مجله غدد درون ریز و متابولیسم ایران
سال بیست و یکم شماره 4 (پیاپی 106، مهر و آبان 1398)

The Frequency-based method is commonly used to estimate the Net Reclassification Improvement (NRI)- and Integrated Discrimination Improvement (IDI) indices. These indices measure the magnitude of the performance of statistical models when a new biomarker is added. This method has poor performance in some cases, especially in small samples. In this study, the performance of two Bayesian and Frequentist methods were evaluated and compared for the diabetes prediction model in pre-diabetic women.

A total of 734 pre-diabetic women aged≥20 years, participated in the first and second phases of the Tehran Lipid and Glucose Study (TLGS) were enrolled in this research and the logistic regression model was used with variables of the Atherosclerosis Risk in Communities (ARIC) in order to estimate the probability of diabetes. Predictors of diabetes in the ARIC study were waist circumference, hypertension, height, weight, age, family history of diabetes, smoking and pulse rate. The Frequentist and Bayesian methods were used to estimate the NRI and IDI. In addition these methods were compared in a small sample size selected randomly from the primary sample. Statistical analyses were performed using R- software version 3.1.3.

Estimates of the NRI and IDI indices by the Bayesian and Frequentist methods provided almost similar results. Adding new markers of wrist size, history of macrosomia, and history of preeclampsia to the ARIC model did not show significant effect on the improvement indices. In the small sample size, IDI and NRI showed better performance in the Bayesian method compared to the frequentist method.

The Bayesian method had a more reliable performance in comparison with the frequency-based method, especially in small samples.

The purpose of the present study was to investigate the effect of twelve weeks of combined exercise training on CTRP3, TNF-α, IL6 and insulin resistance in women with type 2 diabetes.

Thirty-six patients were divided into three groups, i.e. The control group (38.20±3.11 years), the aerobic-resistance combined exercise group(37.63±3.69 year) and the resistance aerobic combined exercise group(38.77±3.3 years). The training program for the combined exercise groups consisted of aerobic exercise with 80 to 95% maximal heart rate, resistance training with 60 to 85% 1RM intensity for 12 weeks (three sessions per week) with different anthropometric variables and levels. Serum TNF-α, IL6, CTRP3 and insulin resistance index were measured before and after exercise. Analysis of variance was performed using 2-way repeated measures of ANOVA and the significance level was set at <0.05.

The main effect showed a significant decrease in serum levels of TNF-α (p=0.001), IL6 (p=0.001) and a significant increase in CTRP3 in the training group (p=0.001). The interactive effect differed significantly between training groups in the post-test, compared to the control group (p=0.001), whereas the changes were similar between training groups. (P=0.001). The interactive effect of CTRP3 showed a significant increase in the post-test between controls and the combined training groups (p=0.001) and the highest increase of CTRP3 was in aerobic-resistance group (p=0.004). There was no significant difference between the groups despite improvement of insulin resistance index (p=0.08).

To conchide, based on the results, the use of combined exercise, especially in the order of aerobic-resistance training, decreased the pro-inflammatory cytokines and increased anti-inflammatory cytokines, combination training is recommended for patients with type 2 diabetes.

Adipose tissue affects body hemostasis by secreting a variety of proteins named adipokines. Plasma levels of apelin decreases after exercise; however, the evidence on gene regulation in adipocytes is rare. The aim of this study was to investigate the association of daily physical activity and applein gene expression and its serum levels in visceral and subcutaneous adipose tissues in non-obese and morbid obese subjects.

In this cross-sectional study, samples of visceral and subcutaneous adipose tissues were collected from patients (64) undergoing abdominal surgery. Data on physical activity was gathered using a valid and reliable International Physical Activity Questionnaire (IPAQ) and the metabolic equivalent (MET) was calculated. Apelin expression in fats was evaluated using the qRT-Real Time PCR method.

