مجله غدد درون ریز و متابولیسم ایران
سال هفتم شماره 2 (پیاپی 26، تابستان 1384)

Obesity is considered to be the most significant risk factor for type 2 diabetes. The aim of this study was to estimate the association of diabetes with body mass index (BMI), waist to hip ratio (WHR), and waist circumference (WC). In a cross sectional study from 1999-2001, 7033 participants of the Tehran Lipid and Glucose Study (TLGS) (2992 men and 4041 women) aged 30-69 years, were studied. All subjects underwent clinical examination including anthropometric measurements. Fasting blood glucose after 12-14 hours overnight fasting and blood glucose, 2 hours after ingestion of 75-gr glucose, were measured. Weight, height, waist, and hip circumference were measured according to standard protocols. Diabetes, general and abdominal obesity were defined by using WHO criteria. The overall prevalence of diabetes was 13.4% (11.9 and 14.5% in men and women respectively, p<0.001). The prevalence of diabetes in subjects with general (based on BMI) and abdominal (based on WC and WHR) obesity was 19, 18 and 20.5% respectively, significantly higher than non-obese subjects (11, 6 and 13.4% respectively, p<0.001). In logistic regression analysis the odds ratio (OR) of having diabetes in subjects with general (based on BMI) and abdominal (based on WC and WHR) obesity after adjustment for age and family history of diabetes was 2.17(1.64-2.87), 2.21(1.66-2.94) and 2.36(1.84-3) respectively in men and 1.46(1.2-1.77), 2.37(1.79-2.88) and 2.79(1.96-3.98) respectively in women (p<0.001). After adjustment for other anthropometrical indices, WHR was an independent predictor of diabetes in both sexes (OR of 2 and 1.96 in men and women respectively, p<0.001) while BMI in women and WC in men lost their association with diabetes. When the effect of both total and abdominal obesity in increasing the risk of diabetes were considered, the highest OR was seen in those with both general obesity (high BMI) and abdominal obesity (high WC or WHR). WHR is a suitable predictor of diabetes independent of BMI and WC in both sexes. In comparison to WHR, BMI in women and WC in men are not suitable indices for prediction of diabetes risk.

It has been shown that Continuous ambulatory peritoneal dialysis (CAPD) changes serum protein levels, and can lead to changes in thyroid function tests (TFTs). At present limited literature is available regarding this topic the aim of this study therefore was to compare the TFTs results of CAPD and HD patients with those of a control grop. In a case control study, 24 CAPDs,36 HDs and 36 controls were randomly selected from among individuals who had undergone at least 3 months of dialysis, and had no history of thyroid disorders or related drug use, which could influence the TFTs. Fasting samples were collected between changes of peritoneal dialysis fluid, and just before initiating of hemodialysis and heparin injections. The TT4, TT3, FT4, FT3, TBG (RIA), TSH(IRMA), were measured. Data presented as Mean±SE and Median, IQ75-25 range. Data were analyzed by ANOVA, Post hoc test (Tukey test) and KruskalWallis using SPSS 10 software. The mean ages of participants in the CAPD, HD and normal groups were (51±3), (54±3) and (40±2) years, respectively. The means for TT4 in CAPD, HD and normal subjects were (6.6±0.3), (6.6±0.2) and (8.8±0.3) µgr/dl, respectively (p<0.0001). The TT4 mean was lower in CAPD and HD than in normal subjects (p<0.01). The means of TT3 in CAPD, HD and normal subjects were (106±3.4), (113±5.5) and (112±3,4) ng/dL, respectively, and were not statistically significant. The means of FT4 in CAPD, HD and normal subjects were (19.2±1.3), (15.8±1) and (14.3±0.6) pmol/l, respectively (p<0.02). The mean for FT4 in CAPD was higher than that of HD and normal subjects (p<0.001). The means of FT3 in CAPD, HD and normal subjects were (2.9±0.1), (3.1±0.1) and (3.8±0.1) pmol/L respectively (p<0.0001). In CAPD patients, FT3 was lower than in normal subjects (p<0.01), but no statistically significant difference with HD was seen. The TBG levels in the dialysate was 3.6±0.3 IU/ml, and its serum level in CAPD group was significantly higher than in others (16.7±0.8, 7.5±0.5 and 8.5±0.4IU/mL respectively p<0.001). TSH (Median,IQ25-75) in CAPD, HD and normal subjects were 1.4 (0.95–2.45), 1.2 (0.9–1.7) and 0.8 (0.6-1.1) mIU/ml respectively. TSH levels were higher in the CAPD group as compared with controls (p<0.001). Two cases of high TSH were observed in the CAPD group. The means of serum albumin in CAPD, HD and normal subjects were (3.6± 0.2) (3.8± 0.1) and (4.2±0.03) gr/dL respectively (p<0.0001), and these levels, in CAPD and HD patients, were lower than in normal subjects (p<0.0001). Apart from FT4 and TBG, all other thyroid function tests did not differ statistically between CAPD and HD individuars / patients. Considering the similarity in changes in TFTs in the CAPD and HD groups, it would seem that CAPD in comparison to HD would shows no additional changes in TFT.

