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1.  Secular trends in serum lipid levels of a Middle Eastern adult population; 10 years follow up in Tehran lipid and glucose study 
To examine trends in the population levels of serum lipids among a Middle-Eastern adult population with high prevalence of dyslipidemia.
A population-based cohort of adult Iranian participants, aged ≥20 years underwent four consecutive examinations between 1999–2001 and 2008–2011. Trends in age and multivariate-adjusted mean lipid levels were calculated using generalized estimating equations.
At each of the 4 assessments, there were significant decreases in levels of total cholesterol (TC) (multivariate-adjusted means, 5.21 vs. 4.88 mmol/L in men; 5.42 vs. 5.07 mmol/L in women), triglycerides (TGs) (2.11 vs. 1.94 mmol/L in men; 1.88 vs. 1.74 mmol/L in women), and an increase in HDL-C level in both genders (0.95 vs. 1.058 mmol/L in men; 1.103 vs. 1.246 mmol/L in women) in multivariate analyses (all Ps <0.001); however, body mass index (BMI) significantly increased simultaneously (25.92 vs. 27.45 kg/m2 in men; 27.76 vs. 30.02 kg/m2 in women) (P < 0.001). There were significant (P < 0.001) increases in fasting plasma glucose (FPG) levels only among men (5.35 vs. 5.73 mmol/L). Results did not change after excluding participants that had cardiovascular disease or used lipid lowering drugs during follow-up. There were significant decreases in the prevalence of hypercholesterolemia, low HDL-C, hypertriglyceridemia (all Ps <0.001) during follow-up. Furthermore, the consumption of lipid lowering drugs significantly increased (P <0.001).
During a 10 years follow-up, favorable trends were observed in the population levels of TC, triglycerides, HDL-C, which could not be fully accounted for by the increase observed in the consumption of lipid lowering drugs. These favorable trends were counterbalanced by the progressive increase in general obesity and FPG level.
PMCID: PMC3912503  PMID: 24456699
Secular trends; Serum lipids measures; Middle Eastern adult population; Cohort; Dislipidemia
2.  Leemoo, a Dietary Assessment and Nutritional Planning Software, Using Fuzzy Logic 
Leemoo is a user-friendly software designed for nutritional planning and dietary assessment applications by cooperation of Research Institute for Endocrine Sciences of Shahid Beheshti University of Medical Sciences, which uses fuzzy logic for the first time. It provides a range of recommended servings for food groups, which are easier for people to follow.
The aim of this research was to describe the applications of this newly introduced software.
Methods and Materials:
Leemoo contains the following databases: food, nutrients, MyPyramid equivalents and physical activity. These databases facilitate diet analysis and planning. The food composition database includes 2920 Iranian food items, with the nutrient composition for up to 64 nutrients.
All databases are flexible for updating. The program can calculate the amounts of nutrients and food group intakes and compare these with Dietary Reference Intakes and MyPyramid recommendations. This software has the ability of nutritional planning and estimates normal intake ranges of seven food groups based on person need.
This software was envisaged for use by health professionals, researchers and ordinary people and can be recommended for educational purpose and nutrition research in Iran. Future studies must be conducted to evaluate the effects of this software on users’ dietary habits and nutrition knowledge.
PMCID: PMC3968974  PMID: 24719623
Nutrition Software; Leemoo; Fuzzy Logic; Food Groups
3.  Incidence of Metabolic Syndrome over 9 Years Follow-Up; the Importance of Sex Differences in the Role of Insulin Resistance and Other Risk Factors 
PLoS ONE  2013;8(9):e76304.
To determine, the predictors of incident metabolic syndrome (MetS) in a community-based cohort of West Asians, during a mean follow-up of 9.3 years, a sample of 2858 non-MetS Iranian adults aged ≥ 20 years were examined at baseline and followed at three year intervals during three consecutive phases. The MetS was defined using the joint interim statement. Cox proportional hazard regression was used to determine the independent variables associated with incident MetS. Overall, 1117 new cases MetS were identified resulting in an incidence rate of 550.9/10000 person years (95% CI: 519.5-584.2). The corresponding incidence rates among women and men were 433.5/10000 person years (95% CI: 398.8-471.2) and 749.2/10000 person years (95% CI: 689.9-813.5), respectively. Baseline-adjusted predictors of developing MetS included all of the MetS components, being overweight or obese in both gender, and family history of diabetes and age only in women. There were significant effect modifications of gender on age (P<0.001), high blood pressure (0.026), high waist circumference (P<0001) and obesity categories (all P ≤ 0.01) in multivariate analysis. After considering HOMA–IR in the model, among women, all of the MetS predictors as well as those with HOMA-IR ≥ 2.23 showed a significant risk for incident MetS [HR: 1.63 (1.16-2.28)]; however, among men all the MetS components (WC was marginally significant) as well as the fourth quartile of HOMA-IR [HR: 1.50 (1.03-2.17)] and being overweight showed a significant risk. Finally, in the pooled analysis, we showed that female gender had lower risk for incident MetS than male [HR: 0.58 (0.47-0.70)]. In the Iranian population, high incidence of MetS, especially among men, was shown. Our findings confirmed that sex- specific risk predictors should be considered in primary prevention for incident MetS.
