مجله غدد درون ریز و متابولیسم ایران
سال بیستم شماره 5 (پیاپی 101، آذر و دی 1397)

Gestational diabetes mellitus (GDM) affects a significant number of individuals worldwide. Self-management is an effective method to control gestational diabetes and the various factors that affect it. This study was conducted to study determinants of diabetes self-management in women with gestational diabetes using the PRCEED model approach. This cross sectional study was conducted on 329 women with gestational diabetes in Qom, during 2018. The convenience sampling method and the multi-sectional questionnaire were used to evaluate knowledge, attitude, self-efficacy, social support, pregnancy distress and enabling factors among the subjects. Data analysis was performed in SPSS v. 21 and Lisrel v. 8.5, using t. test, ANOVA, Correlation and Path analysis. A positive relationship was observed between self-management and predisposing factors such as knowledge (r=0.848, P<0.01), attitude (r=0.132, P<0.05) and self-efficacy (r=0.79, P<0.01); furthermore there was a positive and direct association between self-management and the enabling factors (r=0.353, P<0.01). Regarding the reinforcing factors, social support had a positive and direct relationship with self-management (r=0.173, P<0.01), whereas there was a significant inverse relationship between pregnancy distress and self-management (r=-0.587, P<0.01). Self-efficacy was the strongest predictor for self-management (β=0.87), followed by social support (β=0.80). Study results emphasized the importance of the effects of predisposing, reinforcing and enabling factors on self-management, which could be used as the framework to develop appropriate interventions for women with gestational diabetes.

One of the fundamental needs of health researchers are standard tools used for assessing and evaluating health status. The aim of this study was to conduct a psychometric evaluation of the socio-cognitive determinants questionnaire of type 2 diabetes prevention among 180 individuals, referred to health centers over 30 years in Kermanshah. The questionnaire was designed using the first and second steps of the intervention mapping approach. Describing data and construct validity of the questionnaire was performed through correlations and mutual exclusion of items with exploratory factor analysis, using SPSS-21 at 0.05 significance level. The Kaiser-Meyer-Olkin Measure was 0.860 and Bartlett's Test of Sphericity test was significant at the acceptable level (P<0.001). Based on the conceptual foundations of theory planned behavior, social cognitive theory and health belief model, seven factors were extracted, including attitude, perceived sensitivity, perceived severity, perceived self-efficacy, subjective norms, perceived barriers and behavior with eigen value above 1.1 and factor load level ≥0.4 with 36 items. The seven constructs explained 65.67% of the variance of the hypothesized model. The questionnaire designed was found to have strong psychometric and predictive charactristics with good validity and reliability for evaluating socio-cognitive determinants affecting the implementation of type 2 diabetes prevention behaviors in this at risk urban population.

Dietary Energy Density (DED), defined as the energy content of foods (kJ or kcal) per unit weight of foods (g) has an important effect on the regulation of energy intake and some health-related factors, including adiposity index(AI), weight reduction and weight maintenance; however its function on the regulation of resting metabolic rate (RMR) is less understood. Therefore, the aim of this study was to investigate the association of DED with AI, RMR, respiratory quotient (RQ) and anthropometric indices in overweight and obese women. A total of 301 overweight and obese women were included in this comparative, cross-sectional study. Body composition was measured using the body composition analyzer. RMR was measured by means of indirect calorimetry. Usual food intakes of subjects over the past year were evaluated through the use of a semi-quantitative food frequency questionnaire. There was a significant difference between DED and age, CO2 production, RMR, RMR per kg of weight and the RQ (P<0.05). After adjusting the data for age, lean mass and physical activity, the relationship between DED and RMR per kilogram of body weight and RQ was still meaningful (P<0.0001). There was no significant relationship between DED and AI (P=0.55). Based on the findings of this research, one unit increase in DED causes a 0.89 unit increase in the RMR per kilogram and 0.18 unit increase in RQ, whereas no relationship was observed between AI and DED.

Inflammation plays a critical role in the pathogenesis of diabetic cardiomyopathy. The expression of HMGB1, a proinflammatory cytokine, and its downstream signaling pathway is upregulated in diabetes. The aim of this study was to investigate the effect of 8 weeks aerobic training on the expression levels of the HMGB1-RAGE/TLR4-NF-kB pathway in cardiac tissue of male rats with hyperglycemia. Thirty-six male Wistar rats (mean weight, 231±25g) were randomly divided into three groups (n=12 each): Healthy control, control hyperglycemia and trained hyperglycemia. Hyperglycemia was induced by intraperitoneal injection of strept ozotocin and nicotinamide. Forty-eight hours after completion of the training program (eight weeks aerobic training), cardiac tissue was removed under sterile conditions. Gene expression of HMGB1, RAGE, TLR4 and NF-kB were investigated, using Real-time PCR. For data analysis, one-way ANOVA and post-hoc Tukey’s test were used, with P<0.05 considered statistically significant. Gene expression levels of HMGB1, RAGE, TLR4 and NF-kB were significantly (P=0.001) increased in the cardiac tissue of the hyperglycemic control group, compared with healthy controls. Eight weeks of aerobic training decreased the expression levels of the studied genes (P=0.001). It seems that aerobic training can prevent the negative effects of hyperglycemia via by attenuating gene expression levels of HMGB1, RAGE, TLR4 and NF-kB in the cardiac tissue of rats with hyperglycemia, and could hence be an important mechanism for cardiac function and preventing diabetic cardiomyopathy.

