Direct estimate of population attributable fraction of risk factors for cardiovascular diseases: tehran glucose and lipid study

Cardiovascular disease is the first cause of death and third place in disease burden in Iran. This study estimâtes population attributable fraction [PAF] of Cardiovascular risk factors in Tehran population. PAF is one of the important parameters of measuring population affect of risk factors and evaluating potentiel impact of preventive strategies in community level. In this study 5868 participants above 30 years old of Tehran lipid and glucose study [TLGS] were employed and 501 CVD events detected during 10 years follow-up. Direct estimate of adjusted PAFs using logistic regression which is one of less biased exist methods of PAF calculation were applied. Highest modifiable Cardiovascular risk factor PAFs, in sequence, was smoking [14.16%], hypertension [11.73%], diabètes [7.32%] hypercholesterolemia [6.85%] and central obesity [5.91%] for men, and hypertension [19.25%], diabètes [18.82%], central obesity [9.88%] and hypercholesterolemia [7.95%], for women. Also PAF of hazardous age and premature family history of CVD, as most important nonmodifiable CVD risk factors, were 36.09%, 1 6.61% and 3.95%, 7.56% for men and women respectively. According to the difference of risk factors PAFs ranking in men and women, it is suitable that CVD preventive interventions to be prioritized by sex separately. In this regard, besides special attention to control tobacco use in men, hypertension and diabètes in both sexes and high cholesterol in men and central obesity in women respectively, should be given in priority of preventive strategies

All- ceramic crown preparation and the remained wall thickness of the pulp chamber

Statement of Problem: A minimally invasive method of preparation is essential to prevent tooth structure weakening and pulp irritation; especially for mandibular anterior single-tooth all-ceramic crowns. According to many investigations, one of the most important reasons of pulp injury caused by tooth preparation for different restorative procedures is reduced "remained wall thickness" [RWT]. In order to protect the pulp from irritation, it is necessary to maintain a 0.5 mm of RWT

Purpose: The purpose of the present study was to evaluate the effect of all-ceramic crown preparation on pulp chamber RWT of mandibular incisors

Materials and Method: Mesiodistal and buccolingual initial images of 24 extracted mandibular incisors were provided. The pulp chamber initial wall thicknesses of buccal, lingual and proximal surfaces of cervical, 1and 2 mm above the cervical areas and also the incisal surfaces of incisal sections were measured using digital radiography and Photoshop software. After all-ceramic crown preparation, images were provided at the same initial positions. The initial and remained pulp chamber wall thicknesses were statistically evaluated and analyzed by ANOVA, paired t-test and a post hoc Tukey test

Results: Repeated measures ANOVA showed that the mean of pre- or post preparation wall thicknesses were not significantly different for each surface at the three horizontal levels [p> 0.05]. However, there were significant differences between the surfaces for each section. Comparison of pre- and post-preparation wall thicknesses revealed significant differences [p< 0.05]. Proximal surfaces of cervical sections had the least RWT [0.42 +/- 0.12]

Conclusion: According to the results of the present study, the least amount of initial and remained wall thicknesses of pulp chamber were related to the proximal surfaces, particularly in cervical areas. Therefore a reduction of preparation to 0.7 mm is suggested to prevent future pulp injury for mandibular incisors of 35 to 40-year- old patients and younger who require all-ceramic crown preparations

[Artificial neural network design for modeling of mixed bivariate outcomes in medical research data]

