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Background: Atherosclerosis manifests earlier and more extensive in severity among diabetic patients. It seems Homocystein is one of the accelerating factors in development of atherosclerosis and serum levels Homocystein increase in patients with coronary artery involvement. The aim of this investigation was to compare Homocystein levels between diabetic and non-diabetic patients with coronary artery disease (CAD).
Methods: As a case-control study via non-randomized sampling method we collected 33 diabetic CAD patient and 34 CAD patient with normal GTT test. All participants were matched in age, sex, family history of atherosclerosis, blood pressure, smoking, the level of triglyceride, total cholesterol, LDL-C and Body Mass Index (BMI). Fasting serum Homocystein was measured via ELISA technique and other selected variables also were assessed via conventional laboratory methods. The quantitative variables between two groups analyzed by student t-test, while the qualitative variables examined by X2. We used Pearson –spearman test for correlation analysis between two groups.
Results: 33 diabetic and non-diabetic CAD/MI cases were participated. Among diabetic and non-diabetic subjects, mean age were 59.5±10.5 and 62.5±9.5 respectively. The mean duration of diabetes was 5.4 ± 4.1years. Comparison of the mean Homocystein levels between two groups revealed a significant differences,16.2 ± 4.8 mmol/L in diabetics vs. 10.6 ± 4.8 mmol/L in non-diabetics (P<0.5). Correlation between Homocystein levels and blood glucose, uric acid, triglyceride were r≤0.69, r=0.46 and r=0.51, respectively.
Conclusion: Fasting serum Homocystein in diabetic CAD subjects were higher than non-diabetic CAD cases .Our findings may suggest that the increased level of Homocystein is correlated to high prevalence and severity of atherosclerosis among diabetic individuals.

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Background: The relationship between diabetes and periodontal diseases has already been proved, but the effect of non-surgical periodontal therapy on the control of diabetes is controversial. The aim of this study was to determine the effect of this type of treatment on the control of diabetes.
Methods: In this randomized clinical trial 30 type 2 diabetic patients with moderate to severe periodontitis who were referred to the diabetes clinic of Imam Khomeini hospital during 2004-2005 were studied. The treatment procedure was explained for control group and an informed consent was taken. Scaling and root planning was randomly done for 15 patients, while control group were not treated for periodontal disease. The glycated hemoglobin (HbA1C) and clinical attachment loss was measured for all of the patients before and 2 months after treatment.
Results: At the baseline the clinical attachment loss (CAL) was significantly different between two groups. There was no significant difference between baseline HbA1C in the control and the experimental group. After 2 months the HbA1C was reduced in the treated group which was not statistically significant.
Conclusion: In this study non-surgical periodontal therapy had not effect on the control of type 2 diabetes.

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Background: Diabetes mellitus can have variable and sometimes profound effects upon the oral tissues. It has been shown that uncontrolled or poorly controlled diabetics have particularly a greater incidence of severe recurrent bacterial or fungal infections and periodontal diseases. The purpose of this study was to determine thee relationship between oral manifestations in diabetic patients and duration of disease, and glycemic control.
Methods: We studied 116 diabetic outpatients referred to Diabetes Clinic of Shahid Bahonar Hospital of Kerman Province. We evaluated the following parameters: dental caries, periodontal status, xerostomia, burning sensation and mucosal alterations. We also recorded information about history of diabetes and glycemic control. Data were subjected to SPSS and X, t- test.
Results: The most frequent alterations in this study were gingivitis (96.3%), periodontitis (90.2%), and xerostomia (97.24%). Burning sensation and periodontal diseases were significantly correlated to duration of diabetes (P=0.002, P=0.012 respectively).The results of the present study showed that periodontal diseases occur more frequently in moderately and poorly controlled diabetic patients than in those with good glucose control, but this difference was not statistically significant.
Conclusion: In this study, dry mouth and periodontal diseases are common complaints among diabetic patients. Therefore management of oral diseases in diabetic patients should include a comprehensive evaluation of salivary function and periodontal status.

