was significantly higher than the IDF (AUC0.760 vs. 0.735, p<0.001) but no significant difference was observed between the 2 criteria in model 3. Conclusion: The ATP III and IDF definitions of the MS, it seems can similarly predict CVD after adjustment for the common CVD risk factors and LDL, whereas neither of the 2 definitions had this predictive power after adjustment of their components in addition to the earlier mentioned ones.

Introduction: Insulin resistance and undersecretion play major roles in the pathogenisis mechanism of diabetes mellitus. This study evaluates the correlation between insulin resistance (by HOMA-IR) and the prediction of impaired carbohydrates metabolism. Materials and Methods: Individuals with from among participants of the Tehran Lipid Glucose Study normal FBS and GTT (TLGS) were followed for 3 years. Of these, 3 years later, some cases developed DM type 2, IGT, IFG and IFG-IGT; cases remained normal. Insulin and fasting plasma glucose levels were measured and HOMA-IR index was calculated. Body mass index (BMI), waist circumference, waist to hip ratio (WHR), systolic and diastolic blood pressure, glucose tolerance test, serum lipid profile, history of smoking and family history of diabetes at the beginning and after 3 years were determined. For comparison of variables chi-square test and ANOVA were used. Prediction of development of diabetes, IGT, IFG, IFG-IGT according to quarters of HOMA-IR before and after modifying of confounders were estimated by logistic regression analysis. Power of prediction of multiple modeling was evaluated by the Roc curve. Results: Of the 255 normal cases from among TLGS participants followed for 3 years, when 30 cases developed DM type 2, 89 individuals IGT, 57 IFG and there were 26 cases of IFG-IGT with 53 cases remaining normal. In the first stage there was no difference between study groups in sex, total cholesterol, HDL cholesterol, LDL cholesterol, family history of DM, cigarette smoking and physical activity. Mean fasting blood glucose was higher in cases who developed IGT, DM, IFG, IFG-IGT than in normal cases (91.2±7.9mg/dL, 96.2±9.0 mg/dL, 98.1±8.8 mg/dL and 98.9±8.5 mg/dL vs 86.8±9.9mg/dL in the normal group respectively, p=0.02, p<0.001). Mean HOMA-IR in cases who developed DM, IFG, IFG-IGT was significantly higher than in normal cases (1.9±1.0, 2.2±1.3, 2.5±1.6 respectively vs 1.0±0.9 in normal cases; p=0.014, p<0.001, p??0.001). After 3 years, HOMA-IR increased significantly in all groups (even controls) except those cases who developed IFG, IFG-IGT. There was no correlation between changes in DHOMA-IR and D TG, DHDL-C, DLDL-C and DBP. Logistic regression showed that the quarters of HOMA-IR can predict development of DM, IGT, IFG, IGT-IFG (p<0.001, p=0.001, p<0.001 respectively) Conclusion: This study clearly demonstrated the correlation between HOMA-IR and the probability of developing DM, IGT, IFG, IFG - IGT.

Introduction: Prolactin exists in 3 different molecular forms, i.e., monomeric, big and at times big big (macroprolactine) in human serum. Macroprolactine is a complex of prolactine and IgG and may account for a significant proportion of idiopathic hyperprolactinemia. Its biological activity is considered low or absent, but it is measured by the common immunoassay method, thus can lead to expensive explorations and ineffective treatments. Conventionally the diagnosis of macroprolactinemia has been done by Gel Filtration Chromatography, which cannot be used routinely. Recently Poly Ethylene Glycol has been employed to precipitate macroprolactine, allowing its rapid detection, dependably and inexpensively. The objective of the present work is to assess the incidence of macroprolactinemia in patients with hyperprolactinemia, by its identification with PEG, and to establish the clinical (galactorrhea and oligomenorrhea) and radiological findings (sella MRI) of such a cohort. Materials and Methods: 50 patients with hyperprolactinemia were investigated for macroprolactine. Prolactine was measured before and after precipitation of macroprolactine by PEG, with recovery of <= 40% taken as indicating significant macrorprolactinemia. Results: Macroprolactine was found in 14(28%) patients. In true hyperprolactinemic patients (36 patients) galactorrhea occurred in 59.4%, and oligomenorrhea occurred in 65.6% of patients, but in macroprolactinemic patients, galactorrhea occurred in 8.3% and oligomenorrhea occurred in 25% of patients. Also normal pituitary images were found in 41.2% of patients who had true hyperprolactinemia and in 85.7% of patients with macroprolactinemia.