Mixed outcomes arise when, in a multivariate model, response variables measured on different scales such as binary and continuous. Artificial neural networks [ANN] can be used for modeling in situations where classic models have restricted application when some of their assumptions are not met. In this paper, we propose a method based on ANNs for modeling mixed binary and continuous outcomes. Univariate and bivariate models were evaluated based on two different sets of simulated data. The scaled conjugate gradient [SCG] algorithm was used for optimization. To end the algorithm and finding optimum number of iteration and learning coefficient, mean squared error [MSE] was computed. Predictive accuracy rate criterion was employed for selection of appropriate model. We also used our model in medical data for joint prediction of metabolic syndrome [binary] and HOMA-IR [continues] in Tehran Lipid and Glucose Study [TLGS]. The codes were written in R 2.9.0 and MATLAB 7.6. The predictive accuracy for univariate and bivariate models based on simulated dataset I, where two outcomes associated with a common covariate, were shown to be approximately similar. However, in simulated dataset ?? in which two outcomes associated with different covariates, predictive accuracy in bivariate models were seen to be larger than that of univariate models. It is indicated that the predictive accuracy gain is higher in bivariate model, when the outcomes share a different set of covariates with higher level of correlation between the outcomes

Prediction of diabetes using logic regression

Detection of population at risk of type II diabetes, as a multi-factorial disease, is an important issue because of its individual and social impacts. To date, several studies have been conducted to predict the incidence of diabetes, using different statistical methods. However, despite its clinical importance, it is highly difficult to consider all interactions among risk factors, in ordinary statistical models. This study aimed to extract appropriate logic combination of type 2 diabetes risk factors employing the recently introduced method, Logic regression. The study population was selected from a cohort of the Tehran Lipid and Glucose Study [TLGS]. Data for 3523 participants, aged 20 years and over [57.8% female and 42.2% male] were entered into analysis, for which logistic logic regression method was used. The model parameters were estimated using the Annealing algorithm. To avoid overestimation, the optimal number of logic combinations was determined by the cross-validation method. Deviance, sensitivity and specificity measures were computed to evaluate the logic model and its comparison to ordinary logistic regression; the latter accommodated only the main effects. The prediction power of the two models was compared by Area under ROC curve. R software version 2.8.1 was employed for analyses. Logistic logic regression with the 4 Boolean combination including 5 variables was fitted using the Annealing algorithm and resulted in in deviance of 1203.30. This model had better fit compared to other logic models and also ordinary logistic regression with forward procedure [deviance=1206.88]. The Boolean combination of the above model included impaired fasting glucose [OR=5.53, 95%CI: 4.03-7.59], IGT [OR=5.54, 95%CI: 3.96-7.49], family history of diabetes [OR=1.89, 95%CI: 1.38-2.63], and interaction of high triglycerides or abnormal waist circumference [OR=2.4, 95%CI: 1.73-3.32]; all p-values <0.001. The area under ROC curve for the model was 0.843 [95%CI: 0.813-0.874]. This study showed that the logic regression as a newly introduced method has the ability of recognizing and modelling the interactions between different risk factors. Therefore, it is recommended as an appropriate tool for screening of the multi-factorial diseases such as diabetes

[Effect of weight change on incident of metabolic syndrome and its components according to Iranian waist circumference and NHLBI: TLGS]

The metabolic syndrome includes risk factors for non-communicable diseases such as central obesity, hyperglycemia, dyslipidemia and hypertension accompanied by proinflammatory and hypercoagulability states. The aim of this study was to determine the effects of weight change on incident metabolic syndrome. This was a prospective cohort study, the population of which included all participants of the TLGS, phases one and two,>20 yrs and above, free of metabolic syndrome, based on the Iranian waist circumference, and NHLBI. Iranian waist circumference was defined with different cutoff points, according to cross sectional and outcome-based studies. Data was obtained by interviews, questionnaires, observation, and physical and laboratory examinations.The incidence of metabolic syndrome after 3.1 years of follow up was determined. Percent of weight change [PWC] was divided in five quintiles. Using the logistic regression test, odds ratio and 95% confidence interval of incident metabolic syndrome and its components for these quintiles, after adjusting for confounders, were calculated. Age adjusted incidences of metabolic syndrome after a 3.1 year follow up, according to Iranian WC outcome were 20.6% [males 26%, females 20.9%] and for Iranian WC cross sectional and NHLBI were 26.2% [males 34.4%, females 26.1%] and 23.7% [males 24.4%, females 29.4%] respectively. For both genders, based on Iranian W.C and NHLBI, a weight reduction of at least 1.3%, compared to baseline, in women had a protective effect against incident metabolic syndrome. In men a weight gain of at least 1.4% since baseline resulted in an increase in the odds ratio. In women, weight gain of at least 1.3% since baseline, based on the Iranian WC cross sectional, NHLBI and at least 4% based on Iranian W.C-outcome resulted in progressive incidence of metabolic syndrome. These reductions of at least 1.3% in males and 2.5% in females, decreased the relative risk of abdominal obesity, but had no effect on other components of metabolic syndrome, including: hypertriglyceridemia, low HDL, hyperglycemia, and hypertension. Although in both sexes, increase in weight resulted in abdominal obesity, the cut off points according to various definitions were different. Considering the preventive effect of weight loss against incident metabolic syndrome and abdominal obesity, we recommend educational programs to enhance awareness regarding overweight and obesity and motivate individuals to lose weight

