[Policy priorities of the I.R of IRAN for childhood obesity prevention]

Introduction: Childhood obesity is an important risk factor for adult obesity and its consequences, its prevention and control are hence vital; considering the limited health resources, the most appropriate policies should be implemented

Materials and Methods: After reviewing literature, taking into account national health policies and priorities, of other countries, international organization and guidelines of authorized officials, eight priority criteria and twenty policies for prevention of childhood obesity were extracted and submitted to selected stakeholders as questionnaires to determine policy priorities using the Delphi technique

Results: The three highest score priority criteria were efficacy, feasibility and inequality, Five high priority policies were: 1- Improving public health education in particular for healthy foods; 2- Adding obesity prevention and healthy diet disciplines/lessons to school teaching curriculum for mothers and kindergarten training courses; 3-Improving community and school physical activities and sports by revising management strategies; 4-Controling media regarding food and drink advertising and 5- Encouraging participation in physical activities by implementing revised policies for public transportation

Conclusion: The prioritised policis in addition to other stakeholder opinions can be used for selecting most appropriate strategies and action plans to combat childhood obesity

incidence of thyroid dysfunctions in patients with type 2 diabetes: a twelve-year follow-up of the Tehran lipid and glucose study

Undiagnosed thyroid dysfunction may impair metabolic control in patients with diabetes. Due to the lack of adequate studies on the incidence of thyroid dysfunction in patients with type 2 diabetes mellitus there is no consensus regarding optimal thyroid screening strategies in routine diabetes care. The aim of this study was to determine the incidence of thyroid dysfunction in patients with type 2 diabetes. In this study, patients aged >/=30 years, participants of in the prospective Tehran Lipid and Glucose Study, who had complete thyroid assessments were divided into two groups of 428 diabetic and 2847 nondiabetic controls and followed for 12 years. The incidence of thyroid dysfunction in these two groups was compared and the relative risk of type 2 diabetes for thyroid dysfunction was calculated. Compared to those without diabetes the disorders patients with diabetes were less likely to develop thyroid dysfunction [incidence rate 12.56 vs. 16.50 cases per 1000 person-years, Relative risk 0.74, 95% Cl, 0.534-1.026, P=0.071]. The incidence of thyroid dysfunction in type 2 diabetic patients is not higher than in non-diabetic individuals, indicating that routine screening of thyroid dysfunctions is not recommended in type 2 diabetic subjects

[Effect of legumes intake on the oxidative stress markers in type 2 diabetes patients: a randomized cross-over study]

Oxidative stress plays a key role in the pathogenesis of late diabetic complications, the markers of which could be improved by the beneficial effects of legumes. In this randomized crossover trial, 24 overweight subjects, aged 50-80 years, with type 2 diabetes, were selected. We aimed to determine the effects of non-soybean legumes consumption on oxidative stress markers such as ox-LDL [oxidative LDL], MDA [Malonedialdehyde] and TAC [total antioxidant capacity] in type 2 diabetic patients. The subjects were randomly assigned into two groups, receiving two diets - the TLC [controls] or the TLC diet with legumes [receiving 2 servings of legumes instead of meat three days of the week in the TLC diet]. Duration of each diet was 8 weeks with a 4 week wash-out period. At the beginning and end of each dietary period, fasting plasma glucose, ox-LDL, MDA, TAC and weight were measured. After the nutritional intervention, diabetic patients, those individuals who followed the legume-based TLC diet had significant reduction in ox- LDL [-3.1 +/- 0.5 vs. -0.7 +/- 0.4; P=0.003] and MDA [-1.1 +/- 0.2 vs. -0.3 +/- 0.1; P=0.006], but no change was observed in the TAC and BMI of the case and control groups. The legume-based TLC diet improves oxidative stress markers in diabetic patients, compared to the legume-free TLC diet

[Thyroid derangements in pregnancy]

