مجله غدد درون ریز و متابولیسم ایران
سال چهاردهم شماره 4 (پیاپی 64، آبان 1391)

Diabetic neuropathy is one of the more common complications plaguing individuals with type 2 diabetes. The development and progression of such complications are responsible for much of the morbidity and mortality related to this disease. This investigation evaluated accuracy of lily and Semmes–Weinstein monofilaments examination for diabetic peripheral neuropathy screening. Our study population consisted of 150 patients treated for diabetes mellitus at the Diabetes Clinic of the Ahvaz Jundishapur University of Medical Sciences. The samples were chosen on the basis of a non-randomized sampling. All patients were tested for sensory neuropathy using two types of monofilament (Semmes Weinstein monofilament examination 8, and 10-grams). In the next phase EMG-NCV were examined. Sensitivity and specificity two types of monofilaments were analyzed. The 10-g monofilaments had a sensitivity ranging from 38.5% to 51.3% at sites 1-4, and specificity between 73 to 87.4 the sensitivity and specificity of the 8-g monofilament were 41 to 51.3% and 72.1 to 86.5% respectively. Two types of monofilaments at with 51.3 and 74.8% sensitivity and specificity respectively sites 1 and 4 was the most useful diagnostic test for DPN. These data suggest that the monofilaments may be the optimum methodology for identifying individuals at risk of diabetic peripheral neuropathy. Hence, we recommend screening of patients for neuropathy as soon as they are diagnosed with diabetes.

Although several studies indicate that the quality of life of diabetic individuals decreases compared with non-diabetics, fewer studies have evaluated the association between quality of life and glycemic control in these people. The present study was conducted to assess the association between health-related quality of life and glycemic control in people with type 2 diabetes.

This cross-sectional study was conducted on 125 type 2 diabetic individuals. Indices of glycemic control (serum concentrations of glucose, fructosamine and insulin, insulin resistance and HbA1c percent) were measured after 12-14 hours of fasting. Health-related quality of life was examined by a 36-item short-form health survey questionnaire (SF-36). Using logistic regression and considering the confounding variables, the relationship between quality of life scales and glycemic control were evaluated.

An inverse significant relationship between fructosamine concentration (p=0.04) and glucose concentration (p=0.04) with the general health scale score was observed. There was also a reverse significant relationship between serum glucose concentration and role limitations due to the physical problems scale score (p=0.02) and between insulin concentration and the physical functioning scale score (p=0.04).

There was a significant relationship between some quality of life scales and glycemic indices, indicating that better glycemic control in diabetic individuals enhances their quality of life.

Diabetic dyslipidemia is a complication of diabetes and several studies have demonstrated that nut consumption exerts beneficial effects on serum lipid profile. We designed an intervention study to evaluate the effects of cashew on fasting serum glucose, insulin and lipoprotein in type 2 diabetic patients.

In an 8 week randomized parallel clinical trial, 50 diabetic patients (34 women and 16 men) were randomly assigned to two groups) the intervention (cashew) and the control (regular diet) groups. Cashews replaced 10% of total daily calorie intake in the intervention group. Blood samples were collected from fasting subjects at entry to the study and at the end of the study. All dietary data were obtained using 24-hours recalls at baseline, in the middle and at the end of the study.

Mean HDL-C and insulin concentrations were statistically different between the intervention and control groups (P=0.01, P=0.023, P=0.043 and P=0.023 respectively), while other biochemical indices such as serum glucose and other lipoproteins, were not.

The results indicated that replacing 10% of daily calorie intake with cashew in patients with type 2 diabetes may prevent HDL-C reduction and also decrease serum insulin, and hence possibly play an important role in decreasing cardiovascular risk factors in diabetic patients.