PMCID: PMC3785433  PMID: 24086723
4.  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: 1.61, 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.
PMCID: PMC3793481  PMID: 24130941
Adolescent; metabolic syndrome; obesity; physical activity; TLGS
5.  Prenatal Testosterone Exposure Worsen the Reproductive Performance of Male Rat at Adulthood 
PLoS ONE  2013;8(8):e71705.
The reproductive system is extremely susceptible to environmental insults, for example exogenous steroids during gestational development and differentiation. Experimental induction of androgen excess during prenatal life in female animal models reprograms their reproductive physiology, however the fetal programming of the male reproductive system by androgen excess has not been well studied. We aimed to determine the effect of prenatal exposure of two different doses of testosterone on different gestational days, on the male reproductive system using a rat model. Sixteen pregnant rats were randomly divided into two experimental groups and two control groups. Experimental group І were subcutaneously injected with 3 mg free testosterone on gestational days 16-19 and its controls received solvent for that time; experimental group П were subcutaneously injected with 20 mg free testosterone on day 20 of gestational period and its controls received solvent at the same time. The reproductive system morphology and function of 32 male offspring of these study groups were compared at days 6-30-60 of age and after puberty. The anogenital distance of the male offspring of both experimental groups had no significant differences on the different days of measurement, compared with controls. In the offspring of experimental group І, the testes weight, number of Sertoli, Spermatocyte and Spermatid cells, sperm count and motility and the serum concentration of testosterone after puberty were significantly decreased; except for reduction of sperm motility (p< 0.01), the other effects were not observed in the offspring of experimental group ІІ. In summary, our data show that prenatal exposure of male rat fetuses to excess testosterone disrupted reproductive function, an effect highly dependent on the time, duration and level of exposure. It seems that the reproductive system in individuals exposed to high levels of androgens during fetal life should be evaluated at puberty and likely to be treated.
PMCID: PMC3744450  PMID: 23967236
6.  Dietary polyphenols as potential nutraceuticals in management of diabetes: a review 
In recent years, there is growing evidence that plant-foods polyphenols, due to their biological properties, may be unique nutraceuticals and supplementary treatments for various aspects of type 2 diabetes mellitus. In this article we have reviewed the potential efficacies of polyphenols, including phenolic acids, flavonoids, stilbenes, lignans and polymeric lignans, on metabolic disorders and complications induced by diabetes. Based on several in vitro, animal models and some human studies, dietary plant polyphenols and polyphenol-rich products modulate carbohydrate and lipid metabolism, attenuate hyperglycemia, dyslipidemia and insulin resistance, improve adipose tissue metabolism, and alleviate oxidative stress and stress-sensitive signaling pathways and inflammatory processes. Polyphenolic compounds can also prevent the development of long-term diabetes complications including cardiovascular disease, neuropathy, nephropathy and retinopathy. Further investigations as human clinical studies are needed to obtain the optimum dose and duration of supplementation with polyphenolic compounds in diabetic patients.
PMCID: PMC3751738  PMID: 23938049
Polyphenols; Phenolic acids; Flavonoids; Stilbenes; Lignans; Type 2 diabetes; Diabetes complications
7.  Trimester-Specific Reference Ranges for Thyroid Hormones in Iranian Pregnant Women 
Journal of Thyroid Research  2013;2013:651517.
