Iranian Journal of

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Background: Atherosclerosis is the leading cause of mortality in the developed and some developing countries. Some people believe that opium abuse has beneficial effects for reducing blood lipids and atherosclerosis prevention. In this study, the effect of oral opium addiction on lipid profile and atherogenesis in normal and hypercholesterolemic rabbits was studied.

Methods: Thirty two male Newzeland White rabbits were used in this study. They were divided into four groups including control, hypercholesterolemic, addicted, and hypercholesterolemic addicted and were studied for three months. The blood samples were obtained and lipid profile was determined at the beginning of the study and at the end of every month thereafter. After 90 days aorta was removed to assess for lesion formation.

Results: The levels of cholesterol, triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), and atherogenic index (total cholesterol/HDL-C) in the hypercholesterolemic and hypercholesterolemic addicted rabbits were increased significantly (P<0.001). These increases in lipids and aorta lesion areas were higher in hypercholesterolemic addicted group than hypercholesterolemic group.

Conclusion: These findings suggest that oral opium abuse affects cholesterol metabolism and depending on the dietary condition can have an aggravating effect on atherosclerosis. The protective effect of morphine on cardiac disease is not probably through the modulation of lipid metabolism.

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Background: Children with Type 1 diabetes were present one of the greatest challenges in the worldwide. Health-care providers must be sufficiently aware of diabetes so that such children make utmost benefit of their educational opportunities. The aim of the present study was to compare the effect of three educational methods in raising the level of knowledge of school health-care providers. Therefore the best method would be applied for this purpose.

Methods: In this interventional study 132 samples were randomly chosen from the list of school health care providers of Tehran and divided to the three groups (educated by posters, booklets, and group education). A questionnaire was completed for all the three groups before and after the education. Questionnaire consisted of two parts: -demographic information and 16 questions about diabetes information. Scores were analyzed by descriptive and inferential methods (T-test, ANOVA).

Results: The level of knowledge of school health-care providers was weak in   23.5% of the case, average in   59.8% of cases, and good in 16.7% of cases. The level of knowledge in the groups educated by booklets and group education increased meaningfully, while no obvious increase was observed in the group trained via posters.

Conclusion: From the three aforementioned training methods, group education and education by booklets have the most effect on raising the level of knowledge of health-care providers.

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Background: The prevalence of Diabetes mellitus as the most common metabolic disorder of human is progressively increasing. Dyslipidemia is common among diabetic patients characterized by elevated plasma TG, LDL-C and reduced HDL-C levels which increase risk of cardiovascular events. Fish oil supplement which contains omega-3 has been proposed to correct the atherogenic lipid profile associated with diabetes mellitus. Doubt remain whether the net effect of fish oil supplement on lipid profiles are beneficial in diabetes. We therefore performed this randomized double-blind clinical trial to investigate this.

Methods: Ninety six patients with type 2 diabetes mellitus were randomized assigned to take 3 times daily supplementation (capsule) with either fish oil or corn oil for 8 weeks (48 patients in each group). At begining also end of study we measured laboratory variables (FBS, TG, Total cholesterol, LDL and HDL) in both groups.

Results: At begining of the study demographic and laboratory measurements were similar in both groups (P>0.05).At 8^th weeks there  were  no statistically  significant  differences  in variables  measured except for  LDL and HDL in fish oil  group that leads to increase and decrease respectively. Although both groups show improvement in LDL / HDL and Total cholesterol / HDL ratios but mean charges were statistically significant in fish oil as compared with corn oil group. (P=0.001, P=0.005 respectively).

Conclusion: Fish oil supplement showed statistically significant improvement in LDL/HDL, Total cholesterol/HDL ratios as compared with corn oil. This may leads to decrease cardiovascular events.