Leisure-time physical activity (LTPA), as a lifestyle-related behavior, could be a preventive factor for metabolic syndrome (MetS). We aimed to examine the association between LTPA and MetS among the adults who participated in the Tehran Lipid and Glucose Study (TLGS). In the present cross-sectional study, 4665 adults (1976 males and 2686 females), aged 20-70 years, were selected by multi-stage random cluster sampling from among TLGS participants. Subjects were classified according to their BMI. LTPA was determined via a validated and Modifiable Activity Questionnaire (MAQ), and MetS, according to the JIS criteria. Prevalence of the MetS was higher in obese groups (58.2%) compared to the overweight (36.6%) and normal weight (6%) ones (p<0.001). Normal weight subjects (18.1%) were physically more active than other groups. In the normal weight group with light LTPA, the risk of lower levels of HDL-C and elevated levels of TG were higher than in individuals with vigorous LTPA (OR: 1.15; CI95% 1.05, 2.33) (OR: 1.46; CI95% 1.01, 2.14). In the overweight group, the probability of elevated levels of FBS was higher among individuals with moderate LTPA than in those with vigorous LTPA (OR: 1.65 CI95% 1.37, 3.23), and there was also an inverse association between light LTPA and MetS (OR: 2.08; CI95% 1.03, 4.21). This study confirmed that increased levels of LTPA are associated with a decreased likelihood of any inappropriate changes in components of Mets and the occurrence of Mets.

The aim of this study was to evaluate the association between dietary phytochemical index (PI) and occurrence of metabolic syndrome and its components during a 3 year follow up of Tehranian adults.

This longitudinal study was conducted within the framework of Tehran Lipid and Glucose Study, between the third (2006-2008) and fourth phases (2009-2011). Dietary intakes were collected using a validated semi-quantitative food frequency questionnaire at baseline. The predictor role of dietary phytochemicals for risk of abdominal obesity, fasting glucose intolerance, hypertriglyceridemia, hypertension and metabolic syndrome-according to the international criteria-were evaluated using regression logistic models after adjustment of confounding factors.

The mean of dietary phytochemical index was 29.8±12.3 at baseline. Higher intake of phytochemical-rich foods was associated with a significant descending trend in risk of metabolic syndrome, abdominal obesity, hypertriglyceridemia and hypertension (P for trend < 0.05). Subjects in the highest quartile of dietary phytochemicals intake had a thirty-nine percent lower risk of abdominal obesity (0.61; 95%CI: 0.36-0.99), thirty seven percent lower risk of hypertriglyceridemia (0.63; 95%CI: 0.38-0.99) and a forty four percent lower risk of hypertension (0.56; 95%CI: 0.35-0.90), compared with those in the lowest quartile.

Our findings indicate that higher intakes of phytochemical-rich foods can decrease the risk of metabolic syndrome and related risk factors.

Logic regression is a generalized regression method that can identify complex Boolean interactions of binary variables. This method has been successfully used for analyzing single-nucleotide polymorphism data, because in SNP association studies interactions are important. The aim of this study is to investigate the associations between some candidate gene polymorphisms and HDL concentration using Logic Regression. Subjects for this cross sectional study, 436 subjects (172 men and 264 women) aged≥20 with some polymorphisms, were randomly selected from among participants of the Tehran Lipid and Glucose Study (TLGS). Logic regression analysis was used to identify combinations of main genetic effects and interactions associated with HDL. Cross validation and randomization test were done to avoid over fitting of the models. Cross validation test suggested that the Logic model with four Boolean combinations and four predictors was the best logic model, which after fitting, showed that individuals who carry Apoe SNP ε3 or have high TG have an odds ratio of 2.35 (CI 95%:1.3-4.25) for having low HDL compared to other subjects. Also subjects with high TG have odds ratio 2.73 (CI 95%: 1.65,4.53) for having low HDL. Results of this study shows that Logic Regression is a powerful method to determine the interaction effect between high TG and ApoE SNP for having low HDL.

