مجله غدد درون ریز و متابولیسم ایران
سال پانزدهم شماره 6 (پیاپی 72، اسفند 1392)

Regulation of thyroid function undergoes important alterations to maintain euthyroidism during pregnancy. During normal pregnancy، increased estrogen production from the placenta causes an increase in TBG and total T4 and increase in hCG stimulates the thyroid gland and decreases serum TSH concentration; in addition، thyroxine metabolism and urinary iodine excretion are also increased. Women residing in iodine deficient regions present with goiter and hypothyroxinemia during pregnancy، with overt thyroid dysfunction occuring in 2-3% of pregnancies، and subclinical dysfunction in 10% of pregnancies. Hyperthyroidism is exacerbated during the first trimester، with relative amelioration in the second and third trimesters، and accelerates again during the postpartum period. Transfer of TSH receptor antibodies from placenta may cause neonatal hyperthyroidism with tachycardia، accelerated bone growth and delayed intra-uterine growth. Unrecognized thyroid dysfunction during pregnancy may cause irreversible alterations in pregnancy outcomes and physical and mental development of fetus and neonate. Therefore، proper evaluation، diagnosis and treatment of thyroid deranagements during pregnancy are of outmost importance.

Significant changes in thyroid hormones occur during the first weeks after birth. We assessed the degree of changes in thyroid-stimulating hormone (TSH) and total thyroxin (T4) concentrations in neonates screened seven days after the first high serum TSH levels، just before starting treatment. This prospective study was carried out on newborns referred for their high TSH concentrations on heel blood spot in hypothyroidism screening tests (5-20 miu/ml)، between December 2009 and December 2010. First، serum TSH and T4 were assessed by radioimmunoassay. One week later، in neonates with the first serum TSH≥10، serum TSH and T4 were rechecked before starting treatment. Any definite decision to continue treatment was based on the second test results. The results showed a significant decrease in serum TSH level after one week (p<0. 01). Serum T4 level increased significantly in neonates with the first serum TSH≥40 (p<0. 05)، while no significant difference was observed in other infants with the first serum TSH<40. Incidence rate of Congenital Hypothyroidism (CH) reduced from 1/329 to 1/851، during the study. It may be appropriate to repeat serum T4 and TSH concentrations after 2 and 4 weeks in neonates with normal serum T4 but elevated TSH. In the case of persistent TSH elevation، the infant should be treated as this can prevent unnecessary treatments، family stress and iatrogenic hyperthyroidism in these patients.

Although current data shows that chromium supplementation in type 2 Diabetic patients can improve control blood sugar and lipids there are controversial results about its relevance to improving blood sugar and lipids in diabetes. This study investigates the effect of chromium picolinate supplement on blood sugar and lipids control in patients with type 2 diabetes. This randomized، double-blind،placebo-controlled study was carried out at the Diabetes Clinic of the Loghman Hospital in collaboration with Taban Diabetes Clinic. In this clinical study of 60 patients with type 2 Diabetes، participants were randomized into the double-blind treatment and control groups for 3 months of treatment with 200 µg of chromium picolinate or placebo respectively. Blood sugar and lipids profile were assessed at the beginning and end of the study. Based on the result of this study it has been found that 200 micrograms of chromium consumed over three months could decrease of TG levels dramatically، compared to placebos. TG changes were significantly different between the two groups، (P=0. 048)، without any change in other lipid profiles of the two groups. Findings showed that chromium picolinate treatment for 90 days produced significant improvements in glycemic control compared to placebo، based on significant reductions in both FPG and HbA1c levels in patients with type 2 diabetes mellitus، with significant changes between the two groups (P<0. 001). Results of this study recommend that chromium picolinate prescribed to type 2 diabetes patients could decrease TG، HbA1c and FPG levels.