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Background: Only limited data are available on the benefits of fruits and vegetable consumption on CVD risk factors. The aim of this study was to examine whether and to what extent intake of fruits and vegetables are inversely associated with cardiovascular (CVD) risk factors in adults.                                                           

Methods: In this population-based cross-sectional study a representative sample of 840 Tehranian adults (361 men and 479 women) aged 18-74 years were randomly selected in 1998. Usual dietary intake was assessed with the use of food frequency questionnaire. Portion sizes of consumed foods were converted from household measures to grams and analyzed by using Nutritionist III software designed for Iranian foods. Subjects were categorized based on category cut-points. : 0-1.9, 2-2.9, 3.0-3.9, and>=4 servings/d.

Results: In multivariate logistic regression after adjusting for confounders, dietary fruits and vegetable were found to be significantly and inversely associated with CVD risk factors. Adjusted odds ratio for high LDL concentrations were 1.00, 0.88, 0.81, 0.75(P for trend < 0.01) in first model which was adjusted for age, body mass index (BMI), energy intake, smoking status, dietary cholesterol, and prevalence of diabetes mellitus and coronary artery disease, a trend which was not appreciably altered by additional adjustment for education, physical activity, and saturated, polyunsaturated, total fat, Potassium and vitamin C intakes. This association was observed across categories of smoking status, physical activity, and tertiles of the Keys score.

Conclusion: Consumption of fruits and vegetables more than 4 servings a day is associated with lower concentrations of total cholesterol and LDL-C and with decrease in the risk of cardiovascular diseases.

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It is estimated that up to 40-70% of obesities is attributable to genetic factors.  Monogenic forms of obesity are uncommon.  We present the first such reported case in Iran. The patient presented with a history of severe hyperphagia, rapid weight gain and recurrent infections.  He was born after a normal pregnancy in a highly consanguineous marriage.  His birth weight had been normal.  At age of 18 months he weighted 28 kg.  Apart from obesity and syndactyly of second/third digits in both feet there were no other abnormalities on physical examination.    His fasting serum leptin was 45 ng/ml.  Genotyping revealed 66-bp deletion in codon 514 of leptin receptor gene.

Unfortunately he developed another respiratory infection which was unresponsive to intensive treatment and died following a cardiorespiratory arrest. Genetic assessment is recommended in morbid obese patients especially those with a childhood onset.  Leptin receptor mutations can be associated with immune system deficiency and recurrent infections.

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Background: The aim of this study was to examine the prevalence of the metabolic syndrome (MetS) and its association with coronary heart disease (CHD) in Iranian older individuals.

Methods: In this cross-sectional study, the prevalence of the MetS was determined according to the Third Adult Treatment Panel (ATPIII), the World Health Organization (WHO) and the International Diabetes Federation (IDF) definitions in 720 men and women aged≥65 years. Logistic regression analysis was used to estimate the Odds Ratio (OR) of developing CHD in model 1 an age adjusted model, in model 2 adjusted for age, smoking status, premature history of CHD and LDL cholesterol and in model 3 adjusted for mentioned variables in model 2 plus the components of the MetS according to each definition.

Results: The prevalence of MetS was 50.8%, 41.9% and 41.8% by ATPIII, IDF and the WHO definitions, respectively. IDF had high agreement with the ATPIII definition. In model 2, the ATPIII and the WHO definitions of MetS were associated with CHD by the odds ratio of 1.6 (1.1-2.2) and 1.7 (1.9-2.4), respectively. In model 3, obesity (WHO definition) and high blood pressure (ATPIII and WHO definitions) were associated with CHD.

Conclusion: As defined by the ATPIII and WHO definitions, the MetS was associated with CHD even after adjustment for the conventional CHD risks, but after further adjustment for their components none of these definitions showed association with CHD.

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Background: Non- alcoholic fatty liver disease (NAFLD) is a pathogenic factor of insulin resistance and type 2 diabetes. On the other hand, the circulating liver enzymes including Aspartate aminotransferase (AST), Alanin aminotranferase (ALT) and Gamma glutamyl transferase (GGT) are commonly elevated in asymptomatic patients with NAFLD.

