مجله غدد درون ریز و متابولیسم ایران
سال دوازدهم شماره 1 (پیاپی 49، اردیبهشت 1389)

Cardiovascular disease (CVD) with its high prevalence is mainly responsible for the high mortality and morbidity in type 2 diabetic patients. The aim of this study was to determine the prevalence of cardiovascular risk factors in patients with type 2 diabetes. Clinical information for 752 type 2 diabetic patients was collected in a cross sectional survey. History and physical examination were recorded. Laboratory tests were done for all patients. Data for a total of 752 patients (355 males and 397 females) of type 2 diabetes were analyzed. The mean age of patients was 52.7±10.5 years and the mean duration of first time diagnosis of diabetes was 7.9 ±6.4 years, 51.6% of patients had hypertension. The prevalences of overweight and obesity were 52.5% and 25.7% respectively. Lipid abnormalities were prevalent in a large numbers of our patients, 95.2% had total cholesterol > 200 mg/dL, 3.1% of patients had triglycerides > 150 mg/dl. The prevalences of low HDL-c and dense LDL were 86.9% and 65.8% respectively 73.5% of our patients had metabolic syndrome. HbA1C>7% was found in 75% of patients. Renal involvement was observed in our patients 21.5% of patients had microalbuminuria, 1.6% macroalbuminuria and 8.8% had chronic kidney disease. The high prevalence of CVD in our type 2 diabetic patients found demonstrate the need for more improvement in prevention and treatment of such patients.

The main objective of this study was to investigate the effects of magnesium, zinc, vitamins C and E, and a combination of these micronutrients with vitamin B groups (B1, B2, B6, B12, folic acid and biotin) on blood pressure in type 2 diabetic patients. In a randomized, double-blind, placebo controlled clinical trial, 67 type 2 diabetic patients, 36-69 years old, stratified for sex and were randomly divided into three groups. Each subject received two capsules per day for a period of 4 months, each capsule containing one of the following preparations: Group 1 received 250 mg magnesium and 20 mg zinc, 200 mg vitamin C and 100 mg vitamin E, 10 mg vitamin B1, 10 mg vitamin B2, 10 mg vitamin B6, 10 μg vitamin B12 and 1 mg folic acid (n=22). Group 2: 250 mg magnesium and 20 mg zinc, 200 mg vitamin C and 100 mg vitamin E, (n=23), and group P: placebo (n=22). Blood pressure and biochemical analysis were determined at the beginning and after 2 and 4 months. Fasting blood glucose and HbA1c were determined by glucose oxidase and chromatography methods, respectively. Plasma vitamin C and serum magnesium and zinc were determined by the colorimetric method and serum α-tocopherol using HPLC. Serum malondialdehyde (MDA) was determined by a colorimetric method. Treatment effects were analyzed by general linear modelling. Results indicate that after 2 and 4 months of supplementation levels of plasma vitamin C increased in group 1 (p<0.0001) and group 2 (p=0.029 and p<0.0001, respectively). Serum vitamin E increased in group 1 and 2 (p<0.0001) and serum folic acid increased in group 1, after 2 and 4 months supplementation (p<0.0001). Serum magnesium increased in group 1 after 2 months supplementation (p=0.001) but not after 4 months. After 2 or 4 months supplementation, there were no significant changes in fasting blood glucose or HbA1c in the 3 intervention groups. Levels of systolic blood pressure decreased significantly in group 2 after 4 months supplementation (p=0.012). After 2 and 4 months supplementation, diastolic blood pressure decreased significantly in group 1 (p=0.003 and p=0.012, respectively) and in group 2 (p<0.0001 and p=0.002, respectively) and mean arterial blood pressure decreased in group 1 (p=0.018 and p=0.025, respectively) and in group 2 (p=0.002). Also serum malondialdehyde decreased significantly in groups 1 and 2 (p=0.009 and p=0.041, respectively) after 4 months. The results of the present study indicate that in type 2 diabetic patients, combination of vitamins and minerals might decrease blood pressure.