The purpose of this study was to investigate the relationship between food security and food variety in a population, aged over 40 years. From among the non-diabetic population, aged over 40 years of the Tehran Lipid and Glucose Study, 200 subjects were selected randomly to complete the household food security questionnaire and were divided into four groups including high food security, food security border, low food security, and very low food security. Demographic, anthropometric and dietary intake data of each subject were collected and the dietary diversity score (DDS) was determined based on five food groups of the food guide pyramid. Mean±SD for DDS of subjects was 4.94±1.35, and in the high food security group was significantly higher than in the food insecurity group (the other 3 groups). Mean±SD for food security in the first quartile of DDS (3.04±1.95) was higher than in the third (1.94±2.1, P=0.005) and fourth quartiles (2.22±2.2, P=0.043). The lowest and highest percentages of subjects with high food security were in the first and third quartiles of DDS, respectively. After adjusting sex, age, body mass index, energy intake, job and marital status, the odds of being in the lowest quartile of fruits variety for high food security group was 73% lower than for the low food security group. An inverse correlation was observed between food security score with the DDS (r=-0.42, P=0.012), the fruits variety score (r=-0.45, P=0.004), and the vegetables variety score (r=-0.37, P=0.046). Dietary diversity as an indicator of a healthy diet is associated with food security and increases food security results in dietary diversity, especially in fruit and vegetable varieties.

Nonalcoholic steatohepatitis (NASH), a stage of fatty liver, occuring in individuals with little or no alcohol consumption, is characterized by macro- and microvesicular steatosis with inflammation, ballooning degeneration, hepatocyte necrosis, Mallory bodies and fibrosis. It has been suggested that oxidative stress might play an important role in the pathog­enesis and progress of NASH. The aim of present study was to determine the preventive effect of catalytic antioxidants (two Mn-salen complexes) on diet-induced steatohepatitis in rats. NASH was induced in male N-Mary rats by feeding them with a methionine - choline deficient (MCD) diet for 14 weeks. The rats were randomly assigned to receive vitamin C, EUK-8, EUK-134 (n=5, 30 mg/Kg/day) or vehicle orally. At the end of the experiment, sera biochemical analyses and histopathological examination of liver samples were performed. Treatment of rats with Mn-salens and or vitamin C significantly reduced the sera cholesterol, glucose, aminotransferases and alkaline phosphatase activities, the extent of lipid peroxidation and protein carbonylation whereas the weight and HDL level were significantly increased. In addition, these compounds improved NASH pathological features in liver of MCD fed rats. SPSS statistical software was used for statistical analysis, with P values of less than 0.05 being considered statistically significant. Based on the present data, supplementation of Mn-salen complexes could be beneficial in the prevention of nonalcoholic steatohepatitis in rats.

Adipokines, compounds secreted from adipose tissue, are involved in metabolism control. Omentin is one of the adipokines with different biological roles. Serum levels of Omentin were found to be associated with BMI, insulin resistance, metabolic syndrome, diabetes, and cardiovascular disease in several studies. The aim of this study was to assess the association between omentin level and the PolyCystic Ovarian Syndrome.

This case-control study was performed on 45 patients with Poly Cystic Ovarian Syndrome and 45 normal individuals as controls. BMI and fasting omentin and insulin serum levels were measured by Enzyme-Linked Immunosorbent Assay (ELIZA) method, fasting glucose serum level was measured by enzyme-calorimetric method and insulin resistance index (HOMA-IR) was measured using the relevant equation. Data was analyzed using the independent t-test, Pearson correlation coefficient and by SPSS 16 software.

Omentin serum levels in the patient PCOS group were significantly lower in patients with polycystic ovarian syndrome than in controls. Insulin and glucose serum levels in the PCOS group were significantly higher than in controls, indicating these patients had insulin resistance. There was no significant correlation between serum levels of omentin and HOMA-IR between cases and controls.

This study shows that serum omentin level decreased in PCOS patient in comparison with BMI-matched controls. The findings of this study suggest that changes in omentin serum level may be considered as a criterion of PCOS.

