Overweight and obesity: findings from 20 years of the Tehran lipid and glucose study

Context: the prevalence of overweight and obesity are increasing worldwide and have frequently been associated with health risks. This review highlighted several studies regarding obesity, outlining contributions of over a span of almost two decades in the Tehran Lipid and Glucose Study [TLGS]

Evidence Acquisition: a systematic review was undertaken to retrieve articles related to all aspects of obesity from the earliest available date up to January 30, 2017

Results: prevalence of excess weight, including overweight and obesity were 20.8 and 63.6% among those aged below and above 20 years, respectively. TLGS found a high incidence of obesity with higher incidence in women among Tehranian adults; the cumulative incidence of obesity was 31.3, 38.1 and 23.4% for the whole population, women, and men, respectively. In children and adolescents, younger non-obese 7 - 9 years old, compared to 10 - 11 year olds are at greater risk of obesity. Prevalences of abdominal obesity in men and women were 52.8% and 44.4% respectively. Similar to generalized obesity, a high incidence of abdominal obesity was observed; the total cumulative incidence of abdominal obesity was 76.0% [83.6% for men and 70.9% for women]. Metabolically healthy obese [MHO] and metabolically healthy abdominal obese [MHAO] are two important obesity phenotypes. People with these phenotypes have different risks for cardiovascular disease [CVD], type 2 diabetes [T2DM], and mortality. In the TLGS participants, MHO was found in 2% and 7.7% of the whole and obese population, respectively, whereas MHAO phenotype was reported in 12.4% and 23.5% of the whole and abdominal obese population. In these unstable conditions, during the long term follow up the metabolic risks developed in nearly half of the individuals. During a 12-year follow-up, incident CVD did not increase in the MHO phenotype compared to metabolically healthy normal weight [MHNW] individuals, but the risk of CVD events had increased in all metabolically unhealthy phenotypes. However in another report, over a 10-year follow-up, MHAO phenotype had an increased risk for CVD in comparison to the reference group, metabolically healthy non-abdominal obese [MHNAO] individuals

Conclusions: the TLGS studies bridged the significant gap in knowledge regarding prevalence, incidence, trends, morbidities and mortalities for obesity among Iranian population

Legacy of the Tehran lipid and glucose study: chronic kidney disease

Context: chronic kidney disease [CKD], is correlated with a substantial upsurge in mortality and morbidity worldwide. In this review, we aimed to review the 20-year-findings on CKD of the Tehran lipid and glucose study [TLGS]

Evidence Acquisition: we conducted a systematic review of all studies on CKD that had been performed in the context of TLGS

Results: age adjusted prevalence of CKD, according to estimated glomerular filtration rate [eGFR] assessed with the two abbreviated equations of the modification of diet in renal disease [MDRD] and the CKD epidemiology collaboration [CKD-EPI] were 11.3% [95% confidence interval [CI]: 10.7, 12.0] and 8.5% [95% CI: 7.9, 9.1], respectively. Using MDRD equation, over a mean follow up of 9.9 years, the incidence density rates of CKD were 285.3 person years in women and 132.6 per 10000 person-years in men. Studies on the TLGS population documented that abdominal adiposity defined as waist circumference [WC] categories [P for trend < 0.02] and waist gain inmen[hazard ratio [HR] = 1.7, CI: 1.3, 2.2] significantly affected CKD development. Also, CKD had a significant effect on coronary heart disease [CHD] only in participants with low body mass index [HR = 2.06; CI: 1.28, 3.31 and HR = 2.56; CI: 1.04, 6.31 in men and women, respectively]. Moreover, CKD was among the strongest independent predictors of stroke [HR = 2.01, CI: 1.22, 3.33]. Also, compared to diabetic patients, an abnormal ECG was more prevalent in moderate CKD [P = 0.02]

Conclusions: increased waist circumference and waist gain [only in men] were associated with developing CKD in the TLGS population. CKD was an independent predictor of CHD [in lean individuals] and stroke

GABRIC Diabetes School: an innovative education centre for people with diabetes

Diabetes prevalence and deaths attributable to diabetes continue to rise across globally. Diabetes Self-Management Education and Support [DSME/S] is a critical resource designed to help people with diabetes [PWD] successfully selfmanage their disease; however, its utilization is too low. In the Islamic Republic of Iran, there are currently limited structured educational programmes and no national standards for DSME/S protocol. In response to this, the GABRIC Diabetes Education Association [GDEA] has been developed as a school for diabetics, which has a comprehensive DSME/S programme for PWD with 18 distinct courses on 5 levels for 8 target groups. In addition, GABRIC has developed a database registry with more than 100 000 members throughout the country, of whom 95% are diabetic with a proportion of 82% Type 2 diabetes and 13% Type 1 diabetes. The success of the GABRIC school model results is yet to be investigated through study trials, and offers a fruitful line of research

Metformin and intravascular contrast media: what to do in patients receiving both: a narrative review

Metformin-associated lactic acidosis [M-ALA] is considered to be one of the complications caused by intravascular contrast media [CM] administration in diabetics especially those with coexisting renal or cardiac impairment. We focused on the necessity and duration of metformin suspension in diabetics with normal or impaired renal function scheduled for CT scan with IV contrast. Searching PubMed, Web of Science, and Scopus databases, we reviewed the latest relevant guidelines as well as articles published from 1994 to 2015. There is no global consensus among different guidelines on the duration of the Metformin suspension before CT scan with IV contrast. Also, lack of substantial evidence supporting M-ALA encourages specialists to take a less conservative approach. It is safe to continue Metformin in patients with normal renal function who have no co-morbidities. In cases of equivocal renal function [30