Detection of population at risk of type II diabetes, as a multi-factorial disease, is an important issue because of its individual and social impacts. To date, several studies have been conducted to predict the incidence of diabetes, using different statistical methods. However, despite its clinical importance, it is highly difficult to consider all interactions among risk factors, in ordinary statistical models. This study aimed to extract appropriate logic combination of type 2 diabetes risk factors employing the recently introduced method, Logic regression. The study population was selected from a cohort of the Tehran Lipid and Glucose Study (TLGS). Data for 3523 participants, aged 20 years and over (57.8% female and 42.2% male) were entered into analysis, for which logistic logic regression method was used. The model parameters were estimated using the Annealing algorithm. To avoid overestimation, the optimal number of logic combinations was determined by the cross-validation method. Deviance, sensitivity and specificity measures were computed to evaluate the logic model and its comparison to ordinary logistic regression the latter accommodated only the main effects. The prediction power of the two models was compared by Area under ROC curve. R software version 2.8.1 was employed for analyses. Logistic logic regression with the 4 Boolean combination including 5 variables was fitted using the Annealing algorithm and resulted in in deviance of 1203.30. This model had better fit compared to other logic models and also ordinary logistic regression with forward procedure (deviance=1206.88). The Boolean combination of the above model included impaired fasting glucose (OR=5.53, 95%CI: 4.03-7.59), IGT (OR=5.54, 95%CI: 3.96-7.49), family history of diabetes (OR=1.89, 95%CI: 1.38-2.63), and interaction of high triglycerides or abnormal waist circumference (OR=2.4, 95%CI: 1.73-3.32) all p-values <0.001. The area under ROC curve for the model was 0.843 (95%CI: 0.813-0.874). This study showed that the logic regression as a newly introduced method has the ability of recognizing and modelling the interactions between different risk factors. Therefore, it is recommended as an appropriate tool for screening of the multi-factorial diseases such as diabetes.

Central obesity down regulates adiponectin gene expression and plasma adiponectin concentration. The effects of lifestyle activity modification (LAM) training according to Centers for Disease Control (CDC) and American College of Sports Medicine ACSM guidelines on adiponectin gene expression and its secretion in obese people is not well known. The purpose of this study hence was to examine the effects of LAM on adiponectin gene expression and plasma adiponectin in obese men. Sixteen healthy middle aged men (42.06±6.01 years mean ± SD) participated in this study. The subjects were randomly assigned to the LAM (n=8) and control group (n=8). Subjects in the LAM group walked 2 miles for 30 minutes for 4 days for 12 weeks on treadmill according to the CDC and ACSM guidelines. After 12 weeks LAM training, subjects were asked to avoid any high intensity physical activity for a week. The results showed that weight, BMI, body fat mass, body fat percent, central (visceral and subcutaneous) and peripheral subcutaneous fat volume, waist and hip circumstance and waist to hip ratio (WHR) were decreased significantly after 12 weeks in the LAM group, compared to the controls (P<0.05). After one week detraining, body composition in the training group was maintained and did not change significantly. Also, maximum oxygen uptake, adiponectin gene expression on abdominal and hip subcutaneous adipose tissue were increased significantly in the LAM group compared to controls after 12 weeks (P<0.05). On the other hand, after 12 weeks LAM training no significant differentces were observed in plasma adiponectin and serum high sensitive C reactive protein (hs-CRP), levels between groups, while after one week detraining plasma adiponectin and serum hs-CRP levels were significantly increased and decreased respectively (P<0.05). Although, twelve weeks LAM training improved body composition, cardiorespiratory fitness and adiponectine gene expression in obese men, but the intensity and time of these exercises are not enough to increase plasma adiponectin and hs-CRP reduction.

Supramaximal sprint interval training is an efficient means of improving physical fitness within a short period of time. However the effects of this type of training which cause hormonal and physiological adaptations to increase enhanced aerobic and anaerobic performances, are not well known. Thus, the purpose of the present study was to examine the effects of four weeks of supramaximal sprint interval training on some hormonal and physiological variables. Fifteen trained wrestlers were randomly assigned into two groups, the experimental (EXP=8) and controls (CON=7) groups. Before and after training, subjects performed (a) a graded exercise test and (b) four consecutive Wingate tests with 4-min recovery intervals between each. Resting blood samples were collected before and after training. Both groups followed the same wrestling training program for 4 weeks additionally, the EXP group performed a running-based anaerobic sprint test (RAST) as a supramaximal sprint interval training protocol for 4 weeks, two sessions per week. The EXP group showed improvements in VO2max (+5.4%), Peak power output (34.9%) and Mean Power Output (29.3%) after the training (P<0.05), along with significant increases in total testosterone, total testosterone/cortisol ratio (TCR) and free testosterone/cortisol (FTCR) ratio in the EXP group, but there were no significant differences between groups. Cortisol was tended to decrease in both groups (P>0.05), but none of the variables were changed in the CON group after the training. The current findings suggest that the supramaximal sprint interval training program with short recovery can increase both aerobic and anaerobic performances. The changes observed in FTCR and TCR suggest exercise training-induced anabolic adaptations.

