Does maternal iodine supplementation during the lactation have a positive impact on neurodevelopment of children? Three-year follow up of a randomized controlled trial.

PURPOSE: The aim of this study was to examine, for the first time, the neurodevelopmental outcomes in children whose mothers received different doses of iodine supplements during lactation. METHODS: We conducted a follow-up study on children whose mothers participated in a randomized clinical trial to receive placebo, 150 µg/day or 300 µg/day of iodine until 12 months postpartum. Child neurocognitive development was assessed at 36 months of age using the Bayley Scales of Infant and Toddler Development Third Edition. Linear mixed-model analysis was preformed to assess iodine supplement dose effects on child cognitive, language, and motor functions. RESULTS: A total of 122 children provided neurodevelopmental data as follows: 300 µg/d iodine group: 45; 150 µg/d iodine group: 35; and placebo group: 42. Cognitive scores were higher in children whose mothers received 150 µg iodine/d compared to children whose mothers received placebo [102.8 (SD 13.2) vs. 99.2 (SD 10.5); ß = 4.43, P = 0.032]. However, supplementation with 150 µg iodine/d had no effect on language or motor development. No significant differences were observed in cognitive, language, or motor functions between children whose mothers received 300 µg iodine/d and those whose mothers received 150 µg iodine/d or placebo. CONCLUSION: Maternal iodine supplementation with 150 µg/d during lactation may have a beneficial effect on child cognitive development; however, we found no evidence of either improved or delayed neurodevelopmental outcomes in children whose mothers received iodine supplements at doses higher than recommended. Further randomized controlled trials with larger sample sizes are needed to confirm these results. CLINICAL TRIAL REGISTRY: IRCT201303164794N8; registration date: 2013-05-20.

Is breast milk iodine concentration an influential factor in growth- and obesity-related hormones and infants' growth parameters?

Iodine, a key constituent of thyroid hormones, plays an indirect role in prenatal and postnatal growth. This study aimed to investigate whether breast milk iodine concentration (BMIC) is associated with growth- and obesity-related hormones and subsequently the infants' anthropometric measures. In present study conducted in Tehran (Iran), 94 lactating mothers and healthy infants who were exclusively breastfed were included. Concentrations of iodine, insulin-like growth factor-1 (IGF-1), adiponectin (AD) and leptin (LP) were measured in breast milk samples collected during 3- to 5-day postpartum. Anthropometric measures of infants were assessed at 6 months of life, and age- and sex-specific z-score values were calculated using the World Health Organization growth standards. The median (interquartile range) iodine, IGF-1, AD and LP concentrations were 232.5 (157.5-296.0) µg L-1 , 15.7 (11.9-21.1) ng ml-1 , 13.2 (5.1-29.8) mg L-1 and 1.16 (0.86-1.70) ng ml-1 in breast milk, respectively. No significant correlations were found between BMIC and IGF-1, AD and LP concentrations during the first few days postpartum. In adjusted regression model, BMIC was positively associated with weight-for-length z score of infants. In the presence of IGF-1, AD or LP, the coefficients of BMIC for weight-for-length z score of infants were ß = .003 (P = .021), ß = .002 (P = .028) or ß = .003 (P = .013), respectively. No other anthropometric measurements were associated with iodine or growth- and obesity-related hormones in breast milk. Our findings indicate that BMIC is a potential contributor to infants' growth status, independent of IGF-1, AD or LP concentrations in breast milk. The underlying mechanisms remain to be elucidated.

Weight gain, but not macronutrient intake, modifies the effect of dietary branch chain amino acids on the risk of metabolic syndrome.

