مجله غدد درون ریز و متابولیسم ایران
سال هفدهم شماره 1 (پیاپی 79، فروردین و اردیبهشت 1394)

Undiagnosed thyroid dysfunction may impair metabolic control in patients with diabetes. Due to the lack of adequate studies on the incidence of thyroid dysfunction in patients with type 2 diabetes mellitus there is no consensus regarding optimal thyroid screening strategies in routine diabetes care. The aim of this study was to determine the incidence of thyroid dysfunction in patients with type 2 diabetes. In this study، patients aged≥30 years، participants of in the prospective Tehran Lipid and Glucose Study، who had complete thyroid assessments were divided into two groups of 428 diabetic and 2847 nondiabetic controls and followed for 12 years. The incidence of thyroid dysfunction in these two groups was compared and the relative risk of type 2 diabetes for thyroid dysfunction was calculated. Compared to those without diabetes the disorders patients with diabetes were less likely to develop thyroid dysfunction (incidence rate 12. 56 vs. 16. 50 cases per 1000 person-years، Relative risk 0. 74، 95% CI، 0. 534-1. 026، P=0. 071). The incidence of thyroid dysfunction in type 2 diabetic patients is not higher than in non-diabetic individuals، indicating that routine screening of thyroid dysfunctions is not recommended in type 2 diabetic subjects.

Sexual dysfunction could be influenced by menopause and related hormonal changes. The purpose of this study is to examine the correlation between serum levels of androgens and sexual function in post-menopausal women. This is a community-based، descriptive-analytical study involving 405 post-menopausal women، aged 40 to 65 years، who had reached menopause during the three years prior to the study. A multi-stage، randomized sampling was conducted. Data was collected using the Female Sexual Function Index (FSFI) questionnaire، a researcher-made questionnaire، and blood samples were obtained to assess serum levels of androgens (testosterone، DHEAS)، SHBG and estradiol. Among subjects، 61% had female sexual dysfunction (FSD). Total testosterone levels had a negative correlation with scores in the domain of desire (r=-0. 108، P=0. 029)، DHEAS levels were positively correlated with scores in the domain of pain (r=0. 113، P=0. 022)، and the free estradiol index (FEI) was also positively correlated with scores in the domain of pain (r=0. 115، P=0. 020). Satisfaction with marital relationship had a significant positive correlation with total testosterone levels (r=0. 131، P=0. 008) and the free androgen index (FAI) (r=0. 100، P=0. 044). Examining the correlation between FSFI scores and hormone levels، multiple regression analysis showed that serum levels of total testosterone and FAI were predicting factors، in the domains of lubrication (P=0. 042) and satisfaction (P=0. 021) respectively. Androgenic hormones can affect certain aspects of sexual function in post-menopausal women، subject، which، however، requires further investigation.

Obesity as major global pandemic is associated with increased risk of non-communicable diseases such as cardiovascular complications. This study was conducted to evaluate the association between consumption of sugar-sweetened beverages (SSBs) and weight، waist circumference، triglycerides، HDL cholesterol and blood pressure status in Iranian adults. This cross-sectional study was conducted among 5852 men and women، aged 19-70 years، who participated in the fourth phase (2009-2011) of the Tehran Lipid and Glucose Study. Demographics، anthropometrics، biochemical measurements including triglycerides، HDL and blood pressure were assessed. Intakes of SSBs including carbonated drinks and synthetic fruit juices were measured using a validated food frequency questionnaire. Mean dietary intake of SSBs was 48. 9±77. 8 g/d. After adjustment for all potential confounding variables، significant associations were observed between SSB consumption and BMI، waist circumference، triglycerides، HDL and blood pressure in the fourth quartile. Participants in the highest، compared to the lowest quartile category of SSBs had 25%، 37%، 22% and 32% higher risk of general obesity (OR: 1. 25، 95% CI: 1. 02-1. 50)، abdominal obesity (OR: 1. 37، 95% CI: 1. 15-1. 64)، low HDL cholesterol (OR: 1. 22، 95% CI: 1. 04-1. 44) and hypertension (OR: 1. 32، 95% CI: 1. 08-1. 61)، respectively. Higher intakes of SSBs were found to be associated with a higher risk of general obesity and its related cardiovascular risk factors in Iranian adults.

To identify a dietary pattern predictive of visceral adiposity index (VAI)، using reduced rank regression، and to examine its associations with cardiometabolic risks in the PCOS women. This case-control study was conducted on 53 PCOS women and 167 age-matched healthy women from the population of Tehran Lipid and Glucose Study. Dietary intakes were collected using a semi-quantitative food frequency questionnaire. The associations of dietary pattern with cardiometabolic risks were investigated by Pearson''s correlation and linear regression. In this study، a positively correlated VAI dietary pattern، characterized by high consumption of fried vegetables، vegetable oils (except for olive oil)، fast foods and low cons­umption of dairy، and cruciferous vegetables was identified. The dietary pattern was correlated with triglycerides (rcontrols=0. 32، rPCOS=0. 41)، triglycerides/HDL-C ratio (rcontrols=0. 35، rPCOS=0. 44) and HDL-C (rcontrols=-0. 22، rPCOS=-0. 26) in both groups. The pattern was also positively correlated with waist circumference، total cholesterol (TC)، LDL-C and systolic blood pressure in the controls. After adjustment for age and BMI، dietary pattern was associated with triglycerides (βcontrol=0. 22، p=0. 003; βPCOS=0. 48، P=0. 001) and triglycerides/HDL-C ratio (βcontrol= 0. 23، P=0. 002; βPCOS= 0. 52، P=0. 001) in both groups. The dietary pattern was inversely associated with HDL-C in both groups، but the association was attenuated by adjusting for age and BMI in the PCOS group. High adherence to the dietary pattern was associated with cardiometabolic risks in controls and to a lesser degree in the PCOS group.

