Evaluating the interaction of common FTO genetic variants, added sugar, and trans-fatty acid intakes in altering obesity phenotypes.

BACKGROUND AND AIMS: The results of studies on the effect of trans-fatty acids (TFAs) and added sugars on obesity are not consistent. This study aimed to investigate whether the association of changes in general and central obesity with added sugar and TFA intakes is modified by common fat mass and obesity-associated gene (FTO) polymorphisms, in isolation or in a combined-form genetic risk score (GRS). METHODS AND RESULTS: Subjects of this cohort study were selected from among adult participants of the Tehran Lipid and Glucose Study (n = 4292, 43.2% male). Dietary data were collected using a valid and reliable food frequency questionnaire. The genotypes of selected polymorphisms (rs1421085, rs1121980, and rs8050136) were determined. Genetic risk score (GRS) was calculated using the dominant weighted method. The mean age of participants was 42.6 ± 14 and 40.4 ± 13 years in men and women, respectively. FTO rs8050136 polymorphisms and TFAs have a significant interaction in changing body mass index (BMI) (P interaction = 0.01). There were no changes in waist circumference (WC) and BMI among FTO risk allele carriers, across quartiles of added sugar intake. GRS and TFA intakes significantly interacted in altering the BMI and WC; thus, a higher intake of TFAs was associated with higher changes of BMI and WC in subjects with high GRS (P trend<0.05) compared to individuals with low GRS. CONCLUSION: Our findings suggest that TFA intake can increase the genetic susceptibility of FTO SNPs to BMI or WC change.

Effect of interactions of polymorphisms in the Melanocortin-4 receptor gene with dietary factors on the risk of obesity and Type 2 diabetes: a systematic review.

AIM: To perform a systematic review of the effect of interaction between Melanocortin-4 receptor (MC4R) single nucleotide polymorphisms and diet on the development of obesity and Type 2 diabetes. BACKGROUND: Environmental factors, such as nutrient intakes or feeding behaviours, can modulate the association of polymorphism in the MC4R gene with obesity and Type 2 diabetes mellitus. METHODS: A systematic literature search was conducted in the PubMed, Scopus and Google Scholar databases, with a combination of the following keywords: Diet*, nutr*, melanocortin receptor, melanocortin 4 receptor and MC4R. To assess the quality of observational studies, we used a 12-item quality checklist, derived from the STREGA statement. RESULTS: A total of 14 articles were selected based on the inclusion and exclusion criteria. Consumption of highly salty foods and adherence to a Mediterranean dietary pattern can modulate the association between MC4R polymorphisms and the risk of obesity or Type 2 diabetes. Despite the highly contradictory results of intervention studies, after short-term lifestyle interventions, children with variant alleles of MC4R single nucleotide polymorphisms can lose more body weight, compared with non-carriers, although they may have difficulty in maintaining this weight loss in the long-term. To interpret the results of studies on adults, we need further studies. CONCLUSIONS: The interaction between MC4R genes with dietary factors plays a significant role in the development of obesity or Type 2 diabetes phenotypes. Early detection of MC4R risk alleles in individuals and modification of their diet based on these results could be an efficient strategy to prevent obesity or diabetes in these subgroups.

Metabolic syndrome profiles, obesity measures and intake of dietary fatty acids in adults: Tehran Lipid and Glucose Study.

