مجله دیابت و متابولیسم ایران
سال بیست و چهارم شماره 1 (پیاپی 116، فروردین و اردیبهشت 1403)

The prevalence of overweight, obesity and related complications is increasing rapidly in the world. Also, treating this disease in the presence or absence of co-morbidities has become a challenge. In this article, based on the clinical recommendations of the American Endocrinology Association and the American College of Endocrinology, a comprehensive clinical guide has been written for the stages of treating obese patients and its individualization, and it has been tried to be adjusted as much as possible based on the conditions in Iran.

with a specific search strategy, a complete search was performed in PubMed, Scopus, ISI Web of Science, EMBASE and Google Scholar Cochrane databases. Then, the best clinical guidelines suitable for the Iranian society were selected and using the opinions of specialists and clinical experts, a clinical guideline was prepared for the treatment of obesity in Iranian adults.

In this article, in continuation of the previous article, we answered the questions number 4 to 6 regarding the stages of obesity treatment and its individualization in adults of Iranian society, and presented a total of 60 recommendations in this regard.

In this part of the clinical guide for obesity in Iranian adults, we tried to have a special view on the treatment of these patients and by providing evidence-based recommendations and statements, the treatment process was personalized as much as possible for patients with special conditions so that decision-making in this regard is facilitated for the relevant colleagues in this field.

Leptin and adiponectin are adipokines produced by fat cells and play an important role in obesity. The purpose of this study was to compare the effect of low-calorie diet (LCD) and exercise (Exe) on leptin and adiponectin in middle-aged and elderly adults with overweight and obesity.

A systematic search was conducted in PubMed, Web of Science, SID, Magiran, and Google scholar databases for English and Persian articles published until August 2023. The effect size and 95% confidence interval (CI) were calculated using the random effect model.

The results of 25 studies with 2063 middle-aged and elderly people with overweight and obesity showed that the combination of exercise and diet compared to exercise alone causes a significant decrease in serum leptin [SMD=-0.4, P=0.001], and a significant increase in serum adiponectin [SMD=0.17, P=0.02] in middle-aged and elderly adults with overweight and obesity. Also, findings showed that the diet compared to exercise alone causes a decrease in serum leptin [SMD=-0.16, P=0.1], and a significant increase in serum adiponectin [SMD=0.05, P=0.7] in middle-aged and elderly adults with overweight and obesity. Also, diet compared to exercise alone does not cause a significant change in serum leptin [SMD=-0.11, P=0.2], and serum adiponectin [SMD=0.02, P=0.8] in middle-aged and elderly adults with overweight and obesity.

It is suggested that middle-aged and elderly people to achieve hypoleptinemia and hyperadiponectinemia, use a combination Include exercise training and low-calorie diet in your lifestyle.

The Purpose of this study was to evaluate the effect of High Intensity Interval Training & Royal Jelly on expression of the genes of the hepatic miR-423-5P - FAM3A-AKt2 pathway in rats.

The statistical population was 36 male Wistar rats and reaching a weight of 193 ± 20 grams, they were subjected to a high-fat diet diet and intraperitoneal injection of 25 mg STZ. Blood sugar above 150 to 400 mg/dl was considered as a criterion to ensure that the mice had type 2 diabetes. Then divided into 4 groups (diabetic control group, intermittent exercise, Royal Jelly and exercise-Royal Jelly group). The experimental group of did HIIT with a 20 to 36 m/min. for 8 weeks. Royal jelly experimental groups consumed 100 mg/kg royal Jelly. 48 hours after the last training session, the mice were anesthetized with ether and blood was taken from the heart and tissue was removed, including liver tissue, and the tissue sample was transferred to a freezer temperature of -80. Serum glucose measurements were performed by an Auto analyzer. Insulin was measured by an ELISA kit, and the insulin resistance index was measured by formulas. The expression level of miRNA-423-5P, FAM3A and AKt genes in liver tissue was measured using Real Time-PCR method .the data, analyzed by one-way analysis of variance and Bonferroni’s post hoc and univariate and effect size. The significance level was considered to be p≥ 0.05.

The findings showed that the expression of the hepatic miR-423-5P gene in the experimental groups of intermittent exercise with royal jelly and the exercise group and the gel group significantly decreased compared to the control group, and the expression of the FAM3A gene increased in the experimental groups compared to the control group. Non-significant and the expression of AKt2 gene in the training group and the training group with gel increased significantly compared to the control group, and in the gel group only compared to the control group, there was a non-significant increase, Also, there was a significant decrease in glucose in the experimental groups of HIIT exercise and HIIT- Royal jelly compared to the diabetic control group (p <0.05).Expression of the miR-423-5P gene was significantly lower in all groups compared to control, expression of mRNA FAM3 had insignificant increase and expression of mRNA AKt2 had a significant increase in groups of regular exercise and exercise with nutritional intervention. This gene had an insignificant increase of expression in the group with only nutritional intervention.

