مجله دیابت و متابولیسم ایران
سال سیزدهم شماره 2 (پیاپی 53، آذر و دی 1392)

Assessing of outcomes and risk factors in the form of qualitative variables is common in the most of medical studies and the research objectives are defined as the relationship between these variables. This paper introduces the concepts and basic and applied statistical tests to examine the relationship between these variables in these studies, including chi-square tests. Principles and method of calculating the statistics and hypothesis testing to assess the relationship between qualitative variables (or difference in proportions between groups), were presented taking into account relevant considerations. The method of reporting findings were introduced in the context of contingency tables, for all types of chi-square tests. To investigate the relationship between two binary or multi-category qualitative variables, Pearson chi-square test (in the case of establishing Cochran conditions), Yates continuity correction for small samples, in the case of not establishing Cochran conditions exact P-Value calculated on the basis of exact tests, trend chi-square test for ordinal qualitative variables and McNemar chi-square test for related samples should be used. In addition for tables larger than 2 × 2, when the overall relationship was significant, post hoc tests with appropriate correction is required. In each of these situations, examples based on research, calculations of tests were performed and their results were presented. To investigate the relationship between a set of risk factors and nominal or ordinal qualitative variables, the introduced analyses are recommended considering the situation and purpose of the proposed study.

the aim of this study was to investigate the effect of seven weeks endurance training on RBP4 gene expression in Soleus and Extensor Digitrum Longouse (EDL) Muscles, liver, visceral and subcutaneous fat in type 2 diabetic rats. 50 male wistar rats (5 weeks years old, weight = 93.7 ± 8.9) were purchased and randomly divided into four groups: Control (n=10) (C), Trained (n=10) (T), Diabetic Control (n=15) (DC) and Trained diabetic (n=15) (TD). Diabetes was induced by injection of low dose of streptozotocin (STZ) and feeding with high fat diet. Insulin resistance accuracy was confirmed by HOMA-IR index and Real-time PCR was used for mRNA content. After seven weeks of diabetes induction, the RBP4 mRNA content of the liver (2.37-fold; P < 0.01), visceral fat (2.33-fold; P < 0.01), and subcutaneous fat (1.83-fold; P < 0.05), soleus (1.21-fold; P < 0.05) and EDL (2.03-fold; P < 0.05) were increased. After seven weeks of endurance training significant decrease in RBP4 mRNA content was found in visceral fat (P < 0.05), subcutaneous fat (P < 0.05) and EDL (P < 0.05) between DC and CD. In addition, significant difference between T and TD groups was found for RBP4 mRNA content in liver (p < 0.01), subcutaneous fat (P < 0.01) and EDL (P < 0.01) after seven weeks of endurance training. Type 2 diabetes considerably increases skeletal muscle RBP4 expression in isoform- specific manner. This increase is also seen in liver, subcutaneous and visceral fat. In addition, endurance training decreases the RBP4 expression in EDL, subcutaneous and visceral fat.

the aim of the present study was to investigate the effects of diabetes and seven weeks of endurance training on RBP4 expression in Soleus, extensor digiturom longuse (EDL), liver, visceral and subcutaneous fat in type 2 diabetic rats. Fifty male wistar rats (93.7 ± 8.9 g) were randomly divided into four groups including: control (C) [n=10], trained (T) [n=10], diabetic control (DC) [n=15] and diabetic trained (TD) [n=15]. The combination of Intraperitoneally injection of streptozotocin (STZ) and high fat diet feeding were used for diabetes induction. After seven weeks of endurance training, serum RBP4 and its expression in above tissues were measured by ELISA and western blotting techniques, respectively. diabetes induction increased the RBP4 expression of the liver (3.57-fold, p < 0.01), visceral fat (2.02-fold, p < 0.01), and subcutaneous fat (1.84-fold, p < 0.01) and EDL (2.29-fold, p < 0.01) in DC in comparison to C group. Serum RBP4 concentration was significantly higher in DC (2.9-fold, p < 0.01) and TD (1.84-fold, p < 0.01) in comparison to C group. Endurance training significantly decreased serum RBP4 (p < 0.01) and its expression in visceral fat (p < 0.01) in DT in comparison to DC. type 2 diabetes extensively decreases the skeletal muscle RBP4 expression in isoform – specific manner, liver, subcutaneous and visceral fat. In addition, endurance training decreases serum RBP4 concentration and its expression in visceral fat.