Background. Due to many physiological changes during pregnancy, interpretation of thyroid function tests needs trimester-specific reference intervals for a specific population. There is no normative data documented for thyroid hormones on healthy pregnant women in Iran. The present survey was conducted to determine trimester-specific reference ranges for serum TSH, thyroxine (TT4), and triiodothyronine (TT3). Methods. The serum of 215 cases was analyzed for measurement of thyroid function tests by immunoassay method of which 152 iodine-sufficient pregnant women without thyroid autoantibodies and history of thyroid disorder or goiter were selected for final analysis. Reference intervals were defined as 5th and 95th percentiles. Results. Reference intervals in the first, second, and third trimesters were as follows: TSH (0.2–3.9, 0.5–4.1, and 0.6–4.1 mIU/l), TT4 (8.2–18.5, 10.1–20.6, and 9–19.4 μg/dl), and TT3 (137.8–278.3, 154.8–327.6, and 137–323.6 ng/dl), respectively. No correlation was found between TSH and TT4 or TT3. Significant correlation was found between TT4 and TT3 in all trimesters (r = 0.35, P < 0.001). Conclusion. The reference intervals of thyroid function tests in pregnant women differ among trimesters. Applying trimester-specific reference ranges of thyroid hormones is warranted in order to avoid misclassification of thyroid dysfunction during pregnancy.
PMCID: PMC3690831  PMID: 23841018
8.  The Effect of Community-Based Education for Lifestyle Intervention on The Prevalence of Metabolic Syndrome and Its Components: Tehran Lipid and Glucose Study 
It has been shown that life style modification may decrease the prevalence of metabolic syndrome, but this intervention has not been reported in community setting.
Effect of lifestyle modification on prevalence of metabolic syndrome and its components were assessed in an urban population.
Materials and Methods:
In 6870 participants of Tehran Lipid and Glucose Study aged 20-74 years, the prevalence of metabolic syndrome and its components were measured before and after a 3.6 years interval. Lifestyle intervention was employed at a community level including 2961 individuals and also 3909 subjects which were recruited as controls. Logistic regression analysis was adjusted for age, sex and medications.
After 3.6 years, the rise in the prevalence of metabolic syndrome was less prominent in intervention than control group (P < 0.002 for increase of metabolic syndrome prevalence between groups), with an OR of 0.84 (confidence interval 0.75-0.95). After intervention the prevalence of abdominal obesity, elevated fasting glucose levels, elevated triglyceride and low HDL cholesterol were more prominent in control group, as compared to intervention group.
Community based lifestyle modifications in Tehranian adults delayed rise in the prevalence of metabolic syndrome and some of its components.
PMCID: PMC3860109  PMID: 24348586
Metabolic Syndrome; Lifestyle; Community-Based; Prevalence
9.  Management of Hyperthyroidism in Pregnancy: Comparison of Recommendations of American Thyroid Association and Endocrine Society 
Journal of Thyroid Research  2013;2013:878467.
Appropriate diagnosis and treatment of hyperthyroidism during pregnancy are of outmost importance, because hyperthyroidism has major adverse impact on both mother and fetus. Since data on the management of thyroid dysfunction during pregnancy is rapidly evolving, two guidelines have been developed by the American Thyroid Association and the Endocrine society in the last 2 years. We compare here the recommendations of these two guidelines regarding management of hyperthyroidism during pregnancy. The comparison reveals no disagreement or controversy on the various aspects of diagnosis and treatment of hyperthyroidism during pregnancy between the two guidelines. Propylthiouracil has been considered as the first-line drug for treatment of hyperthyroidism in the first trimester of pregnancy. In the second trimester, consideration should be given to switching to methimazole for the rest of pregnancy. Methimazole is also the drug of choice in lactating hyperthyroid women.
PMCID: PMC3674680  PMID: 23762777
10.  Association of CD36 Gene Variants and Metabolic Syndrome in Iranians 
Aims: The CD36 gene encodes for a membrane receptor that facilitates fatty-acid uptake and utilization. Genetic variants of the CD36 gene have been associated with metabolic syndrome (MetS). We aimed to evaluate the association between the rs10499859A>G and rs13246513C>T polymorphisms and MetS components. Methods: For this case–control study, 140 MetS and 187 normal subjects were randomly selected from the Tehran Lipid and Glucose Study participants. Biochemical and anthropometrical variables were measured. Genotyping for both single nucleotide polymorphisms (SNPs) was performed by polymerase chain reaction–restriction fragment length polymorphism. Results: Case and control groups were not different in allele and genotype frequencies for these SNPs. However, the A and T alleles of these SNPs were significantly associated with elevated levels of high-density lipoprotein cholesterol (HDL-C) before age and sex adjustment (p=0.027 and 0.016, respectively). Association between the A allele and body mass index (BMI) was also significant after adjustment for MetS under the dominant model (p=0.009, β2=0.68). Conclusions: Based on our results, these polymorphisms do affect HDL-C level and BMI (MetS components), although the effect may be slight and restricted specifically to an environment-genotype.