BACKGROUND: To determine the association between fatty acid intake and the prevalence of risk factors for the metabolic syndrome. METHODS: In this population-based cross-sectional study, a sample of 2750 Tehranian subjects (44% men and 56% women) aged 20-74 years, who completed a validated food frequency questionnaire, was studied. The metabolic syndrome (MetS) was defined in accordance with the modified guidelines of the National Cholesterol Education Program Adults Treatment Panel III, and waist circumference was coded according to the newly-introduced cut-off points for Iranian adults (≥95 cm for both sexes). Metabolic risk factors across quartile categories of each type of dietary fat [total fat intake, total poly-unsaturated fatty acid (PUFA) intake, total MUFA intake, total saturated fatty acid (SFA) intake expressed as percentage of energy and quartiles of the ratio of polyunsaturated fat to saturated fat (P : S)] were compared. RESULTS: The mean (SD) ages of participants were 40.8 (14.6) and 38.6 (12.9) years, respectively, for men and women. The mean contribution of fat to energy intake was approximately 26% in men and women. A positive trend over successive quartiles of SFA intake with low-density lipoprotein-cholesterol (LDL-C) and triglyceride, as well as P/S ratio intake with high-density lipoprotein-cholesterol (HDL-C), was found. An inverse association between HDL-C with SFA and PUFA intake and a positive association with MUFA and the P/S ratio was found. A significant association of fatty acid consumption and risk of the MetS in this population was observed, except for total PUFA intake. CONCLUSIONS: Special dietary fatty acids are associated with metabolic risk factors among the Iranian population. Because of the high prevalence of cardiovascular disease and MetS, national nutrition policies must be developed accordingly for the modification of dietary fatty acid intake with respect to causation and prevention.

Fast food consumption and the risk of metabolic syndrome after 3-years of follow-up: Tehran Lipid and Glucose Study.

BACKGROUND: There are growing concern globally regarding fast food consumption and its related cardiometabolic outcomes. In this study we investigated whether fast food consumption could affect the occurrence of metabolic syndrome (MetS) after 3-years of follow-up in adults. METHODS: This longitudinal study was conducted in the framework of Tehran Lipid and Glucose Study on 1476 adults, aged 19-70 y. The usual intakes of participants were measured using a validated semi-quantitative food frequency questionnaire at baseline. Biochemical and anthropometric measurements were assessed at baseline (2006-2008) and 3 years later (2009-2011). Multiple logistic regression models were used to estimate the occurrence of the MetS in each quartile of fast food consumption. RESULTS: The mean age of participants was 37.8±12.3 y, and mean BMI was 26.0±4.5 kg/m(2) at baseline. Participants in the highest quartile of fast food consumption were younger (33.7 vs 43.4 years, P<0.01). Higher consumption of fast food was accompanied with more increase in serum triglyceride levels and triglyceride to HDL-C ratio after the 3-year follow-up. After adjustment for all potential confounding variables, the risk of metabolic syndrome, in the highest quartile of fast foods compared with the lowest, was 1.85 (95% CI=1.17-2.95). The effects of fast food consumption on the occurrence of MetS were more pronounced in younger adults (<30 years), and participants who had greater wait to hip ratio, consumed less phytochemical-rich foods or had low-fiber diet (P<0.05). CONCLUSION: We demonstrated that higher consumption of fast foods had undesirable effects on metabolic syndrome after 3-years of follow-up in Iranian adults.

Disclosure of Cancer Information in Iran: a Perspective of Patients, Family Members, and Health Professionals.

BACKGROUND: In the last decades cancer has become one of the important causes of death in Iran .This study examined perspective of a group of Iranian health professionals, patients and patients' family members regarding their view on disclosure of cancer information at a university hospital in Tehran, Iran. METHODS: The method of study was qualitative semi-structured focused group content analysis. Two group leaders (psychologist and psychiatrist) run the focus groups. Oncologists, nurses, patients and family members participated in separate focus groups. Five group sessions were held to sum up the participants views in four major topics related to disclosure of cancer information to patients and families. RESULTS: Most of physicians and nurses believed that disclosure of cancer diagnosis is a mistake. Family members think that it should be delivered gradually during stages of therapy based on patient's psychological state, but most of the patients consider truth telling as a patient right. All physicians, most of nurses and all the patients see the physician as a person responsible to break the diagnostic disclosure. All patients wanted the physicians to take the total control of decision-making process for their treatment. CONCLUSION: Iranian physicians and nurses hesitate to disclose cancer diagnosis compared to patients, who want to know the truth. Patients, nurses and physicians consider the physician to be the person responsible for delivering the information of cancer diagnosis .Development and implementation of a protocol based on Iranian culture is a necessity.

Reversible posterior leukoencephalopathy syndrome in systemic lupus erythematosus.