Regulation of thyroid function undergoes important alterations to maintain euthyroidism during pregnancy. During normal pregnancy, increased estrogen production from the placenta causes an increase in TBG and total T4 and increase in hCG stimulates the thyroid gland and decreases serum TSH concentration; in addition, thyroxine metabolism and urinary iodine excretion are also increased. Women residing in iodine deficient regions present with goiter and hypothyroxinemia during pregnancy, with overt thyroid dysfunction occuring in 2-3% of pregnancies, and subclinical dysfunction in 10% of pregnancies. Hyperthyroidism is exacerbated during the first trimester, with relative amelioration in the second and third trimesters, and accelerates again during the postpartum period. Transfer of TSH receptor antibodies from placenta may cause neonatal hyperthyroidism with tachycardia, accelerated bone growth and delayed intrauterine growth. Unrecognized thyroid dysfunction during pregnancy may cause irreversible alterations in pregnancy outcomes and physical and mental development of fetus and neonate. Therefore, proper evaluation, diagnosis and treatment of thyroid deranagements during pregnancy are of outmost importance

[Effect of modified diet on lipid profiles in type 2 diabetic patients]

This study compares the effects of modified diets containing legumes on fasting blood glucose and lipid profiles in patients with type II diabetes. In this randomized crossover trial, 24 subjects with type 2 diabetes, age range of 50 to 80 years, were selected and randomly assigned to two groups, one receiving diets of therapeutic lifestyle change [controls] or the other, with therapeutic lifestyle change with legumes [replacing meat with 2 servings of legumes in their therapeutic lifestyle change diet, three days a week]. Period of each diet was 8 weeks with a 4 week wash out period. Fasting blood samples were taken to measure the fasting plasma glucose and blood lipid profiles [LDL-C, triglycerides, HDL-C, total cholesterol]. Compared to the therapeutic lifestyle change diet, in the group with the therapeutic lifestyle change diet with legumes, diet were fasting insulin, total cholesterol and triglycerides were significantly decreased [P<0.05]. After 8 weeks intervention fasting plasma glucose and LDL cholesterol in both diets significantly reduced compared with baseline values [P<0.05], while, no significant change was observed in HDL cholesterol. Replacement of 2 servings of legumes instead of meat 3 days a week in the TLC diet resulted in improved total cholesterol and triglyceride levels

[Eighteen years of universal salt iodization in Iran; the fourth national survey of goiter prevalence and urinary iodine excretion of schoolchildren [2007-2008]]

Iodine deficiency disorders [IDD] have been recognized as a major public health problem in Iran for many years. Following the iodine deficiency elimination program, Iran is now an IDD free country in the Middle-East region. This study was performed to evaluate the adequacy of iodine supplementation after 18 years of universal salt iodization and the current status of iodine nutrition in all 30 provinces of Iran. In this descriptive cross-sectional study, [conducted between Oct 2007-February 2008] 36000 schoolchildren, aged 8 to10 years, were randomly selected from all provinces. Goiter prevalence and urinary iodine excretion in schoolchildren and iodine content of salt at household, factory and distribution sites were measured. Total goiter rate [TGR] in the country was 6.5% [6% grade 1 and 0.5% grade 2], and weighted goiter rate was 5.7%. TGR in Hamedan, Zanjan, Kermanshah, Mazandaran and Gilan was over 10%. The median urinary iodine was 140 microg/L, with urinary iodine levels of 20-50, 50-99 and >/= 100 microg/L being 15.3%, 19.8% and 64.9%, respectively. In four provinces, median urinary iodine was lower than100 microg/L. Mean [ +/- SD] and median salt iodine were 23.2 [13.8] and 34.7 ppm at production level and 32.4 [14.7] and 32.3 ppm at distribution level, respectively. Ninety-eight percent of households consumed iodized salt, and 58% of households had appropriate salt storage. The I.R. Iran has made strong progress in the development of universal salt iodization strategy and meets all criteria for sustainable elimination of iodine deficiency. However, lack of adequate iodine nutrition in some provinces necessitates special attention and proper monitoring

[Goiter and urinary iodine excretion survey of schoolchildren in Qazvin provine: results of 17 years universal salt iodization in Iran [2007]]

The iodine deficiency elimination program, which began two decades ago, has resulted in Iran becoming an Iodine Deficiency Disorders [IDD] free country in the Middle-East region. This study was performed to evaluate the adequacy of iodine supplementation after 17 years of universal salt iodization in the province of Qazvin. In a crosssectional study, 1200 schoolchildren [600 girls and 600 boys], aged 8 to 10 years, were randomly selected from Qazvin province, and evaluated in 2007. Goiter prevalence, urinary iodine excretion and iodine content of household salts were measured and the data obtained were compared with those obtained in 1996 and 2001. Total prevalence of goiter was 0.8%; and no grade 2 goiter was seen. One-tenth of the children enrolled for goiter assessment, were randomly selected for urinary iodine measurement. The median urinary iodine in these 120 schoolchildren was 151 micro g/L, with 4% having urinary iodine excretion less than 50 micro g/L. Sixty-six percent of households were using purified iodized salt, 65% of households had appropriate salt storage, and 30% of the household salts contained less than 15 micro g iodide. Goiter prevalence has significantly decreased in Qazvin province, 17 years after universal salt iodization. Similar to reports from 1996 and 2001, the median urinary iodine of schoolchildren was adequate, indicating a well established sustainable IDD program in Iran

