مجله غدد درون ریز و متابولیسم ایران
سال دهم شماره 4 (پیاپی 40، آبان 1387)

Obesity and its complications are a major health problem in Iran. The aim of this longitudinal study was to determine whether changes in food patterns were related to abdominal obesity in Tehranian adults of district 13. A total of 82 men and 124 women, (≥18 years old), were studied between 1999-2001 and 2004-2007. Subjects with abdominal obesity were defined according to ATPIII and WHO guidelines. Dietary intake was assessed by a food frequency questionnaire and two 24-hour dietary recalls. Food groups were determined according to their nutrients contents and previous literature. Food patterns were derived by factor analysis at each time point. The factor scores for each pattern for each subject were calculated by the amount of the intakes of each of the food groups weighted by their factor analysis coefficient matrix the scores were then standardized (mean=0, SD=1). Changes in food pattern, waist circumference (WC) and waist to hip ratio (WHR) were defined by subtracting the factor score for each food pattern and anthropometric measurements in the two time intervals. Men and women were 51±11 and 45±14 years of age at the end of study respectively. During the two periods of the study, mean WC increased from 89.5±10.4 to 97.6±9.1 in men and from 84.8±13.2 to 88.4±12.4 cm in women (p<0.05). Three dietary patterns were identified and named by factor analysis as follows: Healthy (HDP), Western (WDP) and Mix(MDP). In the WDP, salty snacks and sauces had the highest and in the HDP, vegetables had the highest and whole grain had the lowest loading factors in the two study periods. After adjusting for confounding factors better prediction of WC change was obtained in normal individuals with WDP change(β=0.49, R2=0.21, p<0.01) compared with HDP(β=-0.20, R2=0.11, p<0.05). Change in WDP and HDP were related to the WHR change in abdominally obese persons (β=0.21, R2=0.21, p<0.05), (β=-0.23, R2=0.22, p<0.01) respectively. Results of this study indicate that adherence to HDP and decreasing intake of WDP items prevent central adiposity.

Recent studies have used antropometric measures along with biochemical indicators as screening tools for chronic diseases. Few studies have assessed the relation of Enlarged Waist Elevated Triglycerdemic (EWET) phenotype with diabetes, particularly among individuals with family history of diabetes. This study aimed to evaluate the association of the EWET phenotype with diabetes among individuals with family history of diabetes. Antropometric and biochemical measurments were assessed in a pouplation-sbased cross-sectional study of 332 male and 991 female Isfahani adults, aged 35-55 years. The EWET phenotype was defined as serum trigcylglycerol concentrations ≥ 150 mg/dl and concurrent waist circumference ≥ 88 cm in women and ≥ 102 cm in men. The prevalence of the EWET phenotype was 9.6% among men and 23.6% among women. Individuals with the phenotype had significantly higher antropometric measurements as compared to other groups. After control for age and physical activity, men with the EWET phenotype were significantly more likely to have high serum cholestrol (P<0.001), systolic BP (P<0.01) and diastolic BP (P<0.001). Even after aditional control for BMI the significant associations remained except for low HDL Cholestrol women with the EWET phenotype, who had significantly adverse metabolic risks as compared to other phenotypes, both before or after control for BMI (P<0.001). Individuals with the EWET phenotype were more likely to have diabetes (both genders) and IGT (women only). Our findings showed a significant association between the EWET phenotype and diabetes. This phenotype could be used for early identification of diabetes and IGT.