[Comparison of artificial neural network, logistic regression and discriminant analysis methods in prediction of metabolic syndrome]

Artificial neural networks as a modern modeling method have received considerable attention in recent years. The models are used in prediction and classification in situations where classic statistical models have restricted application when some, or all of their assumptions are met. This study is aimed to compare the ability of neural network models to discriminant analysis and logistic regression models in predicting the metabolic syndrome. A total of 347 participants from the cohort of the Tehran Lipid and Glucose Study [TLGS] were studied. The subjects were free of metabolic syndrome at baseling according to the ATPIII criteria. Demographic characteristics, history of coronary artery disease, body mass index, waist, LDL, HDL, total cholesterol, triglycerides, fasting and 2 hours blood sugar, smoking, systolic and diastolic blood pressure were measured at baseline. Incidence of metabolic syndrome after about 3 years of follow up was considered a dependent variable. Logistic regression, discriminant analysis and neural network models were fitted to the data. The ability of the models in predicting metabolic syndrome was compared using ROC analysis and the Kappa statistic, for which, MATLAB software was used. The areas under receiver operating characteristic [ROC] curve for logistic regression, discriminant analysis and artificial neural network models [15: 8:1] and [15:10:10] were estimated as 0.749, 0.739, 0.748 and 0.890 respectively. Sensitivity of models were calculated as 0.483, 0.677, 0.453 and 0.863 and their specificity as 0.857, 0.660, 0.910 and 0.844 respectively. The Kappa statistics for these models were 0.322, 0.363, 0.372 and 0.712 respectively. Results of this study indicate that artificial neural network models perform better than classic statistical models in predicting the metabolic syndrome

[Central and general obesity measures for prediction of cardiovascular disease in diabetic adults: Tehran lipid and glucose study]

Considering the high prevalence of diabetes mellitus worldwide and in the Middle East countries and high prevalence of cardiovascular disease [CVD] in diabetic patients, this study aimed to compare different abdominal and central obesity measures, as important risk factors of CVD, for prediction of CVD in Iranian men and women with type 2 diabetes. We followed 1010 patients with type 2 diabetes for a median follow up period of almost 8 years. The hazard ratios [HRs] for CVD were calculated for a 1 standard deviation [SD] change in each anthropometric measure, using Cox proportional regression analysis. A hundred and eighty-eight cardiovascular events occurred in diabetic patients. In the age adjusted model, in diabetic men, waist to hip ratio [WHR], waist to height ratio [WHtR] and waist [WC] were associated significantly with CVD but in the multivariate model, only WHR was associated significantly with CVD. WC in diabetic women and WHtR in both genders were marginally associated with CVD. Central obesity measures were stronger than the general obesity parameter for prediction of CVD in adults with type 2 diabetes mellitus and WHR was the most important anthropometric measure in these patients in both genders

effect of life style modification on the occurrence of diabetes type 2 in a 3.5-year study: Tehran lipid and glucose study