Despite higher prevalence of obesity in women, the anti-obesity effects of nitrate have mostly been studied in male animals, using low doses of nitrate for short durations. This study aims at determining effects of long-term (6 months), administration of high doses of nitrate on the obesity indices of normal adult female rats. Female Wistar rats were divided into 3 groups (n=10/group): Control group received tap water and the two treatment groups received water containing 250 and 500 mg/L sodium nitrate for 6 months. Body weight, food intake, and water consumption were measured weekly. Naso-anal length, body mass index (BMI), Lee index, as well as abdominal and thoracic circumferences were determined every two months. Weights of white adipose tissue (WAT) and brown adipose tissue (BAT) were measured at the end of study and adiposity index was calculated. Administration of nitrate had no effect on food intake but significantly (p<0.001) increased water consumption in female rats. Compared to the control group, there was no significant difference in body weight and nasal-to-anal length in the nitrate-treated rats. At the end of study, compared to controls, in nitrate-treated rats, BMI (23%), Lee index (7%), adiposity index (36%), weight of WAT as well as abdominal (5%) and thoracic (6%) circumferences were significantly lower. Weight of BAT was also significantly higher in the interscapular region, i.e 0.23±0.02, 0.39±0.03 and 0.32±0.02 gram in the control and nitrate groups (250 and 500 mg/L), respectively. and in the axillary region 0.24±0.03, 0.33±0.02 and 0.30±0.03 gram in the control and nitrate groups (250 and 500 mg/L), respectively. Nitrate administration prevents increase in adiposity in normal adult female rats, beneficial effects which may be associated with increased browning of WAT.

Following trainging, Reactive Oxygen Spices (ROS) play a crucial role in the regulation of signaling pathways and adaptions in skeletal muscle, including mitochondrial biogenesis and improvement in insulin sensitivity a ROS-induced physical activity can also stimulate myokine production in skeletal muscle. The aim of this work was hence to investigate the role of NADPH Oxidase-2 (NOX2), the main source of ROS generation, in contracting muscle in IL-15 gene expression, as well as anychanges in PGC-1α, as a key regulator of mitochondrial biogenesis, following a period of High-intensity Interval Training (HIIT). Mice were divided into four groups: Wild type (WT) control (WTc) and training (WTt), NOX-2 deficient (ND) control (NDc) and training (NDt). Training groups performed 6-week HIIT, including 2-min running intervals with 100% of their maximum running speed and 2-min rest with 30% of this speed for a total of 60 min; speed was increased 1m/min each week. IL-15, PGC-1α and NOX2 mRNA levels in gastrocnemius muscle were analyzed using Real time. Basal levels of IL-15 mRNA in NDc group were significantly lower than the other groups. Relative gene expression in WTc, WTt, NDc and NDt changed for IL-15 1, 1.15, 0.49 and 0.99 and for PGC-1α 1, 1.73. 0.76 and 1.4 times, respectively in WTt. Post-training muscle PGC-1α mRNA levels increased significantly. Results indicate that IL-15 gene expression in mouse skeletal muscle is dependent on NOX2. And apparently NOX2 deficiency may result in impaired PGC-1α expression and subsequently diminished mitochondrial biogenesis.

Age of menopause is affected by several factors. While several studies have been conducted on various aspects of polycystic ovary syndrome (PCOS), limited publications have assessed the age at menopause and its related factors in PCOS patients. In this review, we aimed to summarize data of articles available, assessing the age at menopause in women with polycystic ovary syndrome (PCOS). Material and PubMed (including Medline), Scopus, and Google Scholar, Web of science, and EMBASE databases (up to 2018) were searched to identify published articles, investigating the actual menopausal age and those predicted by the Anti-Mullerian hormone (AMH) in PCOS patients. The quality of studies included was determined using the Newcastle-Ottawa Scale. Current data of studies available demonstrate that the serum concentration of Anti-Mullerian hormone (AMH), as a reliable diagnostic marker to predict ovarian reserve and age at menopause, is significantly higher in patients with PCOS than healthy women. The results of this review show that, in most studies included, the age of menopause, or its estimation based on the serum AMH level, was significantly higher in patients with PCOS, compared with female controls. Delayed menopausal age can be considered window of hope for PCOS women, suffering from infertility, to retrieve their fertility at in later ages.