Methods: As a nested case-control study, AST, ALT, GGT as well as classic diabetes risk factors, homeostatic model assessment of insulin resistance(HOMA- IR) and C-reactive protein (CRP) were measured in 133 non-diabetic subjects at baseline (68 cases and 65  controls). Conditional logistic regression was used to calculate the odds ratio (OR) of diabetes associated with different hepatic markers. We used factor analysis for clustering of classic diabetes risk factors.

Results: In Univariate analysis, both ALT and GGT were associated with diabetes with ORs of 3.07(1.21-7.79) and 2.91(1.29-6.53), respectively. After adjustment for CRP and insulin, ALT and GGT were still predictive of incident diabetes. When the model was further adjusted for anthropometric, blood pressure and metabolic factors resulted from factor analysis (full model), only ALT was independently associated with diabetes [OR=3.06 (1.01-9.26)]. No difference was found between the area under the receiver operating characteristic curves of the models with and without ALT (0.820 and 0.802 respectively, P=0.4)

Conclusion: ALT is associated with incident type 2 diabetes independent of classic risk factors. However, its addition to the classic risk factors does not improve the prediction of diabetes.

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Introduction: Aspects of social and economic development in ICT has led to new applications of these technologies. Using the portal geriatrics’ is an access point to a wide range of resources and information in the content for geriatric medicine specialists, physicians and other health care workers, elderly and their families. It provides integrated information on the sources and applications of heterogeneous. The National Portal of Geriatric Medicine is the best solution to resolve this problem.This study compares the experience of few developed countries and offer the geriatrics’ portal. Methods: This paper is based on valid studies, library and internet searches in databases like as science directly, Springer, Proquest, and advanced search in Google to review the literature on the geriatrics portal in selected the countries. Findings: Developing a portal is a strategy to support the development and maintenance of all the desirable features of the portal and user needs’ analysis. It could also, characterize the structure and integrated system of geriatric care. It makes the integrity to fulfill of the main condition portal services and the content that offer to the elderly.

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Increasing of the aging population in most of the developed countries should be more attention to the health issues of this aged group. In Iran, the ageing program has been launched and some institutes or organizations have been in charge of this program. The coordination of health policies and activities in elderly care programs and ageing networks could be helped to improve of elderly life span. This paper discusses the performance of different organizations and or other relevant entities regarding an ageing program in Iran and also comparing those activities to the other developed countries.

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

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Background: Today, the internet has been emerged as a potentially effective medium for information exchange and in recent years, the use of web-based training programs has been steadily considered in the prevention and management of chronic diseases such as diabetes. This technology provides an opportunity to make health care more accessible for a large number of people and reduce costs. This review provides a descriptive discussion of web-based behavioural interventions for the management of type 2 diabetes mellitus. Methods: Systematic literature searches were performed using Medline, Embase, Psycinfo, Web of Science and Cochrane library to retrieve articles written in english and published between 2000 and 2012 which fulfilled all inclusion criteria. The search keywords were “diabetes” AND “intervention” AND (“internet OR web”). Only randomised controlled trials and quasi experimental studies were included in this review. Results: A total of 15 studies were reviewed. Goal-setting, personalised coaching, interactive feedback and online peer support groups were some of the successful approaches which were applied in e-interventions to manage type 2 diabetes mellitus. Strong theoretical background, use of other technologies and longer duration of intervention were proven to be successful strategies as well. Conclusion: The web-based interventions have demonstrated some level of favourable outcomes, provided they are further enhanced with proper e-research strategies.