Hyperbilirubinemia is a common problem in newborn infants and may progress to kernicterus if not treated. The objective of this study was to determine the therapeutic effect of clofibrate in full-term healthy neonates with non-hemolytic hyperbilirubinemia. A randomized clinical trial was performed on two groups of healthy full-term neonates with jaundice. Clofibrate group, [n=50], received a single dose of oral clofibrate [100mg/kg], plus phototherapy, while the control group [n=50], received only phototherapy. The mean plasma total bilirubin levels at 12, 24, and 48 hours after treatment were significantly lower in the clofibrate treated group, as compared with the control group [p=0.001]. At 48 hours of treatment, 48% of patients in the clofibrate group, had bilirubin levels<12 mg/dl in comparison with 16% of control group [p=0.001]. Treatment with clofibrate also resulted in a shorter duration of hospital stay as compared to the control group [p0.001]. A single oral dose of clofibrate [100mg/kg], along with phototherapy is more effective than phototherapy alone in treatment of non-hemolytic hyperbilirubinemia in full-term healthy newborn infants

Prevalence of coronary heart disease among Tehran adults: Tehran Lipid and Glucose Study

This study is the first report on the prevalence of coronary heart disease [CHD] and its associated risk factors in adult residents of Tehran. Standard supine ECG data were collected for 5984 men and women aged > /= 30 years and coded by Minnesota criteria. All major cardiovascular risk factors were also measured. Based on Rose angina, self-reported history of CHD or ECG-defined CHD, the aged-adjusted prevalence of CHD was 21.8% [22.3% in women and 18.8% in men]. Variables independently associated with CHD were female sex, age, systolic blood pressure, 2-hour postprandial glucose, body mass index, waist-to-hip ratio and LDL/HDL cholesterol ratio

Comparison of waist-to-height ratio and body mass index for prediction of type 2 diabetes mellitus risk in women: Tehran lipid and glucose study

The aim of this study was to determine which indicator of obesity index is the best predictor of type 2 diabetes mellitus in Iranian women. In an urban Iranian population, we examined 2801 females, aged >/= 20 years who were non-diabetic at baseline. Over a median 3.5 year [11months to 6.3y] follow up, we compared the ability of central obesity indicators [waist circumference [WC], waist-to-hip ratio [WHR], waist-to-height ratio [WHtR]] to body mass index [BMI] in the prediction of type 2 diabetes, based on American Diabetes Association 2003 criteria. To estimate odds ratio [OR] of developing diabetes associated with each quartile of anthropometric variables, we used a multivariate model adjusted for age, hypertension, triglycerides, HDL-C, family history of diabetes [model 1] and a full model adjusted for the variables in model [1] plus abnormal glucose tolerance at the baseline [model 2]. Receiver operator characteristic [ROC] analyses were used to determine the predictive power of each indicator in the development of type 2 diabetes, after adjustment for age. During our follow up, 114 individuals developed diabetes [4.1%]. The OR [95% CIs] of developing diabetes increased to 4.8 [2.1-10.9], 6.7 [2.6-17.1], 8.7 [3.0-24.7], 8.0 [3.1-20.6] for the highest quartiles of BMI, WC, WHR and WHtR compared to the lowest quartile in model [1] respectively. In model [2] the ORs [95% CIs] of the fourth quartile of anthropometric variables decreased, compared to value in model [1], but remained significant [BMI: 3.1 [1.3-7.2], WC: 3.1 [1.1-8.3], WHR: 4.0 [1.3-11.8], WHtR: 3.3 [1.2-8.8]]. Compared to BMI, the WHtR had a higher area under ROC curve [0.72 vs 0.69 P < 0.05], while there was no difference between ROCs of BMI and other anthropometric variables In Iranian women, WHtR is a better predictor of type 2 diabetes than BMI

Improvement in prediction of incident type 2 diabetes using the 2003 criteria of impaired fasting glucose: results from a population-based 6.5-year follow-up study in Iran