Cognitive and emotional deficits in alexithymia lead to various problems in somatic disorders and other medical conditions for example Diabetics. The aim of this study was to examine the effect of alexithymia on relationship between self-care and control of blood sugar in type 2 diabetes patients within the Iranian social and cultural context. The present study was a cross-sectional investigation. The study sample consisted of 100 (60 females and 40 males, aged 40 to 70 years) type 2 diabetic outpatients visiting Labbafinejad hospital during the year 2012. Measures for data collection included demographic, anthropometric and clinical questionnaires, the short scale for diabetes self-care activities and the diabetes-related quality of life. Blood tests were performed to obtain HbA1c levels and other laboratory measures related to the study. Data were analyzed using SPSS16 software. Pearson product correlation results yielded significant negative associations between self- care activities and alexithymia as well as HbA1c levels in type 2 diabetes patients. Results of hierarchical regression analyses indicated that diabetes-related self-care activities explained 40% of HbA1c variance and alexithymia added explanatory variance above and beyond self-care, to jointly explain 58% of HbA1c variance. Based on the present findings, diabetes-related self-care and alexithymia predicted HbA1c levels in patients with type 2 diabetes. Given the evidence on the additive validity of alexithymia in the prediction of HbA1c levels found in the present study, attention to emotional competencies and disorders of Iranian diabetic patients may effectively contribute to their control of diabetes.

Patient education as an integral aspect of communication between health care providers and patients plays an important role in patient health management; Teach Back (TB) is a method of interactive education. Using the teach-back technique not only improves patient’s knowledge and understanding, but also increases patient’s adherence to disease management. Furthermore, self-care education to diabetic patients has always been a key strategy for successful control of diabetes. The aim of this study is assessment the effect of self care education based on Teach Back method on promotion of self care behaviors in type II diabetic patients of Hamadan city, 2012. This interventional quasi-experimental study was performed by choosing 70 type II diabetic patients Random permutation divided into two experimental (n=35) and control (n=35) groups. Educational programs base on TB designed for patients in the intervention group included four sessions. Before and one month after the educational intervention, the results were evaluated. Participants responded to the knowledge and SDSCA questionnaires. Information was collected through interviews and self report, and then data were analyzed by SPSS-20. The results indicated a positive impact of TB on knowledge (p< 0.001) and self-care behaviores (p<0.001) among patients of the intervention group. The results showed the positive effect of education program based on Teach Back method to increase self management among diabetic patients, while implementing such programs seem to be effective in the treatment and prevention of diabetes complications.

Food insecurity refers to the inability to afford enough food for an active, healthy life. The metabolic syndrome, otherwise known as syndrome X or the insulin resistance syndrome, is a collection of cardiovascular risk factors including hypertriglyceridemia, lowered HDL-cholesterol, glucose intolerance, abdominal obesity and hypertension. Recent studies indicate widespread prevalence of food insecurity and metabolic syndrome in various regions of Iran. No studies have been conducted so far to investigate the relationship between food insecurity and the metabolic syndrome in Iran. This study was conducted to investigate the relationship between food insecurity and metabolic syndrome in women. In this study, 130 women 30 to 60 years old with metabolic syndrome as cases and 130 women without metabolic syndrome as controls referred to clinics affiliated to Shiraz University of Medical Sciences were selected. The USDA household food security questionnaire was used to assess food insecurity status. The metabolic syndrome was defined according to the criteria of the Adult Treatment Pane l II (ATP III). The prevalence of food insecurity was 69.2% in cases and 45.4% in controls (P< 0.001). After multiple logistic regression and removal of potential confounders, food insecurity was significantly associated with metabolic syndrome (OR3.2&CI 95%: 1.9-5.6)(P<0.05). Given that food insecurity is an important risk factors for metabolic syndrome, Planners should reduce food insecurity in society, especially women through measures to improve the economic situation and dietary patterns of households.

Mesenchymal stem cells (MSCs), also known as mesenchymal stromal cells, are considered as an important source of adult stem cells in tissue engineering and cell therapy. They are present in various tissues such as, endometrium as the supportive cells. According to anatomical position of endometrial mesenchymal stem cells that put them in neighborhood of the fetus, they may have a significant role in fetus tolerance during pregnancy. This study was conducted to evaluate the molecular mechanism of immunosuppressive affect of endometrial mesenchymal stem cells. Mesenchymal Cells from bone marrow and endometrium were cultured at density of 2 ×105 cells/ml at presence of 100IU/ml and 500IU/ml INF-γ (IFN-gamma) and expression of indoleamine 2 3-dioxygenase (IDO) were studied after 72 hours by real-time PCR and immunocytochemistry. The study showed that IDO expression in cells exposed to IFN-γ was increased compared to the cells in the absence of IFN-γ (p<0.05). Additionally, up regulation of IDO expression was higher in endometrial cells than bone marrow cells. From these results it is concluded that endometrial mesenchymal stem cells may be used as a good candidate for cell therapy.