The use of creatine (Cr) as a nutritional supplement to aid athletic performance has gained widespread popularity among athletes. However, concerns have recently been expressed over the potentially harmful effects of short and long term Cr supplementation on health. Therefore this study was conducted to determine effect of creatine monohydrate (CrM) ingestion and resistance training on serum Alanin Aminotransferase (ALT) & Aspartate Aminotransferase (AST) changes in non-athlete males. Twenty non-athlete males (age 22.25±2.02yr, weight 71.55±4.72Kg and height 171.92±5.98 Cm) were selected and studied in two groups, the training-creatine (TC): n=10, and the training-placebo (TP): n=10, in a double-blind trial. Both groups participated in resistance training and completed two months of weight training (75% one repeat maximum). The TC group consumed a 250 ml CrM solution supplement (0.07 g/kg/day, creatine) during the training protocol, while the control group just placebos (0.07 g/kg/day, wheat flour). Venous blood samples were obtained before and 48h after the last session and serum ALT and AST activities were measured using the auto-analyzer system. Data was statistically analyzed by dependent and independed t-test, with a 0.05 significance level. There were no significant differences in serum ALT and AST activity between the TC (ALT, P≤0.102 AST, P≤0.086) and TP groups (ALT, P≤0.265 AST, P≤0.009). Nor were any significant differences observed in mean and changes range for ALT and AST activities between the TC and TP groups. The results suggest that two months resistance training and CrM ingestion had no adverse effects on hepatic cellular damage indices. However, more research is needed to identify the side effects of acute and chronic CrM ingestion and resistance training.

Animal studies reveal that conjugated linoleic acid (CLA) alters body composition, but few studies have examined the effects of CLA supplementation on body composition and leptin concentration in post menopausal women. In the present study, A randomized, double blind, placebo-controlled trial was performed to examine the changes in body composition and leptin concentration following 12 week supplementation of either 4 capsules of CLAG80 containing 3.2g CLA (50: 50 ratios of cis-9, trans-11 and trans-10, cis-12 isomers) or 4 placebo capsules (high oleic sunflower) in post-menopausal women. Seventy-six healthy post-menopausal women were randomized to receive placebo or 3.2g CLA for 12 weeks. Dual-Energy X-Ray Absorptiometry was used to measure body composition at baseline and after 12 weeks. Blood samples were collected after 10-12 hours fasting before and after intervention in order to determine leptin levels. Subjects completed 3 day dietary records during the trial, at week 0 (baseline), and at weeks 6 and 12. These dietary records were coded by the same dietitian, and analyzed using Food Processor II. Anthropometric measurements were done according to standard methods. Baseline data for time since menopausal age, BMI, fat mass, lean mass, waist circumference, physical activity and systolic and diastolic pressure were similar in both groups. Dietary CLA in the CLA and placebo groups were 104.5±43.2 mg and 99.5 ±38.2 mg respectively. Although lean body mass increased by 0.87 kg in the CLA group (p<0.00) after 12 weeks of intervention, leptin concentration did not change in either group. Conjugated Linoleic Acid supplementation improves loss of skeletal muscle in postmenopausal women. Keywords: CLA, Body composition, Leptin, Post-menopausal women, Animal studies reveal that conjugated linoleic acid (CLA) alters body composition, but few studies have examined the effects of CLA supplementation on body composition and leptin concentration in post menopausal women. In the present study, A randomized, double blind, placebo-controlled trial was performed to examine the changes in body composition and leptin concentration following 12 week supplementation of either 4 capsules of CLAG80 containing 3.2g CLA (50: 50 ratios of cis-9, trans-11 and trans-10, cis-12 isomers) or 4 placebo capsules (high oleic sunflower) in post-menopausal women. Seventy-six healthy post-menopausal women were randomized to receive placebo or 3.2g CLA for 12 weeks. Dual-Energy X-Ray Absorptiometry was used to measure body composition at baseline and after 12 weeks. Blood samples were collected after 10-12 hours fasting before and after intervention in order to determine leptin levels. Subjects completed 3 day dietary records during the trial, at week 0 (baseline), and at weeks 6 and 12. These dietary records were coded by the same dietitian, and analyzed using Food Processor II. Anthropometric measurements were done according to standard methods. Baseline data for time since menopausal age, BMI, fat mass, lean mass, waist circumference, physical activity and systolic and diastolic pressure were similar in both groups. Dietary CLA in the CLA and placebo groups were 104.5±43.2 mg and 99.5 ±38.2 mg respectively. Although lean body mass increased by 0.87 kg in the CLA group (p<0.00) after 12 weeks of intervention, leptin concentration did not change in either group. Conjugated Linoleic Acid supplementation improves loss of skeletal muscle in postmenopausal women.

