مجله غدد درون ریز و متابولیسم ایران
سال دوازدهم شماره 2 (پیاپی 50، تیر 1389)

The world is facing a dramatic rise in the prevalence of diabetes, most of which is occurring in the low- and middle-income countries. This is having a major impact on the quality of life of hundreds of millions of people and their families. Furthermore, nutrition, especially intakes of fruit and vegetable have important effects on glycemic control and prevention of diabetic complications. The present study was designed to assess the fruit and vegetable consumption in type 2 diabetic patients and their relationship with socio-demographic factors in Tehran. A cross-sectional study was conducted on 367 type 2 diabetic patients. Fruit and vegetable consumption was determined, using 169-item food frequency questionnaire. Information on demography and socio-economic factors was obtained from related questionnaires. Vegetable consumption was significantly lower in retired or jobless patients (p=0.04), and higher in patients who had children (p=0.003). Also, fruit consumption was significantly higher in patients with 3 or less children. No significant association was observed between fruit or vegetable consumption and education levels, parent's job levels, household size, ethnicity, family income, food expense and duration of living in Tehran. Based on logistic regression, employment was significantly related to the consumption of vegetable (p=0.012).

Systemic and vascular inflammation are two risk factors for the development of diabetic nephropathy. In diabetic patients, serum systemic and vascular inflammatory factors have positive correlations with albuminuria. The present study was designed to investigate the effects of combined administration of lipoic acid and pyridoxine on the serum concentrations of these factors in patients with diabetic nephropathy. The study was a double-blind randomized clinical trial in which 38 patients with diabetic nephropathy (23 females and 15 males) were randomly assigned to either the supplement-taking or the placebo group. The patients in the supplement group received 800 mg lipoic acid and 80 mg pyridoxine daily for 12 weeks, while the placebo group received corresponding placebos. At baseline and the end of week 12, a urine sample and 10 ml blood was collected from each patient after a 12 to 14-hour fast and serum high sensitive C-reactive protein (hs-CRP), soluble intercellular adhesion molecule type 1 (sICAM-1), soluble vascular cell adhesion molecule type 1 (sVCAM-1), sE-selectin, Interleukine-6 (IL-6), glucose, percent of blood hemoglobin A1c and urinary albumin were measured. In the present study, no significant differences were observed between the two groups in mean changes of hs-CRP, IL-6, sICAM-1, sVCAM-1, sE-selectin, glucose, percent of blood hemoglobin A1c. Mean urinary albumin concentration decreased significantly in the supplement-taking group at the end of week 12, compared to the baseline (P<0.05) and the reduction was significant in comparison with the placebo group (P<0.05). The results of the present study indicate that combined administration of lipoic acid and pyridoxine has no effect on serum systemic and vascular inflammatory factors, but it reduces urinary albumin concentration significantly. Therefore, combined administration of lipoic acid and pyridoxine may have an effective role in retarding the progression of diabetic nephropathy with a mechanism different from the effects of these supplements on inflammation.

This research, aimed at determining the psychometric properties of the Diabetes Management Self – Efficacy Scale (DMSES) in type II diabetes patients. We Selected 112 patients with type II diabetes (according to diagnosis of profession), reffered to Alzahra hospital and asked them to complete the questions (for determining reliability). To study the concurrent validity of DMSES, 40 patients were asked to complete the General Self – Efficacy Inventory (GSES) and Diabetes Care Behavior Inventory. Result Showed that all four subscales have significant and relatively high test-retest and internal reliability. The coefficients of concurrent validity were significant (0.81, 0.48), and results of the correlation matrix showed that the scale has good internal structure. Results of this research is similar to other versions of DMSE in other languages, and the DMSES scale was shown to be a valid and reliable instrument and can be a common and cross-cultural instrument.

The metabolic syndrome includes risk factors for non-communicable diseases such as central obesity, hyperglycemia, dyslipidemia and hypertension accompanied by pro-inflammatory and hypercoagulability states. The aim of this study was to determine the effects of weight change on incident metabolic syndrome.

This was a prospective cohort study, the population of which included all participants of the TLGS, phases one and two, >20 yrs and above, free of metabolic syndrome, based on the Iranian waist circumference, and NHLBI. Iranian waist circumference was defined with different cutoff points, according to cross sectional and outcome-based studies. Data was obtained by interviews, questionnaires, observation, and physical and laboratory examinations.The incidence of metabolic syndrome after 3.1 years of follow up was determined. Percent of weight change (PWC) was divided in five quintiles. Using the logistic regression test, odds ratio and 95% confidence interval of incident metabolic syndrome and its components for these quintiles, after adjusting for confounders, were calculated.