Association between physical activity and metabolic risk factors in adolescents: Tehran lipid and glucose study

Physical activity [PA] is associated with the metabolic syndrome [MetS] and its components. This study aimed to examine the association between PA and MetS and its components among normal weight and overweight/obese adolescent in Tehran Lipid and Glucose Study [TLGS]. This cross-sectional study includes 777 adolescents, aged 12-18 years, who were selected by multi-stage random cluster sampling from among TLGS participants. Subjects were classified as normal weight and overweight/obese based on the age- and sex-specific standardized percentile curves of BMI for Iranian population. Levels of PA were assessed using a standardized and modifiable activity questionnaire [MAQ], and categorized into tertiles. MetS was defined according to the Cook's criteria. Prevalence of the MetS was higher in overweight/obese than normal group [35% vs. 3%; P: 0.02]. Normal groups were more physically active [50% vs. 44%]; however, difference was not significant. There was a significant association between the light PA and risk of lower level of HDL-C before and after adjustment, in normal weight group [OR: 1.62, CI 95%: 1.11, 2.35; OR: 1.65, CI 95%: 1.12, 2.44, respectively]. The overweight/obese group with light and moderate PA had a higher risk of having abdominal obesity than those with vigorous PA, only after adjustment for determined covariates [OR: 1.11, CI 95%: 1.07, 1.21; OR: 1.06, CI 95%: 1.01, 1.08, respectively]; the association between MetS and PA was not significant. The results of this study confirm the association between PA and some individual components of MetS such as waist and HDL-C

Diagnostic values of metabolic syndrome definitions for detection of insulin resistance: Tehran lipid and glucose study [TLGS]

This study examines the characteristics and agreement between different definitions of metabolic syndrome [MetS] and insulin resistance [IR]. A total of 347 non-diabetic individuals who were >/= 20 years of age were selected from the Tehran Lipid and Glucose Study [TLGS]. Subjects were categorized as having MetS by the Adult Treatment Panel III [ATP III] and the Joint Interim Statement [JIS]. IR was estimated by using the homeostasis model assessment [HOMA-IR]. According to ATP III and JIS criteria 38.9% and 38.2% of subjects had MetS respectively. The sensitivity of ATP III was 52.3% and specificity was 65%; for JIS the sensitivity was 52.3%, with a specificity of 66.5%. Kappa between ATP III or JIS and HOMA-IR was 0.14 and 0.16, respectively. Based on receiver operating characteristic [ROC] analysis, the use of waist circumference [WC] and fasting plasma glucose [FPG] for the diagnosis of IR in women showed a diagnostic accuracy equal to or instead of counting MetS components using modified ATP III or JIS. WC optimal cut points for prediction of IR were 93.5 cm for men and 92.5 cm for women. ATP III and JIS definitions have low sensitivities and specificities for detecting IR. There is poor agreement between these criteria and IR

[Trends of obesity and abdominal obesity in Tehranian adults [1999-2008]]

Background and Aim: Treatment of low-grade glioma [LLG] is one of the problems of neurosurgeon. According to reports, treatment of LGG tumors has been successful with stereotactic brachytherapy [SBT with temporary [125] Iodine seeds]. Due to the lack of reported experience in our country in this regard, this study was conducted on patients treated in Shohada-Tajrish Hospital between 2004 and 2011

Materials and Methods: This case series was conducted on consecutive patients with diagnosed LGG tumors treated with SBT [125 Iodine seeds]. Patients follow-up were at least 6 months. Survival of patients was assessed with the Kaplan-Meier method

Results: During the study period 8 patients [7 male and 1 female] with a mean age of 31.1 +/- 10.6 y were treated. One patient died due to respiratory and cardiac problems. The overall survival was 42% and 7 patients were alive by the last follow-up

Conclusion: It seems using SBT [temporary [125] Iodine seeds] in the treatment of LGG tumors is acceptable. It is recommended to compare the efficacy of this method in newly diagnosed patients compared with those who did not respond to the previous treatments

Conjugated Linoleic Acid and lipid profile of postmenopausal women

Most animal studies have shown that trans-10 and cis-12 isomers of Conjugated linoleic Acid, [CLA] tend to increase insulin resistance. But the effect of equal isomers of CLA [50:50 ratios of cis-9, trans-11: trans-10, cis-12 isomers] on lipid profiles, glucose, and insulin resistance and sensitivity in postmenopausal women is not clear. In the present study, we performed a randomized, double blind, placebo-controlled trial to examine the changes in lipid profiles, glucose, and insulin concentration following 4 CLAG80 capsules containing 3.2g CLA [50:50 ratios of cis-9,trans-ll: trans-10, cis-12 isomers] or 4 placebo capsules supplementation for 12 weeks in postmenopausal women. Seventy six healthy postmenopausal women were randomized to receive placebo or 3.2 g CLA for 12 weeks. Anthropometric measurements were done. Blood samples were collected after 12-14 hours fasting before and after intervention. Insulin resistance and insulin sensitivity were estimated based on the homeostasis [HOMA] and QUIKI models. In weeks 0, 6 and 12 during the trial, subjects completed 3d dietary records. These dietary records were coded by the same dietitian, and analyzed with the Food Processor program. There were no significant effect on serum lipids, insulin, glucose, insulin resistance and insulin sensitivity over 12 weeks in postmenopausal women. Mixed isomer CLA supplementation had no effect on serum insulin, lipids profile, glucose and insulin resistance/sensitivity during 12 weeks of intervention in postmenopausal women