Hypertension due to its high prevalence and its relation to cardiac disease is considered a major problem in industrialized countries its prevalence varies in different countries and in various regions within a country. The purpose of the present study is to determine the size of the problem and its distribution in a study population being educated using community-based medicine in Kermanshah in 2005. For the study, 8495 persons (1957 families) were randomly selected as the subjects they were medically examined by a team including two general practitioners and a health worker, and were evaluated for blood pressure, height and weight, history of high blood pressure and taking of anti-hypertension drugs the 5147 subjects were aged over 15-years. Each subject\'s blood pressure were recorded once in sitting position using a sphygmomanometer. The collected data were analyzed using descriptive statistics (frequency percentage, mean, standard deviation) and inferential statistics (T-test and Chi Square). The 5147 participants (56.9% females and 43.1% males) had an average age of 34.4±15.1 years. A prevalence of stage 1 & 2 hypertension 14.3% (14.1% in males and 13.7% in females) and prehypertension prevalence of 15.8% was reported. The prevalence of high blood pressure was 60.7% among 65-year-olds. The average systolic pressure and diastolic pressure were reported to be 117.5±18.3 and 74.5±13.6 respectively. The average systolic and diastolic pressure in males were significantly different from that of females (P=0.0001).There was a significant relation between age increase and prevalence of high blood pressure. Also, an increase in BMI showed a significant increase in blood pressure. A high prevalence of elevated blood pressure was documented in this population of Kermanshah obesity and old age were observed to be the interventional risk factors accompanying high blood pressure.

Recent studies have reported the role of catalytic antibodies in the pathogenesis pattern of some diseases. Autoimmune reactions playing a role in some type 2 diabetic patients and the β- cell autoimmune markers were found to be present in some of these patients. The presence of such antibodies was assessed in the plasma of patients suffering from type 2diabetes. Antibodies in 3 diabetic patients and 7 non-diabetic control subjects were purified using protein-G sepharose affinity column chromatography and S-300 gel filtration methods purity of the IgG antibodies was confirmed by SDS-PAGE and in western blot analysis and proteolytic activity of electrophoretically homogenous IgG antibodies was confirmed with zymogram analysis. The purified antibodies were incubated with insulin at 37°C for 6 days and the effect of antibodies on insulin degradation was assessed by Acetic Acid-Urea polyacrylamide gel electrophoresis. Insulin degradation effect was observed only in purified antibodies in the 2 diabetic patients and it was not seen in the 7 control subjects and the remaining diabetic patients. Our data revealed, for the first time, insulin degradation by isolated IgG from 2 diabetic patients. This finding may not only explain the insulin resistance observed in some diabetic patients, but may most likely propose also a new mechanism for occurrence of the disease.

Dehydroepiandrostrone (DHEA) is one of three adrenal hormones and the most abundant estroid hormone in the body. Compared to other adrenal hormones, it decreases with advancing age, being 10-20% in the seventies, hence it is called the fountain of youth. Recently DHEA has been noticed for many of its effects including its antidepressant, protective effect on neuron injuries, effect on the hypocampaus and vascular endothelium, and its effects on autoimmune disease such as Lupus and ulcerative colitis there is however controversy regarding its effects on insulin sensitivity. Based on glucose tolerance tests, subjects were selected from among patients, attending the Isfahan endocrine research center 30 IGT patients by cross-over were treated with DHEA or placebo for six months and insulin sensitivity at the beginning and the end of treatment were compared. In the first three months, the mean changes in the drug group were: DHEA-S 94μg/dL (P-value0.008), HOMA-IR 0.62 (P-value 0.6), insulin 1 μIU/mL (P-value0.3), FBS 10.5 mg/dL (P-value 0.1) and changes in placebo group were: DHEA-S 2.5 (P-value 0.6), HOMA-IR 0.9 (P-value 0.03), FBS 15.5 (P-value 0.1), insulin 3.5 (P-value 0.05). In the second three months, the mean changes in the drug group were: DHEA-S 166 μg/dL, FBS 4.6 mg/dL, insulin 0.6 μIU/mL, HOMA-IR 0.2, while changes in the placebo group were: DHEA-S 25, FBS 5.8, insulin 1.5, HOMA-IR 0.6. This study showed that the treatment with DHEA did not improve insulin sensitivity, but probably is effective in preventing increase in insulin resistance.

