Iranian Journal of

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Diabetes during pregnancy is either concurrent diabetes, diagnosed before pregnancy, or ‘gestational diabetes mellitus’ (GDM), first diagnosed in pregnancy. GDM is the commonest metabolic disorder of pregnancy, with a prevalence of one to 14 percent, depending on the reporting team. The prevalence of GDM in Tehran is 4.7%. Diabetes concurrent with pregnancy is diagnosed according to the recently revised criteria of the National Diabetes Data Group (NDDG). GDM is diagnosed with a 100-gram 3-hour glucose tolerance test (3hGTT100), with at least two abnormally high readings being required for a definite diagnosis. Screening for GDM is still a matter of dispute. Universal or selective screening? Each has its supporters. The American Diabetes Association (ADA) recommended universal screening until 1997, and this is still recommended for areas with a high prevalence of GDM. Diabetes during pregnancy has multiple potential consequences for mother and fetus fetal macrosomia being the commonest. The children of diabetic mothers are also more likely to become overweight and develop impaired glucose tolerance. ADA recommendations for glycemic control in diabetic mothers-to-be include maintaining their fasting blood glucose between 60 and 95mg/dl, and their postprandial blood glucose between 80 and 120mg/dl. Measurement of urinary ketones is recommended when the patient is on a calorie-restricted diet. Lifestyle changes are an integral part of management. Insulin requirements and calorie intake must be adjusted in line with weight gain as pregnancy progresses.

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Background: Numerous studies have confirmed the association between type 1 diabetes mellitus (DM1) and polymorphisms of HLA genes on chromosome 6p21. Controlled DNA studies in Belgium recently have found a statistically significant association between DM1 and certain HLA class II genes, especially DRB1Lys71+.
Methods: 81 Danish families (each with at least 2 members with DM1) and 82 healthy controls were assessed for HLA polymorphisms. 54 of the 81 diabetic families were also assessed for polymorphisms at the HLA-B-DQB1, HLA-B-DQA1, and TNF-A and TNF-B loci. Affected sib-pair analysis was used to study correlation between DM1 and DRB1 alleles encoding Lys71+.
Results: Homozygous expression of DRB1Lys71+ carried a relative risk (RR) of 103.5 for DM1. There was a very strong correlation (p<1×10-6) between DM1 and DRB1 alleles encoding Lys71+. Family-based association studies showed that DRB1Lys71+ was the most important determinant of DM1 in carriers (haplotype relative risk = 8.38). Haplotype analysis confirmed this.
Conclusion: The DRB1Lys71+ allele confers genetic predisposition to DM1 most strongly of all.

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Background: Diabetes mellitus is a common chronic disorder with multiple disabling long- and shorter-term complications, the majority of which can be controlled if not prevented. The management of diabetic patients is a major drain on both health budgets and time.
Methods: We reviewed the records of 101 patients with diabetic foot ulcer, who had received treatment at either Doctor Shariati or Imam Khomeini hospital.
Results: Out of 101 patients (56.4% male and 43.6% female) with diabetic foot ulcer, 34.7% had eventually undergone amputation.
Conclusion: Our findings highlight the need for control and prevention programmes aimed at reducing the risk factors for and complications of diabetic foot ulcer.

