The Pooled Cut-off Point of Waist Circumference as Core Component of Metabolic Syndrome Diagnosis among the Iranian Population; a Systematic Review and Meta-Analysis

Introduction: According to a nationwide study, one-third of the Iranian population suffer from metabolic syndrome (MetS). The most controversial criteria for the diagnosis of MetS is central obesity which would be defined by waist circumference (WC) and needed to be gender and ethnic-specific. There are several national studies that reported different cut-offs for WC so the present study aimed to do a systematic review and meta-analysis to achieve an overall statistical estimate of WC for the Iranian population. Method: A comprehensive search was conducted in international databases from inception to June 2020. The search keywords were waist circumference AND metabolic syndrome AND cut AND Iran. We used the QUADAS-2 tool for quality assessment and the HSROC model for estimating pooled specificity, sensitivity, and the cut-off point from included studies in R software. Results: A total of 3571 studies were evaluated and 24 studies fulfilled the inclusion criteria. Finally, 8 studies were included. All the studies were cross-sectional. Studies with missing MetS prevalence were excluded. Most of the studies had an unclear risk of bias in patient selection. There was a wide variation among reported cut-offs for WC from national and original studies. The Pooled cut-off points of WC for the diagnosis of MetS was 90.55 cm (95%CI: 90.51-90.60) in men and 89.24 cm (95%CI: 89.13-89.36) in women. The pooled sensitivity and specificity in men were 0.67 and 0.68, respectively and the pooled sensitivity and specificity in women were 0.61 and 0.57, respectively. Conclusion:  Our results were highly consistent with the only national study and the only consensus about WC cut-off. Further nationwide studies are suggested to be involved in a Mata-analysis for calculating more precise WC cut-off

Prevalence of diabetes and other cardiovascular risk factors in an Iranian population with acute coronary syndrome

BACKGROUND: Coronary artery disease is the leading cause of death in industrialized countries and most patients with diabetes die from complications of atherosclerosis. The objective of this study was to determine the presence of diabetes mellitus and other conventional coronary heart disease risk factors (cigarette smoking, hypertension and hyperlipidemia) in patients with acute coronary events in an Iranian population. METHODS: The study included 514 patients with unstable angina or myocardial infarction (MI) out of 720 patients admitted to CCU ward of a general hospital from March 2003 to March 2005. History of diabetes, hypertension and cigarette smoking, demographic indices, coronary heart disease and diabetes mellitus treatment, myocardial enzymes, serum triglycerides (TG) and cholesterol and fasting and non fasting blood glucose levels and HbA1C of diabetics were recorded of admission sheets. The data were structured to appropriate one way ANOVA, T tests, and chi square test with SPSS 13 product for windows. RESULTS: Out of all patients 35.8% were female, 30% were diabetics (Duration 13.4 ± 8.7 years), 42% were smoker and 91% were hypertensive. Twenty four percent had MI and 76% had unstable angina. MI was significantly higher in diabetic patients (36.4% vs. 19.2%, P < 0.001). Location and extension of MI and myocardial enzymes did not differ between diabetics and non-diabetic patients. Diabetic patients were older than non diabetics (65 ± 11.6 vs. 59.7 ± 12.5 years, p < 0.05). Five (66.7%) out of 9 patients with fatal MI were diabetics (Odds Ratio = 2.98). Age, duration of diabetes and HbA1c levels, did not differ between diabetic patients with or without MI. Hypertension and current smoking was significantly higher in patients with MI compared to patients with unstable angina (p < 0.05). Serum TG, HDL-C, LDL-C and total cholesterol level did not differ between patients with MI and unstable angina. Diabetic patients compare to non diabetic patients were more hypertensive (96% vs. 88.7%, p < 0.005) and had higher serum triglyceride (TG over 200 mg/dl, 35.1% vs. 26.4, p <0.05). Diabetes was more frequent among women than men (36.4% vs. 26.4%, p < 0.05). Women were older than men (65 ± 11.6 vs. 59.2 ± 13 years, p < 0.005) and had higher total serum cholesterol (200 ± 41.8 vs. 192 ± 42.5 mg/dl, p < 0.05) and HDL-C levels (49.7 ± 22 vs. 40 ± 13 mg/dl, p < 0.005). Ninety seven percent of all patients had at least one of cardiovascular risk factors (hypertension, smoking, diabetes, high cholesterol and low HDL-cholesterol levels). CONCLUSION: In this study 19 out of 20 patients with acute coronary event have at least one of conventional cardiac risk factors. Diabetes and hypertension are leading risk factors, which may directly or indirectly interfere and predict more serious complications of coronary heart disease