PMCID: PMC3326263  PMID: 22047506
11.  Dietary Quality among Tehranian Adults in Relation to Lipid Profile: Findings from the Tehran Lipid and Glucose Study 
The prevalence of dyslipidaemia has been increasing in developing countries that are undergoing nutrition transition. However, the association of diet quality and lipid profile has not been well-understood in these countries. The aim of the current study was to compare the ability of three diet quality indices—the Mediterranean diet scale (MDS), healthy eating index-2005 (HEI-2005), and diet quality index-international (DQI-I) in relation to changes in lipid profile between baseline and 6.7 years of follow-up. Baseline data from two 24-hour dietary recalls provided by 469 adults with mean age of 38.7±12.3 years, who were participants of the Tehran Lipid and Glucose Study, were analyzed to describe dietary intakes. Data on anthropometry, sociodemography, physical activity, and other lifestyle variables were recorded, and a comparison of baseline and follow-up data revealed changes in the concentrations of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). A general linear model was used in assessing changes in lipid profile depending on adherence to diet quality indices at baseline, after adjustment for age, smoking status, waist-circumference, body mass index, physical activity, and energy intake. A significant interaction was observed between scores and sex, and upon stratification, males in the highest quartile score of the HEI-2005 had significantly lower TG changes than those in the lowest quartile, after adjusting for confounders (-8.8 vs 2.9, p=0.038). No association was apparent in females (-0.2 vs 11.2, p=0.297). In addition, a positive association was found between DQI-I and HDL-C (Q1=0.6 vs Q4=-2.0, p=0.044) in males. In both sexes, all these indices were weakly associated with TC while none was associated with LDL-C. It is concluded: adherence to the HEI-2005 recommendations was weakly associated with reduced TG concentration in an urban Iranian adult population. The MDS and DQI-I were not related to change in lipid profile.
PMCID: PMC3702357  PMID: 23617203
Diet quality index-international; Healthy eating index-2005; Lipid profile; Mediterranean diet scale
12.  Intake of Dairy Products, Calcium, Magnesium, and Phosphorus in Childhood and Age at Menarche in the Tehran Lipid and Glucose Study 
PLoS ONE  2013;8(2):e57696.
Studies indicate that milk intake is associated with insulin-like growth factor 1 (IGF-1) concentrations and height in childhood, whether milk and other dairy products promote puberty remains unclear. This study aimed to investigate influences of pre-pubertal intakes of milk, yogurt and cheese on menarcheal age in Tehranian girls. The associations of total dietary calcium (Ca), magnesium (Mg), and phosphorus (P) with menarcheal age were also examined.
This prospective study was conducted on 134 pre-pubertal girls, aged 4-12 years at baseline, who participated in the Tehran Lipid and Glucose Study (TLGS), and were followed for a median of 6.5 years. Dietary intakes were determined at initiation of the study using two non-consecutive 24-h dietary recalls and the age of menarche was documented during the follow-up. Logistic regression was used to calculate the risk of reaching menarche ≤ 12 years according to pre-pubertal levels of dairy or mineral intakes.
The risk of earlier menarche was higher in girls with higher intakes of milk [OR: 2.28 (95% CI: 1.03–5.05)], Ca [OR: 3.20 (95%CI: 1.39–7.42)], Mg [OR: 2.43 (95% CI: 1.12–5.27)] and P [OR: 3.37 (95 % CI: 1.44–7.87) after controlling for energy and protein intake, interval between the age at study initiation and the age of menarche, and maternal age at menarche (Model 1). Girls in the middle tertile of cheese intakes had a lower risk of reaching menarche ≤ 12 years than those in the lowest tertile after controlling for covariates in model 1. These associations remained significant after further adjustment of BMI Z-score at baseline. The relationship of Ca, Mg, and P with menarche remained after further adjustment for height Z-score at baseline, whereas the association between milk and cheese intakes became non-significant.
Pre-pubertal intake of milk, but not cheese and yogurt, may hasten age at menarche.