Age adjusted incidences of metabolic syndrome after a 3.1 year follow up, according to Iranian WC outcome were 20.6% (males 26%, females 20.9%) and for Iranian WC cross sectional and NHLBI were 26.2% (males 34.4%, females 26.1%) and 23.7% (males 24.4%, females 29.4%) respectively. For both genders, based on Iranian W.C and NHLBI, a weight reduction of at least 1.3%, compared to baseline, in women had a protective effect against incident metabolic syndrome. In men a weight gain of at least 1.4% since baseline resulted in an increase in the odds ratio. In women, weight gain of at least 1.3% since baseline, based on the Iranian WC cross sectional, NHLBI and at least 4% based on Iranian W.C-outcome resulted in progressive incidence of metabolic syndrome. These reductions of at least 1.3% in males and 2.5% in females, decreased the relative risk of abdominal obesity, but had no effect on other components of metabolic syndrome, including: hypertriglyceridemia, low HDL, hyperglycemia, and hypertension. Although in both sexes, increase in weight resulted in abdominal obesity, the cut off points according to various definitions were different.

Considering the preventive effect of weight loss against incident metabolic syndrome and abdominal obesity, we recommend educational programs to enhance awareness regarding overweight and obesity and motivate individuals to lose weight.

This study aimed at investigating the association between obesity indices (Body Mass Index (BMI), Waist Circumference (WC), Waist to Hip Ratio (WHR)) and dietary patterns derived from Reduced Rank Regression (RRR) analysis among Tehranian adults in a cohort study.

Over a duration of 6 years, 141 adults were examined before and after 6 years for obesity indices. Dietary intakes were recorded at baseline by two 24 hour dietary recalls. RRR analysis derived five patterns with respect to total fat, polyunsaturated-to-saturated fat ratio, cholesterol, fiber and calcium intakes. The calculated factor scores were categorized in quintiles and changes in obesity indices were scrutinized within these quintiles.

The first pattern (traditional) showed high loadings on refined carbohydrates, whole grain, vegetables, red and processed meat, saturated and trans fat, egg, showing significant high positive correlation with fat, cholesterol and calcium intakes (r=0.478, 0.626, and 0.486, respectively p<0.001). All obesity indices had an increasing trend across quintiles of pattern score (p<0.05 for BMI and WHR, p<0.001 for WC). The fifth pattern (egg) had high loading for eggs, salty snacks, and fruits, and negative loadings for red and processed meat, saturated and trans fat, plant oil, and dairy products, indicating increasing trends for WC (p<0.001) and WHR (p<0.05) after adjustment for potential confounders. Other patterns showed non-significant trends for obesity indices.

RRR analyses were indicative of two dominant dietary patterns correlated with increase in obesity indices in Tehran.

There is convincing evidence that family environment plays an important role in influencing the obesity related-behaviors in adolescents. Considering the necessity of understanding the familial correlates of obesity in adolescents, and the lack of related studies in Iran, this study aimed to explore mothers’ perceptions and experiences regarding these associated factors of overweight and obesity related behaviors in adolescents. A grounded theory approach was used for analyzing the participant's experiences, and their perceptions. To collect data, 6 semi-structured focus group discussions were conducted with 25 mothers who had at least one overweight or obese child. Based on open sampling, with the aim of maximal variation of the participants’ experiences, two demographically diverse areas from the north and south of Tehran were selected and then followed with theoretical sampling. All the focus group discussions were audio recorded and transcribed verbatim. Data collection and analysis were done simultaneously using the Strauss and Corbin analysis method. Five main familial correlates of overweight and obesity in adolescents emerged from data: 1) Parents with inadequate knowledge, 2) Parents’ modeling of unhealthy behaviors, 3) Dissimilarity of members, 4) Maternal employment and 5) Children’s studies being the top priority for parents. Findings demonstrate familial correlates of overweight and obesity in adolescents as perceived by mothers, correlates that must be addressed by effective interventions for tackling overweight and obesity in adolescents.

Childhood overweight and obesity, major public health concerns, show a drastically rising tread worldwide. Associated with an increased risk of developing cardiovascular and endocrine problems, overweight children are more likely to be overweight adults. This study was done to evaluate the prevalence of overweight, obesity, and underweight among high school students in Sanandaj, Kurdistan, Iran. This study was performed in 2007 on 694 students from Sanandaj high schools. Socio-demographic information was collected using a questionnaire, completed during interviews. Weight and height were measured. Body mass index (BMI) was calculated and overweight/obesity was defined using age- and sex-specific BMI cut-off points, proposed by the World Health Organization Expert Committee on Physical Status (World Health Organization, 1996). Children with BMI-for-age at or above the 95th percentile, between 85 and 95th percentile and less than 5th percentile were considered as being obese, overweight and underweight respectively. Descriptive and analytical statistics were used to analyze the data. The average of BMI was 20.7 and prevalences of overweight, obesity and underweight were 11.2, 3.2 and 7.6 % respectively. Levels of overweight/obesity (14.4%) differed significantly between boys (18.2 %) and girls (10.7 %). The highest percentage of overweight/obesity (20%) was found among 14-years olds. Boys showed a consistent decrease in overweight/obesity with increasing age, a trend not demonstrated in girls. Results indicated that the prevalence of overweight/obesity among high school students in Sanandaj is near national averages for adolescents. Overweight/obesity were observed more in boys than in girls. As a group, girls demonstrate a lower prevalence of obesity (1.1%) when compared to national averages. Based on the results of this study, 22 percent of the high school students in Sanandaj have inappropriate weight, which calls for appropriate intervention programs.

