مجله غدد درون ریز و متابولیسم ایران
سال یازدهم شماره 2 (پیاپی 44، تیر 1388)

Diabetic foot ulcer is one of the major complications of diabetes mellitus patients occurring in 15% of these individuals. The aim of this study is to evaluate the risk factors of diabetic foot ulcer and determine its treatment in diabetic patients. Methods and Materials: This cross-sectional study was performed on 100 diabetic patients with foot ulcer, hospitalized in the Shahid Beheshti and Yahayanejad hospitals in Babol from 2003 to 2004. Information was collected with two questionnaires, one for demographic characteristics and the other covering the risk factors of diabetic foot ulcer and its treatment. Data was analyzed by SPSS software, P values <0.05 were considered significant. There was no significant difference between gender and smoking, or alcohol consumption and obesity (p>0. 05). Foot ulcer occurred incidentally in 66% of patients and in 18%, foreign bodies were the cause. Seventy-three percent of patients (27 males and 46 females) had abnormal foot structure, revealing a significant difference between sex and abnormal foot structure (P=0. 001). Although diabetic foot ulcer cannot be prevented, but controlling the risk factors and educating people, can significantly decrease the incidence rate and morbidity.

Anemia is a common problem in diabetic patients, who usually suffer from a greater degree and severity of anemia based on their level of renal impairment, compared to non diabetic patients. This study investigates the prevalence of anemia in type 2 diabetic patients and aims to determine the role of different stages of nephropathy in development of anemia in these patients. Methods and Materials: For this study, 1962 outpatients, with type 2 diabetes were selected. A full blood count and iron indices were obtained for all patients. Anemia was defined as Hemoglobin<13g/lit in males and <12 g/lit in females. The correlation of anemia with other variables including sex, age, duration of diabetes, fasting blood sugar, glycosylated hemoglobin, glumerolar filtration rate, albuminuria, uric acid and metabolic syndrome was identified with multivariate logistic regression analysis. In males 9.2% and among females 10.4% of patients had anemia. The prevalence of elevated albuminuria (micro or macroalbuminuria) was 38. 1%. Of our patients, 8.1% had moderate (creatinine clearance <60 ml/min/ 1. 73 m2) and 31. 4% had mild (CCr= 60-90) renal impairment. Patients with moderate renal impairment had significantly higher levels of anemia than patients with mild renal failure (30% Vs. 9%, p<0.001). Patients with diabetes and macroalbuminuria were also likely to have more anemia than patients with microalbuminuria (32.4% Vs. 8.4%, p<0.001) also patients with microalbuminuria were also more likely to have anemia than patients without elevated albuminuria (8. 4% vs. 5. 7%, p<0. 001). Anemia has a high prevalence in type 2 diabetic patients. Any degree of renal impairment and albuminuria are risk factors for anemia in such patients.

Some cell culture and animal studies have reported that Conjugated Linoleic Acids (CLAs) have several health related benefits. CLAs have been shown to have antiadipogenic, antiatherogenic, antidiabetogenic and anti-inflammatory properties. While increase in insulin resistance with 10-trans, 12-cis isomer of CLA was reported in some animal studies, there are controversial results about a 50:50 isomer mixture. The object of the present study was to determine the effect of CLAs supplementation (providing equal proportions of c9, t11 and t10, c12 CLA) on plasma glucose, insulin, proinsulin, C-peptide, insulin sensitivity, insulin resistance, beta cell function and HbA1c in patients with type 2 diabetes mellitus. The study was performed as an 8-week randomized double-blind, placebo-controlled parallel intervention. Participants were 39 (19 men and 20 women) type 2 diabetic subjects (35 to 50 Y, BMI >25 and <30), stratified according to sex, age and BMI into two groups. Group one were given 3.0 g CLA/d (3×1g capsules, a 50:50 isomer blend of c9, t11 and t10, c12 CLA) and, group 2 took CLA placebos (soy bean oil) for 8 weeks. Blood sample collection after fasting and 2 hours after a standard breakfast, was done before and after the intervention in order to determine insulin, glucose, pre insulin, c-peptide and HbA1c levels. No significant differences were seen in fasting and postprandial glucose, insulin, proinsulin, C- peptide and HbA1c levels between groups or in insulin resistance, insulin sensitivity, beta cell function and beta cell responsiveness. CLA supplementation has no effects on diabetes glucose level and insulin function and its prescription is not recommended.