PMCID: PMC3581542  PMID: 23451261
13.  Leisure-Time Physical Activity and Its Association With Metabolic Risk Factors in Iranian Adults: Tehran Lipid and Glucose Study, 2005–2008 
We examined the association between leisure-time physical activity (LTPA) and metabolic syndrome (MetS) among 4,665 randomly selected adults who participated in the Tehran Lipid and Glucose Study, 2005–2008. Normal-weight participants with light LTPA had higher risk of low high-density lipoprotein cholesterol and elevated levels of triglycerides than those with vigorous LTPA. Overweight adults with moderate LTPA had higher risk of having elevated levels of fasting blood glucose than adults with vigorous LTPA and, in the same group, we found an inverse association between light LTPA and MetS after adjustment for sex, age, education levels, smoking, and calorie intake. Although participants in the normal-weight and obese groups with vigorous LTPA had higher risk of high systolic blood pressure than participants with moderate LTPA, this finding had no clinical significance. Increased LTPA is associated with decreased risk of any damaging changes in the markers of MetS.
PMCID: PMC3600871  PMID: 23489641
14.  The Structure of Metabolic Syndrome Components Across Follow-Up Survey From Childhood to Adolescence 
The choice of what parameters are needed for the diagnosis of Metabolic syndrome (MetS) has been criticized due to the lack of an actual “gold standard” diagnostic test even in adults. This problem seems to be greater in children and adolescents.
Stability assessment of factor structure underlying metabolic syndrome (MetS) components from childhood to adolescence in a panel study.
Patients and Methods
A total number of 643 (305 boys and 338 girls) children (from 1999 to 2001), aged 6-10 years, with a complete median follow-up of 6.7 years (from 2006 to 2008) were selected among participants of Tehran Lipid and Glucose Study. We proposed 6 measured variables based on risk factors defined in Adult Treatment Panel III guidelines to describe clustering of MetS components.
The Goodness of fit of the two-factor model, extracted from exploratory factor analysis, was appropriate for boys and girls in both stages of the study using confirmatory factor analysis. Systolic blood pressure (SBP) and triglycerides (TGs), with parameter estimates (PE) of 1 and 0.75, respectively, were the greatest risk factors at baseline in boys and girls. Waist circumference with PE of 0.88 and 0.62, and SBP with PE of 0.99 and 0.86 in adolescent boys and girls, respectively, were important risk factors.
Our panel study supports the stability of the two-factor six-variable model across two developmental stages from childhood to adolescence, among which adiposity, SBP, and TG were the predominant risk factors.
PMCID: PMC3693654  PMID: 23853615
Adolescent; Childhood; Factor Analysis; Statistical
15.  Barriers to healthy nutrition: perceptions and experiences of Iranian women 
BMC Public Health  2012;12:1064.
A sound understanding of community perceptions and experiences regarding barriers to a healthy diet is a prerequisite for the design of effective interventions aimed at prevention of diet-related non-communicable diseases (NCDs). This study focused on exploring barriers to healthy nutrition as experienced by women participating in the Tehran Lipid Glucose Study (TLGS).
A grounded theory approach was used for analyzing the participants’ experiences and their perceptions regarding these barriers. Data collection was conducted through sixteen semi-structured focus group discussions, between 2008 and 2009. Participants were 102 women, aged 25-65 years, selected and recruited from the TGLS cohort. All interviews and focus group discussions were audio recorded and transcribed verbatim. Constant comparative analysis of the data was conducted manually according to the Strauss and Corbin analysis method.
The study revealed that the most important barriers to healthy nutrition were: 1) Interpersonal/cultural effects, 2) Lack of access to healthy foods, and 3) Food preferences.
Understanding these barriers might contribute to existing literature by providing evidence from a different culture, and help design effective preventive strategies, and implement appropriate interventions among Tehranian families.
PMCID: PMC3542289  PMID: 23227832
Healthy nutrition; Barriers; Qualitative study; Non-communicable diseases
16.  Association between dietary phytochemical index and 3-year changes in weight, waist circumference and body adiposity index in adults: Tehran Lipid and Glucose study 
High intakes of phytochemical-rich foods have favorable effects on the prevention of chronic diseases. In this study we assessed the dietary phytochemical index (PI) in relation to 3-year change in weight, waist circumference (WC), body adiposity index (BAI) among Tehranian adults.
This longitudinal study was conducted in the framework of Tehran Lipid and Glucose Study, between 2006–2008 and 2009–2011, on 1938 adults, aged 19–70 y. The usual intake of participants was measured at baseline using a validated semi-quantitative food frequency questionnaire and dietary PI was calculated. Anthropometric measures were assessed both at baseline and 3 years later. Multiple regression models were used to estimate mean difference changes in anthropometrics associated with various dietary PI.