Mean age for non-obese and morbid obese groups was 45.6 and 39.6 years, and total physical activity was 1093 and 894 (MET), respectively. The expression of apelin was significantly higher in subcutaneous fat in morbid obese subjects, compared to non-obese adults (P=0.038). After controling age, waist circumference and insulin levels, total MET was significantly associated with subcutaneous adipose tissue (β=0.519 and β=0.395) in both, the non-obese and obese groups. Among obese individuals, occupational-related activity was associated with apelin expression in subcutaneous adipose tissue (β=0.391).

The association of physical activity and adipose tissue gene expression in non-obese and obese individuals indicates the positive effects of active lifestyles on adipokines secreted from adipose tissues.

Snack consumption is associated with cardiovascular disease (CVD) risk factors in children and adolescents. The aim of this study is to investigate the association of snack consumption and carotid intima media thickness (CIMT) among overweight and obesity children and adolescents.

In this cross sectional study, a total of 339 participants, aged 6 to 13 years with the body mass index Z score ≥1 enrolled in this study. Data on anthropometric measurements, pubertal status, and CIMT were documented. Food intakes of participants were measured by a valid and reliable food frequency questionnaire (FFQ). Linear and logistic regression were estimated. 

Mean age of study participants was 9.3 years and with 68.4% of obesity. After controlling for confounders, including age, sex, energy intake, puberty status, physical activity, and body mass index, one SD increase in intake of nuts decreased the CIMT, by 0.126 mm (P value=0.019). Moreover, participants in the last tertile of nuts intake had 63% lower risk of high CIMT in comparison with those who consumed less than 1.74 serving/wk of nuts (P for trend=0.006). When nuts intake was replaced by the sweet unhealthy snacks the CIMT decreased by 0.15 mm.

Our findings emphasize the positive impact of nuts consumption as a healthy snack on subclinical stages atherosclerosis. Clinical trial studies could examine the effect of different kinds of nuts consumption on CIMT and complications of CVD risk factors.

Peripheral arterial disease (PAD) is common in diabetic patients, and about half of the patients with diabetic foot ulcers (DFU) have concomitant peripheral arterial disease (PAD). The purpose of this study was to select an appropriate and comprehensive clinical guide in the management of DFU. The part of the practical guide that pertains to this is based on three systematic reviews in three sections of diagnosis, prognosis, and treatment for DFU in patients with PAD.

In this study, the ADAPTE methodology process consiss of the three stages of preparation, acceptance or final adoption and finalization for the localization of an international clinical guide.

Results are presented in the form of questions and recommendations in three sections, i.e. diagnosis, 2 questions and 3 recommendations, diagnosis  prognosis and treatment. In the diagnosis section, and in the prognosis section (2 questions and 6 recommendations), and in the treatment section (3 questions and 8 recommendations).

In this practical guide, our take home massage, i.e. what we should learn and practice is summarized as follows:  1) We examine a patient with diabetes for peripheral arterial disease yearly. 2) Despite the best possible treatment in patients with DFU, if the wound does not improve after six weeks, we should refer the patient to a vascular surgeon. 3) Patients with PAD, associated with foot infections are at high risk for extreme amputation of the lower limbs and need urgent interventions. 4) All patients with diabetes with ischemic DFU should receive appropriate therapeutic treatment, similar to that for cardiovascular patients.

Polycystic ovary syndrome (PCOS) in adults is diagnosed based on clinical, biochemical, and radiological criteria, although in adolescents, some of these criteria may overlap with the normal process of puberty, which may lead to difficulty in diagnosis of this syndrome. This review is an evolutionary approach for diagnostic criteria of PCOS in adolescents.

In this study, Google Scholar, SID, Magiran, PubMed, Scopus, and Web of Science databases were searched for retrieving articles published up to August 2019 in the term of PCOS diagnostic criteria in adolescent females.

So far, researchers and scientific societies of gynecology, pediatrics, and endocrinology, have described several criteria for the diagnosis of PCOS in adolescents. According to available scientific evidence, it is necessary to clarify the diagnostic standards for all three clinical, laboratory and radiological criteria to prevent false diagnosis of this syndrome in adolescent females.

Although evidence suggests that the risk of complications of PCOS may be reduced by accurately diagnosing and early treating in adolescence, the diagnostic criteria are still unclear and further studies are needed.