Reversible posterior leukoencephalopathy syndrome (RPLS) is an acute form of cerebrovascular injury that has been described recently in the setting of uncontrolled hypertension, puerperal eclampsia, or treatment with certain immunosuppressive drugs, including cyclosporine. It is reversible if treated promptly. Two patients with systemic lupus erythematosus (SLE), renal failure, and uncontrolled hypertension developed acute cerebrovascular symptoms; one had seizures and the other had headache and blurred vision. Both patients showed abnormal predominantly posterior lobe findings on neuroimaging films. The patients' symptoms and imaging abnormalities resolved completely with prompt correction of their hypertension and concomitant treatment with corticosteroids. RPLS should be recognized in SLE patients with uncontrolled hypertension and renal failure who present with headaches, seizures, cortical blindness, and other visual abnormalities. Prompt treatment with control of hypertension and withdrawal of precipitating drugs may be most important and can prevent permanent neurologic damage.

Pregnancy-related changes: a retrospective review of 278 cervical smears.

Pregnancy-related physiologic changes are well recognized. However, the normal range of changes as reflected in the cervical smear have not been adequately described. Review of 278 abnormal cervical smears from 153 pregnant/preabortal and 125 postpartum/ abortal patients revealed the following: 21 high-grade squamous intraepithelial lesion (HGSIL) cases, 46 low-grade squamous intraepithelial lesion (LGSIL) cases, 185 atypical squamous cells of undetermined significance (ASCUS) cases, and 26 atypical glandular cells of undetermined significance (AGUS) cases. Surgical correlation (excluding 18 products of conception and 153 placentas) was available in 98 (35%) of the cases. Dysplasia was confirmed on biopsy of 11 cases cytologically diagnosed as HGSIL (7 CINII/III and 4 CIN I), 19 cases cytologically diagnosed as LGSIL (6 CIN II/III and 13 CIN I), 35 cases of ASCUS (4 CIN II/III and 31 CIN I), and 2 cases of AGUS (1 CIN III and 1 CIN I). Decidualization was present in six cervical and three endometrial biopsies. The remaining 180 cases revealed pregnancy-related changes in most of the atypical groups and a few in the dysplasia groups. With pregnancy, both cervical glands and stroma undergo physiologic changes. These result in squamous metaplasia due to ectropion and cells with hypervacuolated cytoplasm and atypical nuclei reflecting endocervical gland hyperplasia and/or Arias-Stella reaction. The decidual cells are large, with variably staining cytoplasm and a large nucleus. Degenerated decidual or trophoblastic cells can also shed from the endometrium and mimic HGSIL. Despite the caution required in this population, dysplastic changes should not be underestimated.

Choriocarcinoma metastatic to the breast diagnosed by fine needle aspiration.

Fine needle aspiration (FNA) was used to study nodules in the left breast of a patient with a previous history of uterine choriocarcinoma. The FNA smears contained numerous malignant mononucleated cells and multinucleated giant cells. The cytologic diagnosis was metastatic choriocarcinoma, which was confirmed by histologic study of excised tissue. That diagnosis would have been difficult to make cytologically if the previous history had not been known; the differential diagnosis of multinucleated giant cells in an aspirate from a breast mass is discussed.

Air CT cisternography in the diagnosis of vascular loop causing vestibular nerve dysfunction.

Considerable interest has developed in otology concerning the relationship between the vascular loop and compression of the eighth nerve, producing vertigo. Several authors have described the radiographic findings relative to the anatomy of these vascular loops. Few previous articles have dealt with cases that have had surgical confirmation or repair of the defect. Our presentation concerns 27 patients who were studied by air CT cisternography of the cerebellopontine angle cistern and internal auditory canal followed by surgical repair. We postulate dampened pulsation as the reason for being able to visualize the vessels on the air study. The diversity of vessel-eighth nerve defects is illustrated. Compression of the vestibular nerve by a vascular loop should be considered one of the causes of intractable vertigo and motion intolerance and is a differential diagnosis in Meniere disease. Air CT cisternography is useful in diagnosing this condition in patients who do not respond to medical treatment.