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Background: The non-enzymatic glycosylation (NEG) of proteins in diabetes damages both the structure and function of these proteins. In vivo and in vitro studies have shown that NEG of proteins and advanced glycosylation end-products (AGE) contribute to the pathogenesis of both macrovascular, such as atherosclerosis, and microvascular complications, such as retinopathy and nephropathy, in diabetes.
Methods: We studied the electrophoretic mobility, fluorescence at isoelectric pH, and time-dependent AGE formation of glycosylated albumin. For the first time, we have used isoelectric focusing to study serum glycosylated albumin in diabetic patients and healthy controls. Results: After 10 weeks incubation with glucose, the electrophoretic mobility of glycosylated albumin increased 21.3% compared with normal albumin. The isoelectric pH of albumin decreased from 4.6 on day 1 to 4.1 on day 7. The increase in electrophoretic mobility was accompanied by the drop in pH during the first week of incubation. These changes correlated well with those observed by fluorescence. The glucose content of the albumin samples decreased during the first week of incubation, but gradually increased thereafter. Fluorescence readings agreed with these observations. Using isoelectric focusing, there was a significant difference between the serum albumin of diabetic and normal individuals (p<0.001).
Conclusion: Increased electrophoretic mobility during the first week with a simultaneous decline in isoelectric pH shows that AGE formation begins after the first week. The reduction in glucose concentration during the first week and its subsequent increase during the second week may be attributed to the formation and hydrolysis of AGE. This method may be used to determine the stability or progress of diabetes.

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Introduction: Elevated plasma total homocysteine is an independent risk factor for cardiovascular disease and a sensitive marker of vitamin B12 and folate insufficiency. Folate and vitamin B12 have a protective effect on cardiovascular disease. This effect may be partly explained by mechanisms independent of homocysteine. This survey is the first population based study to evaluate the plasma total homocysteine, folic acid and vitamin B12 in 1214 healthy Iranian persons.
Methods: This study which was a part of the Cardiovascular Risk Factors Survey in the Population Lab region, has been designed and conducted based on MONICA/WHO project. A total of 1214 people have been recruited and assessed on serum homocysteine, folic acid and vitamin B12 with interview, questionnaires, examination and blood sampling. Blood samples were gathered in Venoject tubes and analyzed according to standard methods.
Results: The variables were assessed in 1214 participants include 428 men (35.3%) and 786 women (64.7%). Prevalence of hyperhomocysteinemia was 96.4% in men and 83.3% in women (p<0.0001). Geometric mean of serum homocysteine was 19.02 ± 1.46 µmol/l in men and 14.05± 1.45 µmol/l in women (p<0.004) and increased with age. Folic acid deficiency was seen in 527 (98.9% )men and 833 women (98.0%). 161 (30.1%)men and 232(27.2%) women had vitamin B12 deficiency.
Conclusion: These results revealed that the prevalence of hyperhomocysteinemia, folic acid and vitamin B12 deficiency was higher than other communities considerably. Preventive interventions as food fortification with folic acid is necessary.

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Background: Elevated total plasma Homocysteine, is an independent risk factor for cardiovascular disease. Folate and vitamin B12 have not only a protective effect on cardiovascular disease but also an essential effect on total Homocysteine concentrations (tHcy). This survey has been conducted to evaluate the determinants of tHcy in 1191 healthy Iranian adults.
Methods: This study which was a part of the Cardiovascular Risk Factors Survey in the Population Lab Region, has been designed and conducted based on MONICA/WHO project. A total of 1191 people have been recruited and assessed on serum Homocysteine, Folic acid and vitamin B12, triglycerides, cholesterol, HDL-C, LDL-C, FBS, BMI, BP and smoking, with interview, questionnaires, examination and blood sampling. Blood samples were analyzed according to standard methods.
Results: The variables were assessed in 1191 participants include 416 men (34.9%) and 775 women (65.1%). Prevalence of hyperhomocysteinemia was correlated significantly with male sex and aging. Hcy levels were inversely related to serum Folate and vitamin B12 concentrations. After further adjustments, we detected a positive correlation between tHcy and age, male sex, smoking and BMI, and a negative one with LDL-C and diabetes. Although there was a correlation between tHcy and blood pressure, after age, sex, BMI and smoking adjustment, it just remained significant in women and with systolic blood pressure.
Conclusion: We found that dietary and lifestyle parameters such as Folate intake and smoking habit are the main determinants of distribution of plasma Homocysteine in an apparently healthy population. We assumed that lifestyle changes could have considerable subsequences in public health. Our findings confirm the potential advantages of dietary improvements and increased intake of nutrients along with smoking cessation in order to prevent cardiovascular diseases in high-risk patients.