Because of undesirable serum lipoprotein profiles, postmenopausal women are at risk of cardiovascular disease. Soy protein may help protect against these risk factors although its effect on homocysteine and Lp (a) is not clear however, the effects of soy bean in hyperlipidemic postmenopausal women has not been assessed independently yet. The aim of this study was to determine the effects of soy bean on serum concentration of homocysteine, Lp(a) and lipoproteins in hyperlipidemic postmenopausal women. In a randomised clinical trial with parallel design, 34 hyperlipidemic postmenopausal women were randomly assigned to group 1 and given 130 g soy bean containing 50 g/d soy protein and 159/9mg isoflavones, while group 2 continued their usual diet for 10 weeks (controls). Serum lipoproteins, homocysteine and Lp (a) were measured at baseline and after the 10 th week. There were significant decreases in Lp (a) LDL-c, TC, LDL-c/HDL-c, TG/HDL-c, TC/HDL-c in group 1, as compared to group 2, after ten weeks of study (p<0.05, p<0.001, p<0.01, p<0.01, p<0.05 and p<0.05 respectively) at the end of the study. Similarly, Lp(a), homocysteine, LDL-c, TC, LDL-c/HDL-c, TG/HDL-c, TC/HDL were significantly decreased (p<0.01, p<0.05 p<0.01, p<0.01, p<0.01, p<0.05, p<0.01) at the end of the study, compared with initial values of the soy group. We can conclude that Soy protein reduces CVD risk in postmenopausal women because of both modest reductions in serum lipoproteins and Lp(a) in hyperlipidemic postmenopausal women.

Leptin, the product of the ob gene, plays a significant role in the pathogenesis of obesity and type 2 diabetes mellitus. The aim of this study was to compare serum leptin level in non-diabetic and type 2 diabetic obese subjects and assess its relationship to anthropometric indices. This cross-sectional study was performed on 35 obese subjects with type 2 diabetes and 35 non-obese, non-diabetics. Fasting lipid profiles were measured using enzymatic methods. The NycoCard HbA1c Kit was used to measure HbA1c. Serum leptin, insulin and glucose levels were measured by an enzyme immunoassay, using a commercially available kit and glucose oxidase methods respectively. The insulin resistance index was calculated by homeostasis model assessment (HOMA-IR). The mean of insulin resistance index (HOMA-IR), HbA1c, diastolic blood pressure, triglyceride and fasting glucose in diabetics were significantly higher than in non-diabetic subjects (P < 0.05). Serum leptin levels were significantly lower in diabetics than in non-diabetics (21.51±2.18 vs. 30.36±2.46) and were significantly higher in women than in men (31.85±17.96 vs.12.80±9.02) in the diabetic and (36.11±10.99 vs. 23.55±15.72) in non-diabetic groups. There was a direct and significant correlation between serum leptin levels with hip circumference (r= 0.450, p= 0.04) in diabetics and (r=0.590, p=0.000) in non-diabetics, and between leptin and BMI (r= 0.666, p= 0.000) in diabetic and (r= 0.490, p= 0.003) in non-diabetic groups. Since the mean serum leptin level is lower in obese diabetes, compared to non-diabetics, further studies are required to clarify the mechanisms of lower leptin levels in obese diabetic subjects.