[ incidence of subclinical thyroid dysfunction and it's natural course in the Tehranian adults]

The aim of this study was to determine the incidence of thyroid dysfunction and the natural course of subclinical thyroid disorders in the Tehranian community. All individual >/= 20 years, who participated during the first to third phases [6 years, 7 months], of the [Tehran Lipid and Glucose Study] and provided the relevant data were included in this study. Both Tpo-Ab and TSH were measured. In 808 TPO-Ab negative individuals who were not taking any thyroid and anti-thyroid drugs and without a history of thyroid disease, thyroid surgery, goiter and thyroid nodules, mean, median, 2.5, 5, 95, 97.5 percentile TSH were determined. On the basis of 2.5 and 97.5 percentile, normal reference range for TSH was 0.4- 5.8 micro u/mL. In those, whose TSH fell outside the reference range, T3, T4 and T3 uptake were measured and FTI was calculated. In the first stage, 1065 women and 693 men had normal thyroid tests. After 6.7 years the incidence of clinical hypothyroidism was 0.28 in 1000 women and 0.21 in 1000 men, subclinical hypothyroidism was 11.59 in 1000 women and 4.69 in 1000 men, clinical hyperthyroidism was 1.4 in 1000 women and 0.21 in 1000 men, subclinical hyperthyroidism was 5.72 in 1000 women and 3.62 in 1000 men. In this period, increasing positivity of TPO-Ab from 15.9 to 17.7% in women was significant. [P=0.06] In the first stage 8 women had subclinical hypothyroidism, 5 still did on follow-up, one was normal, and one was diagnosed with clinical hypothyroidism. The remaining one was hyperthyroid on levothyroxin. Two women with subclinical hyperthyroidism in the first stage were normal in follow-up, without any treatment. In the first stage 2 men had subclinical hypothyroidism, and in follow-up, one was same, while the other was diagnosed with clinical hypothyroidism. Normal range of TSH was 0.4-5.8 micro u/mL in the Tehranian community. There was significant increase of the frequency of subclinical thyroid disorders in both genders and frequency of clinical hyperthyroidism and TPO-Ab positive in women. Compared to clinical thyroid disorders, the incidence of subclinical thyroid disorders, was more significant

[Comparison of ordinary and multilevel logistic regression in determining goiter related factors in children]

The aim of this research was comparison of multilevel and ordinary logistic regression in determining goiter related factors in children, based on hierarchical structure of the data. Data of 35747 schoolchildren, aged 8-10 years, was collected in 2007 by the Research Institute of Endocrine Sciences, Shahid Beheshti University of Medical Sciences. Stratified and cluster random sampling methods were employed in 30 provinces across the country. Goiter status, sex, area of residence, altitude from sea level and status of Iodized salt storage in households were documented. Multilevel logistic regression model was applied and the results compared to those obtained using ordinary logistic regression. The study showed that 5.74% of the pupils suffered from goiter. The variance of the 2nd level [districts] was estimated as 0.941 [SE=0.092] in the two-level model[p<0.001], in which no significant relation was seen between goiter and altitude from sea level [OR=1.27; 95%CI: 0.78, 1.62]. in the three-level model, the variance in the third level [provinces] was 1.031 [SE=0.287] [P<0.001]. In the final three-level model, only sex and area of residence were found to be significant. results showed that, compared to two and three level logistic regression models, the variances of parameter estimates are underestimated in the ordinary logistic regression

[Evaluation of urinary iodine concentration and iodine content of households salt in south of Tehran]