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Background: High prevalence of consanguineous marriages has been reported in Iran. Since this pattern of marriage may increase the prevalence of diseases with autosomal recessive pattern of expression, the study was assigned to determine this among patients referred to diabetes and osteoporosis clinics of Dr Shariati hospital, Tehran, Iran.   

Methods: The consanguineous marriage was studied among 1789 couples of three successive generations via Questionnaire.

Results: The prevalence of consanguineous marriages in three successive generations was 9%, 17% and 19%, respectively with an increasing pattern of prevalence. Overall the prevalence of first cousins marriage was 10% with 69% among consanguineous marriage group. The higher the level of education, the lower the prevalence of consanguineous marriage.

Conclusion: In view of the increasing prevalence of consanguineous marriage that may be followed by some trouble consequences about disease expression, it seems necessary to provide facilities for genetic counseling before marriage for youth.

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Introduction: The height measurements in the elderly are associated with several problems. In this study we used a model to predict of the Iranian people aged height from age, shin length and forearm length. Methods: A total 165 aged people ≥60 years were randomly selected based on medical record number of about 800 eligible older people who lived in Kahrizak Charity Foundation. Standing height, shin length and forearm length were measured. Data from 99 participants were used to creat a predicting multivariate linear regression model for estimation of standing height of older men and women. The data of the rest 66 participants were used for models testing. Result: The following equations were created: Men height = 78.928+ (1.430× shin length) + (0.817×forearm length)-(0.176×age) The height of women = 71.694+ (1.414×shin length) + (1.084× forearm length)-(0.277× age) R2 were calculated as 0.63 for men and 0.52 for women. Error of estimation was +0.44 cm and it was - 0.16cm and +1.09cm for men and women respectively. Estimated heights were not significantly different from standing statures. Conclusion: height was predictable from shin length and for forearm lengths and also age with a relatively small error in the estimation among Iranian older people. The error of model is more in women than men.

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Objective(s): The purpose of the present study is to better understand relationships between mental health components (Psychological distress, Psychological wellbeing) and utilization of health services and community aged care services among the Iranian elderly living in Sydney metropolitan area. These findings will, in part, fill the gap in gerontological knowledge and also help to health policy makers, social fairness, increasing fairness to the Iranian elderly migrants, and also increasing their more access to the aged care services. Material & methods: In this cross sectional study 302 old people were selected via a random sample among 1209 Iranian aged people 65 years old and over migrated in Australia. In this study 302 old people 65 years old and over participated who lived in Sydney state’s of Australia for at least 6 months prior to the survey. This study has done in 2005-7. Multiple methods were utilized to collect data including telephone interviews, face to face interviews, or a written survey instrument by mail. The tools used were based on the “annual elderly health survey in 2000” through Australian ministry of health. The mental health instruments applied were psychological well being (Yeild), and psychological distress (K6). The service utilization tools included utilization of aged care services (basic and supportive), and use of health services. T test, ANOVA and liner regression applied to predict of mental health components by SPSS ver.15 soft wear. Results: demonstrated that the majority of respondents reported feeling so sad and nervous most of the time in the last four weeks. The bulk of respondents had moderate level of psychological distress. About one quarter of respondents had lower level of feeling of wellbeing in the last four weeks preceding this study. Use of health services and community basic aged care services are predicted by mental health status of Iranian elderly respondents. However, mental health status could not predict utilization of community supportive aged care services. Conclusion: Generally, use of interpreters and organized community services were predicted with mental health components among the Iranian elderly migrants.