AIMS: The aim of this study was to investigate whether both weight change and the background intakes of macronutrient modulate the association between dietary branch chain amino acids (BCAAs) and the risk of metabolic syndrome (MetS). METHODS: This prospective study was conducted within the framework of theTehranLipidand Glucose Study. BCAA intakes were collected using a valid and reliable semi-quantitative food frequency questionnaire. MetS components were defined according to the modified national Cholesterol Education Program Adult Treatment Panel III. Weight change was categorized as weight gain (≥ or <7% over 8.9 year follow-up). Dietary fat and carbohydrate intake were categorized as above/below the median intake. RESULTS: Among participants with weight gain ≥ 7% during follow-up, intakes of both dietary BCAAs and its various sources (below or above the median intake) were associated with higher risk of MetS, compared with subjects with lower intakes of BCAAs and weight change ≤ 7%. Background dietary fat and carbohydrate did not modify the association of dietary BCAAs and its various sources with the risk of MetS. CONCLUSIONS: Weight change, but not dietary macronutrient intake, modulates the association between dietary BCAAs and risk of MetS among adults.

Mediterranean dietary patterns and risk of type 2 diabetes in the Islamic Republic of Iran.

BACKGROUND: More than 1% of urban Iranians aged >20 years develop type 2 diabetes annually. A major contributing factor is overweight due to energy imbalance and poor quality diet. Even though there are reports on the beneficial effects of some isolated foods on glucose metabolism, researchers are increasingly focusing on dietary patterns versus single foods. AIMS: The aim of this study was to evaluate the association between adherence to a Mediterranean diet and risk of type 2 diabetes. METHODS: The current study was a case-control study nested in the cohort of the Tehran Glucose and Lipid Study. Among participants who met the study criteria, 187 incident cases of diabetes were identified and matched with 374 healthy controls according to sex, age, date of data collection, and previous history of lifestyle intervention. RESULTS: In the highest Mediterranean Diet Scale (MDS) category there were higher intakes of energy, fibre, glycaemic load, carbohydrate, total fat, and olive oil. However saturated fatty acid and monounsaturated fatty acid intakes decreased in higher MDS categories. The multiple adjusted odds ratios (ORs) for type 2 diabetes among individuals with medium (score 3-4) and high (score 5-8) adherence to MDS were 0.79 (95% CI:0.38-1.65) and 0.93 (95% CI:0.44-1.96), respectively, compared to individuals with low adherence (score 0-3). CONCLUSION: Adherence to the Mediterranean dietary pattern was not associated with type 2 diabetes. Increased rates of type 2 diabetes in the Islamic Republic of Iran might be accounted for by the cultural and traditional differences between the Iranian and the Mediterranean dietary patterns.

Lactating Mothers and Infants Residing in an Area with an Effective Salt Iodization Program Have No Need for Iodine Supplements: Results from a Double-Blind, Placebo-Controlled, Randomized Controlled Trial.

BACKGROUND: The necessity of iodine supplementation in lactating mothers residing in countries with sustained salt iodization programs for iodine sufficiency of breast-fed infants remains unclear. The aims of this study were to investigate the effect of iodine supplementation on iodine status and growth parameters of lactating mothers and breast-fed infants and to compare these data with that of formula-feeding mothers and their infants during the first year of infancy. METHODS: In this multicenter, double-blinded, randomized clinical trial conducted in four healthcare centers in Tehran (Iran), healthy lactating mothers and their term newborns aged 3-5 days were randomly assigned to treatment groups: placebo, 150 µg/day iodine, or 300 µg/day iodine. They were followed up for 12 months. Formula-fed infants aged 30-45 days and their mothers were randomly selected from the same centers. The primary outcomes were maternal and infant urinary iodine concentrations (UICs), breast-milk iodine concentrations (BMICs), and infant growth parameters, measured at 1, 2, 4, 6, 9, and 12 months during routine health visits. The formula-fed group was assessed at 2, 4, 6, 9, and 12 months of age. Analysis was by per protocol principle using mixed-effects models. RESULTS: Mother-newborn pairs (n = 180) in treatment groups and partially/exclusively formula-feeding mother-infant pairs (n = 60) participated between October 2014 and January 2016. Median baseline UICs in the treatment groups were 84 µg/L (interquartile range [IQR] 41-143 µg/L) in mothers and 208 µg/L (IQR 91-310 µg/L) in their infants. The values in the formula-fed group were 76 µg/L (IQR 40-144 µg/L) in mothers and 121 µg/L (IQR 66-243 µg/L) in infants. The 300 µg/day iodine group showed significantly higher UICs and BMICs than did the other treatment groups; infant UICs in the 150 µg/day iodine, placebo, and formula-fed groups were similar. Infants in all groups showed iodine sufficiency (median UIC ≥100 µg/L) throughout the study period. Anthropometric measurements were similar between the treatment and formula-fed groups over the study period, except at the last follow-up visit at 12 months. CONCLUSION: Supplementation of breast-feeding mothers with either 300 or 150 µg/day iodine improved their iodine status. However, the iodine status of infants in all groups studied indicated iodine sufficiency during the first year of infancy, demonstrating that in countries with effective salt iodization program, iodine supplementation for lactating mothers is unnecessary.