It is now evident that adipose tissue functions as an endocrine organ by releasing adipokines, and the levels of a number of inflammatory markers elevated in overweight and obese individuals. The objective of this study was to examine the association between inflammatory markers (IMs) including C-reactive protein (hs-CRP), Interleukin-6 (IL-6), Homocystein (Hcy) and obesity variables in Tehran Lipid and Glucose Study (TLGS) adults. In this cross-sectional study, 352 individuals (132 men and 220 women), age ≥19 years, were randomly recruited from among TLGS population. Individuals were categorized based on the waist circumference. The serum levels of IMs were determined using the Enzyme Linked Immunosorbent Assay (ELISA) method. The mean age of participants was 46.1±16.1years and Abdominal obesity were present in 199(56.5%) individuals. The levels of hs-CRP and IL-6 were higher in abdominally obese group (1507±3.3 vs. 577.8±4.3 ng/mL p<0.001) (3.6±3.3 vs. 1.9±3.8 pg/mL p< 0.001), and in the same group, the best predictors (based on the adjusted R2) for hs-CRP, IL-6 and Hcy were waist (WC), waist to height ratio (WHtR) and wrist, respectively. Hip and WHtR were the best predictors for Hcy and hs-CRP in normal group; there was no variable significantly correlated with IL-6, therefore it was not possible to consider an independent predictor for IL-6. According to this study, obesity is associated with IM levels, and in abdominally obese group, the best predictor for Hcy, hs-CRP and IL-6 were Wrist, waist and WHtR respectively.

There are growing concern globally regarding fast food consumption and its related cardiometabolic outcomes. In this study we investigated whether fast food consumption could affect the occurrence of metabolic syndrome after 3-years of follow-up in adults or not. This longitudinal study was conducted in the framework of Tehran Lipid and Glucose Study on 1476 adults, aged 19-70 years old. The usual intakes of participants were measured using a validated semi-quantitative food frequency questionnaire at baseline. Biochemical and anthropometric measurements were assessed at baseline (2006-2008) and 3 years later (2009-2011). Multiple logistic regression models were used to estimate the incidence of the MetS in each quartile of fast food consumption. The mean age of participants was 37.8±12.3 years old, and the mean BMI was 26.0±4.5 kg/m2 at baseline. Participants in the highest quartile of fast food consumption were significantly younger (33.7 vs. 43.4 years, P <0.01). Higher consumption of fast food was accompanied with more increment in serum triglyceride levels after the 3-year follow-up (10.6±2.3 vs. 4.4±2.3 percent in the fourth and first quartile, respectively, P<0.01). After adjustment for all of the potential confounding variables, the risk of metabolic syndrome, in the highest quartile of fast foods compared with the lowest, was 1.85 (95% CI= 1.17-2.95). We demonstrated that higher consumption of fast foods had undesirable effects on metabolic syndrome after 3-years of follow-up in Iranian adults.

Discordance (the presence of different categories of T scores in two skeletal sites of a single patient) can affect the physician’s decision to start medication or not. The present study was therefore conducted to assess the prevalence of T-score discordance between spine and femoral neck as well as its risk factors in a group of postmenopausal Iranian women. The present analytical cross sectional research was conducted based on the results of IROSTEOPs study on 8146 postmenopausal women referred to the bone mineral density (BMD) center of Shariati Hospital affiliated to Tehran University of Medical Sciences between 2000 and 2011. Based on their BMD results, the patients were categorized into three groups: Concordance and Minor and Major discordance. The factors affecting the risk of developing discordance was then studied through uni/and multivariate logistic regression. Discordance between spine and femoral neck was reported in 3741 (45.9%) of the participants. Multivariate logistic regression revealed that older age, higher number of pregnancies and higher body mass index (BMI) are the main risk factors for T-score discordance at the studied sites. The use of hormonal replacement therapy (HRT) on the other hand played a protective role. It could be concluded that performing BMD at two different sites is necessary for the Iranian population, particularly postmenopausal women.