The mean age of participants was 40.4 ± 13.0 y, at baseline, respectively. Mean weight gain was 1.49 ± 5.06 kg (1.65 ± 5.3 kg in men and 1.34 ± 4.9 kg in women) during 3-year period. After adjustment for potential confounding variables including age at baseline, sex, BMI, educational levels, smoking, physical activity, total energy intake, dietary intake of carbohydrate, fat and protein, dietary intakes of whole grains in the highest quartile category of PI were inversely associated with 3-year changes in weight and WC (P for trend <0.05). Dietary intake of fruits in the highest quartile was also associated with lower weight gain during the study period (P for trend <0.05). There was significant inverse association between the highest quartile category of dietary PI with the 3-year changes in weight and BAI (P for trend <0.05).
Higher dietary PI could have favorable effects on prevention of weight gain and reduction of body adiposity in adults.
PMCID: PMC3546027  PMID: 23206375
Dietary phytochemical index; Waist circumference; Body adiposity index; Weight gain; Tehran lipid and Glucose study
17.  Risk factors for ischemic stroke; results from 9 years of follow-up in a population based cohort of Iran 
BMC Neurology  2012;12:117.
Data about the risk factors of stroke are sparse in the Middle East populations. We aimed to determine the potential risk factors and their population attributable fraction (PAF) for stroke in an Iranian population.
A cohort Study consisted of 1089 men and 1289 women, with mean (SD) ages of 61.1(7.6) and 59.0(6.7) years, respectively. Cox regression was implemented to estimate the hazard ratio (HR) of each risk factor for stroke events in a stepwise method. We calculated a multivariate adjusted population attributable fraction (PAF) for any risk factors remained in the model.
During 9.3 years of follow-up, 69 events of stroke occurred with incidence rates of 4.5 (95% CI: 3.3-6.0) and 2.5 (1.7-3.6) in 1000 person-years for men and women respectively. Among potential risk factors, only age ≥ 65 years (HR: 2.03, CI: 1.24-3.31), male gender (HR: 2.00, CI: 1.16-3.43), hypertension (HR: 3.03, CI: 1.76-5.22), diabetes mellitus (HR: 2.18, CI: 1.34-3.56), and chronic kidney disease (CKD) (HR: 2.01, CI: 1.22-3.33), were independently associated with increased risk of stroke events in the total population. A paired homogeneity test showed that the hazard ratio of CKD did not differ from other independent risk factors. The PAFs were 29.7% and 25% for male gender and age ≥ 65 as non-modifiable and 48.6%, 29.1% and 22.0% for hypertension, CKD and diabetes as modifiable risk factors respectively.
Following this population based study of Iranians, we demonstrated that among modifiable risk factors, CKD as well as hypertension and diabetes are the strongest independent predictors of stroke.
PMCID: PMC3517457  PMID: 23031547
Chronic kidney disease; Hypertension; Diabetes; Stroke; Population attributable fraction
18.  Subclinical Hypothyroidism in Pregnancy: Intellectual Development of Offspring 
Thyroid  2011;21(10):1143-1147.
The effects of maternal subclinical hypothyroidism (M-SCH) on the neuropsychological development of the offspring are not clear. We evaluated the intellectual development of children of mothers who had M-SCH during the pregnancy for these children.
Sixty-two children were recruited. After excluding those age <4 or age >15, 44 were enrolled. The mothers of these children were part of a sub-pool of 90, of 441 hypothyroid women of reproductive age seen in Tehran endocrine clinics between 1991 and 2003 and who were observed during gestation. Mothers were receiving levothyroxine (LT4) before gestation. Mothers of 19 children (control group) had normal serum thyrotropin (TSH) during the pregnancy that produced these children. Mothers of the other 25 children had increased TSH during the comparable pregnancy. Nineteen mothers had M-SCH (case group) and six had overt hypothyroidism. Serum TSH and free T4 (FT4) and urine iodine were measured, and seven cognitive performance and intelligence quotient (IQ) tests were performed.
Case children were similar to control children with respect to gender, age, parental education, maternal age at time of pregnancy and at the time of their hypothyroidism, percent mothers having thyroid peroxidase antibodies, LT4 dose of mothers during pregnancy, gestational age at delivery, birth weight, and duration of breast feeding. Maternal TSH (mean±standard deviation) in the case group during their mother's pregnancies was 11.3±5.3 and 1.4±1.0 mU/L in the controls (p<0.001). Serum TSH, FT4 and urinary iodine concentrations were similar in the two groups. Total IQ, performance IQ, and verbal IQ were similar, being 120±14, 117±12, and 121±16, respectively, in the case group and 121±11, 120±7, and 117±15 in the control group. Cognitive performance tests were similar in both groups. No relationships were observed between variables and IQ except for education level of the mother and neonatal weight.