Appetite influences energy homeostasis. Nesfatin-1 and Acylated ghrelin are orexigenic and anorexigenic peptides that play an important role in obesity and energy balance. The purpose of this study was to determine the influence of one cycle circuit resistance training on the Nesfatin-1 to Acylated ghrelin ratio in adolescent overweight. Twenty male students، age 18±0. 92 years، weight 83. 57±5. 62 kg and BMI 27. 48±1. 5 kg/m2 (mean ±SE) were randomly allocated to the intervention and control groups. Subjects performead circuit-resistance training protocol with 60% 1RM، 3 sessions per week for 12 weeks. Levels of Plasma Nesfatin-1، Acylated ghrelin، Cortisol، Insulin and Growth hormone، were measured using the ELISA method. Results revealed that after 12 weeks circuit resistance training، Nesfatin-1 (P=0. 005)، acylated ghrelin (P=0. 02)، the Nesfatin-1 to Acylated ghrelin ratio (P=0. 008) and growth hormone (P=0. 04) levels increased in the plasma significantly whereas cortisol (P=0. 05) decreased significantly. A significant positive correlation (R=0. 79) was found between Plasma Nesfatin-1 and GH whereas a significant negative correlation (R=-0. 729) was seen between Plasma Nesfatin-1 and cortisol (P≤0. 05). It seems that frequent circuit resistance training with moderate intensity increases levels of Nesfatin-1 and Acylated ghrelin، indicating that interaction between Nesfatin-1and acylated ghrelin may has a role in food intake and body weight modulation.

Metabolic disorders such as dyslipidemia and insulin resistance are associated with progression of non alcoholic fatty liver disease (NAFLD) and can lead to cardiovascular problems، the most common cause of death in these patients. The amount and composition of dietary fat are influential factors for blood lipid and glucose levels. The aim of this study was to assess the effects of virgin olive oil on serum lipid and glucose levels in the NAFLD patients on weight loss diets. This 12 week-clinical trial was carried out on 50 patients with non-alcoholic fatty liver). Subjects were randomly assigned into groups A (receiving the equivalent of 20% of total daily energy requirement from olive oil) or B (receiving their normal consumption of oil. At the beginning and end of the study، dietary intakes، anthropometric parameters، fasting plasma glucose and lipid levels were measured. At the end of the study، as compared to commonly used oil، olive oil resulted in significant reductions of serum triglycerides (P<0. 05)، and TG/HDL-C ratio [identified as an atherogenic index and a powerful predictor of cardiovascular disease risk] (P<0. 05). Consuming a diet rich in virgin olive oil along with a slight weight loss in NAFLD patients، can be effective in the treatment and prevention of the consequences of cardiovascular complications of this disease.

FABP4 (A-FABP or aP2) is a member of the fatty acid-binding protein family that plays an essential regulatory role in energy metabolism and inflammation. The aim of this study was to investigate the effect of resistance training with progressive load on plasma levels of FABP4 and the lipid profile in Streptozotocin-induced diabetic rats. Twenty four male Wister rats (12-14 weeks old) were randomly divided into three groups: Non-diabetic control، diabetic control، and diabetic training. Rats in the diabetic training group were subjected to a resistance training program (3 days/wk، for 4 wk)، which consisted of climbing a ladder while carrying a load suspended from the tail. Plasma levels of glucose، FABP4 and lipid profiles، as well as liver cholesterol and triglycerides were measured. Plasma FABP4 concentration in the diabetic control group was significantly lower compared with non-diabetic controls and diabetic training groups respectively، (P=0. 016 and P<0. 001). We did not find any significant difference in plasma lipid profiles between the groups. The amount of liver triglycerides in the diabetic training group was significantly lower compared with the non-diabetic control group (P=0. 020). Results indicated that 4 weeks resistance training decreases liver triglycerides، and increases plasma FABP4 concentrations in streptozotocin induced diabetic rats. Further research is needed to elucidate the physiological significance of circulating FABP4 levels.

Diabetes is a complex and chronic disease associated with patients’ quality of life. Previous studies have considered self-care as an important and necessary parameter for changing personal lifestyle and influencing the control of diabetes. The purpose of present study was to examine the relationship between self care activities of type 2 diabetic patients’ and glycated hemoglobin levels (HbA1c) as well as their perceived diabetes-related quality of life. This is a cross-sectional study 100 (60 females and 40 males، aged 40 to 70 years) type 2 diabetic out-patients visiting the Labbafinejad hospital in 2012. Measures of data collection included demographic، anthropometric and clinical questionnaires، the short scale for self-care activities and the diabetes-related quality of life. Blood tests were performed to obtain HbA1c levels and other laboratory measures related to the study. Pearson''s correlation coefficients showed a significant association between better reported self-care activities and lower HbA1c levels along with better perceived diabetes-dependent quality of life. Results of regression analyses، after control of age indicated that self-care activities explained 40% of HbA1c variance and 58% of quality of life. Based on the present data، diabetes-related self care predicted HbA1c levels and diabetes-dependent perceived quality of life in patients with type 2 diabetes، results that draw attention to the psychological factors effective in the prevention of diabetes complications and hence help in the conceptualization، planning and design of treatment policies for more effective control of type 2 diabetes.