فهرست مطالب

International Journal of Endocrinology and Metabolism
Volume:22 Issue: 4, Oct 2024
- تاریخ انتشار: 1403/10/22
- تعداد عناوین: 6
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Page 1
Context:
This paper aims to review the findings of the Tehran Obesity Treatment Study (TOTS) on obesity and bariatric surgery (BS).
Evidence Acquisition:
The objective of this review is to assess all aspects of BS in individuals with severe obesity, focusing on research conducted within the TOTS framework.
Results and ConclusionsThe TOTS studies have produced significant national-level findings, highlighting critical issues related to the effectiveness and outcomes of bariatric procedures, the importance of comprehensive nutritional management, and the complications associated with these interventions in this population.
Keywords: Tehran Obesity Treatment Study, TOTS, Bariatric Surgery, Severe Obesity, Sleeve Gastrectomy, Gastric Bypass -
Page 2Background
The macronutrient composition of daily meals plays a crucial role in influencing the body's metabolic responses during the postprandial phase. However, existing research on the effects of macronutrients, particularly fats and carbohydrates, has produced inconsistent findings.
ObjectivesThis study aims to evaluate the postprandial effects of two high-protein meals—one low in fat and high in carbohydrates (HP-LF-HC) and the other high in fat and low in carbohydrates (HP-HF-LC)—on energy metabolism, appetite response, and blood markers in overweight and obese men and women without underlying health conditions.
MethodsThis study was conducted as an acute randomized crossover clinical trial at the Health Monitoring Center of Mashhad University of Medical Sciences (MUMS) within Imam Reza Hospital, Mashhad, Iran. A total of 30 overweight and obese men and women, meeting the eligibility criteria and free of underlying diseases, were recruited through a public call. Participants were randomly assigned to receive both intervention meals, with a washout period of at least one week between each trial.
ResultsThe primary outcomes focused on the acute effects of the two dietary interventions on energy metabolism, particularly resting metabolic rate (RMR), and appetite response. Secondary outcomes included changes in lipid profiles, insulin, blood glucose levels, thyroid hormones, and epinephrine.
ConclusionsThis study aims to identify which macronutrient composition most effectively enhances resting energy expenditure. The findings could provide valuable insights for dietitians in developing more efficient dietary plans, helping overweight and obese individuals maintain an ideal weight or achieve weight loss by modifying food composition without altering meal volume.
Keywords: Obesity, Protein, Fat, Carbohydrate, Metabolic Factors, Over Weight -
Page 3Background
Hyperglycemia in pregnancy (HIP) comprises gestational diabetes mellitus (GDM) and pre-existing diabetes; type 1 diabetes (T1DM), type 2 diabetes (T2DM), and undetermined diabetes. Hyperglycemia in pregnancy leads to fetal and maternal complications.
ObjectivesTo observe and compare glycemic profiles (GP) and hypoglycemia awareness (HA) in women with GDM and pre-existing diabetes.
MethodsThis prospective observational comparative study enrolled women with HIP registered at Sulaimani Maternity Teaching Hospital from January to April 2024. Self-monitoring blood glucose (SMBG) was used to document GP through mean blood glucose (MBG) analysis and the proportions of hyperglycemic, euglycemic, and hypoglycemic records. The Gold score was used to assess HA. Statistical analysis was conducted using SPSS version 27.0, employing chi-square, Mann-Whitney, Fisher's exact test, Kruskal-Wallis test, ANOVA, and independent t -tests. A P-value of ≤ 0.05 was considered significant.
ResultsOne hundred patients were included in the final analysis. Half of the women were over 35 years old, 53% had GDM, and 47% had pre-existing diabetes. The MBG levels at fasting, 1-hour post-breakfast, and post-dinner were significantly highest in T1DM and lowest in GDM, while the levels were similar after lunch. Compared with pre-existing diabetes, women with GDM had a significantly greater proportion of euglycemic records and a lesser proportion of hyperglycemic and hypoglycemic records. Daily insulin requirements were significantly higher in women with pre-existing diabetes than in those with GDM (0.52 ± 0.35 vs 0.24 ± 0.12 units/kg, respectively, P < 0.001). Hypoglycemia episodes (HE) were 5.7 vs 1.83 events/patient/month in pre-existing diabetes vs GDM, respectively (P = 0.002). Using the Gold score to determine HA, 40% of T1DM patients had reduced HA, 40% had borderline HA, while 20% of T1DM and patients with other types of diabetes had normal HA (P < 0.001).
ConclusionsWomen with GDM had a significantly more stable GP, fewer HE, and lower insulin requirements than those with pre-existing diabetes. Type 1 diabetes patients had the most unstable GP, with significantly higher proportions of hyperglycemic and hypoglycemic records and reduced HA.
Keywords: Glycemic Profile, Hypoglycemia Awareness, Gestational Diabetes, Hyperglycemia In Pregnancy -
Page 4Background
Metabolic Syndrome (MetS) is a prevalent condition associated with an increased risk of cardiovascular disease (CVD) and CVD mortality. Due to the limited clinical applicability of MetS, the standardized continuous metabolic syndrome severity score (cMetS-S) has the potential to provide continuous assessment of metabolic risk.
ObjectivesThis study evaluated the optimal cMetS-S cut-off points in the Tehran Lipid and Glucose Study (TLGS) for predicting CVD and CVD mortality.
MethodsThe study included 7,776 participants over 30 years old at baseline, followed for 18 years. Sex-specific sensitivity (SS) and specificity (SP) of cMetS-S measures for predicting CVD and CVD mortality were evaluated using a receiver operating characteristic (ROC) curve, along with the area under the curve (AUC), employing a naive estimator and considering event failure status and MetS variables.