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Background: The aim of this study was to determine the prevalence of cardiovascular disease (CVD) risk factors among type 1 diabetic patients referring to Isfahan Endocrine & Metabolism Research Center.

Methods: In this cross-sectional study, the prevalence of CVD risk factors including dyslipidemia, smoking and hypertension was determined in type 1 diabetic patients aged 15-30 years.  Serum cholesterol <170 mg/dl, LDL<100 mg/dl , HDL>35 mg/dl , TG<150 mg/dl, systolic blood pressure<120 mmHg and diastolic blood pressure<80 mmHg were considered as optimal control levels.

Results: Among 219 studied diabetic patients (mean age=22.5±10.3, female/male=120/99), the mean cholesterol and HDL-C level was higher in women (176±34.9, 46.4±34.1) than men (162.9±32.4 vs. 41.5±10.1) (P<0.05). The prevalence of smoking, hypercholesterolemia, LDL>100 mg/dl, HDL<35 mg/dl, hypertriglyceridemia and hypertension was 6.9% (n=15), 47.4% (n=104), 53.5% (n=117), 22.8% (n=50), 18.3% (n=40) and 7.7% (n=17), respectively. HDL<35 mg/dl was more prevalent among men as compared with women but cholesterol> 170 was more frequently detected in women (P<0.05).

Conclusion: Considering the rather high prevalence of CVD risk factors in type 1 diabetic patients in Isfahan, and in view of modifiability of these risk factors, educating patients on appropriate glycemic control and increasing physical activity is necessary as well as close monitoring of these risk factors.

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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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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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High plasma homocysteine is identified as an important risk factor for cardiovascular disease. Epidemiological studies have shown that increased plasma homocysteine is related to a higher risk of coronary heart disease, stroke and peripheral vascular disease. Homocysteine may have an effect on atherosclerosis by damaging the inner lining of arteries and promoting blood clots .Folic acid and other B group vitamins help break down homocysteine in the body and folate fortification of foods reduces the average homocysteine level in the population. Low blood levels of folate are also linked with a higher risk of fatal coronary heart disease and stroke. Homocysteine levels are strongly influenced via diet, as well as via genetic factors. Many common genetic disorders and problems (such as vitamin deficiency) adversely affect the metabolism of homocysteine. Common causes of a high homocysteine level include dietary deficiency of folate and B group vitamins, hypothyroidism, kidney disease, psoriasis, and some medicines. Clinical trials to date have not provided consistent evidence that lowering homocysteine levels reduce strokes, heart attacks and other cardiovascular events notwithstanding it is recommended to lower a high homocysteine level because it is a risk factor for heart disease. Homocysteine abnormalities also contribute to birth defects and dementia and folic acid supplementation in the pre-conceptual period is effective in preventing recurrent and primary neural tube defects.

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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: 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 Methods: In this experimental study, 40 obese women (BMI&ge30 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. Results: 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. Conclusion: Long-term aerobic exercise combined with grape extract consumption may reduce the lipid profile parameters.

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

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Background: Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease is increasing in adults and children worldwide. Obesity, insulin resistance or diabetes type II, hyperlipidemia and hypertriglyceridemia plays a major role in the epidemiology of this disease. Cytokeratin 18 (CK-18) the major intermediate filament protein in the liver is a marker of increased hepatocyte apoptosis. The aim of this study was to determinate CK-18 level as a marker of hepatocyte apoptosis and paraoxonase as a biochemical marker for lipid peroxidation.