Considering the high sensitivity of bone to mechanical stimulations, one of the potential ways of impressing bone tissue in clinical perspective, is applying physical and mechanical loads. In this study, we compared the effect of progressive resistive exercise versus pulsed electromagnetic fields on total ALP, calcium, phosphorus and cortisol, and anthropometric variables in primary postmenopausal osteoporotic women.

Thirty estrogen-deficient postmenopausal women were assigned randomly to pulsed electromagnetic field therapy (PEMF), resistance training (RT), and control groups. Treatment in the PEMF group consisted of 45 min induction of rectangular wave with frequency of 30 Hz and intensity of 40 Gauss; the RT group consisted of performing trunk, upper and lower body resistance exercises that progressed during 6 weeks from 50% to 85% 1RM, for approximately 45 min, 3 days/week. Throughout this duration of six weeks, the control group was requested not to change their physical activity routines and dietary intakes. Blood total ALP, Ca2+, P, and cortisol was measured before and after 6 weeks.

After 6 weeks of PEMF or RT, total ALP increased significantly in the control group. Fat mass was significantly decreased in RT group after 6 weeks and increased significantly in controls. In all groups serum Ca, P, and cortisol showed no significant changes after 6 weeks.

Regarding the increase of total ALP in the RT and PEMF groups, it seems that PEMF can be used instead of RT for improving bone metabolism in high risk, severely osteoporotic patients.

The purpose of this study was to determine the effects of L-carnitine supplementation on carbohydrate (CHO) and fat metabolism after resistance exercise. In this investigation, using a double blind, randomized, crossover, repeated measure design (1 wk washout), 10 healthy resistance-trained men (Mean±SD: age, 24.03±2.00 yr; mass, 72.26±5.31 kg; height, 173.90±5.02 cm) consumed 2 g placebo or LC supplement daily for one week and then performed 6 exercises of a resistance exercise protocol. Each workout was performed for 3 sets of 12 repetitions with 55% 1RM and rest periods were kept to 60 s between all sets and workout. Expired gases were measured for calculating CHO and fat oxidation. Venous blood samples were obtained before and after supplementation, immediately after resistance exercise and after the 1st and 24th hour after resistance exercise. Samples were analyzed for markers of glucose, NEFA, glycerol and insulin. Also L-carnitine plasma concentrations were measured, before and after supplementation. The results of this study suggest that plasma carnitine concentrations increased 14% (p≤0.05) with L-carnitine supplementation, with no change in the placebo trial. Compared to the placebo trial, CHO oxidation was reduced significantly (p≤0.05) with L-carnitine supplementation immediately after resistance exercise. However there were no statistically significant differences between the L-carnitine and the placebo conditions for any of the other variables examined (p>0.05). Increased plasma insulin concentrations with L-carnitine and placebo after resistance exercise attenuated result in attenuate fat oxidation in this study.

The association between subclinical thyroid dysfunction and coronary heart disease and cardiovascular mortality is controversial. In this cohort studiy we reviewed the association between subclinical thyroid dysfunction and coronary heart disease and cardiovascular mortality. Electronic search was done in medline and PubMed from 1950 to 2010 and fourteen related studies were found. Because of the heterogenicity between studies for defenitions and adjusted variables, those with larger sample size (more than 2000) were included for final analysis. Eight cohort studies met criteria for selection, but the results differed. In one study with the largest sample size the risk of cardiovascular mortality was increased in women for every one unit increase in serum TSH. In another study with a similar follow up duration of about 20 years, coronary heart disease events and cardiovascular mortality were increased in groups with subclinical hypothyroidism. In one study with moderate follow up of 12.5 years, the risks of cardiovascular mortality and coronary heart disease events were not increased in the group with subclinical thyroid dysfunction, compared to the euthyroid group. We found no definite conclusion based on the studied papers. However, it seems that subclinical thyroid dysfunction may cause an increased risk of coronary heart disease and cardiovascular mortality. We propose that larger cohort studies with appropropriate design for decreasing heterogenicity should be implemented, using dynamic thyroid function.