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Introduction: Studying of physical and mental health of older adults is important for health care services to elderly. With increasing ageing population and chronic diseases among older people, the expenditure of ageing services will increase. Thus, it is necessary to clear a cut point chronological age for starting ageing career. The aim of this paper is to understand health differences between two cohorts (60-64 and 65-69) of older adults. Methods: This study is cross-sectional and descriptive-analytical study. Data collected by structured questionnaire. The study population was 60 -64 and 65-69 cohort groups of older adults who living in rural and urban areas of Tehran in 2011. The sample size was estimated 400 people those were chosen using cluster sampling. Findings: The findings of study showed significantly differences between two groups of older adults, 60-64 and 65-69, in terms of physical health that measured using activity of daily living(ADL) and limitation of physical function. In contrast, there were no significant differences between two age groups in psychological wellbeing and mental illness. Based on results, complementary health services can start from 65 years old and providing counseling services according to women and men differences.

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Introduction: Mental disorders are common in the elderly.The purpose of this study was to assess the general health status and its related factors among people ≥ 65 years in different districts of Tehran. Methods: This study has used data of the participants ≥ 65 years old in urban health equity and response tool (Urban-HEART) study. Finally the data of 1313 elderly were considered for this study. Variables included demographic characteristics (gender, age, education level, family size, marital status and employment status) and mental health using the Persian GHQ -28 questionnaire (domains: somatic, depression, insomnia and anxiety) and quality of life using the SF12. Results: The mean age of participants was 73.68 (5.91) (women=627 and men=686). GHQ-28 median of scores the participants were 24.00 (22.00)[20.00 (27.00) in women and 19.00 (19.00) in men (P<0.01)].Based on GHQ-28 cut-point 23, 50.2%of the participants had mental health problems, [61.2% women and 40.1% men (P<0.01)].The residents of third municipality districts had the best mental health (26.3% of men and 38.5% of women had mental health problems) and the aged of 20th municipality district had the worst health status (65.7% of males and 84.2% of women had mental health problems).In multivariable logistic regression model, for each year of increment age, 2.9% chance of mental health problems increased (P<0.01). With increasing level of education, mental health status was improved (P trend < 0.01). The relationship between family size and mental health was not significant (P =0.06). Conclusion: Mental health status of the elderly in Tehran was worse than the many other countries. The elderly lived in 20th municipal district, had the worst and the dwellers in the 3th district had the best mental health status.

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Background: Falling is one of the health problems among aged population. Elderly living in institutions are at greater risk of falling than those dwellings in the community, due to their health status and environmental conditions. This study was designed and conducted aimed to address the factors affecting falls in Kahrizak Charity Foundation (KCF). Methods: This is a prospective longitudinal study, which 194 of residents of KCF were participating in it with inclusion criteria were selected by Random Cluster sampling. They were enrolled after signing an informed consent. At baseline the data of demographic, lifestyle, past medical history and visual ability were collected by interviewing. The anthropometric measurements were performed as well. Cognitive status data were collected using abbreviated mental test (AMT) questionnaire and mini mental state examination (MMSE), balance status was assessed using the Tinetti mobility test (TMT) and its balance and gait sub- scores, depression was detected using the geriatric depression scale-15 (GDS-15). The participants were monitored for the falls occurrence its complications by daily call with caregivers and filling out the special forms for the recording of the falls occurrence by the head nurse. Data were analyzed using univariate and multivariable Cox-regression models. Results: The mean age of the participants was76.02 (8.82) years and the mean follow-up days was 754.40±189.26 days. 44 cases of falls were recorded during follow-up (over two years). The fall rate was 22.7 subjects per 100 participants per year. History of stroke, Parkinson's disease, visual loss, taking antidepressants, TMT score and TMT balance sub-score after adjustment (for age, sex, body mass index and survival time) were associated with falls. Conclusion: The falls among nursing home elderly residents were associated with a history of chronic diseases such as stroke and Parkinson's diseases, visual acuity, use of antidepressants and the TMT and its balance sub score.