ResultsThe cut-off point of cMetS-S for CVD was 0.13 (SS: 65.5%, SP: 59.6%) for the total population, 0.44 (SS: 49.6%, SP: 68.1%) for men, and 0.27 (SS: 64.2%, SP: 69.2%) for women. The cut-off point of cMetS-S for CVD mortality was 0.53 (SS: 51.3%, SP: 71.9%) for the total population, 0.76 (SS: 35.1%, SP: 76.2%) for men, and 0.28 (SS: 78.8%, SP: 66.4%) for women. The AUC (95% CI) of MetS based on the International Diabetes Federation (IDF) and Joint Interim Statement (JIS) definitions were 60.0 (65.3 - 56.8) and 61.1 (59.6 - 56.8) for CVD, and 59.3 (56.0 - 62.5) and 59.4 (56.3 - 62.6) for CVD mortality.
ConclusionsThe cut-off points of cMetS-S for CVD and CVD mortality differ between men and women. The cMetS-S could be a better predictive tool for CVD and CVD mortality than MetS.
Keywords: Continuous Metabolic Syndrome Severity Score, Cardiovascular Disease, Mortality, Metabolic Syndrome -
Page 5Background
Obesity is a complex disease that has become increasingly prevalent. While obesity itself is not new, its widespread occurrence is a more recent concern. Stimulating brown adipose tissue (BAT) and promoting the browning of white adipose tissue (bWAT) have shown promise as therapeutic targets to increase energy expenditure and counteract weight gain.
ObjectivesThis study aimed to investigate two main aspects. First, we examined how obesity affects the expression of the fibronectin type-III domain containing 5 (FNDC5) and uncoupling protein 1 (UCP1) genes in male Wistar rats. Second, we assessed the effects of six weeks of aerobic exercise, exposure to cold water, and the combination of both on the expression of the FNDC5 and UCP1 genes in obese male Wistar rats.
MethodsIn this experiment, 25 male Wistar rats were randomly assigned to five groups (5 rats per group) after inducing obesity. The groups included: A control group (C), an obesity group (O), an obesity group exposed to cold water (OC), an obesity group engaged in aerobic exercise (OE), and an obesity group exposed to both cold water and aerobic exercise (OCE). The aerobic exercise sessions lasted 30 - 60 minutes, with a speed of 15 - 25 meters per minute. The cold water exposure protocol involved shallow water (2 - 4 cm) with a temperature of 14 - 18°C. The OCE group performed both aerobic and cold water exercises in each session. The expression of the FNDC5 gene in the soleus muscle and the FNDC5 and UCP1 genes in subcutaneous fat was evaluated using Real-Time PCR. All statistical analyses were performed using SPSS software version 16, with a significance level set at P ≤ 0.05.
ResultsObesity significantly increased the expression of the FNDC5 gene (P = 0.008). After six weeks of aerobic exercise (P = 0.016) or cold water exposure (P = 0.016), there was a significant decrease in FNDC5 gene expression. Surprisingly, the combination of both interventions did not result in a significant effect (P = 0.75). On the other hand, none of the interventions—whether aerobic exercise, cold water exposure, or their combination—had a significant effect on the expression of the UCP1 gene (P > 0.05).
ConclusionsThe increase in FNDC5 gene expression caused by obesity may serve as a compensatory mechanism to cope with the condition. However, both cold water exposure and aerobic exercise appear to mitigate this increase in FNDC5 gene expression through enhanced thermogenesis.
Keywords: Obesity, Exercise, Cold Temperature, Thermogenesis, FNDC5, UC51, Subcutaneous Fat, Adipose Tissue, White -
Page 6Introduction
Sertoli cell tumors are rare sex cord-stromal tumors, accounting for less than 1% of primary testicular tumors. They typically arise in the testes and ovaries, with other localizations being uncommon. We present the case of a Sertoli cell tumor in the adrenal gland, which, to our knowledge, is the first reported in the literature.
Case PresentationA 44-year-old male patient was admitted to the clinic for endocrine surgery for laparoscopic surgery of a right adrenal gland incidentaloma measuring 57 × 47 × 59 mm, discovered during a routine abdominal ultrasonography. The patient had a history of hypertension but no other comorbidities. Biochemical and physical examinations revealed no signs of hypercortisolism. Urinary metanephrine and normetanephrine levels were within normal limits. A right laparoscopic adrenalectomy was performed, and a 5 cm tumor was identified without evidence of locoregional invasion. Pathological examination confirmed a Sertoli cell tumor of the adrenal gland. Immunohistochemical analysis revealed positive staining for vimentin, steroidogenic factor 1 (SF1), and beta-catenin, while chromogranin A, hCG, PSA, and TTF1 were negative. The Ki-67 index was 3%. The patient was subsequently referred to a urologist, where testicular ultrasonography showed no abnormalities. There were no signs of recurrence during a 15-month follow-up period. Additionally, the patient’s biannual antihypertensive treatment was discontinued by a cardiologist 1.5 months post-surgery.
ConclusionsSertoli cell tumors are an exceptionally rare entity. To our knowledge, this is the first reported case of a primary Sertoli cell tumor originating in the adrenal gland. Given their potential for malignancy, regular follow-up and additional diagnostic evaluations may be necessary. Laparoscopic adrenalectomy appears to be a suitable definitive treatment for this condition.
Keywords: Sertoli Cell Tumor, Adrenal Gland, Laparoscopic Surgery, Case Report