فهرست مطالب mahdieh akhoundan

Studies have shown that many people with diabetes are fasting in the holy month of Ramadan. Ramadan fasting causes several changes in metabolism, habit and lifestyle that are associated with an increased risk of hypoglycemia and hyperglycemia in diabetic patients. An educational program based on behavioral science theory in the field of diet and medication changes, proper physical activity during Ramadan fasting, recognizing risks and symptoms of fasting complications and the management may improve the diabetic patient's ability in changing lifestyle, reduce the risk of fasting complications and weight and metabolic control during Ramadan. This study aimed to investigate the effect of nutritional education program based on health belief model (HBM), on the knowledge of type 2 diabetic patients who fast in Ramadan.
This randomized clinical trial was conducted on 53 type 2 diabetic patients referring to the Diabetes Clinic of Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences and tending to fast during Ramadan, who were recruited based on the research inclusion criteria. The subjects were randomly assigned into two groups of intervention (n=28) and control (n=25). A week before Ramadan, the intervention group was educated based on HBM. In a week before and after Ramadan, the data on demography, HBM components and knowledge were collected through face-toface interview by trained nutritionists.
The research results revealed that the education program in the intervention group significantly increased the HBM components such as perceived severity, perceived benefits, perceived barriers, and self-efficacy comparing to the baseline and the control group (P The findings showed an increase the knowledge level and improvement in the HBM components in the intervention group compared with the control group. It seems that focused Ramadan education could increase Ramadan knowledge of patients and empower them to proper management of diabetes during the holy Ramadan.

Role of dietary modifications on the treatment and management of diabetes and complications was shown by many researchers. This study was designed to examine the association of major dietary patterns with diabetes-related cardio-metabolic risk factors in Iranian diabetes.
Totally, 525 type 2 diabetic subjects with mean age 55 ± 10 yr were included in this cross-sectional study in 2014 that followed for at least two years by the Diabetes and Metabolic disease Clinic of Tehran University of Medical Sciences, Tehran, Iran. Blood samples were collected after 12 h fasting for glycemic and lipid profiles. Information on the general characteristics, anthropometric, blood pressure measurements and physical activity level was collected. Dietary data were obtained by a validated food frequency questionnaire. Dietary patterns were obtained factor analysis (principal component analysis).
Three major dietary patterns retained through principal component analysis: Western like (high in sweets, fast foods, carbonated drinks, red meat, mayonnaise, nuts, refined grains, potato and visceral meat), Asian like (high in vegetables, low-fat dairy, fish, poultry and egg), and Traditional like (high in high fat dairy, oils, whole grains, vegetables and fruits). Western like dietary pattern was positively associated with fasting serum glucose (P=0.05), total cholesterol (P=0.005) and low-density lipoprotein cholesterol (P=0.008). After extensive adjustment for potential confounders, the association of serum total cholesterol and Western like dietary pattern remained significant (P=0.03).
Modifications in dietary pattern, especially in those who have a Western dietary pattern, may be effective in preventing or delaying diabetes-associated cardio metabolic complications.

Ramadan fasting is specific intermittent fasting comprising significant changes in routine lifestyle pattern and may affect body homeostasis and metabolism. In spite of several studies conducted on the effects of Ramadan fasting on various aspects of health and disease, because of heterogeneity in methodology and procedures (sometimes inevitable), a comprehensive concluding for reliable results as in most conditions is impossible. Based on basic studies and those have been conducted in this field, this paper suggests a checklist contains, as far as possible, important factors to be considered in designing, interpreting and comparing the results of Ramadan fasting studies. Accordingly, circadian rhythm, season/latitude sensitivity, serum osmolarity and, lifestyle changes (including dietary intakes, physical activity, sleep quality and duration, smoking and, etc.) may be of great importance. Also, a close definition of the number of fasting days and it consecutively or alternatively must be presented with reference to sex. Appropriate time points for blood/urine sampling would be varied case by case.

