[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

[Temporal changes in lipid profile and anthropometric parameters according to body mass index, among Iranian adults]

The aim of this study was to examine in the lipid profile during 3.6 years and anthropometric parameters in Iranian adults the changes during 3.6 year body mass index [BMI]. Among participants of the Tehran lipid and glucose study [TLGS], 2940 non-diabetic adults, aged 20 years and older, who remained within the same BMI group during the two phases of the survey and were not taking lipid lowering drugs were investigated. We used ANCOVA and the repeated measures test for delineating short time trends in mean levels and ratios of serum lipids as well as anthropometric parameters across BMI groups [WHO classification]. In all BMI groups the anthropometric indices of central and general obesity increased and total cholesterol [TC] [p<0.05] and high density lipoprotein cholesterol [HDL-C] [p<0.001] levels decreased in both genders. Among men, the greatest decline in total cholesterol levels was observed in obese persons [7%], whereas the greatest decline in HDL-C levels was observed in normal-weight persons [9%]. A significant increase in TC/HDL was observed only in men, whereas among the normal-weight sub-group, TC/HDL increased both in men [9%] and women [6%]. Despite increases in general and abdominal obesity parameters, we observed favorable trends in total cholesterol levels. However declines in HDL cholesterol levels, and resulting increases in TC/HDL, particularly among normal-weight persons, could serve as a warning for increased risk of ischemic heart disease

[Goiter surgery and urinary iodine concentration in 7-10-year-old children, Azarbayejan-Gharbi Province, 2001]

Iodine deficiency disorder [IDD] is a worldwide health problem. Parts of Iran, such as Azarbayejan-Gharbi, 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 Azarbayejan-Gharbi 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 7.2% [6.7% in girls and 7.8% in boys]. The median urinary iodine was 14.6microg/dl. 83.9% had urinary iodine of more than 10microg/dl, while 2.6% 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 Azarbayejan-Gharbi province, meanwhile, urinary iodine concentration of children has reached to WHO approved rate. Thus, Azarbayejan-Gharbi province could be classified among "iodine-deficiency-free" areas in Iran

[Changes in body weight and body fat distribution as risk factors for metabolic syndrome in Iranian women]

To examine the association between changes in body weight and body fat distribution and development of metabolic syndrome. Changes in body weight and body fat distribution and the appearance of metabolic syndrome over a 3 year duration were assessed in 2176 women of the Tehran Lipid and Glucose Study. Metabolic syndrome was defined according to ATPIII criteria. Body fat distribution was determined by waist to hip ratio, waist circumference and hip girth. Stable waist and hip were defined successively as +/- 2cm and -2cm to 0cm, respectively. The mean age of subjects was 36.4 +/- 12.7 years and the incidence of metabolic syndrome was 19 percent during this period. After controlling for age, family history, smoking status and physical activity, weight gain was monotonically related to the risk of development of metabolic syndrome [for each Kg of weight gained, risk increased by 1.15%]. Changes in waist to hip ratio of over 0.07 cm, were significantly associated with risk [P<0.05], independent of the risk associated with weight change. Compared with women who had a stable waist,. 3cm increase in waist circumference had 3.33 times [95%CI: 2.14-5.22] the risk of metabolic syndrome and. 5cm increase in hip girth had 1.58 times [95%CI: 0.99-2.54] the risk of metabolic syndrome. Findings show that changes in weight and body fat distribution are associated with the risk of metabolic syndrome

[Effects of cool dialysate temperature on stabilizing hemodynamic parameters in diabetic patients undergoing hemodialysis]

Hypotension is the most common acute complication of hemodialysis. To ameliorate symptomatic hypotiension during dialysis, cool temperature dialysate has been recommended. Since reports show that not all patients benefit from cool dialysis, it seems necessary to determine which patients benefit more from cool dialysis. The aim of this study is to investigate the effect of cool dialysis on hemodynamic parameters in diabetic patients; serum nitric oxide levels also were determined to find any possible association. Twenty diabetic patients [mean age 63.3 +/- 7.5] were included in the study. Each patient was dialyzed twice, once using cool and once using warm dialysate solution. Apart from a change in temperature to 35°C, all other conditions remained the same during the study. Hemodynamic parameters including SBP, DBP, and HR were measured hourly, the number of hypotension episodes was also determined. Oral temperature was measured before and after dialysis. Serum urea and nitric oxide metabolites [NOx] were determined before and after hemodialysis. SBP, DBP, and MAP decreased significantly during warm, as compared to cool, dialysis. Maximum decreases in SBP, DBP, and MAP were seen in the third hour of dialysis and these were 18, 17, and 14 percent for warm and 6, 1, and 4 percent for cool dialysis respectively. HR showed no significant difference between the two groups. Compared to before dialysis, NOx levels decreased significantly in cool and warm conditions after dialysis [59 +/- 5 vs. 37 +/- 4, and 63 +/- 7 vs. 41 +/- 5, respectively, P<0.01]. Cool dialysis could decrease episodes of hypotension and stabilize hemodynamic parameters in diabetic patients. Mechanisms other than increased serum nitric oxide levels are involved in hemodialysis hypotension in diabetic patients

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

Iodine deficiency disorder [IDD] is a worldwide health problem. Parts of Iran, such as Kohkilouyeh-va-Bouyerahmad, 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 Kohkilouyeh-va-Bouyerahmad 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 7.7% [6.5% in girls and 8.7% in boys]. The median urinary iodine was 17.7microg/dl. 84.7% had urinary iodine of more than 10microg/dl, while 14.3% had urinary iodine levels of <5microg/dl. None of the candidates has urinary iodine of less the 21microg/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 Kohkilouyeh-va-Bouyerahmad province, meanwhile, urinary iodine concentration of children has reached to WHO approved rate. Thus, Kohkilouyeh-va-Bouyerahmad province could be classified among [iodine-deficiency-free] areas in Iran

