مجله دیابت و متابولیسم ایران
سال چهاردهم شماره 4 (پیاپی 61، فروردین و اردیبهشت 1394)

The prevalence of non-communicable disorders such as metabolic syndrome (MetS) is high in developing countries. Metabolic syndrome is a disorder of energy utilization and storage، diagnosed by a co-occurrence of three out of five of the following medical conditions: abdominal (central) obesity، elevated blood pressure، elevated fasting plasma glucose، high serum triglycerides، and low high-density cholesterol (HDL) levels. The present review aims to discover the genetic variant reported in association with MetS. The database for genotypes and phenotypes (dbGaP) and the database for genetic associations and human genome (HuGE navigator) were utilized in order to search for genes and their corresponding polymorphisms related to MetS. Additionally، an electronic literature search for other Iranian studies and the genetic aspect of TLGS was completed using PubMed. For phenotype selection in PheGenI، 30 traits were chosen and after the analysis، 21 of them were in common results with MetS. After finding the common variation between traits and MetS، omitting the repeated SNPs، 173 variations were remained. Finally، results distinguished six of the most important genetic regions found to have strong association with MetS. Identifying major genes that are responsible for the metabolic syndrome may improve the medical care for treating individuals with metabolic syndrome، and eventually may lead to personalized medicine in which treatment is tailored genetically to the patient’s needs. The present candidate regions is a respectable start to replicate genetic studies in large affected Iranian individual which we hope leads us to improve our medical care in this field.

Existing studies show that a poor diet has an effect on the progression of non-alcoholic fatty liver disease (NAFLD). The aim of the present study was to systematically summarize the results of studies on the relationship between dietary intakes and NAFLD. A review of Scopus, PubMed, Cochrane Library, Magiran, Medlib and SID databases and theses in the National Library of the Islamic Republic of Iran was conducted to identify epidemiological studies concerning NAFLD, food groups and dietary patterns. Cross-sectional, case-control and cohort studies with documented in English were selected for this systematic review. Duplication, topic, type of study, study population, variables examined and quality of data reporting of articles were evaluated. Of 2128 articles found in the initial search, 33 were reviewed in full-text; of these 6 articles were included in the systematic review. The literature review showed patients with NAFLD consumed more red meat, fats and sweets and less whole grains, fruits and vegetables. The Western dietary pattern was positively associated with the risk of NAFLD and adherence to the Mediterranean diet was negatively correlated to hepatic steatosis. The results of the systematic review indicate that different dietary intakes may be associated with development of NAFLD and its related factors. Due to limited research documented on this topic, further prospective studies are recommended.

One of the important goals in control diabetes to maintain normal levels of glycated hemoglobin, but different social and psychological factors such as social support and alexithymia play role on process of this control. The purpose of present study was to examine the role of alexithymia on the association of social support and glycated hemoglobin in patients with type 2 diabetes. This was a cross-sectional study. The study sample consisted of 100 (60% females, 40-60 years) type 2 diabetic out-patients visiting the Labbafinejad hospital in 2013. The sample of the present study was a convenience sample. Measures of data collection included demographic and anthropometric questionnaires, Multidimensional Scale of Perceived Social Support, Toronto Alexithymia Scale and test of glycated hemoglobin. The collected data were analyzed, using multiple regression analysis. Pearson's correlation coefficients showed a significant association between better reported perceived social support and lower alexithymia and glycated hemoglobin. Results of hierarchical linear regression analyses indicated that social support explained 23% and alexithymia 31% of glycated hemoglobin variance. As well as, alexithymia moderated association between perceived social support and glycated hemoglobin in patient with type 2 diabetes. Based on the present data, alexithymia has moderate role on the association between perceived social support and glycated hemoglobin in patient with type 2 diabetes. The results of this study highlight effective psychological factors in glycated hemoglobin which can help in the conceptualization, planning and design of treatment policies for control and treatment of type 2 diabetes.

One of the serious complications of type 1 diabetes is a sudden increase and drop in blood glucose levels causing risks of anesthesia and coma. Thus, an important step towards the optimal control of the disease is to use intelligent methods with low error rate and available information in order to predict and prevent such complications. In this paper, a combined Fuzzy SARSA algorithm was employed to design an expert system to predict fluctuations in blood glucose levels in patients with type 1 diabetes. The aim of this paper is to propose and implement a new algorithm based on reinforcement learning and fuzzy logic called FSA (Fuzzy SARSA Algorithm) to develop an expert system. The medical data used in this article were related to 3 Iranian female patients with type 1 diabetes. The data included parameters such as the type and dose of injected insulin and time interval between the hours of recorded blood glucose level and the one at the beginning of the period. A well-known reinforcement learning algorithm called SARSA was implemented with fuzzy logic. The Fuzzy SARSA algorithm was used in an expert system to predict fluctuations in blood glucose levels in patients with type 1 diabetes. The results of the expert system with the proposed FSA algorithm for a learning factor included the parameters of blood glucose level at the beginning of the period (mg/dlit), short-acting injected insulin dose in to the body (unit), long-acting injected insulin dose (unit), stress level (unit), physical activity level (unit), used carbs (gr), and the interval between the beginning and end of the period (hour). They indicated that the factor managed to keep blood glucose levels at 85% in a normal range of 80 to 120, and it had 15% error. The error was observed in cases in which there was no proper exploratory factor for short-acting and long-acting injected insulin. According to the results, it was found that the proposed algorithm for intelligent system, with an approximate reduction of 15% in prediction error, can be used as a good model to predict fluctuations in blood glucose levels in patients with type 1 diabetes in comparison with other conventional methods including the ones based on reinforcement learning. In addition, other prediction methods based on artificial intelligence such as neural networks can be used to predict the results accurately.