Physical Inactivity Is Correlated with Levels of Quantitative C-reactive Protein in Serum, Independent of Obesity: Results of the National Surveillance of Risk Factors of Non-communicable Diseases in Iran

Increased C-reactive protein (CRP) levels are associated with coronary heart disease, stroke, and mortality. Physical activity prevents cardiovascular disorders, which can be partly mediated through reducing inflammation, including serum CRP levels. The association of different intensities of physical activity, sedentary behaviours, and C-reactive protein (CRP) levels in serum was examined after adjustment for markers of adiposity, including waist-circumference and body mass index (BMI), in a large population-based study. Using data of the SuRFNCD-2007 study, a large national representative population-based study in Iran, the relationship between quantitative CRP concentrations in serum and physical activity was examined in a sample of 3,001 Iranian adults. The global physical activity questionnaire (GPAQ) was used for evaluating the duration and intensity of physical activity. Total physical activity (TPA) was calculated using metabolic equivalents for the intensity of physical activity. Quantitative CRP concentrations in serum were measured with high-sensitivity enzyme immunoassay. The CRP levels in serum significantly correlated with TPA (r=-0.103, p=0.021 in men and r=-0.114, p=0.017 in women), duration of vigorous-intensity activity (r=-0.122, p=0.019 in men and r=-0.109, p=0.026 in women), duration of moderate-intensity activity (r=-0.107, p=0.031 in men and r=-0.118, p=0.020 in women), and duration of sedentary behaviours (r=0.092, p=0.029 in men and r=0.101, p=0.022 in women) after multiple adjustments for age, area of residence, BMI, waist-circumference, smoking, and diabetes mellitus. Physical activity (of both moderate and vigorous intensity) is inversely associated with the quantitative CRP levels in serum, independent of diabetes and body adiposity

Temporal analysis of the incidence of meningitis in the Tehran metropolitan area, 1999-2005

<p>Abstract</p> <p>Objectives</p> <p>The aim of this study was to describe the temporal determinants of meningitis incidence in the population living in the Tehran metropolis.</p> <p>Methods</p> <p>All cases of meningitis reported to health districts throughout the Tehran metropolis from 1999 to 2005 were abstracted from patient files. Referral cases (patients who did not reside in the Tehran metropolis) were excluded. For each year, sex- and age-specific incidences were estimated. Temporality and its determinants were analyzed using Poisson regression.</p> <p>Results</p> <p>Age-specific incidence is highest among males younger than 5 years of age at 10.2 cases per 100,000 population per year. The lowest incidence was among females aged 30 to 40 years at 0.72 cases per 100,000 population per year, with an overall male-to-female incidence ratio of 2.1. The temporal analysis showed seasonality, with a higher risk of meningitis in spring at a rate ratio of 1.31 with a 95% confidence interval (CI) of 1.20 to 1.41 and in autumn (rate ratio = 1.16, 95% CI 1.06, 1.27). For periodicity, we found a peak of occurrence around the years 2000 and 2003.</p> <p>Conclusion</p> <p>The epidemiology of meningitis in Iran follows similar patterns of age, sex, and seasonality distribution as found in other countries and populations.</p