The appropriate combination and composition of hypocaloric diets for obese women with polycystic ovary syndrome (PCOS) is still unclear. The aim of this study was to investigate the effects of a high protein-low glycaemic load diet on reproductive hormones in obese women with PCOS.

In this single blind clinical trial, sixty overweight and obese women with PCOS, not using metformin, were randomly assigned in one of two groups, the modified with a 30% protein-low glycaemic load diet, and the conventional with 15% protein. Reproductive hormones, glucose and insulin were measured for 49 subjects at baseline and after 12 weeks.

Weight loss showed no significant difference in the two groups. Changes in means for testosterone in the modified and conventional groups (0 to 12 weeks), were 1.78±1.52 to 1.31±1.27 and 1.51±0.63 to 1.15±0.57 ng/ml, respectively (p<0.001). FSH, LH, estradiol, progesterone and prolactin did not change. Insulin and HOMA reduction was significant for modified diet (p<0.001).

Weight loss had a significant effect on reduction of androgens. The main effect of modified diet with high protein and low glycaemic load was observed on insulin and HOMA, a finding which should taken into consideration for women with PCOS.

Elevated levels of serum biomarkers such as C-reactive protein (CRP), and homocysteine have been independently associated with cardiovascular disease risk. However, the prevalence of concurrent changes of these biomarkers after short term circuit resistance training in females is unknown, as is their association with cardiovascular disease. Our aim was to compare the effects of short term circuit resistance training on serum homocysteine and CRP concentrations in active and inactive females. Forty-Three healthy, female university students, mean age 22/74±3/9 y, weight 59/91±9/8 kg, height 165/9±0/04 cm, BMI 21/73±3/1 (kg/m2), PBF 26/47±5/01, and Vo2max 38/65±5/43 (ml/kg/min), were randomly assigned to four groups active experimental (AE, n=8) active control (AC, n=8) inactive experimental (NE, n=13) inactive control (NC, n=14). For 2 weeks subjects performed short term circuit resistance training, 5 times per week (10 sessions) the exercises include chest press, leg extention, sit-ups, lat. pull down, front row, foot raising, back extention, and leg curl with free weights and machines, During the first week the training was done at 40% of their one-repetition maximum (1RM) for 15 repetitions and 3 sets, and during the second week the intensity of training was increased to 50% 1RM,, while other features of training remained constant. Both before and 48 hours after the last training session, fasting and resting blood samples were collected. Homocysteine using HPLC and CRP using the immunoturbidometric method were evaluated. Comparison within groups showed that homocysteine concentration in all 4 groups was reduced and CRP showed increase in the active experimental group but did not change in the inactive group. In comparison between groups there were no significant differences in homocysteine and CRP levels. It seems that short term circuit resistance training can be used as a method of preventing cardiovascular disease in women, and it can be recommended as a lifestyle intervention to promote health.

Apoc3, an apolipoprotein, is well known as a lipolysis inhibitor. It inhibits lipolysis by both HP and LPL activity inhibition and has been studied as a factor for hypertriglyceridemia for years. C-482T polymorphism in apoc3 gene promoter has associated with hypertriglyceridemia and insulin resistance, factors associated with the metabolic syndrome association factors.

Subjects were randomly selected from the Tehran Lipid and Glucose Study. A 231 bp segment of the mentioned gene was amplified by PCR and the polymorphism revealed by RFLP using the MspI restriction enzyme.

Allele frequencies obtained for APOC3 -482C and -482T polymorphisms were 0.653 and 0.347 respectively. Genotype frequencies were in conformity with the Hardy-Weinberg expectation.

The observed genotype and allele frequencies were similar to those reported for other Caucasians samples. The data generated from this study will be of importance in the context of ongoing studies concerning the factors that influence lipid levels in Iranian populations.

Cytokines are a group of proteins that play a central role in mediating inflammatory responses to pathological stimuli such as infection and tissue damage. However, cytokine production is also modulated by a range of physiological stimuli such as exercise. Skeletal muscle has recently been identified as an endocrine organ. It has been suggested that cytokines or other peptides that are produced, expressed, and released by muscle fibers should be classified as “myokines”. These myokines exert paracrine, endocrine and autocrine effects. IL-6 was discovered as a myokine because of the observation that it increases up to 100-fold in the circulation during physical exercise. Because of its metabolic roles, IL-6 production by skeletal muscle during physical activity created a paradox. As IL-6 is markedly produced and released in the postexercise period when insulin action is enhanced whereas, on the other hand, IL-6 has also been associated with obesity and reduced insulin action. Also, muscle mass and its function are influenced by different cytokines, in particular by IL-6, IL-15 and TNF-α more prominently during exercise. This review focuses on the myokines, their regulation by exercise and their roles in immune and metabolism, considering the effects of cytokines on muscle mass and function.