All pulmonary complications of diabetes have not yet been identified completely and results of limited studies available show controversial results. This study aims to determine lung involvement in diabetic patients with and without retinopathy and compare them with healthy subjects. This cross-sectional study was conducted on three groups, 33 diabetic patients with, and 33 patients without retinopathy and 33 healthy subjects as the control group. Diabetic patients were matched with the control group in terms of weight, height, age and sex. Spirometry was performed using a portable spirometer and the results compared with the appropriate statistical software. Diabetic patients did not show significant reduction in FEV1 and FVC compared to the control group (p>0.05) but PEFR showed significant reduction (p<0.001). Mean PEFR values were lower in patients with retinopathy compared to subjects without retinopathy, difference not statistically significant (p >0.05). FEV1/FVC was significantly higher in diabetics than nondiabetics, and also in patients with retinopathy in comparison to patients without retinopathy (p<0.001). PEFR and FEV1/FVC values, in regard to duration of diabetes (≥10 Yrs), had significantly reduced and increased respectively (p=0.039, p = 0.049). Type of diabetes control (Insulin Vs Oral agents) did not show significant changes in spirometeric parameters between patients with and without diabetes (p >0. 05). This study showed that the pulmonary function is impaired in diabetes mellitus. Increased FEV1/FVC and decreased PEFR present a restrictive pattern in diabetic patient. And the severity of pulmonary complications seems to be correlated with other complication o f diabetes(retinopathy). Duration of diabetes has a significant association with pulmonary complications, whereas the type of treatment has no effect on pulmonary function. To design screening tests for lung involvement in diabetic patients, we need more precise and extensive studies.

Recent studies indicate that Visfatin, a newly identified adipocytokine, may have potential proinflammatory effects. Since, the relationship between serum visfatin levels and metabolic syndrome (MetS) has not been established, the aim of this study was to explore the association between serum visfatin levels and anthropometric variables and the metabolic syndrome. Thirty-seven patients with MetS and 37 age matched controls (mean age 46.35±1.6 years) were included. Metabolic syndrome in patients was defined based on the 2005 criteria of the International Diabetes Federation, and anthropometric and biochemical profiles were documented. Serum Visfatin was measured using an enzyme immunoassay (EIA) kit. Using the t-test, data were compared between groups and Pearson's correlation coefficient was used to evaluate the relationship between continuous variables. P values <0.05 were considered as statistically significant. Serum Visfatin level was significantly lower in metabolic syndrome patients (P<0. 05) compared controls, log visfatin: 1.74 ± 0.27ng/ml vs. 1.86 ±0.13 ng/ml, respectively. There was no significant correlation between serum visfatin levels and any anthropometric or any metabolic parameters in patients with metabolic syndrome or the control group. The results of this study showed that serum visfatin level was decreased in patients with MetS, indicating that Visfatin cannot be considered as a new proinflammatory adipocytokine for the metabolic syndrome.

Adolescence is a critical period of growth and development, and inadequate nutrition during this period may increase the incidence of obesity, sexual maturation delay, high blood pressure and osteoporosis in adulthood. This study was conducted to determine the prevalence of underweight, overweight and obesity and some dietary factors associated with it in adolescent high school girls in Lahijan, north of Iran. In this descriptive-analytical study, 400 students were selected by random stratified sampling from 12 schools. Data collected were demographics status, 24-hour dietary recall, food habits and food frequency questionnaires were completed for all samples. Weight and height were measured and BMI was calculated. BMIs at or above the 85th and 95th percentiles for age and sex (based on WHO standard) were classified as overweight or obese, respectively. Data were analyzed by the SPSS program and ANOVA, chi-square and pearson correlation tests. The prevalence of underweight, overweight and obesity were 4. 7%, 14. 8% and 5. 3%, respectively. Mean energy, carbohydrate and fat intakes were significantly higher for overweight/obese girls than for under weight and normal weight ones (P<0. 0001). A significant positive correlation was observed between consumption frequencies of fried and fast foods with BMI (respectively: r=0. 24, P<0. 0001 and r=0. 19, P<0. 0001). High energy, fat and carbohydrate intakes as well as consumption of fast and fried foods were associated with BMI in adolescent girls. Hence, more attention must be given to improving the nutritional status and dietary patterns of adolescents through policy making, nutritional education and implementing changes in nutritional styles.