Trend of cigarette smoking in Iranian adult population from 2000 to 2011 based on four national surveys

Background: Tobacco smoking has been a major health concern for many years. People's awareness of the potential health hazards and government policies might change its pattern and prevalence of use. In order to monitor its conversion, determining the overall pattern of tobacco use and trend analyses would be crucial, which were aimed in the present study. Methods: Patterns of smoking in four national surveys conducted in years 2000, 2005, 2007, and 2011 with 33300, 89337, 5287, and 8837 participants, respectively, were assessed. Current status of cigarette, pipe and water-pipe smoking, the number of cigarettes used per day, and the age of smoking initiation were major parameters. After weighting based on province, residential area, gender, and age group, trend analysis was done through complex samples general linear model using IBM SPSS Statistics for Windows, Version 20.0. The values in the first survey (2000) were considered as reference points and categories. Results: While current cigarette smoking prevalence has been decreased (13.5% in 2000 to 11.3% in 2011) P&lt;0.001, the average of pack-years increased. There was no significant decline in the mean age of initiation. It is also true for the prevalence of pipe and water-pipe smoking, which showed no noticeable difference compared to 2000. Conclusion: According to our findings it seems that health policy makers should focus more on designing programs targeting water-pipe consumption and also pay attention to the trends among subgroups for tailoring policies and scheme implementation

Severe Diabetic Ketoacidosis and Coronavirus 2019 (COVID-19) Infection led to Diagnosis of Autoimmune Polyglandular Syndrome

To this day, millions of people in the world have been diagnosed with corona virus 2019 (COVID-19). This disease cannot only lead to higher mortality rates among those with underlying Diabetes Mellitus (DM), but also may trigger DM in susceptible patients. Therefore, incidence of new-onset DM increased during the pandemic as a result; treatment of patients with diabetes and COVID-19 is important and needs further investigations. Here, we report a 27-year- old woman with past medical history of premature ovarian failure (POF) since14 years ago, who initially presented with severe diabetic ketoacidosis (DKA) which was triggered by COVID-19 and later through her lab results hypoparathyroidism was also detected. She was treated for DKA and COVID-19 Infection concomitantly, and she was also diagnosed with autoimmune polyglandular syndrome due to her multiple autoimmune endocrine organ involvements.

Bezpieczeństwo i skuteczność dwufazowej insuliny aspart 30 (BIAsp30) u Irańczyków chorych na cukrzycę typu 2: otwarte, nierandomizowane, wieloośrodkowe badanie - irańska podgrupa badania IMPROVE&#8482;