Obesity is considered to be a chronic disease with multifactorial etiology. The purpose of this study was to identify predictors of obesity among total energy and macronutrient intakes in a group of Tehranian children. 390 children aged 3-13 years (221 boys, 169 girls) were selected randomly from among participants of the Tehran Lipid and Glucose Study. Body size was measured based on weight and height using body mass index (BMI, Kg/m2). Children with BMI over 85th centiles were considered overweight. Dietary intake data were assessed by trained interviewers using two non-consecutive 24-hour recalls. Under-reporters of energy intake were excluded from the study. Dietary composition was assessed in terms of calorie-adjusted amount of macronutrients intake and absolute dietary intakes, and data were entered in multiple regression models controlling for confounding variables and mutual effects of other macronutrients. The average BMIs of children 3-8 y and 9-13 y were 15.2±1.9 and 17.7±3.8(Kg/m2), respectively. Prevalence of overweight in girls was higher than in boys (19.2% Vs 16%, p<0.01). Absolute and adjusted dietary protein intakes were positively associated with BMI in boys aged 3-8 y (ß=0.63,p<0.05 and ß= 0.4, p<0.05). In both sexes only the absolute amount of fat intake contributed to BMI (ß=0.2 p<0.001 and ß=0.3, p<0.01). Adjusted carbohydrate intake was found to be negatively associated with BMI in boys (ß= -0.6, p<0.001). The results and evidence indicate that a positive association exists between protein intake and BMI in 3-8 year old children, whereas only absolute amounts of fat intake are positively associated with obesity. Obesity was found to be inversely correlated with carbohydrate intake.

Decreased rates of bone fracture have been reported in hypercholesterolemic patients treated with statin compounds. Considering the higher prevalence of bone fractures in diabetic patients compared to non-diabetics, this study was performed to determine the effect of lovastatin on the bone mineral density (BMD) of postmenopausal women with type 2 diabetes.

In this clinical trial study, 60 postmenopausal womean with type 2 diabetes were divided into 2 groups (with and without hypercholesterolemia) matched for age, diabetes duration, BMI and duration of menopause. Hypercholesterolemic subjects were treated with lovastatin for 18 months. Using DXA, bone densitometries was performed in all patients before and at the end of the study and the results were compared.

Total hip and lumbar spine BMD significantly increased in the treated group (p<0.01). In control subjects BMD decreased in total hip and increased in lumbar spine, but not significantly. Percentage changes of BMD in the femoral neck, wards triangle, trochanter, total hip and lumbar spine were 3.5%, 15.7%, 1.7%,3.29% and 3.2% respectively in the treated group as compared to -2.54%, 3%, -2.2%, -2.2% and 1.1% in control subjects, respectively.

According to our findings, lovastatin can increase the BMD in postmenopausal women with type 2 diabetes. It seems that these agents may slow the process of osteoporosis or stop its progression, especially in hypercholesterolemic patients.

Thalassemia major, as hemolytic disorder leads to increased iron load in patients and despite current treatment with deferouxamine the precipitation of iron in different endocrine systems results in disturbances in theses endocrine systems. In this study we evaluated endocrine disorders in patients with thalassemia major.

Subjects were patients with thalassemia major who referred to the endocrinology clinic. All of them underwent thyroid function tests and biochemistry assays. Growth hormone stimulation with levodopa, was done if indicated. FSH and LH, stradiol and testosterone were requested for adolescents.

44 patients 8.5 to 25 years old, underwent all tests. 40.9% of them were female. 11.3% of them had diabetes, and 88% of adolescents had hypogonadotropic hypogonadism. 15.9% had hypocalcemia and hyperphosphatemia. None of them had thyroid disorders. Height of 90.9% of patients was under the fifth percentile. Only 22.2% had abnormal response to stimulation test with levodopa. 22.7% of patients, had normal results for endocrine tests.

Our result showed that despite deferoxamine treatment in our patients, thalassemia major endocrine disorders were common. Hence, more effective treatment with deferoxamine appropriate dose and time of initiation is recommended.

Diabetes, the most common endocrine disorder has an adverse effect on patient’s quality of life. Hence, the need for a valid means or instrument to assess te reliably quality of life of such patients. The objective of this research is to design and validate such an instrument. The Diabetic Clients Quality of life (DCQOL) instrument development process consists of 3 stages 1. Concept definition 2. Items selection and 3. Psychometrics properties (validity and reliability) of DCQOL.The first and second stages include literature reviews and semistructured interviews with diabetic patients clients. The third stage includes assessment of content validity, face validity, construct validity (factor analysis), criterion-related validity (concurrent validity), internal consistency (alpha Cronbach) and stability (test-retest reliability) of DCQOL. In this study 145 diabetic clients selected randomly from research centers were participated. The DCQOL was developed with 70 items in four dimensions (physical, psychological, social, disease and treatment) and global item about quality of life at five- point likert scale.The DCQOL included 61 items after content and face validity. The results of factor analysis revealed 45 items with physical, psychological, social, economical and disease and treatment factors for explanation of DCQOL construct. The results of criterion-related validity revealed linear, positive and significant relations between DCQOL and SF-36. The results of internal consistencey revealed alpha Cronbach of 0.88-0.93 for factors and 0.95 for DCQOL, and a test-retest reliability of 0.86-0.90 for factors and 0.92 for DCQOL. The, DCQOL,with 45 items five-point likert scale, is a valid and reliable means for assessing the quality of life of diabetics.