Iodized salt is the main dietary source of iodine in Iran. Previous studies have shown sustainable elimination of iodine deficiency disorders in Iran. The aim of this study was to evaluate urinary iodine concentration and the iodine content of households salt in the south of Tehran in 2009. This cross-sectional study, 91 households were enrolled through randomized cluster sampling. A total of 147 adult subjects [62 males, 85 females], aged 18 and over, were selected from households to provide 24 hr urine samples. Urinary iodine and creatinine concentrations were measured by using the digestion method and autoanalizer assay, respectively. Daily salt consumption was estimated and household salt iodine content was measured by titration. Mean +/- SD iodine concentration of household salt was12.7 +/- 14.7 ppm, and 64.8% of household salts contained < 10 ppm iodine. The median of Urinary Iodine Concentration [UIC] was 48.0 micro g/l. There was no statistically significant difference in UIC, between men and women. The median daily salt consumption was 9.1 g. According to WHO/ICCIDD/UNICEF classification, 17.0, 30.6, 45.6 and 6.8 percent of participants had UICs >100, 50-99, 20-49 and <20 micro g/l, respectively. Iodine contents of household salts were not adequate in the south of Tehran, indicating Tehranians in this region, previously iodine sufficient, now suffer from moderate iodine deficiency. These findings show necessity of more detailed surveys for iodine nutrition improvement and emphasize the importance of attention being paid to the risk of iodine deficiency recurrence in Iran

Thyroid volumes in tehranian schoolchildren 15 years after universal salt iodization

Correct interpretation of ultrasonographic measurement of thyroid volume in goiter surveys depends on the availability of valid reference criteria from iodine sufficient populations. There is a lack of consensus of opinions on universal reference values for thyroid volume. Our objective was to describe thyroid volume measured by ultrasonography in Tehranian schoolchildren who had been living in an iodine sufficient area their entire life. This cross-sectional study was performed on 464 schoolchildren, aged 7-15 yr in Tehran, fifteen years after distribution of iodized salt. Data were collected on age, sex, weight, and thyroid size was ascertained by palpation and ultrasonography. The prevalence of goiter was 2.3% by palpation. All goitrous subjects had grade 1 goiter thyroid volumes determined by ultrasonography were comparable in boys and girls of all ages. The best predictors of thyroid volume were age, weight, and body surface area. The median thyroid volumes of Tehranian schoolchildren in this study were lower in all age groups compared with our previous 2001 study and updated provisional WHO/ICCIDD reference values. Tehranian schoolchildren currently living in an iodine sufficient area, where they have spent their entire lives, have smaller thyroid glands than recommended international references. Existing values for universal thyroid volume reference ranges should be re-considered

Goiter and urinary Iodine excretion survey of 8-10 years old school children in Tehran province, 17 years after universal salt iodisation [2007]

Following two decades of intensive efforts work in IDD elimination, Iran has been recognized as an IDD free country in the Middle-East region. This study was performed to evaluate the adequacy of iodine intake, 17 years after universal salt iodization in Tehran and to compare the results with those of previous studies. In this cross-sectional study, 8 to l0 year-old schoolchildren, randomly selected from Tehran province, were evaluated in year 2007, using data gathered on goiter prevalence, urinary iodine excretion, iodine content of household salts and thyroid volume measured by ultrasonography; the results obtained were compared with those documented for 1996 and 2001. In this study, 1200 children were evaluated. Total prevalence of goiter was 2.3%; no one had grade 2 goiter. The median urinary iodine in 120 schoolchildren was 94.1 microg/L. Only 54.9% of Tehranian households were using iodized salt and salt storage was appropriate in 47.9% of households; salt used by 62.5% of households had less than 15 microg iodide. Ultrasonic measurement of thyroid volume was performed in 464 schoolchildren, aged 7-15 years, and while the median thyroid volume of girls aged 7-11 years was slightly more than that of boys, the 97[th] percentile thyroid volume of both sexes was similar for all age groups. Thyroid volumes were significantly correlated with age, weight, height and body surface area. Goiter prevalence has decreased significantly in Tehran, the central province of Iran, 17 years after universal salt iodization. However the median urinary iodine of school children has decreased in comparison to results of studies conducted in 1996 and 2001. Continuous monitoring of national programs is essential for IDD elimination

[History of the iodine deficiency in the world and Iran]