Methods: This case–control study was done on 51 subjects with confirmed NAFLD by ultrasound and 30 healthy individuals. CK-18 is proposed as a biomarker alternative cell death. The serum was used for measurement of the apoptosis-associated neo-epitope in the C-terminal domain of CK-18 by the M30-Apoptosense ELISA kit. The M30 detection antibody recognizes a neo-epitope mapped to positions 387 to 396 of CK18, so called CK18-Asp396 that is only revealed after caspase cleavage of the protein and is postulated as a selective biomarker of apoptosis. Serum PON1 activity was assayed using a synthetic substrate. Paraoxon substrate (diethyl-p nitrophenylphosphate), was deliberated using the increase of absorbance at 412 nm at 37 ◦C. 

Results: There were significant differences regarding serum cytokeratin 18 (p=0.005), paraoxonase activity (p=0.03), triglycerides (p=0.04) and low-density lipoprotein (p=0.04) between NAFLD and healthy subjects. Between CK-18 and paraoxonase with the early stages of fatty liver disease are associated.

Conclusion: This study suggests that serum levels of cytokeratin 18 can be useful in predicting non-alcoholic fatty liver disease. Paraoxonase activity (PON1) should be considered a biochemical marker of lipid peroxidation and the need for follow-up in patients with NAFLD

Keywords: Non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), Cytokeratin 18 (CK-18), Paraoxonases

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Background: According to the World Health Organization, cardiovascular diseases are the leading cause of death. Behavior modification to improve lifestyle habits can reduce the risk of cardiovascular disease. The aim of this study was to investigate the health promoting lifestyle in Patients with cardiovascular disease in 2014.
Methods: After approval of the study, 352 patients with cardiovascular disease in Gonabad city were enrolled 2014. Data were collected using Health Promoting Lifestyle Promoting (HPLP2) questionnaire. Then analyzed using SPSS software and the Mann-Whitney and Kruskal-Wallis tests. The significance level of P value was considered to be less than 0.05.
Results: Three hundred and fifty-two patients (232 females and 120 males) were recruited, with a mean age of 61.89 ± 1.34 years. The highest mean score of lifestyle was 24.45 ± 8.05 in personal relationships and the lowest was 12.65 ± 5.60 in the area of stress management. All structures had the direct impact on the lifestyle that the most direct impact was social relations (R2= 0.329) and the least direct impact was stress management (R2= 0.164) and the strongest predictor of lifestyle in the mechanisms related to physical activity with the overall effect 14.38 was based on the pattern walker.
Conclusion: Considering, life style has a significant effect on cardiovascular disease. It is possible to improve the lifestyle of patients by providing steps to prevent and control this disease.

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Background: Hemodialysis is the most common treatment in patients with end stage of renal disease (ESRD). Patients undergoing hemodialysis due to multiple drug treatments, special food programs and being able to cope with their illness need to self-care activities. Due to lack of information about the role of health literacy in effectiveness of self-care in these patients, this research aimed to determine the correlation between self-care and health literacy in patients undergoing hemodialysis in Valiasr Hospital of Arak in 2015.
Methods:  In this descriptive correlational study, 93 undergoing hemodialysis patients selected by objective sampling method. Data collecting instruments were "demographic questionnaire", "self-care questionnaire " and "Health Literacy for Iranian Adults questionnaire". The content and face validity of questionnaires was assessed. Reliability assessed through internal consistency (Cronbach's alpha) and Intra- Class Correlation Coefficient. Data were analyzed by SPSS, version 21, using, Kolmogorov–Smirnov test, Descriptive Statistics and Kolmogorov–Smirnov test. 
Results: The results showed that 79/6% of patients were male and 20/4% were female with an average age of 54/18 ± 13/9 year. The mean score of self-care and health literacy were 146/90± 45/46, 88/14± 36/42 and were at a moderate level. The lowest score of self-care and health education related to the field of fluid intake and decision-making and behavior. There was a significant positive correlation between self-care and health literacy (p<0/0001, r= 0/6).
Conclusion: The existence of a significant positive correlation between self-care and health literacy showed that the hospital managers and the nurses must pay more attention to what patients undergoing hemodialysis need. Considering the importance of health literacy in the care of patients undergoing hemodialysis, it seems necessary to nursing administrators and Politicians use educational programs tailored to the patient's health literacy level in order to promote their health and quality of life.
 