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Background: Because of various health problems, the risk of the death in the elderly is higher than adults. The purpose of this study was to investigate the causes of the death, and comparing the cause of death that recorded on the death certificates and those were extracted from the medical records review. Methods: Variables included the demographic characteristics (age and sex), time of death and the cause of death were recorded in the death certifies and those were extracted from the medical records. Results: The mean of death age was 83.8 (8.50) years and in women and men were 84.2 and 81.5 years, respectively, (P < 0.01).The most prevalent cause of death was sudden cardiac death based on both death certificates recorded and review of medical records were 42.5% and 25.9% respectively. Sudden cardiac death in both methods was higher in women than men. Using the kappa, the highest degree of correspondence about the cause of death between two method was about gastrointestinal bleeding (K = 0.76) and then the cancers (K = 0.71) and respiratory infections (K =0.67). Total Kappa of two methods for causes of mortality was 0.50. The most cases of death were reported during 12:00 – 13:59 and 8:00 – 9:59am, time period (16.2 % and 14.1% respectively). Conclusion: the causes of deaths, which are recorded in the elderly nursing homes, do not have enough accuracy. Due to the high incidence of sudden cardiac death in elderly in nursing homes, resuscitation facilities and teams may be helping to reduce these types of death.

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Background: increasing the population of aged, Consequently Increasing rate of chronic disease and to decreasing quality of life level caused many problems in different communities. The important aim of this study was surveying the effect of an educational intervention by use of the educational components of precede model on quality of life in the elders. Methods: This semi-empirical research was performed on 54 aged people in two group-case and control- for the Aged in 2009. In this study two questionnaires the designed questionnaire based on PRECEDE model and the questionnaire on the quality of life standard of the World Health Organization (WHOQOL) were used and the quality of life of the aged people in two groups before and after one month from the educational interference was evaluated. Independent t-test paired T-test, one way ANOVA, was used for data analysis. Results: The average total score of the quality of life of the aged people of test group, showed a meaningful difference before and after educational interference with a p quality less than 0.05, but there wasn’t a meaningful difference between total scores of two groups. Though the relationship of attitude (predisposing factors), enabling factors (skills) and behavioral factors with quality of life of a p quality less than 0.05 was meaningful. But knowledge (predisposing factor) and reinforcing factors didn’t show a meaningful relationship with the quality of life. Conclusion: It seems that the health, education and health promotion programs are effective on quality of life in the aged people.

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Background: One of the common problems of the elderly, which increase of its prevalence with aging is the dementia and the cognitive impairment. We can help the involved patients to have a better quality of life with early diagnosis of the cognitive impairment. The aim of this study was an assessment of the validity and reliability of the Persian version of the abbreviated mental test (AMT) among the older people in a nursing home setting. Methods: 176 eligible elderly people aged ≥ 60 years living in KahrizakCharity Foundation (KCF), were selected randomly based on medical record number. Demographic information and past medical history of the participants were collected. Geriatric depression scale 15 (GDS-15), global deterioration scale (GDS) forms and also the Persian version of the abbreviated mental test (AMT) were administered. The participants were assigned to two groups the normal and impaired cognitive groups, based on DSM-IV diagnostic criteria. The GDS cut-points were used for assessment of validity, sensitivity and specificity of the Persian version of AMT. Results: The mean age of the participants was 77.30 (7.94) years. The Persian version of AMT had good discriminated validity in diagnosis of normal and impaired cognitive participants (7.35 ± 2.33 and 5.99 ± 2.29, P < 0.01 respectively) and at cut-point AMT< 8,(based on GDS cut-point) it had a sensitivity and specificity 92.15 % and 81.50% respectively. The sensitivity and specificity based on theism IVcriteriawere 64.9% and 64.0% at cut-off point equal to 7, respectively. The internal consistency of the Persian version of AMT was acceptable (Cronbach’salpha coefficient =0. 76). As well as the external reliability (intra-rater) of this instrument was good inter-class correlation coefficient (ICC) = 0.89) Conclusion: The Persian version of the AMT has appropriate validity and reliability in Iranian older people.