Iodine deficiency today is a risk factor for delayed growth and development and is the most common preventable cause of brain damage worldwide. Over of 2 billion [38%] of the world's population from 130 countries are at risk. Iodine deficiency causes inadequate thyroid hormone production, iodine being essential constituent of the thyroid hormone. Iodine deficiency was once considered a minor problem, causing goiter; however it is now known that the effects on the developing brain are much more deadly, and constitute a threat to the social and economic development of many countries. The history of iodine deficiency began with the first reports of goiter and cretinism, dating back to the ancient civilizations, the Chinese and Hindu cultures and then to Greece and Rome. The first detailed descriptions of these subjects, and documentation of the word "cretin" appeared in Diderot's encyclopedia in 1754, to refer to an "imbecile who is deaf, dumb with a goiter hanging down to the waist" at that time widely present in Switzerland, southern France and Northern Italy. The 19[th] century marked the beginning of serious attempts to control the problem, however, not until the latter half of the 20[th] century that the necessary knowledge for effective prevention and control was acquired; present-day practice is based on the work of David Marine, who in 1915, declared that "endemic goiter is the easiest known disease to prevent." In the same year, Hunziger proposed that iodized salt be used for goiter control in Switzerland. Today the number of countries with iodine deficiency as a public health problem has decreased from 110 to 45, between 1993 and 2003, An estimated 41 million annual newborns stiff come into the world unprotected from brain damage as a result of iodine deficiency. Monitoring of IDD elimination programs and education are two of the crucial elements for sustainability. Successes in some countries, e.g., Iran, China, Cameroon and Peru, show that sustainable optimal iodine nutrition is possible

[Marked reduction in goiter prevalence and eventual normalization of urinary iodine concentrations in Iranian schoolchildren, 10 years after universal salt iodination [third national survey of iodine deficiency disorders 2000]]

Two years after legislation of salt iodization of 40 parts per million [ppm] in 1994, goiter was still endemic and urinary iodine concentration [UIC] remained elevated in many provinces of Iran. Goiter prevalence and UIC were compared two and seven years after sustained consumption of uniformly iodized salt by Iranian households. From December 2000 to June 2001, schoolchildren [7-10 yr] of all provinces were randomly selected by cluster sampling; their goiter rate, UIC, and household salt iodine levels were compared to similar data collected in 1996. Factory salt iodine produced in 2001 was also compared to that of 1996. Ultrasonographically determined thyroid volumes of 7-10 yr old children were compared in 2001 to those of 1999. Total, grade 1, and grade 2 goiters were 13.9 vs. 53.8%, 11.0% vs. 44.8%, and 2.9% vs. 9.0%, in 2001 [n=33600] vs. 1996 [n=36178], respectively [p<0.0001]. Median [range] UIC in 2001 [n=3329] was 165 [18-410] micro g/L and in 1996 [n=2917] was 205 [10-2300] micro g/L [P<0.0001]. Means for iodine salt content were 32.7 +/- 10.1 and 33.0 +/- 10.2 [P=0.79] in households and 33.2 +/- 13.4 and 33.8 +/- 13.2 [P=0.67] in factories, in 2001 and 1996, respectively. Only 7-yr-old children in 2001 [the only group with probably no history of iodine deficiency] showed significantly smaller thyroid volumes compared to those in 1999. After seven years of optimized iodized-salt supplementation in Iran, adequate UIC values and marked reduction in goiter rate have been achieved

[Goiter survey and urinary iodine concentration in 7-10-year-old children, Tehran province, 2001]

Iodine deficiency disorder [IDD] is a worldwide health problem. Parts of Iran, such as Tehran, had been known as endemic areas for goiter. IDD was accepted as a priority health problem in our country and a National IDD Council was formed in 1989. This study was performed to evaluate the National IDD Council program in 2001 among 7-10-year-old children in Tehran province. In this cross sectional study, 1200 children [M/F ratio=1], aged 7-10 years, were selected and grading of goiter was performed in accordance to the WHO criteria. Urinary samples were obtained from 120 children and urinary iodine was measured using digestion method. Total prevalence of goiter was 5.1% [3.5% in girls and 6.3% in boys]. The median urinary iodine was 19 microg/dl 80.8% had urinary iodine of more than 10microg/dl, while 11.2% had urinary iodine levels of <5microg/dl. None of the candidates has urinary iodine of less the 2microg/dl. there was no significant difference between sexes and urban or rural areas. Results have revealed that the total prevalence of goiter has significantly decreased among children in Tehran province, meanwhile, urinary iodine concentration of children has reached to WHO approved rate. Thus, Tehran province could be classified among [iodine-deficiency-free] areas in Iran