To investigate whether using the 2003 criteria for impaired fasting glucose [IFG] improves the prediction of Type 2 diabetes mellitus [T2DM] in comparison to the 1997 criteria. A total of 5794 non-diabetic subjects, aged 42 +/- 13 years, were followed for 6.5 years. T2DM was defined based on the WHO 1999 criteria. Cox regression analysis was used to calculate the relative- risk [RR] of developing T2DM. Model discrimination was assessed by calculating the area under the receiver operating characteristic curve [AUC]. During the follow-up, there were 351 new cases of T2DM. In univariate analysis, the RR of the 1997 and 2003 criteria were 9.6 [7.5-12.3] and 8.4 [6.4-10.0] respectively. After adjustment for a full range of diabetes risk factors, the RR of the 2003 criteria was higher compared to that of the 1997 definition [RR [95%CI]: 3.3 [2.6-4.2] vs. 2.4 [1.8-3.2] respectively]. Inclusion of the 2003 criteria in the multivariate model significantly improved discrimination in comparison to the 1997 definition [AUC [95%CI]: 0.78 [0.74-0.83] vs. 0.74 [0.70-0.79], P<0.01]. When fasting glucose is used in community screening for pre-diabetes state, the 2003 IDF criteria yield significantly better results than the original criteria for prediction of future T2DM

[Role of C - reactive protein in prediction of type 2 diabetes: Tehran lipid and glucose study]

Several studies suggest that CRP plays a role in the pathogenesis of diabetes in adults. We tested the hypothesis that elevated levels of CRP at baseline can predict later onset of type 2 diabetes mellitus. In a nested case-control study, serum level of CRP was measured from stored samples of 73 control and 80 cases from among participants of the Tehran Lipid Glucose Study, who had been followed for 3.6 years. In age adjusted model, levels of CRP were associated with an increased risk of type2 diabetes, OR 3/6 [95% Cl: 1.5 - 8.2] for tertile 3 versus 1, p.001. However in multivariate analysis the association between CRP and type 2 diabetes was significantly decreased after adjustment for fasting plasma glucose, body mass index, family history of diabetes, HOMA-IR, OR .8 [95% Cl: 0.2 - 2.8] for tertile 3 versus 1, p 0.7. Elevated levels of CRP were associated with an increased risk of type 2 diabetes; however, the association was not independent of other diabetes risk factors, including fasting plasma glucose, body mass index, HOMA-IR and family history of diabetes

[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

[High prevalence of diabetes and abnormal glucose tolerance in urban Iranians aged over 20 years: determining an effective screening strategy for un-diagnosed diabetes]

The aim of this study was to determine the prevalences of diagnosed and undiagnosed diabetes mellitus, impaired fasting glucose [IFG], impaired glucose tolerance [IGT], and combined IFG/IGT and to develop an effective screening strategy for undiagnosed diabetes in a large urban Iranian community. The study population included 9,519 participants of the Tehran Lipid and Glucose Study, aged > 20 years, with full relevant clinical data. Age-standardized prevalence of diabetes and glucose intolerance categories were reported according to the 2003 American Diabetes Association definitions. The numbers needed to screen [NNTS] to find one person with undiagnosed diabetes were estimated from age-adjusted logistic regression models. The prevalences of diagnosed and undiagnosed diabetes, isolated IFG, isolated IGT, and combined IFG/IGT were 8.1%, 5.1%, 8.7%, 5.4% and 4.0% in men and 10%, 4.7%, 6.3%, 7.6%, and 4.5% in women respectively. Un-diagnosed diabetes was associated with family history of diabetes, increased body mass index [BMI >/= 25 kg/m2], abdominal obesity, hypertriglyceridemia, hypertension and low HDL-C levels. Among men, a combination of increased BMI, hypertension, and family history of diabetes led to an NNTS of 1.6 [95%CI: 1.57-1.71] and among women a combination of family history of diabetes and abdominal obesity, yielded an NNTS of 2.2 [95%CI: 2.1-2.4]. Approximately 32% of Tehranian adults had either diabetes or some degree of other glucose tolerance abnormalities. Nearly 40% of total cases with diabetes were undiagnosed. Screening individuals with family history of diabetes, BMI25 kg/m2, abdominal obesity and hypertension may have substantial advantages