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Background: Diabetes mellitus is one of the most common endocrine diseases. Cardiovascular disease (CVD) is one of the leading causes of death in patients with type 2 diabetes. The aim of this study was to investigate the metabolic profile of plasma amino acids in diabetic patients with cardiovascular disease.
Methods: The present study is a descriptive-analytical cross-sectional study on 140 patients including 35 patients with type 2 diabetes and cardiovascular disease (CVD.DM), 35 patients with type 2 diabetes and non-cardiovascular disease (DM). 35 non-diabetic patients with cardiovascular disease (CVD.nDM) and 35 non-diabetic patients with non-cardiovascular disease (HS) were referred to Diabetes Clinic No. 1 of Tehran University of Medical Sciences.
Results: 76 (54.3%) were male and 64 (45.7%) were female. The highest concentrations of glutamine and isoleucine were observed in DM.CVD, asparagine, serine, arginine, threonine, alanine, tyrosine, valine in DM.nCVD and methionine in CVD.nDM. The lowest concentrations of tyrosine and tryptophan in DM.CVD has been detected , and  methionine has been detected in DM.nCVD. The amino acids alanine, glutamine, tyrosine, valine, methionine, leucine, lysine and arginine significantly increased the chances of developing DM.nCVD. For each increase in Z-score per plasma concentration of isoleucine, the chances of developing cardiovascular disease without diabetes were significantly increased.
Conclusion: The amino acids alanine, glutamine, tyrosine, valine, methionine, leucine, lysine and arginine are involved in predicting the risk of DM.nCVD and isoleucine and methionine are involved in predicting the risk of CVD.nDM.

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Background: In many years, finding modern and appropriate treatments for diseases, especially chronic diseases (such as chronic metabolic diseases) have been one of the most important issues. On the other hand, limitations related to organ transplantation have made a serious need for advanced therapeutic strategies. In this respect, researchers have recognized the benefits of stem cells as a suitable tool. Accordingly, the application of stem cells for the treatment of various diseases has been considered in many countries around the world especially Iran.
Methods: A review of the history of stem cell studies in Iran and the world was conducted and the Cell Therapy and Reconstructive Medicine Research Center was introduced as one of the leading centers in this field and a review was conducted on the activities of this center.
Results: The history of studies related to cell-based therapy in Iran back to 1990. Subsequently, the Cell Therapy and Reconstructive Medicine Research Center, by providing services based on GMP principles, has provided clinical services in accordance with international standards and has conducted various researches in this field.
Conclusion: The purpose of the current review is to examine the strategies and challenges around the research and treatment opportunities using stem cells in mentioned center.
 

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Non-Communicable Diseases (NCDs) are the major cause of premature death and disability due to diseased globally, imposing a heavy burden on the health systems. Four main categories of NCDs are cardiovascular diseases, neoplasms, diabetes, and chronic respiratory diseases. Iran, the second greatest country in the Middle East Region, has been through an important transition period of communicable diseases toward NCDs in the last decades. One of the effective approaches to control NCDs is implementation of population-based studies and interventions, trying to reduce risk factors and incidence of NCDs through investigations in the populations. Endocrinology and Metabolism Research Institute (EMRI) and Non-Communicable Diseases Research Center (NCDRC) are the pioneers trying to study and control various NCDs during the last decades in Iran. In this review, we are going to inspect some of the major completed and ongoing projects of this research institute to highlight valuable efforts to reduce burden of NCDs in Iran, and make a successful example for national and regional public health policy makers and authorities.