IQ level and cognitive performance of children born to LT4-treated hypothyroid mothers is similar in those whose mothers have M-SCH during pregnancy compared with those whose mothers have normal serum TSH concentrations during pregnancy.
PMCID: PMC3179614  PMID: 21943136
20.  Incidence of Chronic Kidney Disease and Its Risk Factors, Results of Over 10 Year Follow Up in an Iranian Cohort 
PLoS ONE  2012;7(9):e45304.
To examine, the predictors of incident chronic kidney disease (CKD) in a community-based cohort of Middle East population, during a mean follow-up of 9.9 years. In a sample of 3313 non-CKD Iranian adults ≥20 years the estimated glomerular filtration rate (eGFR) was calculated at baseline and at three year intervals during three consecutive phases. The eGFR <60 mL/min/1.73 m2 was defined as CKD. Multivariate Logistic regression analysis was used to determine the independent variables associated with incident CKD. The incidence density rates of CKD were 285.3 and 132.6 per 10,000 person-year, among women and men, respectively. Female gender per se was associated with higher risk of CKD, compared with males. Among women, age, eGFR, known diabetes, being single or divorced/widowed, hypertension (marginally significant) and current smoking were independent risk factors for CKD; however the intermediate degree of education and family history of diabetes decreased the risk by 40% (P<0.05). Among male subjects, independent predictors of developing CKD included aging and hypertension (with significantly higher risk than in women, P for interaction<0.05), eGFR, new diagnosed diabetes, high normal blood pressure; abdominal obesity decreased the risk of CKD about 30% which was marginally significant. In the Iranian population,>2% of individuals develops CKD each year. Our findings confirmed that sex- specific risk predictors should be considered in primary prevention for incident CKD.
PMCID: PMC3459968  PMID: 23028919
21.  Analysis of loss of heterozygsity effect on thyroid tumor with oxyphilia cell locus in familial non medullary thyroid carcinoma in Iranian families 
Indian Journal of Human Genetics  2012;18(3):340-343.
22 nuclear families (78 persons including 12 patients) with papillary and follicular tumors were selected in a period of six months from Milad hospital. Five microsatellite markers (D19S413, D19S391, D19S916, D19S568, D19S865) on 19p13.2 were selected for genetic analysis. Genomic DNAs was extracted; PCR and polyacrylamide gel electrophoresis method were used for variation detection.
The results show that 5.4% of the follicular carcinomas and 17.9% of the papillary carcinomas presented LOH at recognition sites. LOH of Papillary carcinoma detected about 13.9% and follicular carcinoma 7.2% in this study. The frequency of informative cases was not similar for each marker: D19S413 (41.1%)[1], D19S391 (12.5%), D19S916 (10.7%), D19S568 (1.8%) and D19S865 (3.6%). Loss of hetrozygosity in D19S413 predicts the relation between variation in this region and the disease.
Our findings showed an average of 13.9% LOH in FNMTC cases. Among the five major microsatellites, D19S413 was the most informative for LOH analysis of FNMTC.
PMCID: PMC3656524  PMID: 23716943
Familial non medullary thyroid carcinoma; Iran; loss of heterozygosis; thyroid tumor with oxyphilia cell
22.  Obesity Dilemma: Are There Enough Bariatric Surgeons? 
PMCID: PMC3693640  PMID: 23843826
Obesity; Diabetes Mellituss Type2
23.  Adolescent lipoprotein classifications according to National Health and Nutrition Examination Survey (NHANES) vs. National Cholesterol Education Program (NCEP) for predicting abnormal lipid levels in adulthood in a Middle East population 
To compare the predictive ability of adolescent lipoprotein classification using the National Examination Survey (NHANES) cut points and those of the National Cholesterol Education Program (NCEP) for predicting abnormal levels in adulthood.
From 1032 adolescents, aged 14–19 years, participants of the Tehran Lipid and Glucose Study, all lipid measures were determined at baseline and again after 6 years. Multivariable Odds Ratios (ORs) were calculated for borderline and high categories of lipids to predict dyslipidemia in adulthood, considering the normal level as a reference. Area under the receiving characteristics curve (AUC) was used to assess the predictive ability of each adolescent lipid classification.