[C-Reactive protein in risk prediction of cardiovascular outcomes:Tehran lipid and glucose study]

The main aim of this study was to evaluate the utility of C-reactive protein [CRP] in risk prediction of cardiovascular outcomes. In a nested case-control study, 207 cardiovascular events among participants over 30 years of the Tehran Lipid and Glucose Study [TLGS] were documented during 3 years of follow up. Cases that were free of cardiovascular disease at baseline [126 subjects] were matched to 259 normal controls for age and sex. High sensitivity CRP and traditional cardiovascular risk factors were measured at baseline. Modest correlation was found between CRP and body mass index [r=0.34], waist-to-hip ratio [r=0.22], total cholesterol [r=0.24] and calculated 10-year Framingham coronary risk score [FRS] [r=0.27] [all P values <0.001]. The age and sex adjusted relative risk of cardiovascular events for subjects in the highest quartile of the population distribution of CRP when compared with the lowest quartile was 2.6 [95% CI=1.4-5.1, P=0.006]. After additional adjustment for traditional cardiovascular risk factors the odds ratio decreased to non-significant levels [0.8,95% CI=0.3-1.9]. Addition of CRP did not improve the area under receiver operating characteristic curve of risk functions that was based on traditional cardiovascular risk factors or FRS. It is concluded that for short-term prediction of cardiovascular outcomes in the Iranian population, when traditional cardiovascular risk factors are known measurement of CRP has no additional value

[Prediction of cardiovascular disease in individuals aged over 40 years according to fasting and postchallenge glycemia: Tehran lipid and glucose study]

Hyperglycemia is a known a risk factor for cardiovascular disease [CVD], including coronary heart disease [CHD] and stroke. This risk is continuous and graded across the distributions of fasting plasma glucose [FPG], and levels of plasma glucose after an oral glucose challenge. Both fasting and 2-h postchallenge glucose [2hpg] levels contribute to average glycemia, but the relative contributions of fasting and postchallenge hyperglycemia to CVD risk remain uncertain. Considering the high prevalence of cardiovascular disease [CVD] in Tehran, this study was designed to evaluate the effects of difference levels of fasting and postchallenge hyperglycemia in prediction of cardiovascular disease. In this cohort study, all participants of the Tehran Lipid And Glucose Study [TLGS] [3694 subjects], aged over 40years, free from clinical CVD [coronary heart disease, stroke] or medication-treated diabetes were assessed for prediction of incident CVD events. We used the interquartile range [IQR] as a unit of exposure for continuously distributed glycemic measures in predicting CVD risk. Also, the Framingham Risk Score [FRS] was determined in this population at baseline. We recorded the cardiovascular events in 6.1 +/- 0.6 years of follow up for all subjects. Finally, we assessed ability of fasting and postchallenge hyperglycemia in prediction of cardiovascular disease. Mean age of the study population was 53.9 years; undiagnosed diabetes in this population was present in 346 [9.3%] of the 346 subjects; 172 [49.7%] had 2hPG >/= 200mg/dL without FHG. There were 148 CVD events. In separate sex- and CVD risk-adjusted models,] hazard ratio [HR] for CVD with fasting plasma glucose [per [14 mg/dL] increase] was 1.15 [95% CI: 1.08-1.22]; and HR for CVD per 49 mg/dL increase in 2hPG was 1.23 [95% CI: 1.14-1.33]. When modeled together, the HR for FHG decreased to 1.03 [95% CI: 0.93-1.13] and for 2hPG remained significant [95% CI: 1.20, 1.05-1.38]. In this study, postchallenge hyperglycemia was an independent risk factor for CVD

[Metabolic risks in individuals with normal body mass index and normal waist circumference]