Leptin, a protein with a cytokine-like helical structure and molecular weight of 16 KDa, regulates the body weight and homeostasis of the energy in the body. Adiponectin has protective and special metabolic effects as well as anti-inflammatory ones, and the adiponectin level in human blood has an inverse ratio relation with the insulin resistance. The purpose of this study was to compare levels of leptin and adiponectin, and related hormones in the serum of obese children and adolescents. Sixty obese subjects were divided into two groups of 30 children and 30 adolescents. Anthropometric characteristics were recorded and adiponectin and leptin testosterone, growth, insulin, and cortisol hormones were measured in a fasting state in all subjects. The serum levels of leptin (101%), adiponectin (98%) and cortisol hormone (38.62%) were significantly higher in children than in adolescents (p<0/05). When leptin and adiponectin were adjusted to body fat mass, the same results were observed. Serum levels of testosterone (82.58%), insulin (34.47%) and growth hormone (36.36%) were significantly higher in adolescents than in children (p<0/05). The ratio of leptin to adiponectin had no significant difference among children and adolescents. Levels of leptin and adiponectin are higher in children than in adolescents.

Improvement of abdominal obesity indices in middle-aged obese women by of exercise training has significant importance. The aim of the study was to assess the effects of rhythmic endurance training on abdominal obesity indices (waist to hip ratio, waist circumference, waist to high ratio, body fat %) in working women. This study was a randomized controlled clinical trial conducted on, middle-aged women, aged >35 years, with abdominal obesity, regular menstrual cycle, without regular exercising, registered nurses & midwives, medicine, rehabilitation, para clinic, health sciences university and all administrative departments of the Iran university of Medical Sciences. Volunteer participants (n=31) were randomly separated into cases (n=17) and controls (n=14). The case group has rhythmic endurance training for 8 weeks. At the beginning and the end of the study, in addition to completion of questionnaires, anthropometrical data, VO2 Max determined by tape, calipers and a chronometer. The results obtained showed that endurance training had no significant effect on waist-to-hip ratio in the cases, but significant positive changes on waist circumference, waist-to-high ratio and body fat percentage were seen. Decrease in waist to hip ratio was not significant after endurance training, probably due to short duration of exercise (8 weeks) and also may be related to lack of diet control.

The role of breast-feeding in protection against childhood acute leukemia is uncertain. In this study, we tested the hypothesis that breast-feeding decreases the risk of 300 patients we investigated childhood acute leukemia. In a case control study, we inrestigated 300 patients, aged 2±13 years, with acute leukemia, as well as 300 controls, individually matched for age and sex. Information regarding breast-feeding was obtained through face to face interviews with mothers. Findings showed that there was a significant relationship between duration of breast-feeding and childhood acute leukemia (P<0. 001). Breast-feeding of less than 1-months durations, when compared with feeding of longer durations 19-24 months was associated with increased risk of childhood acute leukemia (OR=3. 54). In this study, breast-feeding was associated with a reduced risk of childhood acute leukemia. Our findings suggest that future epidemiologic and experimental efforts should be directed at investigating the relationship between breast-feeding duration and all malignancies among children.