It seems that HIIT and royal jelly consumption, both alone and in combination, although with greater effect, can create favorable changes in the expression of Mir 4235p. FAM3A and AKt2 help to improve the condition of the liver.

Diabetic cardiomyopathy is one of the main risk factors related to diabetes, which can be caused by atrophy of the cardiomocytes. It is supposed that the MuRF1 gene intermediate as an agent for heart atrophy. Hence, the purpose of current study was to investigate the effect of eight weeks' aerobic exercise protocol on murf1 gene expression in cardio-myocyte of diabetic Wistar rats.

In this study, 30 male Wistar rats with an age of eight weeks and an average weight of 288 grams were randomly divided into three groups of 10 including healthy control, diabetic control and aerobic exercise group after two weeks of adaptation to the environment. The exercise groups went under aerobic training programs using treadmill (5 days/wks., for 8 wks.) 60%-75% Vo2max. MuRF1 mRNA level was measured in cardio myocyte using Real-Time PCR. The results were compared by statistical methods.

The changes in the expression of Murf1 genes expression in cardio-myocyte of diabetes group were significantly higher than the other groups (P< .05). The expression of Murf1 gene in continuous training group reduced significantly after eight weeks' aerobic exercise training (P󠇟< .05).

This study demonstrated that eight weeks' aerobic exercise training can lead to reduction of Murf1 genes expression level and might be a good prescription for diabetic persons. However, further studies are needed to confirm this theory.

Interval exercises with high intensity and consumption of plant extracts probably have beneficial effects on inflammatory indicators. The aim of this study was to investigate the effect of eight weeks of High-Intensity Interval Training (HIIT) and the consumption of Loquat leaf extract on the serum levels of TNF-α and interleukin-18 in obese men with non-alcoholic fatty liver disease.

In this semi-experimental study, forty men with non-alcoholic fatty liver disease with body mass index (33.92 ± 1.82) with informed written consent were randomly selected and assigned into four groups: control, training, Extract, Extract + training (Each group of 10 people). Exercises were performed for eight weeks and three sessions per week for 60 minutes with intensity between 80-95% of the reserve heart rate. Two capsules of 250 mg of Loquat leaf extract were also prescribed daily. Paired t-test and analysis of covariance were used.

A significant decrease in the levels of TNF-α (15.3%) and interleukin 18 (14.9%) was observed in the training + extract group (P<0.05). A significant difference was observed in the levels of TNF-α (P=0.001) and interlock 18 (P=0.001) between the groups, and these changes were more significant in the Extract + training group than in the training and extract groups.

It is concluded that performing intense intermittent training along with Loquat leaf extract will be able to improve TNF-α and interleukin 18 indices related to fatty liver in people with non-alcoholic fatty liver disease. However, confirmation of this hypothesis requires more research.

Cardiac function in diabetic people is affected through different cellular mechanisms; One of these important cellular pathways is the c-Jun N-terminal kinases (JNKs), whose dysfunction can lead to heart failure; Therefore, the aim of this research is to investigate the effect of moderate intensity interval training on total and phosphorylated content of c-Jun N-terminal kinases protein in heart tissue of type 1 diabetic rats.

In this experimental study, 12 two-month-old male Sprague Dawley rats with an average weight of 300±20 grams were selected. Type 1 diabetes (blood sugar above 300) was induced to rats through intraperitoneal injection of streptozotocin (with a dose of 50 mg per kilogram of body weight) solution. The rats were randomly divided into two groups, diabetic training and diabetic control; The training group performed MIIT for four weeks at an intensity of 55-75% of maximum speed. Data analysis was done through independent t-test in GraphPad Prism software version 9.5. The significance level of the current research is P≤ 0.05.

The intracellular content of JNK protein after four weeks of MIIT showed a significant decrease in both total (P= 0.01) and phosphorylated (P= 0.0001) forms. On the other hand, the ratio of total to phosphorylated intracellular content of JNK protein did not show a significant change after four weeks of MIIT (P= 0.23).

MIIT led to a decrease in the content of total and phosphorylated forms of JNK protein, which could possibly lead to less cell death in cardiac cells of diabetic subjects.