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Background: The flexible structure of proteins is one important factor in the formation of ordered aggregates (amyloid fibril). This is a major problem for therapeutic proteins such as insulin. Study on the induction and inhibition of insulin fibrillation process with specific compounds such as aromatic derivatives may provide useful information about means of stabilization of protein structures. Methods: To induce fibrillation, regular insulin was incubated in phosphate buffer (pH=7.4) during 24 hours. Amyloid formation was investigated by using Congo red absorbance and transmission electron microscopy (TEM). Then nodular amyloidosis was observed in mice upon amyloid fibril injection, after which the excised nodule was studied by Congo red staining and polarized light microscopy. Then, some aromatic compounds effect was investigated on the fibrillation process. Results: Regular insulin form mature amyloid fibrils at pH=7.4, 37°C after 24 hours. Silibinin had the highest inhibitory effect on that process. Furthermore, Amyloid fibril injection in mice caused nodular amyloidosis. Conclusion: Regular insulin has a high potential to undergo amyloid aggregation. Nodular amyloidosis confirms fibril formation by insulin under in vitro condition. Silibinin could be considered as a potential compound capable to increase protein structure stability.

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Background: One of the important indicators of diabetes treatment and control is enhancement of quality of life in patients with diabetes. Therefore, in recent years, quality of life in these patients regarded by therapists and researchers and increased studies in this field. The aim of this study was collection and integration of these studies results to investigate the effect size of sport and psychological interventions on quality of life in patients with type 2 diabetes by meta-analysis method. Methods: For this purpose, 25 acceptable studies (15 psychological interventions, 10 sport interventions) in terms of methodology (hypothesis, research method, statistic population, volume of sample, sampling method, instrument measure & statistic analysis method) selected, and meta-analysis performed on them. Research instrument was checklist of meta-analysis. Results: The study findings showed that the rate of effect size of psychological interventions on quality of life in patients with type 2 diabetes was d=0.95 (p<0.00001) and the effect size of sport interventions on quality of life in this patients was d=2.2(p<0.00001). According to Cohen’s chart both effect sizes of sport and psychological interventions were high. Conclusion: psychological and sport interventions can be effective on improvement of quality of life in patient with 2 diabetes.

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Background: Reducing in mortality rate due to improved health status in recent years has led to an increased number of elderly people in the world. Therefore, this study aimed to determine the structure of the home care plane in developed countries to provide practical implementations for Iran. This paper is based on valid studies, library and internet searches in databases like science directly, Springer, Proquest, and advanced search in Google to review the literature on the home care programs in developed countries. Results: Documents showed that developed countries have established the aimed, needs, priorities programming of the elderly home care plan. Those groups of countries have designed the home care services to care of older people in their homes respect to maintained of their function and ability as independent individuals. Conclusion: The investigations have been shown that community-based services and home care programs that is not considered as a medical service component, could be eliminated the support needs, and helped the elderly people to live independently and continue their life with quality. Considering the significant role of home services in the prevention of hospital readmission in elderly and to maintain of independency rate and also increasing the quality of life in elderly people, is a necessary issue in Iran that makes to improve on the quality of life in Iranian seniors

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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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Background: Vitamin D deficiency is an unrecognized epidemic and a common health problem worldwide. The objective of our study was to determine the prevalence of vitamin D deficiency and its relationship with overall and abdominal obesity in adolescent girls. Methods: This cross-sectional, descriptive study was conducted on girls aged 14-17 years whom were selected by multistage random sampling from four districts of Boukan. Questionnaires about general characteristics, dietary intake and physical activity were completed by interviewing with the subjects. Anthropometric measurements were performed. Fasting blood samples were collected for determining of serum of 25 (OH) D levels. Data was analyzed by using SPSS software and descriptive statistics tests and partial correlation test. Results: The Mean of serum 25(OH) D was 7.26 (SD 2.81) ng/ml and 100% of subjects had vitamin D insufficiency. According to CDC (Centers for Disease Control and Prevention) criteria the prevalence of overweight, obesity and abdominal obesity were 18.5%, 1.4% and 26.4% respectively. There were significant reverse correlation between serum 25(OH) D and WC (r= -0.112, p=0.047). Conclusion: The Results of this study indicate that vitamin D deficiency is a major health problem among studied adolescents. Given the reverse association between vitamin D status and abdominal obesity appropriate approaches are needed to improve vitamin D status and lowering the prevalence of obesity among adolescents. Such conditions may prevent prevalence of chronic disease in adolescents' lives over the coming years.