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Background: Diabetes is the fourth leading cause of death in the world. And because so many people around the world have the disease, or are at risk for it, diabetes can be called the disease of the century. Diabetes has devastating effects on the health of people in the community and if diagnosed late, it can cause irreparable damage to vision, kidneys, heart, arteries and so on. Therefore, it is necessary to have methods to diagnose this disease in the early stages. In this article, data mining is used to diagnose diabetes.
Methods: The main algorithm used in this paper is the random forest algorithm. To evaluate the efficiency of the proposed algorithm in diagnosing diabetes, a data set was used that included 768 samples (patients) and had 8 characteristics. Because the stochastic forest algorithm is a hybrid algorithm created from several decision trees, it achieves high accuracy in diagnosing diabetes.
Results: Using this algorithm, we were able to increase the accuracy of diabetes diagnosis to 99.86%.
Conclusion: Diabetes is the fourth leading cause of death in the world. Different algorithms have been used to diagnose this disease. We tried to use an algorithm that has a very high degree of accuracy compared to other algorithms for diagnosing this disease.

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Background: Non-alcoholic fatty liver disease (NAFLD) is a pathological syndrome associated with increased serum levels of liver enzymes. The purpose of this study was to investigate the impact of exercise training on liver enzymes (ALT, AST, and GGT) and liver fat content in adults with NAFLD.
Methods: The PubMed, Web of Science, SID, Magiran, and Google scholar databases were searched until February 2022 for English and Persian articles. Meta-analyses were performed to compare the impact of exercise training on liver function in patients with fatty liver. SMD and 95% confidence interval (95% CI) were calculated using effect models. Also, the I2 test was used to determine heterogeneity, and the Funnel plot and Egger tests at a significant level of 0.1 were used to determine publication bias.
Results: The results of meta-analysis of 36 studies with 1602 patient with NAFLD, showed that exercise training caused a significant decrease in ALT enzyme [SMD=-0.73, (95% CI: -0.51 to -0.95), p=0.001], AST enzyme [SMD=-0.61, (95% CI: -0.39 to -0.83), p=0.001], GTT enzyme [SMD=-0.66, (95% CI: -0.18 to -1.14), p =0.007], and intrahepatic fat [SMD=-0.58, (95% CI: -0.78 to -0.38), p=0.001].
Conclusion: The findings of the present meta-analysis show the important role of exercise training (aerobic, resistance, and combined training) in improving liver function. So, all three types of aerobic, resistance, and combined exercise are suggested as a non-drug approach to reduce liver enzymes and intrahepatic fat for adults with NAFLD.

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Background: Fetuin-A, as a hepatokine, plays an important role in the regulation of whole-body metabolism, which is increased with chronic diseases. Therefore, the aim of this meta-analysis is to investigate the effect of exercise training on Fetuin-A levels in individuals with metabolic and kidney diseases.
Methods: A systematic search was conducted in PubMed, Web of Science, and Google Scholar databases until November 2022 using the keywords "exercise training" and "Fetuin-A". To determine the effect size, standardized mean difference (SMD) and 95% confidence interval were calculated using CMA2 software. Heterogeneity was evaluated using the I2 test, and publication bias was evaluated by visual interpretation of the funnel plot and Egger's test. The quality of the included studies was evaluated using the PEDRO checklist.
Results: A total of 16 studies including 21 trials arms and 554 subjects with type 2 diabetes, obesity and kidney disease were included in the meta-analysis. Exercise training resulted in a significant decrease in Fetuin-A levels [-0.93 (CI: -1.35 to -0.51) P= 0.001]. There was a high heterogeneity (I2= 89.24, P= 0.001) and also a significant publication bias (P= 0.001). The results of subgroup analysis based on the type of exercise training showed that aerobic training resulted in a significant decrease in Fetuin-A (P= 0.001) while the reduction of this marker with combined training was not significant (P= 0.33).
Conclusion: Exercise training, especially aerobic training, results in a decrease in Fetuin-A levels in metabolic patients, which may be contributed to the beneficial effects of exercise.