Antibody secretion in human may be the result of the changes in protein structure, or polymorphism in human thyroid peroxidase (TPO) gene that are the reason for presence of the Anti TPO. In this study we examined the association between of A1936/G exon11 polymorphism of TPO gene in respect to Anti-TPO level and in a sample population of Tehran. We enrolled 190 individuals with 47±2 y an average age of case-control groups. PCR-ARMS was used to amplify the segment of exon11 polymorphisms. In exon 11, the genotype frequencies were in conformity with the Hardy-Weinberg expectation. The results of this study show that the frequencies were 0.7298 for the G allele and 0.2710 for A allele. The presence of the G allele is significantly associated with increased anti-TPO level (GG: 238±57 IU/ml vs. AA: 74±33 IU/ml, P<0.05). The G allele frequenc in the group with anti-TPO>100, was higher than that of the A allele. The results indicated that G allele carriers of exon 11 are exposed to increased Anti-TPO levels higher than A carriers.

Digestion is an important step in urine iodine determination methods. High temperatures and long heating durations can be considered as weaknesses of the present methods. The aim of the study was assessment of microwave use for digestion of urine and decompostion of interfering substances, aimed at shortening the time and increasing safety in the procedure. Random urine samples were processed by conventional acid digestion and also by new microwave optimized digestion methods. After digestion, iodine levels of samples, digested by the two mentioned methods, were also determined using chemical colorimetric kinetic reaction Ce+4 and Ce+3 according to the well known Sandell-Kolthoff reaction. Microplate reading format by ELISA reader was used to increase speed and precision of reading. Sensitivity, precision and comparison results were assayed in both the methods as well. Optimized microwave digestion showed that merely a 10 min duration is adequate for complete digestion of urine samples. Intra- and inter- assay coefficients of variation were 6.7- 9.3% and 9.8-12.3% respectively. The final results of the comparison of iodine contents of samples, were obtained through the two microwave and conventional methods, showed acceptable correlation (r=0.928). The assay recovery was 91-113% and the sensitivity 5 µg/dL. The results of this study showed that the microwave procedure for urine digestion is acceptable. The digestion method obtained comparable results with conventional digestion methods, and can hence replace conventional electrical heat digestion methods.

In insulin resistance animal models, insulin uptake from periphery to the brain is impaired. While insulin is not involved in glucose transfer to the neurons, it is required for neuron survival and function through binding to its receptor. Furthermore, an insulin homologue called insulin like growth factor (IGF-I) is abundantly expressed in mature rats, acts in parallel with the insulin in brain, binds to the insulin receptor and its serum levels reduced in insulin resistance. In this study, we sought to investigate whether the expression of brain IGF-I is altered in the insulin resistant animal model. Wistar rats were fed with 10% fructose in their drinking water up to 4 months and induced with the insulin resistance. The rats were killed, perfused with 4% PFA, and their brains were sectioned and studied for the immunoreactivity of the IGF-I. Results showed that there is an increased intensity of IGF-I in most brain areas. Altogether, despite the low levels or lack of insulin in brain of the insulin resistant animal model, increased expression of the brain suggests a compensatory mechanism to maintain the insulin function.