Introduction: Hyperprolactinemia is seen not only in pregnancy but also in several pathological conditions, However, some patients with hyperprolactinemia are diagnosed as idiopathic, because the causes are unknown. They are subjected to repeated radiological examinations to find a microadenoma, to a long term treatment with bromocriptine, and even to a surgical intervention.There is evidence that macroprolactinemia, in which most circulating PRL form large protein complexes (>150 KDa), is a major cause of idiopathic hyperprolactinemia. Macroprolactinemic patients are clinically characterized by lack of or less hyperprolactinemia - related symptoms. The objective of this study was to assess the prevalence of macroprolactinemia in hyperprolactinemic patients. Materials and Methods: Prolactin was measured before and after precipitation of macroprolactin by polyethylene glycole in 113 hyperprolactinemic (PRL>28 mg/L patients. Results: In 23% of the patients, macroprolactinemia was found. Conclusion: Considering the high prevalence of macroprolactinemia and to avoid diagnostic and therapeutic pitfalls, the screening for macroprolactinemia in all hyperprolactinemic patients is recommended.

Introduction: Clinical decision rules have been designed and developed to assist physicians in identifying the patient with osteoporosis. The aim of this study was to evaluate the performance of three decision rules in an Iranian post menopausal population. Materials and Methods: Three osteoporosis risk indices, the osteoporosis self assessment tool (OST), osteoporosis risk assessment instrument (ORAl), and the body weight criterion for 5573 out patients without any risk factors for secondary osteoporosis or receiving active bone medication and with negative history of prior fragility fraction were calculated. BMD at spines and femoral neck were measured via dual x-ray absorptiomety and the patients categorized to normal, osteopenic and osteoporotic according to WHO criteria. The sensivity, specifity, positive predictive value negative, predication value and area under receiver operating curve in identifying the osteoporotic women were determined for each decision rule and compared. Results: In this study, the prevalence of osteoporosis was 30.8%, 20% in lumbar spines and neck of femur, respectively. The sensivity of these risk indices in indentifying women with osteoporosis ranged from 70% to 84/1% and the specificity ranged from 44.6-65.6%. The area under curve (ROC) in identifying those patients with osteoporosis was significantly better for OST (0.75) and ORAl (0.74) compared with the body weight criteria (0.66). The negative predicative value ranged from 80% to 93%, while positive predication values ranged from 33% to 54%. Conclusion: Our data provide evidence showing OST, ORAl to be useful clinical tools, assisting clinicians in making decisions regarding which women need to be to referred for BMD testing but more evidence however needed is to confirm validity of body weight criterion.

Introduction: Hemodialysis patients (HD) with functional iron deficiency (FID) often develop resistance to recombinant human erythropoietin (rHuEpo). Recent studies suggest that intravenous ascorbic acid (IVAA) may circumvent rHuEpo resistance, while oral (AA) is readily attainable. The aim of this study was to evaluate efficacy and safety of oral versus intravenous vitamin C on FID and whether this can improve anemia in hemodialysis patients. Materials and Methods: In this study, 31 hemodialysis patients with serum ferritin >100 mg/L, transferin saturation (TS) <30% and Hb <11g/dL were selected and randomly divided into the oral and IV groups. The IVAA group received vitamin C 1.5 g, administered weekly and the oral group, 125 mg vitamin C daily for two months. Hb, ferritin, serum iron, Tsat and serum oxalate were measured at the beginning of the study and 2 months later. Independent - sample T-Test were used for inter group comparison. P value<0/05 was considered significant. Results: Mean Hb difference was 1.1±0.7 g/dL in the oral and 0.1±1g/dL in the IVAA group, being significantly higher in the oral group (p=0.02). There were no significant differences between the two groups in the delta means of ferritin &Tsat (p=0.5, p=0.3). Delta means of serum oxalate in the 2 groups were 0.05±0.4mg/L and 0.1±0.3mg/L respectively, difference not significant (p=0.3). Conclusion: Oral AA significantly increased Hb in HD patients suffering from FID. Considering the feasibility and cost-effectiveness, clinicians could consider oral instead IVAA in rHuEpo hyporesponsive patients undergoing HD.

Introduction: Autoantibodies and heterophile antibodies may be interfere with immunoassay methods and yield false results, leading to incorrect diagnosis and consequently inappropriate diagnostic and therapeutic interventions, which eventually may not be only costly, but also endanger the patient's health. Interference of autoantibodienature are usually analyte specific (i.e Anti-T3 interfere only in T3 assay) and those due to heterophile antibodies are usually method specific (such as IRMA or two-site methods). This is a case report of a patient presenting with nonspecific symptoms suspected of hyperthyroidism; the TFT, and T3 evaluations were more than twice were normal range exclusively by RIA method. After ruling out interferences due to binding proteins disorders and autoantibodies by in house methods, use of blocking and removal technique show that this false result in T3 assay was caused by a heterophile antibody from Ig G class. In our review of literature this is the first case report of interference in exclusively T3 assay by RIA method due to the heterophile antibody.