Physical growth disorder in children, aged under 5-years, is a common health problem in developing countries, including Iran, where national studies have shown that the prevalence of stunted growth disorder is approximately 15 percent. The aim of this study was to determine effects of supplemental zinc on physical growth in children with retarded growth. The study was a 12-month community-based RCT which incorporated 6 months of zinc supplementation to 2-5-year-old children with height-for-age index less than the 25th percentile of NCHS (n=90) children were assigned randomly into either the Zinc Group receiving 5 ml of a solution containing 5 mg of zinc as zinc sulfate (ZG, n=40) or the Placebo Group who received placebo (PG, n=45) daily (7d/wk) for 6 months. The children's weight, height, mid-upper arm, Z-score for height for age, weight for age and weight for height were measured at baseline and monthly for 12 months. Data were analyzed by the SPSS statistical package. Student-t test was used for comparing the means and chi-square and Fisher's exact test were performed to compare categorical variables. Eightly-five children completed (55.3% girls, 44.7% boys) the study supplementation compliance with supplement consumption was 95-100% and the two groups were not significantly different. The means of total weight increments (Kg) among girls in the PG and ZG groups were 2±0.9 and 2.6±1.1 (PV=0.05), respectively and for boys were 2.1±0.8 and 2.7±0.8 (PV=0.04), respectively. The mean of total mid arm circumference increments (Cm) among girls in the PG and ZG groups were 1.23±0.46 and 1.7±0.51 (PV=0.8), respectively these figures for boys were 1.43±0.51 and 1.19±0.39 (PV=0.1), respectively. The means of total height increment (Cm) among girls, in the PG and ZG groups were 8.28±2.23 and 9.64±1.7 (PV=0.02), respectively these figures for boys were 8.34±3.14 and 11.7±1.96 (PV=0.001), respectively. At baseline, stunted rates in the ZG and PG groups were 26.7% and 15% respectively (NS). However, these rates in the 6th month of intervention in ZG and PG were 2.5 and 20%, respectively (PV= 0.01). The results of this study showed that administration of 5 mg zinc daily to young children have significant effects on growth, particularly if the interventions are focused on stunted children.

Physical activity causes changes in hematological parameters in athletes which finally result in cessation off their exercises, an issue that should be given attention. There is limited data avaliable about the effects of protein supplements, containing amino acids and other useful substances, on hematological parameters of resistance to exercise in athletes. This study was carried out to investigate the effect of whey protein supplementation, after resistance to exercise in healthy athletes. In this clinical trial, changes of hematological parameters were studied after one month exercise training and whey protein supplementation in 32 healthy volunteers (16 treated cases 16 controls placeboes). Each day, whey protein supplement(6.6 g/day) and placebo(same dose, starch) were consumed between meals, by with the volunteers. Every one exercised with 80% 1RM, basically on stationary circuit principal, for one hour a day, five days a week. Before and after beginning of study, fasting blood specimens were taken and WBC, RBC, HGB, HCT, MCV, MCH, MCHC, PLT and percent of white blood cells were measured separately. Statistical analyses were carried out using Student t- test and paired t-test (SPSS version 15). Levels of WBC, RBC, HGB, HCT, PLT, MCHC in two groups significantly (P<0.05) decreased, but there was no difference between two groups. MCV increased in the groups, but again there was no difference between them. MCH and percent of lymphocytes were unchanged in both groups. In the supplement group, the percentages of the neutrophils and other white blood cells showed no significant changes, but in the placebo group, there were significantly increased and decreased, respectively. However there was no significant difference between the two groups in the percentage of white blood cells, separately. The present study showed that one month of Whey protein supplementation with 6.6 g/day is ineffective on hematological parameters changes after resistance to exercise. Further studies, with different dosages and longer periods of time are recommended.

Despite the widespread medical use of glucocorticoids, reports of factitious administration of these hormones have been uncommon. We herein report an unprecedented rise in outbreak of Cushing’s syndrome in Tehran among addicts using Tamgesic (a brand of Buprenorphine) to help them through the narcotic withdrawal stage, without knowledge of the glucocorticoid content of the black-market drug. Case histories of 19 patients with a final diagnosis of iatrogenic Cushing syndrome were reviewed. Liquid chromatography/mass spectrometry (LC-Mass) method was used to evaluate glucocorticoid existence in the brand. No Buprenorphine was present in the vials. Each Tamgesic vial contained 0.4 mg of Dexamethasone disodium phosphate and some amount of heroin. The duration of injection abuse and the number of vials used per day was 4.5 (1-18) months and 6.5 (2-20), respectively. Physical findings of the cases were not different from those of the classic endogenous Cushing’s syndrome but their serum cortisol and urinary free cortisol were suppressed. Severe life-threatening complications were demonstrated in five cases. Surreptitious use of steroids resulting in Cushing’s syndrome may be more common in opium addicts a high degree of suspicion is needed to uncover this disorder. Whenever facing a Cushingoid appearance in addicts, the possibility of using black market drugs with corticosteroid contents should be kept in mind.