Applying the NCEP classification, the prevalences of high total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides and low high density lipoprotein cholesterol (HDL-C) in males were 12.1%, 12.9%, 26.1% and 34.2% respectively; in females the corresponding prevalences were 15.4%, 17.9%, 21.4% and 25.0%, respectively. Using NHANES cut points, the prevalence of high TC, LDL-C and triglycerides were lower, than those defined by NCEP; the ORs of high categories of lipids (defined by NHANES) were higher than ORs based on the NECP classification, except for HDL-C. For all lipid measures, both classifications had similar predictive abilities, except for TC/HDL-C, which had higher predictive power applying the NHANES classification rather than the NCEP one (AUC 71% vs. 68%, respectively).
No differences were found between NCEP and NHANES classifications for prediction of adult dyslipidemia, except for TC/HDL-C. Because of their simple application, NCEP cut points can be used in clinical settings.
PMCID: PMC3477115  PMID: 22937812
24.  Dietary total antioxidant capacity and the occurrence of metabolic syndrome and its components after a 3-year follow-up in adults: Tehran Lipid and Glucose Study 
There is growing evidence that dietary antioxidants could have favorable effects on the attenuation and prevention of metabolic disorders. In the current study we investigated the association of dietary total antioxidant capacity (TAC) and metabolic syndrome (MetS) components and the occurrence of the MetS during a 3-year follow-up.
This longitudinal study was conducted in the framework of Tehran Lipid and Glucose Study, between 2006–2008 and 2009–2011, on 1983 adults, aged 19–70 y. The usual intakes of participant were measured using a validated semi-quantitative food frequency questionnaire and dietary TAC was estimated at baseline. The MetS components were assessed at baseline and 3 years later. Multiple logistic regression models were used to estimate the occurrence of the MetS and its components according to dietary TAC quartile categories.
The mean age of participants was 40.4 ± 13.0 y, and mean BMI was 27.03 ± 4.9 kg/m2 at baseline. After adjustment for potential confounding variables, TAC was associated with MetS components at baseline. Participant with highest TAC score had lower weight and abdominal fat gain during the 3 year follow-up. The chance of having the MetS, abdominal obesity and hypertension after 3 years decreased across the increasing dietary TAC quartile (P for trend < 0.01). Dietary TAC more than 1080 μmolTE/100 g of food, resulted in a 38% decrease in the risk of central obesity (OR = 0.62, 95% CI = 0.38-0.99).
We demonstrated that higher dietary antioxidant intakes have favorable effects on metabolic disorders and, more interestingly, prevent subsequent weight and abdominal fat gain during a 3-year follow-up.
PMCID: PMC3556123  PMID: 22849424
Dietary total antioxidant capacity; Antioxidant-rich foods; Metabolic syndrome
25.  “Association between moderate renal insufficiency and cardiovascular events in a general population: Tehran lipid and glucose study” 
BMC Nephrology  2012;13:59.
Chronic kidney disease(CKD) has been proposed as a risk factor for cardiovascular disease (CVD). There is conflicting evidence among community based studies regarding the association between CKD and CVD. Furthermore, in order to assess the possible interaction between CKD and BMI, we also examined the association between CKD and CVD, across different BMI categories.
The risk of CVD events was evaluated in a large cohort of participants selected from the Tehran Lipid and Glucose Study. Participants(mean age, 47.4 years) free of previous CVD were followed up for 9.1 years. GFR ml/min per 1.73 m2 was estimated using the MDRD formula.
Of the 6,209 participants, 22.2%(1381) had CKD with eGFR ml/min per 1.73 m2 <60 at baseline. Almost all of them (99%) were in stage 3a. Moderate renal insufficiency only predicted CVD outcomes independently when we adjusted for age and sex. After further adjustment, the presence of moderate CKD lost its statistical significance to confer an independent increased risk of CVD events with a hazard ratio of: HR: 1.14, CI 95% 0.91-1.42. Furthermore, when participants were categorized according to CKD status and BMI groups, after further adjustment, no interaction was found(P = 0.2).
CKD was not an independent risk factor for CVD events in a community-based study in a Tehranian population and the higher prevalence of CVD in subjects with mild to moderate renal insufficiency might be due to the co-occurrence of traditional CVD risk factors in this group.
PMCID: PMC3413571  PMID: 22799559
Chronic kidney disease; Cardiovascular disease; Body mass index; Glomerular filtration rate; General population

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