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Background: There is increasing interest about the relationship between metabolism, obesity and function of thyroid hormones in recent decades. This study aimed to determine the validity of a “thyroid and metabolism questionnaire” and its relationship with metabolism status and function of thyroid hormones. Methods: It was a descriptive cross-sectional study on 164 people aged 20-64 years who were selected randomly from nutrition clinic. “Thyroid and Metabolism questionnaire” including 25 questions were completed for everyone. Biochemical parameters including serum level of T3, T4 and TSH were measured. Resting energy expenditure [REE] was measured by indirect calorimeter. Results: The mean measured REE and calculated with Harris-Benedict formula were 1826.7 ± 475.34 and 2277.6 ± 454.54 kcal in men and 1410.8 ± 205.5 and 1670.73 ± 136.10 kcal in women respectively. The final score of this questionnaire had no significant association with measured REE. REE showed indirect relationship with serum level of T3, T4, T3/T4 and inverse relationship with TSH. Metabolism status of every participant was obtained via measuring and calculating REE with set and formula. The metabolism status of participants showed no agreements with metabolism status that predicted from “Thyroid and Metabolism” questionnaire. There was no significant association between metabolism status that was measured by indirect calorimeter and calculated from “Thyroid and Metabolism” questionnaire. From 25 questions of this questionnaire, only questions number 1, 4, 16 and 23 showed significant association with measured REE [P< 0.05]. Conclusion: Results of this study showed that “Thyroid and Metabolism” questionnaire had internal consistency, but not validity.

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Background: obesity is the major health problems affecting communities worldwide and the prevalence is rapidly rising. Obesity as a lifestyle-related factor increases the risk of many diseases. Omentin is a new adipocytokine that is abundantly expressed in visceral fat tissue and its expression levels reversely correlated with obesity. The purpose of this study was to investigate the association between Val109Asp genetic polymorphism of Omentin gene and obesity risk in women. Methods: This case - control study was done on 260 women, including 186 women with BMI<30 as a control group and 74 women with BMI&ge30 with obesity. Omentin genotypes were determined by the use of polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP). The data were analyzed using the computer software SPSS for windows version17. Results: Genotype frequencies of the Asp/Asp, Asp/Val and Val/Val in the control group were 65.6%, 31.7%, 2.7% and obese patients were 51.4%, 39.2%, 9.5%, respectively. Comparison of genotype frequencies in the two groups showed that women with Val/Val genotype in compare to Asp/Asp had greater risk for complications of obesity (OR: 4.5, 95%CI: 1.3-14.9, P: 0.01). Conclusion: There is significant association between Val109Asp polymorphism in omentin gene and obesity in Iranian women.

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Background: The aim of this project is to investigate the relation between disease perception and the coping methods in confrontation with the stress of being mother of a type1 diabetic child. Methods: Statistical populations under investigation were all those mothers with type1 diabetic child Who were referred to Kermanshah Taleghani Hospital Clinic in 1392 (during summer).According to simple randomized sampling considering The Morgan method 103 mothers were selected To gather data Illness Perception Questionnaire and Coping Inventory for stressful situation were used Research design was on correlation. Statistical analyses were done through significance test o Pearson correlation coefficient and step by step regression. Results: Results has shown a significant correlation between emotional centered confrontation approach and approach of inevitable confrontation with disease perception. There is also a significant relation between emotional centered confrontation approach and the consequences of self control of disease nature, anxiety, disease cognition and emotional responses. There is significant relation between task specific centered approach and sequences, self control, disease nature, anxiety, disease cognition and emotional responses. There is significant relation between inevitable confrontation approach and sequences, self control, disease nature, anxiety and disease cognition. Also results have shown that variables including task oriented confrontation approach, emotional centered and inevitable one are good predictors of mothers with type one diabetic ‘disease perception. Conclusion: In the light of the above we can conclude that stress confrontation methods are effective on disease perception of mothers with type one diabetic child and more perception of mothers would lead to application of more proper stress confrontation methods.

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