It seems that the risk of cardiovascular diseases increases adults of the Middle-Eastern region within the normal limits of BMI and WC, as defined for universal application by the WHO. This study was conducted to determine a point of BMI and WC above which the chances of having cardiovascular risk factors increased. In this population-based cross-sectional study, a representative sample of 3447 subjects [1781 males and 1666 females] with normal body mass index [BMI = 19-<25 kg/m2 for both genders] and normal waist circumference [WC] [<102 cm for men and <88 cm for women] were included. Demographic data was collected anthropometric indices and blood pressure were measured according to standard protocol. Hypertension was defined based on Joint National Committee VI [JNC VI]. Biochemical analysis was conducted on fasting blood samples. Diabetes was defined as fasting plasma glucose [FPG] >/= 126 mg/dl or 2-hour plasma glucose [2hPG] >/= 200 mg/dl. Dyslipidemia was considered based on Adult Treatment Panel III [ATP III]. The presence of "at least one risk factor" and "at least two risk factors" of the three major risk factors for cardiovascular disease [hypertension, dyslipidemia, diabetes] were also evaluated. Men had higher WC than women [79.6 +/- 6.5 vs. 74.7 +/- 6.2 cm, P<0.001], while their BMIs was not statistically different [22.4 +/- 1.6 vs.22.4 +/- 1.6, P=0.224]. The prevalence of all metabolic risk factors increased with BMI and WC in both genders such that those in the highest category of BMI and WC had the highest prevalence of all metabolic abnormalities. Individuals in the highest category of BMI [24 -< 25 kg/m2] had significantly higher odds for being at risk for metabolic risk factors [odds ratios ranging from 1.3 to 1.6 for men and 1.36 to 2.0 for women for different risk factors] compared to those of the first category [19 -< 20 kg/m2]. Also, individuals in the highest category of waist circumference [95 -< 102 cm for men and 85-88cm for women] had significantly higher chances for having metabolic abnormalities [odds ratios ranging from 2.6 to 4.5 for men and 2.1 to 2.6 for women for different risk factors] compared to those in the first category [62-<70 cm for men and 60 -< 65 cm for women] in both genders. It is concluded that the cut-points of BMI and WC suggested by WHO are inappropriate for the Tehranian urban population and that the appropriate cut-points of BMI and WC should be lower in this population

[ effect of impaired fasting glucose and impaired glucose tolerance in prediction of incident type 2 diabetes: Tehran lipid and glucose study]

The aim of the current study was to ascertain which impaired glucose homeostasis at baseline is predictive of conversion to type 2 diabetes in an Iranian non-diabetic population. This is a population-based cohort study conducted in 4134 non-diabetic residents of Tehran [the capital city of Iran], aged over 20 years, from 1999 to 2004. Fasting plasma glucose and glucose levels after ingestion of 75 g glucose were measured at baseline [1999-2001] and at follow up [2002-2004] with mean follow up duration of 3.4 years. ADA 1997 and 2004 criteria were used to determine the glucose tolerance status of the participants at baseline and follow up. Using ADA 1997 criteria, the cumulative incidence of diabetes for participants with IFG and IGT, isolated IGT and isolated IFG was 32.3, 10.7 and 9.5% respectively compared with 1.2% for those with normal glucose tolerance at baseline. After application of the new criteria the corresponding incidence rates were 24.8, 6.5 and 5.9% vs. 0.7%. In multivariate logistic regression analysis, the odds ratio for incident diabetes was 1, 6.5[2.5-16.7], 7.7[4.7-12.6] and 28.9[15.6-53.5] in subjects with normal glucose, isolated IFG, isolated IGT and both IFG and IGT respectively using ADA 1997 criteria. The corresponding odds ratios after application of the new criteria were 1, 4.6[2.5-9.0], 6.8[3.6-12.9] and 27.1[15.5-47.5] respectively. In addition to fasting and 2-hour glucose [p<0.001], the waist-to-hip ratio was an important risk factor for developing diabetes [p<0.01]. Both isolated IFG and isolated IGT, and especially combined IFG and IGT, based on either the new or previous ADA criteria are strong predictors for development of type 2 diabetes