During Ramadan fasting quantity and quality of dietary intake may change. There was no data on nutrient patterns in Ramadan fasting. The purpose of this study was to identify Ramadan major nutrient patterns among those who fast in Tehran, Iran. 510 fasting people aged 18-65 years and BMI 18.5-40 Kg/m2 were recruited in our study by 2-stage cluster sampling method in June-July 2014. Data on the socio-demographic and physical activity level were collected by questionnaire. Usual diet during Ramadan was estimated by valid and reliable food frequency questionnaire. BMI was calculated based on measured height and weight. Three nutrient patterns derived by conducting principal component factor analysis on 30 major nutrients. Micronutrient and fiber pattern which characterized by high intake of vitamin K, total fiber, iron, manganese, magnesium, β-carotene, folate, vitamin B12, potassium and calcium was adversely associated with weight (b=-0.16, P= 0.004). High protein pattern had great loadings on protein, riboflavin, phosphorous and zinc which physical activity level was decreased by tertiles of this pattern (b=0.13, P=0.02). High carbohydrate pattern which presented high positive loadings on carbohydrate and thiamin and negative loading on total fat, poly unsaturated fatty acids and monounsaturated fatty acids was positively associated with BMI (b= 0.12, P=0.03). Adherence to different Ramadan nutrient patterns is associated with weight, BMI and physical activity level. People on high in carbohydrate may have a higher BMI and low micronutrient density diet that should be considered in Ramadan fasting nutrition educational programs.

The aim of this study was to assess public knowledge about the effects of Ramadan fasting on various aspects of health and its association with fasting decision-making. This cross-sectional study was conducted on 600 subjects. The association between fasting and participants’ knowledge and attitudes toward Ramadan fasting, anthropometric measurements, physical activity, depression, anxiety, stress, dietary intake, and prior history of diseases was evaluated. The results indicated an adverse correlation between negative attitudes towards the effects of Ramadan fasting and adherence to fasting (P<0.0001). The prevalence of gastrointestinal disorders was higher in the non-fasting group (P=0.002). No significant association was found between other investigated variables and fasting adherence. It seems that negative thinking about the effects of Ramadan fasting may be inversely associated with fasting decision-making. Therefore, evidence-based educational programs may improve public knowledge and encourage fasting among eligible people.

Physiological stress may affect eating habits and also foods intake may alter the physiological stress. According to the reports of high levels of serum cortisol as a stress biomarker in type 2 diabetic patients; the aim of this study was to investigate the relationship between dietary patterns and serum cortisol concentration in type 2 diabetic patents. This cross-sectional study was conducted on 241 type 2 diabetic patients in 2013. Major dietary patterns were obtained by factor analysis. Serum cortisol was measured at 8 am. Serum cortisol level was compared among tertiles of dietary patterns using ANCOVA adjusted for confounders (age, sex, BMI, and fasting blood glucose). Linear regression analysis was performed to assess the association between serum cortisol and scores of dietary patterns. Three major dietary patterns were identified as Western, healthy and healthy like. None of the variables age, waist circumference, body mass index, physical activity level, duration of diabetes and fasting blood glucose was significantly associated with serum cortisol. After adjustment for confounders, no statistically significant difference was found in mean serum cortisol among tertiles of dietary patterns or no statistically significant association between serum cortisol and dietary patterns scores. Mean serum cortisol was 12.95±5.10 nmol/L which was in normal range. This study showed that in type 2 diabetic patients, normal levels of serum cortisol were not associated with the adherence to Western, Healthy and Healthy like dietary patterns.