Arterial fibrodysplasia: a regional cause of peripheral occlusive vascular disease.

The authors studied 17 cases of symptomatic arterial fibrodysplasia involving peripheral arteries without concomitant renovascular hypertension in Iranian males (age range: twenty-two to forty-five years). Affected arteries were most commonly the femoral, iliac, and popliteal, but in 2 cases the axillary and brachial arteries were also affected. Three cases were progressive. Differential diagnosis of arterial fibrodysplasia is discussed. It is concluded that this entity is the most common cause of peripheral occlusive vascular disease in younger Iranian males.

Cytopathology of alpha chain disease involving the central nervous system and pleura.

Alpha chain disease, a lymphomatous disorder characterized by the synthesis and secretion of an abnormal IgA immunoglobulin devoid of light chains, involves mainly the gastrointestinal tract. This paper presents the cytologic and histologic findings in two cases of alpha chain disease involving the central nervous system and pleura. Most of the cell populations in the cerebrospinal fluid (CSF) and pleural fluid resembled immature plasma cells (immunoblasts); many of these cells were degenerated, with well-preserved plasma cells seen more rarely. While the definitive diagnosis of alpha chain disease depends on immunochemical analysis of serum proteins, cytology can play a role by the identification of malignant cells in CSF and pleural fluid specimens. A positive staining of such cells by the methyl green pyronin reaction may permit the correct diagnosis to be suggested.

Ultrasonography of hepatic hydatid cysts: new diagnostic signs.

Eighty-five cases of hepatic hydatid cysts were examined by ultrasonography. On the basis of sonographic patterns (as well as clinical symptomatology and surgical, bacteriologic, and pathologic findings), four groups of cysts were identified: uninfected, organizing, suppurative, and degenerated. A specific sign is defined to differentiate hydatid cysts from cystic lesions of other types. Organizing cysts are defined and ways to differentiate them from infected cysts sonographically are discussed. An analysis was made of the echographically detected material between the daughter cysts previously referred to as "matrix." Clues are given to differentiate infected cysts from liver abscesses. A classification correlating the pathology with the life cycle of the parasite in the human body is proposed.

Cytopathology of peritoneal endometriosis caused by ruptured ovarian cysts.

The cytopathologic features of two cases of peritoneal endometriosis (secondary to ruptured ovarian endometrial cysts) are described. Both patients presented with abdominal distension and tenderness and were clinically thought to have an abdominal tumor. Preoperative cytologic examination of peritoneal fluids gave a diagnosis of endometriosis in both cases. The endometrial tissue was present in the smears as honeycombs, syncytia and tight clusters of both epithelial and stromal cells. Subsequent surgery confirmed the cytodiagnosis in both cases. These cases emphasize the need to include endometriosis in the differential diagnosis of peritoneal effusions, especially in women.

Role of angiography in the diagnosis of pancreatic neoplasms.

The vascular architecture of the pancreas has been described, but few reports indicate preoperative accuracy. During the last 3 years, selective superior mesenteric and celiac angiography was performed in 471 patients. In 35 of these patients, additional selective angiography of the superior pancreaticoduodenal and inferior pancreaticoduodenal arteries was performed to reveal the detailed vascular pattern of the pancreas and its surrounding structures. Exploratory surgery was performed in all patients except the four control subjects. The angiographic findings reflected a poorly vascularized infiltrating lesion with invasion of the blood vessels and serpiginous encasements. Peripancreatic extension of the tumor indicated nonresectability. In early pancreatitis, the pancreas showed increased vascularity and occasional stretched vessels. In more advanced pancreatitis, the arteries were prominent and irregular with increased parenchymal accumulation of contrast medium in the capillary phase. In pseudocysts of the pancreas, the only finding was stretching of the vessels around the lesion. A well circumscribed lesion with increased contrast medium in the capillary and venous phases diagnostic of pancreatic adenoma. Pancreatic angiography is an important diagnostic tool in evaluating and staging pancreatic neoplasms.