The Effects of Iodine Fortified Milk on the Iodine Status of Lactating Mothers and Infants in an Area with a Successful Salt Iodization Program: A Randomized Controlled Trial.

Iodine deficiency during the first two years of life may cause irreversible brain damage and mental retardation. The aim of the present study was to investigate, for the first time, the effect of iodine fortified milk on the iodine status of lactating mothers and their infants. In this multicenter randomized controlled trial, 84 lactating mother-infant pairs from health care centers were randomly selected. After meeting the inclusion criteria, lactating mothers were randomly assigned to two groups: the iodine fortified milk group and the control group (n = 42 each). Maternal and infant urine and breast milk samples were collected at 3-5 (baseline), 7, 10, 14 days, and 1 month postpartum, for a measurement of the iodine concentration. A total of 84 lactating mothers, with a mean age of 28.2 ± 4.5 years, and 84 infants, with a mean age of 4.2 ± 0.7 days, were included in the study. Compared to mothers of the control group, mothers receiving iodine fortified milk had higher urinary (p < 0.001) and breast milk (p < 0.001) iodine concentrations. Urinary iodine levels in infants revealed no significant differences between the two groups. The findings of this study indicate that supplementation with daily iodine fortified milk provides iodine nutrition adequacy among lactating mothers. However, it had no effect on the iodine status of infants, who were previously iodine sufficient.

Evaluating the effect of knowledge, attitude and practice on self-management in patients with type 2 diabetes.

AIMS: Type 2 diabetes mellitus is a common disease imposing a great economic burden to health systems. As the prevalence of type 2 diabetes in Iran has grown over the past decades, it has become necessary to evaluate the level of knowledge, attitude and practice of type 2 diabetic patients in our country for policy planning to increase the patients' awareness of diabetes and its complications and, in the long run, decrease costs of treatment. The aim of this study was to evaluate the level of knowledge, attitude and practice of patients with diabetes and its relationship with self-managing of disease and quality of life. METHODS: This study was conducted with the aim of assessing the knowledge, attitude, self-reported practice, self-care and health-related quality of life (HRQoL) among patients attending diabetes clinic of Torfeh academic hospital in Tehran, Iran, during April to June 2014. The study population comprised of 120 type 2 diabetic patients aged above 30 years receiving anti-diabetic medications visiting Torfeh's outpatient diabetes clinic for follow-up care. Face-to-face interviews were carried out to fill five questionnaires evaluating patients' knowledge, attitude, practice, self-care and HRQoL. Demographic characteristics were recorded at the beginning of the study. Laboratory data were extracted from patients' most recent medical documents. Data were analyzed using Statistical Package for Social Science (SPSS) version 21. RESULTS: 120 type 2 diabetic patients (86 female and 34 male patients) with mean age of 55.98 ± 9.50 years were evaluated. The mean score of knowledge, attitude, practice, self-care and HRQoL was 67.99 ± 10.38, 73.43 ± 11.84, 64.69 ± 16.63, 58.22 ± 12.24 and -1.13 ± 0.6, respectively. There was a significant negative relationship between HbA1c and patients' practice. We did not find any correlation between patients' knowledge, attitude or practice and their HRQoL. There was a significant direct relationship between patients' knowledge with their attitude and practice. CONCLUSION: This study observed a good level of knowledge, attitude and practice but a low level of self-care and HRQoL among patients. As knowledge and attitude have a direct relationship with practice and the number of people with diabetes continues to rise, we can help patients improve practice and decrease the burden of diabetes complications and their related expenditures by increasing their knowledge.