[Prescribing practices in childhood gastro-enteritis and its comparison with WHO guidelines]

Dehydration resulting from acute diarrhea kills 1.5 million children each year. Rational management is based on oral re-hydration as recommended by the World Health Organization. This study was conducted to define the rationality of prescriptions written for acute watery diarrhea in children. A cross-sectional study was done on children who had been treated for acute gastroenteritis during the two weeks prior to their visit to the clinics of two teaching hospitals. Information obtained through interviewing the caretakers and scrutinizing the prescriptions, was documented. Prescribing practices of general practitioners and pediatricians were compared in three settings; private offices, hospital outpatients, and general polyclinics. 273 prescriptions were analyzed. An average of 4.1+/-2.3 drugs had been prescribed on each visit. At least one antibiotic was included in more than 76% of prescriptions. 60% of children were not given ORS. An injection was written in 51% of prescriptions and anti-emetics in 61%. There was no significant difference between general practitioners and pediatricians in the number of drugs per prescription. 75.7% of pediatricians and 78.5% of GPs had prescribed at least one antibiotic [p=0.58]. In teaching hospitals the average number of drugs prescribed for each visit was 3.1, in polyclinics, 3.2 and in private offices 3.6 [p=0.03]. Unjustified use of medicines and sub-optimal management of acute gastroenteritis were identified in more than 70% of prescriptions. Further studies and effective training programs are urgently needed to reverse current irrational treatment practices

[ prevalence of goiter and urinary iodine exertion in school-aged children in Zanjan]

Iodine deficiency was a public health problem in Iran before iodine supplementation. In order to evaluate the iodine status of school aged children in Zanjan, this survey was conducted in the frame work of national monitoring survey in 2001 to find the prevalence of goiter and urinary iodine level. 1200 schoolchildren, aged 7-10 years, were selected randomly from all regions of Zanjan, and the grade of goiter, in 600 boys and 600 girls, was determined according to WHO classification. Urinary iodine content was measured using the digestion method in one tenth of the school children. Total goiter rate was 19.7%, 225% in girls and 16.8% in boys. Median urinary iodine was 18.1 microg/dl. Urinary iodine was above 10 microg/dl in 85.1% and less than 5 microg/dl in 1.6%, no one had urinary iodine below 2microg/dl. There was no difference in goiter prevalence and urinary iodine between gender and rural or urban school children. It is concluded that urinary iodine levels in school children of Zanjan province are indicative of adequate iodine intake. There is considerable decrease; in goiter rate as compared to survey of 1986. Zanjan province therefore can be considered an "iodine deficiency free" zone

[Beneficial effects of a DASH [Dietary Approaches to Stop Hypertension] eating plan on features of the metabolic syndrome]

This study aims at determining the effects of the Dietary Approach to Stop Hypertension [DASH] eating plan on metabolic risks, in patients with metabolic syndrome. This was a randomized controlled outpatient trial conducted on 116 patients with metabolic syndrome. Three diets were prescribed for 6 months a control diet, a weight reducing diet emphasizing on healthy food choice, and the DASH diet with reduced in calories and increased in fruit, vegetables, low fat dairies, whole grain and reduced in saturated fat, total fat, cholesterol and restricted to 2400 mg Na. The main outcome measures were the components of the metabolic syndrome. Relative to the control diet, the DASH diet resulted in higher HDL [7 and 10 mg/dL], lower TG [-18 and -14 mg/dL], SBP [-12 and -11 mmHg], DBP [-6 and -7 mmHg], weight [-16,-14 Kg], FBS [-15 and -8 mg/dL], and weight [-16 and -15 kg], among men and women respectively. [all P<0.001]. The net reduction among men and women in TG [-17 and -18 mg/dL], SBP [-11 and -11 mmHg], DBP [-5 and -6 mmHg] and FBS [-4 and -6 mg/dL], weight [-16,-15 Kg] and increase in HDL [5 and 10 mg/dL] was higher in the DASH group [all p<0.05]. The weight reducing diet resulted in significant change in TG [-13 and -10 mg/dL], SBP [-6 and -6 mmHg], weight [-13 and -12 kg] among men and women, respectively [all p<0.05]. Conclusions: The DASH diet can likely reduce most of the metabolic risks both in men and women the related mechanisms need further study

[ prevalence of goiter and urinary iodine exertion in school-aged children in Sistan-Balouchestan]

Iodine deficiency and disorders resulting from it has long been recognized as a grave nutritional health concern. Sistan and Baluchestan Province, in studies conducted prior to Iodine dispensation, was among the regions with high prevalence of endemic goiter in Iran. 1200 schoolchildren, aged 7-10 years, were selected randomly from all regions of Sistan-Balouchestan, and the grade of goiter, in 600 boys and 600 girls, was determined according to WHO classification. Urinary iodine content was estimated using the digestion method in one tenth of the schoolchildren. Total goiter rate was 33.3%, 31.2% in girls and 35.3% in boys. Median urinary iodine was 19.8 micro g/dl. Urinary iodine was above 10 micro g/dl in 84.4% and less than 5 micro g/dl in 5.1%, no one had urinary iodine below 2 micro g/dl. UIC levels and goiter prevalence were not statistically different between boys and girls and also between urban and rural areas. It is concluded that the rate of goiter in Sistan-Balouchestan has decreased significantly since 1996 and urinary iodine levels in schoolchildren are indicative of adequate iodine intake based on WHO desirable level: Sistan-Balouchestan province therefore can be considered an "iodine deficiency free" zone