Data available reports that the novel biomarkers of cardiovascular diseases have more sensitivity and accuracy in anticipating cardiovascular disease. Hence, considering the significant role of physical activity in decreasing and preventing these diseases, determining the type of physical activity, its duration and intensity, and appropriate pattern significantly promotes the individual's health. In this study, effects of two training methods, the aerobic and anaerobic, on some pre-inflammatory cytokines in adult male rats were compared. In this experiment, 54 male wistar rats (3 months), were kept in a controlled condition, randomly divided into three groups, the control, aerobic and anaerobic groups. The training program was conducted for a period of 12 weeks - 3 sessions per week, specified durations and intensity. To assess the influence of one session of an aerobic and anaerobic, training program, following the program, the first blood sample was taken. After the 24th and 36th sessions, the second and the third blood samples were obtained. Blood samplings were done after 14 hours of fasting and 24 hours after the final training session. Data were analyzed with Kolmogrov-Smirnov, One Way ANOVA, Repeated Measurement and the LSD post hoc tests, at the level of α ≤ 0. 05. Aerobic training causes a significant decrease in quantities of sICAM-1(p<0. 001), inflammatory mediators of IL-1β (p<0. 01), and TNF-α (p<0. 05), whereas anaerobic training leads to a significant increase in quantities of sICAM-1(p<0. 01), IL-1β (p<0. 05) and TNF-α (p<0. 05). The results of this study show that the regular aerobic training (55-85% Vo2max) causes a significant decrease in novel biomarkers of cardiovascular diseases, whereas intensive anaerobic training (100 and over 100%Vo2max) causes a significant increase in these, and exposes the body to the risk of inflammatory impairment. Therefore, it is possible that decrease in the novel anticipating factors of cardiovascular diseases after regular aerobic training could be due to reduction of the atherogenesis process, whereas anaerobic training could have the opposite effect.

Several clinical studies indicate deterioration of sexual behavior in diabetic patients. The pathophysiological mechanisms of diabetic sexual impotence remain obscure. In this study the therapeutic effects of melatonin on sexual behavior were investigated through the central serotonergic system in diabetic rats. In this study, 30 male adult Wistar rats, weighing 200±20 g, were used. Animals were divided into three groups, the controls (C), diabetic (D) and the melatonin-treated diabetic (M) group. Experimental diabetes was induced by intraperitoneal injection of 50 mg/kg streptozotocin. Melatonin was injected (10 mg/kg i. p.) after 3 days of streptozotocin injection for 30 days. At the end of the administration period, the sexual behavior of each male rat to an ovariectomized female rat was assessed for 40 min. Serotonergic type 2 (5-HT2A) receptor activities were investigated through spontaneous WDS behavior, and experimental data were statistically analyzed. First mount, first intromission and first ejaculation latencies significantly (p<0. 05) increased in diabetic rats as compared to controls. Melatonin treatment significantly (p<0. 05) reduced these responses in the M group, compared to the D one. Also the number of mounts, intromissions and ejaculations significantly (p<0. 05) decreased in diabetic rats compared to controls. Administration of melatonin significantly (p<0. 05) increased these activities in the M group as compared to the D one. Calculation of copulatory efficiency and the sexual activity index of each rat indicate that reproductive activity in diabetic rats was significantly (p<0. 05) less than other two groups. The number of WDS responses was significantly (p<0. 05) different in all three groups. Sexual dysfunction in diabetic animals was accompanied by decreasing of 5-HT2A receptor activities, and melatonin prevented the diabetes-induced sexual impotence by modulating of central serotonergic system activity.

Osteoporosis is one of the most common metabolic bone diseases. Half of all women over the age of 50 years suffer an osteoporosis-related fracture in their lifetime. Treatment regimen consists of both nonpharmacologic and pharmacologic therapy. One most effective nonpharmacologic therapy is continuous and suitable exercise.

The aim of this review is to assess the effects of exercise on Bone Mass Density (BMD). The results of related clinical trials suggest that all exercises do not have positive effects on BMD and the type, severity and duration of exercise are important factors in increasing BMD.

It seems that a combination of weight bearing and resistance exercises, as a specific and continuous program has an effect on increasing BMD. Some clinical trials showed that strength exercise is also effective. Concussion: Since osteoporosis more commonly affects postmenopausal women, an organized exercise program including aerobic and light exercise is effective in increasing BMD. Considering the positive effects of exercise, regular exercise programs are in these women are recommended.