The possibility that childhood obesity is a chronic disease in adulthood becomes enormous. The incidence and spread of obesity has increased substantially over the past two decades. The importance of personal health and quality of life has prompted researchers to study in this field. The aim of this study was to investigate the changes of serum levels of leptin, insulin, lipid profile, and body mass index after a period of sprint interval training in obese children. In this study, 30 obese children aged 9 to 11 years were randomly targeted placed in two groups (Training and control group). Sprint interval training was conducted for 8 weeks. Before and after training, measurements of leptin, insulin, lipid profile, and body mass index were measured. Data were analyzed using independent t-test (p<0.05). Data analysis showed that after training, leptin, insulin and cholesterol levels were significantly reduced (p=0.001). Also, a significant decrease in BMI was seen (p=0.01). Sprint interval training on leptin, insulin and cholesterol in obese children has a significant impact and this exercise improve body mass index in these individuals.

Hyperlipidemia is a major cause of cardiovascular diseases (CVD) and the most common problems in the community. The present study examined the effect of grape seed supplementation along with aerobic activity on lipid profile in elderly women. In this experimental study, 40 obese women (BMI≥30 kg/m2) over 60 years were selected and randomly divided into two groups (supplement + Exercise and control group). The exercise program included aerobic exercise with 50% of maximum heart rate for three times a week for 8 weeks plus Grape seed extract supplement 200 mg daily for 8 weeks. Blood sampling after fasting period for 12 hours in pretest and 48 hours after the last training session was taken. To compare data between groups t-test was used. The results showed significant differences in the levels of cholesterol, triglycerides and LDL-C and pre-test and post-test group supplemented along with sports activities. Long-term aerobic exercise combined with grape extract consumption may reduce the lipid profile parameters.

A unique subset of Individuals with normal body mass index (BMI= 18.5-24.9 kg/m2) and high body fat percentage (above 30% in women and 23% in men) that are termed as normal weight obese, are at increased risk for development of the metabolic syndrome and chronic diseases because the adipose mass and the excess of fat mass are an important source of proinflammatory cytokines. The aim of the present study was based on this hypothesis that women with high body fat percentage and normal body mass index are at increased risk for the metabolic syndrome in compared to healthy non obese women. This was as case-control study in which 40 obese women with normal weight (BMI= 18.5-24.9 kg/m2) and body fat percentage above 30% (FM> 30%) and 30 non-normal weight obese women (BMI= 18.5-24.9 kg/m2) and fat percentage less than 25% (FM <25%) who were matched for age (mean age = 28 years) recruited for this study. The components of metabolic syndrome including Anthropometric variables, blood pressure and fasting plasma concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, glucose and insulin were measured. The anthropometric measurements including waist and hip circumferences in NWO was higher than non-NWO (respectively; 74.78±4.81 vs. 70.76±2.91 and 99.12±4.32 versus 93.16±2/91, Pvalue<0.001), while the waist-to-hip ratio did not differ between the two groups (p=0.448).Also no significant differences were observed in concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, fasting plasma glucose, systolic and diastolic pressure between groups. Fasting serum insulin and insulin resistance was higher in NOW compared to non NWO (Pvalue<0.05) and insulin sensitivity in NWO was lower than non NWO (0.357 versus 0.374, pvalue = 0.043). Because of the higher serum insulin concentration and the lower insulin sensitivity, obese women with normal body mass index but high body fat percentage can be associated with a higher risk for metabolic dysregulation and metabolic syndrome compared to healthy women with the same body mass index and normal body fat percentage.

Resistin levels and insulin resistance increase in obese humans. Also, inactive life is associated with high risk of increased insulin resistance. The purpose of this study was to investigate effect of twelve weeks aerobic training on serum levels of resistin, and adiponectin-resistin (AR), homeostasis model assessment-adiponectin (HOMA-AD), and IRAR indices in sedentary obese men. In a semi-experimental study, twenty one sedentary obese men were randomly placed into two groups: aerobic training (n=10, 27.8±3.2 yr, 93.5±7.1 kg, 31.7±3.4 %, BMI 32.0±3.5 kg/m2) and control (n=11, 27.1±3.1 yr, 94.7±6.0 kg, 31.2±3.1 %, 32.2±3.3 kg/m2). General characteristics of subjects, serum levels of resistin, and HOMA-AD, AR, and IRAR indices were assessed before and after training. Aerobic training consisted of twelve weeks pedaling on cycle ergometer (3 sessions per week, intensity 60-70% of reserved heart rate, duration of each session 20-40 min). Data analyzed by SPSS16 software. Statistical significance was considered at P<0.05. After the training period, serum levels of resistin (P=0.016), HOMA-AD (P=0.007), AR (P=0.020) and IRAR (P=0.003) were reduced, while none of mentioned parameters in control group did not change significantly (P>0.05). Circulating levels of resistin and HOMA-AD, AR, and IRAR, that are novel indices for insulin resistance, were reduced after twelve weeks aerobic training. Therefore, sedentary obese men can reduce risk of type 2 diabetes and cardiovascular diseases with performing aerobic training.