Evaluating the Effect of Knowledge, Attitude, and Practice on Self-Management in Type 2 Diabetic Patients on Dialysis.

Background. Type 2 diabetes is an increasingly common condition with several preventable microvascular complications such as kidney damage. Nephropathy is expensive to manage, especially as hospital dialysis treatment. Improving patients' knowledge, attitude, and practice (KAP) toward their condition can achieve better control, delay complications, and improve their quality of life. This study evaluated the KAP and self-care behaviors of diabetic patients on dialysis and variables that affect it. Methods. This cross-sectional study was conducted at Shahid Beheshti academic hospitals of Tehran, Iran. Face-to-face interviews were held to fill five validated questionnaires: three evaluating KAP, one evaluating self-management, and one evaluating quality of life. Result. 117 diabetic patients on hemodialysis (42 females) with mean (SD) age of 68.70 ± 9.26 years were enrolled in the survey. The scores for patient's KAP, self-care, and quality of life were 59.90 ± 11.23, 44.27 ± 8.35, 45.06 ± 12.87, 46.21 ± 10.23, and 26.85 ± 13.23, respectively. There was significant negative correlation between patients' knowledge and attitude with their glycosylated hemoglobin level and their fasting blood sugar. There was significant correlation between patients' knowledge and practice with their self-care activities. Conclusion. The present study suggests that patients' KAP scores have a practical effect upon self-care behavior. This highlights the needs for effective diabetes education programs in developing countries like Iran.

A visceral adiposity index-related dietary pattern and the cardiometabolic profiles in women with polycystic ovary syndrome.

BACKGROUND & AIMS: Visceral adiposity index (VAI), an indicator of visceral adiposity, has been found to be associated with cardiometabolic disturbances in women with polycystic ovary syndrome (PCOS). The association of dietary intakes with VAI, and subsequently cardiometabolic variables is still unclear. The aims of this study were to identify a dietary pattern associated with VAI and to investigate whether this pattern is associated with cardiometabolic variables in PCOS women. METHODS: The study was conducted on 53 PCOS women, aged 18-45 years, diagnosed according to National Institutes of Health (NIH) criteria, and 167 age-matched normo-ovulatory women who were recruited from the Tehran Lipid and Glucose Study. Reduced rank regression was applied to determine a dietary pattern that explains the maximum variation of the VAI. Associations between the dietary pattern and cardiometabolic profiles were investigated using linear and logistic regression, adjusted for age and BMI. RESULTS: A VAI dietary pattern was identified characterized by high consumption of fried vegetables, vegetable oils (except olive oil), salty snacks, legumes, eggs, fast foods and low consumption of traditional sweets, high and low fat dairy, cruciferous vegetables, sugars and honey. A one standard deviation (SD) increase in dietary pattern score was significantly associated with higher triglycerides (TGs) (ßcontrol = 0.22, p = 0.003; ßcase = 0.48, p = 0.001) and TGs/HDL-C ratio (ßcontrol = 0.23, p = 0.002; ßcase = 0.52, p = 0.001) in both groups. After adjusting for age and BMI, a 1-SD increase in dietary pattern score was associated with increased risk of VAD in PCOS (OR 2.77; 95% CI 1.15, 6.66) and control groups (OR 2.41; 95% CI 1.41-4.12). In the control group, the risk of hypercholesterolemia, hypertriglyceridemia, high LDL-C, low HDL-C, hyperglycemia and IGT + IFG increased significantly per 1-SD increase in dietary pattern score, which all remained significant after adjusting for age and BMI, except for the risk of high LDL-C. Among the cardiometabolic abnormalities, only the risk of hypertriglyceridemia was significantly associated with dietary pattern score in women with PCOS, which lost its significance after adjusting for age and BMI. CONCLUSION: The VAI dietary pattern affects most cardiometabolic variables in controls, but to a lesser extent in PCOS women. Our study suggests that relationships between diet and cardiometabolic risk profiles may be modified by PCOS status.