Diabetes mellitus is a disease that affects 6.6% of the population, approximately 3 million people, in Iran for many years, the usage of therapeutic herbal medicine has been common in Iran. In the present study, the effects of an olive leaf liquid extract on blood levels of glucose and lipids have been studied in a rat model. Twenty-four adult male Wistar strain rats (200-250g) were divided randomly into three groups (experimental, diabetic and non diabetic controls), and housed in single cages. Diabetes was induced with injection of Stereptozocine (60 mg/kg, i.p.) and the control group was given an injection of normal saline. The experimental group received aqueous extract of olive leave (750 mg/kg) intra gastric for four weeks. Finally, blood samples were taken and measured for glucose and lipids levels. Administration of olive leaf extract caused a significant decrease in blood levels of glucose, cholesterol and triglycerides (P<0.01), whereas an increase in HDL-C levels was seen (P<0.05), with no significant changes in LDL-C values in diabetic rats. It appears that olives plant extract can have significant effects on various blood glucose and lipids in diabetic rats, although further work is needed to elucidate the extent and mechanism of these changes.

Mutations in the SLC26A4 gene in the DFNB4 locus is responsible for syndromic (Pendred syndrome) and non-syndromic hereditary hearing loss (HHL). In many populations, mutations in this gene have been reported as a second cause of HHL. The objective of this study was to investigate the prevalence of SLC26A4 mutations in our HHL consanguineous families. After completing clinical evaluation and obtaining signed consent forms from each family, we included 80 families with two or more affected individuals, referred to the Genetics Research Center (GRC). All families that previously tested negative for the DFNB1 locus were candidates for homozygosity mapping using STRs for DFNB4 locus. Families localized to this region were subjected to complete DNA sequencing. Twelve out of 80 families were mapped to DFNB4. Sequence analysis of 12 linked families revealed 10 mutations in 8 families. (T420I, 1197delT, G334V, R409H, T721M, R79X, S448L, L597S, 965insA, and L445W). The T420I, G334V, L597S and R79X were novel mutations we did not find any mutation in the four linked families, nor did we detect any nonsyndromic families with mutation in the SLC26A4 gene. We have been able to identify mutation in the SLC26A4 gene in only 8 of 80 families. In 12 families, we detected some degree of diffuse or nodular goiter three out of 12 families showed thyroid function impairment and in five of 12 families there were positive prechlorate discharge tests. Eight families that showed mutation had normal temporal bone scan. This investigation, demonstrated that the SLC26A4 gene mutation is the most prevalent syndromic hereditary hearing loss in Iran, a finding in accordance with reports from other countries.

Type I diabetes is an autoimmune disease associated with T lymphocytes function in beta cells. This process can increase cytokine secretion, which can cause beta cell inflammation and death. Since GABA, (γ-aminobutyric acid) is a major inhibitory neurotransmitter, and low concentration of GABA can increase cytokine secretion, the aim of this study was demonstrate to the inhibitory effect of GABA administration on cytokine secretion and decrease in beta cell death and also to show the ability of beta cells in insulin secretion. Seven week old CD1 mice were used. To induce diabetes, animals received 40 mg/kg of STZ five days continuously. Two months later, animals were divided into two groups, one receiving 200 micromole of GABA and the other (controls) the same volume of PBS for 10 weeks. Serum glucagon levels, and alpha cells significantly decreased in the (IL12 IL1β, TNFα) mass and some cytokine levels in the GABA group. Plasma insulin level and beta cell mass significantly increased in comparison to the control group. From the results of this study we conclude that GABA administration causes inhibition in cytokine secretion, improves beta cell mass and increases insulin secretion. May be, in the future, if GABA shows no side effects we can use GABA for type one diabetes.