[Anticardiolipin antibody in type I diabetic patients]

Type 1 diabetes mellitus is an autoimmune disorder which is associated with different organ specific autontibodies including anticardiolipin antibody [ACLA]. The association of ACLA with diabetes has not been widely reported. The aim of this study was to determine the prevalence of ACLA IgG and IgM and evaluation of their possible association with other auto-antibodies, duration of disease and status of control of blood glucose in type 1 diabetes patients. In a cross sectional study, 48 patients with type 1 diabetes in Bandar Abbas were compared with 41 age and sex matched healthy persons for the presence of ACLA [IgG and IgM], Rheumatoid Factor [RF] and Anti Nuclear Antibody. The mean age of diabetic patients was 20/5 +/- 10 years. High titers of ACLA [IgG and/or IgM] were more common in type 1 diabetic patients than in healthy controls [18% vs. 0%, p<0.01] with no significant difference between males and females [4 and 12% respectively]. Unlike ACLA IgG, the mean value of serum ACLA IgM was significantly higher in type 1 diabetic patients than in controls [6.8 +/- 2.8 vs. 4.5 +/- 2.4 GPLU/ml]. Among type 1 diabetic patients, those with high titers of ACLA [ACLA+] were older and had higher age of onset of diabetes than those with normal titers, but there were no difference in duration of diabetes or level of HbA1c between them. No significant difference was observed in the prevalence of ACLA+or the mean values of ACLA IgG and IgM between recently [<1 years] and previously [>1 years] diagnosed diabetic patients. ACLA+patients were also more likely to show positive RF than the ACLA-group[25 vs. 0%]. The relatively high prevalence of ACLA [+] in type 1 diabetic patients and its association with other autoantibodies may reflect an abnormal immunologic response in some stages of type 1 diabetes. ACLA might be added to the list of autoantibodies that should be measured in type 1 diabetes patients

Prediction of cardiovascular disease by metabolic syndrome in individuals aged over 40 yrs according to the ATP III and IDF definition: Tehran lipid and glucose study

Different results have been reported on the association between metabolic syndrome [MS] and cardiovascular diseases [CVD]. The aim of this study is to determine the role of the Adult Treatment Cholesterol Program [ATP III] and International Diabetes Federation [IDF] definitions of metabolic syndrome in predicting CVD. In this cohort study, all individuals aged over 40 yrs, phase I participants of the TLGS, with no histories of CVD were selected. Based on the APT III and IDF criteria of the MS syndrome, they were divided into those with and those without the condition. All of the subjects were followed for a mean duration of 4.9 +/- 0.8 years for occurrence of CVD. The predictive ability of different definitions of the MS was evaluated in different regression models that included only the MS [model 1] and were also adjusted for age, sex, family history of premature CVD and smoking [model 2], serum LDL [model 3] and other components of the MS [model 4]. There were 3777 individuals' aged 54 +/- 10 years 1536 [41%] where normal according to the both criteria of the MS and 1714 [45%] and 1900 [50%] subjects had MS according to the ATP III and IDF criteria respectively. New CVD occurred in 143 individuals [3.7%]. In our study, the MS was the predictor of CVD in the first three models according to ATP III and IDF criteria however, in model 4, none of the definitions of MS predicted CVD. After calculation of the area under the curve [AUC] for model 2 and 3, it was observed that the power of the ATP III criteria in model 2 for prediction of CVD was significantly higher than the IDF [AUC 0.760 vs. 0.735, p < 0.001] but no significant difference was observed between the 2 criteria in model 3. The ATP III and IDF definitions of the MS, it seems can similarly predict CVD after adjustment for the common CVD risk factors and LDL, whereas neither of the 2 definitions had this predictive power after adjustment of their components in addition to the earlier mentioned ones