There has been no data on population based dietary patterns during the Ramadan fasting month. The purpose of this study was to detect Ramadan major dietary patterns among those who fast in Tehran. This cross-sectional study included 600 subjects, aged 18-65 with body mass index (BMI) of 18.5-40, who had decided to fast during Ramadan. Anthropometric measurements, usual physical activity level and educational status were collected two weeks before Ramadan. Information on Ramadan dietary intakes was obtained using a food frequency questionnaire and factor analysis was used to identify major dietary patterns. We identified four major dietary patterns: 1) Western-like pattern; high in fast foods, salty snacks, nuts, potato, fish, poultry, chocolates, juices; 2) high cholesterol and high sweet junk food pattern; high in pickles, sweets and condiments, butter and cream, canned fish, visceral meats and eggs; 3) Mediterranean-like pattern; high in vegetables, olive oil, dates, dairy, dried fruits, fruits, red meats, tea and coffee and 4) Ramadan-style pattern; large consumption of Halim, soups, porridges, legumes and whole grains, soft drinks, Zoolbia and Bamieh. Age was positively and inversely associated with Mediterranean-like (P = 0.003; r = 0.17) and Ramadan style (P = 0.1; r = -0.13) dietary pattern, respectively. Pre-Ramadan physical activity level was associated with a Mediterranean-like dietary pattern (P < 0.0001; r = 0.20). This study showed a Ramadan-specific dietary pattern has unique characteristics, which has not yet been identified as a model of dietary pattern. Also, among identified dietary patterns, Mediterranean-like was the healthiest.

Fasting in diabetic patients is accompanied by various changes in metabolism, lifestyle and medication. Evaluation of diabetic patients’ knowledge in the field of fasting conditions, the fasting-induced changes, complications, and ways to deal with them, is the first step towards efficient and effective diabetes self-management training in Ramadan fasting. The purpose of this study was to design a valid and reliable questionnaire on fasting knowledge of diabetic patients and evaluate the knowledge and determinant factors in diabetic patients. In this study a questionnaire on diabetic patient’s awareness was designed in 5 sections: 1- fasting conditions in patients with diabetes (fasting status of diabetic patients), 2- drug use, 3- controlling of blood glucose, 4- physical activity and 5- diabetic diet in Ramadan. Validity and reliability (Cronbach's alpha coefficient=0.79) of the questionnaire was confirmed. In a cross-sectional study, the fasting knowledge of 200 diabetic patients of Diabetes and Metabolic disorders clinic were examined, before Ramadan 2012. The association between the knowledge and patients’ age, sex, weight, diabetes duration, educational levels, Ramadan fasting group education, fasting blood sugar, HbA1c and type of diabetes were evaluated. The mean of total correct answers were 46% with the highest scores in dietary information (62.5%) and lowest in physical activity (18%) and drug use (23%). Significant positive association was found between total and each part scores with patients’ educational level. Also group of participating in the Ramadan fasting education study and group of non- participating, showed significant difference in response to questions. Findings of this study revealed (indicated) poor fasting knowledge in diabetic patients. Educational programs before Ramadan can increase awareness and could improve self-management of diabetic patients during Ramadan fasting and decrease complications.

No comprehensive study has been conducted on risk factors of sexual dysfunction in women with diabetes mellitus.. The aim of this study was to consider all possible influencing variables including hormonal, physical and, psychological status, socioeconomic status, and dietary intake to get more accurate and reliable results..Patients and Sexual function was assessed by Iranian validated female sexual function index (FSFI).The variables of the study were demographic and diabetes-related factors, stress-depression, physical activity, blood pressure, anthropometric measurements, lipid profile, cortisol, sex and thyroid hormones, 25-hydroxy vitamin D, and dietary intake.. Among all investigated variables, partner relationship showed a strong positive association with FSFI (β = 1.93 ± 0.41, P < 0.0001). In addition, not considering partner relationship, FSFI showed a significant negative association with age (β = -0.19 ± 0.20, P = 0.04), stress-depression score (β = -0.08 ± 0.04, P = 0.04), DD (β = -0.03 ± 0.01, P = 0.04), and systolic blood pressure (β = -0.14 ± 0.06, P = 0.03). Significant associations between FSFI and serum sex hormones and other biochemical were found in neither postmenopausal nor non-menopausal women. The means of SFSI in postmenopausal women were greater than non-menopausal (P = 0.02).. It seems that in our population, female sexual function was much more than just a hormonal or physical problem and psychological factors, especially partner relationship and stress-depression, are the most determinants. In addition, age, duration of challenging with disease, and the lack of controlling systolic blood pressure were common factors that decreased sexual function..