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Background: Oral health is an important issue in elders’ life in both food consumption style and their self-esteem. The aim of this study was to survey the oral health among aged people in Gorgan city. Methods: In a cross sectional study and through a standard questionnaire, the data of 869 aged people who were resident in the areas where were covered by 4th and 5th Health Station of Gorgan Health Center, has been analyzed. Participants (over 60 years old persons) entered in the study through a census method are asked about their oral health by trained persons. Data analyzed by descriptive statistics and Chi-Square test. Alpha level set at 0.05. Results: Complete toothless was 54.3 percent in male and 62.6 percent in female. Totally teeth preservation rate was 6.4 percent in male and 1.5 percent in female. The mean and standard deviation of tooth loss were 22.5±12.4 in male and 24.4±11.2 in female. The Complete toothless significantly was high in single people compared with married one. Completely toothless was low among aged people with less than or equal to four children and was low among aged people in the worst status of economic situation. Conclusion: Oral health among the study population was in a bad situation. For preservation of teeth till adult age, appropriate planning and interventions is necessary.

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Background: Dementia is a common health problem in the elderly. Studies have shown that levels of pulse wave velocity (PWV) could predict cognitive impairment. The objective of this study was assessment of the relationship between arterial stiffness levels and cognitive status among the older people. Methods: In this cross-sectional study, 60 individuals included 31 women and 29 men aged ≥ 60 years who were admitted to Khatam-Ol-Anbya hospital in Tehran and were eligible, were randomly selected according to admission code. Data such as demographic information, Global Deterioration Scale level, Geriatric Depression Scale -15 score, were collected by face to face interview. The arterial stiffness was measured using Sphygomocor system by calculation of carotid to femoral pulse wave velocity. Data analyzing was conducted using univariate and multivariable logestic regression models. Result: The mean age of the participants was 72.62 (7.62) and it was significantly higher in cognitive impairment than those who had normal cognition [73.40(7.36) vs. 70.27(8.00) respectively, P = 0.05]. The average years of the schooling in individuals with normal cognitive status was higher than the other groups (P < 0.01). Average pulse wave velocity in the participants was 11.81(4.11) meters per second. The PWV was significantly increased with the exacerbation of the cognitive impairment (7.24 m/s in normal group vs. 15.52 m/s in the severe cognitive impaired group, P < 0.01). Conclusion: The pulse wave velocity has an inverse relationship with cognitive status. It seems that arterial stiffness associates with lower levels of cognitive status independent to other cardiovascular risk factors.

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Background: The present study was conducted to assess the association between duration of oral contraceptive pills consumption and metabolic syndrome. Methods: Study subjects were selected among 5532 of women 15-45 years old aged participating in Tehran Lipid and Glucose Study (TLGS). TLGS questionnaires were used for data collection. Results: Metabolic syndrome and its components did not significantly differ between study sub groups after adjustment for confounders. Conclusion: OCPs duration of consumption does not affect prevalence of metabolic syndrome among non menopausal women.

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Gangliosidosis GM1, is a lipid storage disorder due to deficiency of the lysosomal enzyme &beta-galactosidase. This deficiency leads to lysosomal accumulation of gangliosidosis GM1 to be, which contributes to swelling, cell damage and dysfunction of the organs. Gangliosidosis GM1a rare neurodegenerative disorder. Mongolian spots are significant clinical sign in some of the metabolic diseases, such as gangliosidosis GM1, but limited information is available. Hepatomegaly, hypotonia, edema, seizures, and skeletal malformations and Cherry red spot in the macula of the eye are of other symptoms of the disease. In this paper, we present a 10-month-old child with gangliosidosis GM1 type 1 with extensive mongolian spots who was referred the Hajar Medical Educational Therapeutic Center Shahrekord.

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Background: 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. Methods: 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. Results: 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). Conclusion: 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