Increasing patient empowerment in order to improve diabetes self-care plays an important role in disease control. One of the most important measures/steps in this field is promoting patients'' self-efficacy which can lead to greater participation of the patient in treatment and prevention of serious complications in patients. The purpose of this study hence was to determine the predictors of self-efficacy for self-care behavior in patients with type II diabetes In order to plan educational interventions in health promotion strategies. This is a descriptive study conducted on 187 diabetic patients referred to Hazrat Ali diabetes clinic in Isfahan، using the convenience sampling method. Health literacy، self-efficacy and diabetes knowledge in patients were assessed by standard questionnaires i. e FCCHL، DMSES and DKQ respectively. The data collected was analyzed، using descriptive and inferential statistics by means of SPSS vr. 17 software. There was a statistically significant association between functional، communicative، and critical، health literacy and diabetes knowledge with patient’s self-efficacy for diabetes self-care. Pearson''s correlation coefficient revealed that all of these factors had a linear and direct relationship with self-efficacy and the predictive power (R2) was equal to 0. 37. Functional health literacy is a better predictor of self-efficacy for self-care behaviors in diabetic patients. Considering the importance of self-efficacy in educational interventions for improving diabetes self-care، well documented in various studies، raising patient levels of knowledge and health literacy as predictors affecting self-efficacy is imperative.

Alterations in lipids metabolism are one of the important mechanisms for the treatment of insulin resistance and، hence for type 2 diabetes. On the other hand، PGC-1 supportFields]> QUOTE AWT IMAGE α supportFields]>، as a key regulator of mitochondrial biogenesis and function، by increasing β-oxidation of lipids plays an important role in improving insulin sensitivity. In the present study، the effects of Epigallocatechin-3-Gallate (EGCG)، an anti-obesity and enhancer of lipid catabolism agent، on PGC-1 supportFields]> QUOTE AWT IMAGE α supportFields]> protein expression was examined and compared with the anti-diabetic drug Rosiglitazone (RGZ). After differentiation of C2C12 myoblasts to myotubes، insulin resistance was induced by palmitate treatment. Afterward، PGC-1α protein expression was examined using the western blot method before and after treatment with insulin and after EGCG and RGZ treatment. Palmitate treatment significantly decreased PGC-1 supportFields]> QUOTE AWT IMAGE α supportFields]>protein expression in the C2C12 cells (P=0. 001). Treatment of these cells with EGCG had no significant effect on the PGC-1 supportFields]> QUOTE AWT IMAGE α supportFields]> protein expression (P=0. 67)، whereas treatment with RGZ significantly increased expression of this gene at protein level (P=0. 003). In addition، this significant increase in PGC-1 supportFields]> QUOTE AWT IMAGE α supportFields]> protein expression was maintained by simultaneous treatment with EGCG and RGZ (P=0. 001). Our results showed that the effect of EGCG on PGC-1 supportFields]> QUOTE AWT IMAGE α supportFields]> protein expression was not significant، whereas RGZ significantly improved the palmitate-induced reduction of PGC-1 supportFields]> QUOTE AWT IMAGE α supportFields]> protein expression. Overall، it seems that anti-diabetic effect of EGCG is not exerted through its effect on the expression of PGC-1 supportFields]> QUOTE AWT IMAGE α supportFields]> gene، in contrast to that of RGZ.

Publications evaluating the effects of probiotics on glycemic parameters، body weight change and food intakes have increased steadily in recent years. This study hence assessed all related human and animal studies. In the present systematic review، we used search engines to collect relevant data until May 2014، concerning the effects of probiotics on body weight changes، fasting plasma glucose (FPG)، oral glucose tolerance test (OGTT)، glycated hemoglobin (HbA1c)، insulin، and insulin resistance in T2DM. Twenty-five animal and four human articles met our inclusion criteria، articles which generally reported positive effects of probiotics on glycemic parameters. Lactobacillus sub-strains were used in all studies except for one. Most of the human and animal studies reported significant reduction in FPG and delay in the onset of T2DM، respectively; only animal studies reported significant reduction in OGTT. Few studies showed significant reduction and increase in HbA1c and insulin levels، respectively. Most studies reported significant increment in body weight after intervention، whereas only a few reported significant reductions in this parameter. This study showed that the administration of probiotics have beneficial effects on glycemic parameters، although their effects on body weight were inconsistent. Therefore، considering the controversial results among human and animal reports، more data evidence is needed to conduct a meta-analysis.