We designed this study to investigate the effects of oral L-carnitine administration on fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and lipid parameters in patients with diabetes mellitus type II.

The effect of L-carnitine on FPG and lipid parameters was investigated in 22 male and 14 female type II diabetic patients, mean age±SD was 51.3±3.7 years. The patients were randomly divided into 2 groups (i.e.test and control groups). One gram of L-carnitine or placebo was given orally three times a day to the test and control groups respectively for a period of 12 weeks.

Fasting plasma glucose in the test group decreased significantly from 143±35 mg/dl to130±33 mg/dl (p=0.03), and a significant increase of triglycerides (TG) from 196±61 mg/dl to 233±116 mg/dL (p=0.05), of APO A1 from 94±20 mg/dL to103±23 mg/dl (p=0.02), of APO B100 from 98±18 mg/dL to108±22 mg/dl (p=0.02) after 12 weeks of treatment was observed. There were no significant changes in LDL-C, HDL-C, HbA1C or in total cholesterol (TC) between the two groups.

L-carnitine significantly lowers fasting plasma glucose but increases fasting triglycerides in type II diabetic patients.

Considering the hypoglycemic and hypolipidemic effect of the fenugreek seed and hypoglycemic effect of its leaf, this study was conducted to evaluate the hypolipidemic effect of its aqueous leaf extract. Male Wistar rats were divided into control, extract-treated control, diabetic, and extract-treated diabetic groups. Fenugreek extract was administered at doses of 100 and/or 200 mg/Kg (i.p) every other day three days after the induction of diabetes for a period of 2 months. Serum total cholesterol, triglyceride, LDL- and HDL-cholesterol levels were measured one week before the study and again 4 and 8 weeks after the experiment. Serum total cholesterol significantly increased (p<0.05) in diabetic rats, with the extract treatment having no effect in this respect there was a non-significant increase in triglyceride levels in diabetic rats again with no effect of extract treatment. On the other hand, LDL- and HDL cholesterol levels significantly increased (p<0.01) and decreased (p<0.05) in diabetic rats respectively, and administration of the extract significantly (p<0.05 and p<0.01) reversed these changes. The results showed that treatment of diabetic rats with aqueous extract of fenugreek could improve the inappropriate changes in LDL- and HDL-cholesterol and this could reduce the ensuing cardiovascular complications caused by diabetes mellitus.

The most common thyroid malignancy, papillary thyroid carcinoma constitutes 50-90% of differentiated follicular cell-derived thyroid cancer worldwide. Papillary carcinoma commonly metastasizes to lymph nodes in the lateral and central neck regions, and in the mediastinum. Rarely does metastases to the lymph node present as a cervical cystic mass. Here we report a 32 year-old female with lateral cervical neck cyst as the only sign of papillary thyroid carcinoma, who referred to us with a chief complaint of a cervical mass since 3 months. Physical examination revealed a 2x2 cm mass posterior to the right sternocliodomastoid without any relation to the thyroid. The cervical mass was resected and pathology report showed papillary carcinoma, most probably of branchial cleft cyst or thyroid origin. The result after thyroidectomy was papillary thyroid carcinoma. Conculsion: It is recommended that in all individuals, especially younger ones, referring with lateral cervical cysts, the likelihood of papillary throid carcinoma be seriously considered and investigated.

Quantitative Ultrasound (QUS) is a noninvasive and inexpensive portable method for bone mineral densitometry (BMD). QUS measures some other parameters like elasticity and microarchitecture in addition to BMD. This study designed to determine the normal values of QUS parameters (SOS, BUA and SI) of the calcaneus in a normal population of Tehran.

BMDs of the heel in 259 normal men and women, 20 - 76 Y/O (participant of the Iranian Multicenter Osteoporosis Study (IMOS) were assessed using Achilles+ (a QUS device from Lunar corp.) After assessment of normal values, Stiffness Index (SI) percentiles (2.5, 50, 97.5) in men and women were established.

Mean values of SOS, BUA and SI in women were s36/75±1527/25, 121/42±15/1, 94/46±17/92 respectively and in men were 1553/63±43/20, 127/80± 13/09, 100/19±18/77 respectively. Mean of SI in men and women 20 - 40 Y /0, had no significant difference with reference data used for QUS device. On the other hand there was a good correlation between diagnostic groups in reference values and results of our study (K= 0/875). Relation between age and sex and QUS parameters was significant.

Results of this study show a good correlation between normal values of QUS of an Iranian population in this study and reference values of the American and European populations.