Introduction: To evaluate the clinical profile of BIAsp 30 (30% soluble insulin aspart, 70% protamine-crystallized insulin aspart) (NovoMix®30) in type 2 diabetes patients in routine clinical practice in Iran. Material and methods: IMPROVE&#8482; was a 26-week, multinational, open-label, non-randomized study in patients with type 2 diabetes. The safety and efficacy of BIAsp 30 were assessed at baseline and at 13 and 26 weeks. The titration of BIAsp30 was at the physician&#8217;s discretion. Results: In Iran, 478 patients (47% male) previously treated with oral antidiabetic drugs (OADs) (N = 159, 33.3%) and/or insulin other than BIAsp30 (N = 317, 66.3%) or a few who were treatment-na&#239;ve (N = 2, 0.4%) participated in the study. After 26 weeks of treatment with BIAsp 30, the rate of reported major hypoglycaemic episodes was reduced by 88.1% from baseline (baseline v. Week 26: 0.303 v. 0.037 episodes/pt-year; p < 0.001). No significant differences in minor hypoglycaemic episodes between baseline and Week 26 were found. Glycaemic control was significantly improved from baseline to Week 26 with a mean HbA1c reduction of 1.2 &#177; 1.9%. Patients&#8217; quality of life as measured by the DiabMedSat questionnaire significantly improved from baseline (58.1) to the end of the study (75.4, p < 0.001). Conclusions: BIAsp 30 therapy appeared safe and effective and improved quality of life in Iranian patients with type 2 diabetes after 26 weeks of treatment. (Pol J Endocrinol 2010; 61 (4): 364-370)Wstęp: Celem badania była ocena profilu działania insuliny BIAsp 30 (30% rozpuszczalnej insuliny aspart, 70% insuliny krystalizowanej z protaminą) (NovoMix®30) u chorych na cukrzycę typu 2 w warunkach standardowej opieki zdrowotnej w Iranie. Materiał i metody: IMPROVE&#8482; było 26-tygodniowym, wieloośrodkowym, międzynarodowym, otwartym i nierandomizowanym badaniem z udziałem chorych na cukrzycę typu 2. Bezpieczeństwo i skuteczność insulin BIAsp 30 oceniano na początku badania oraz po 13 i 26 tygodniach. Dawkowanie insuliny BIAsp30 było zależne od zaleceń lekarskich. Wyniki: W irańskiej części badania uczestniczyło 478 chorych (47% stanowili mężczyźni) leczonych dotychczas doustnymi lekami hipoglikemizującymi (N = 159, 33,3%) i/lub insuliną inną niż BIAsp30 (N = 317, 66,3%) oraz nieliczna grupa pacjentów niestosujących wcześniej farmakoterapii (N = 2, 0,4%). Po 26 tygodniach leczenia insuliną BIAsp 30, częstość epizodów ciężkiej hipoglikemii zmniejszyła się o 88,1% (wartości wyjściowe v. tydzień 26: 0,303 v. 0,037 epizodów/pacjenta-rok; p < 0,001). Dane dotyczące częstości epizodów lekkiej hipoglikemii na początku badania i po 26 tygodniach leczenia nie różniły się istotnie. Odnotowano natomiast poprawę kontroli glikemii; po 26 tygodniach odsetek HbA1c obniżył się średnio o 1,2 &#177; 1,9% w stosunku do wartości wyjściowej. W okresie od rozpoczęcia do zakończenia badania nastąpiła istotna poprawa jakości życia chorych, oceniana przy użyciu kwestionariusza DiabMedSat; punktacja wynosiła odpowiednio 58,1 i 75,4 (p < 0,001). Wnioski: Terapia insuliną BIAsp 30 stosowana przez 26 tygodni u Irańczyków chorych na cukrzycę typu 2 okazała się bezpieczna i skuteczna, a ponadto spowodowała poprawę jakości życia pacjentów. (Endokrynol Pol 2010; 61 (4): 364-370

Diabetes Care in Iran: Where We Stand and Where We Are Headed

Background: The prevalence of diabetes has steadily increased in Iran from the time of the first published nationally representative survey in 1999 and despite efforts and strategies to reduce disease burden. Objectives: The aim of the present review was to describe the current status of diabetes care in Iran. Methods: A selective review of the relevant literature, focusing on properly conducted studies, describing past and present diabetes care strategies, policies, and outcomes in Iran was performed. Findings: The quality of diabetes care has gradually improved as suggested by a reduction in the proportion of undiagnosed patients and an increase in affordability of diabetes medications. The National Program for Prevention and Control of Diabetes has proven successful at identifying high-risk individuals, particularly in rural and remote-access areas. Unfortunately, the rising tide of diabetes is outpacing these efforts by a considerable margin. Conclusions: Substantial opportunities and challenges in the areas of prevention, diagnosis, and management of diabetes exist in Iran that need to be addressed to further improve the quality of care and clinical outcomes

Distributions of High-Sensitivity C-Reactive Protein, Total Cholesterol-HDL Ratio and 10-Year Cardiovascular Risk: National Population-Based Study

The present study aimed to evaluate the distributions of High-Sensitivity C-reactive protein, TC-HDL ratio and 10-year risk of cardiovascular diseases among Iranian adult population. We conducted a cross-sectional study on a total of 2125 adults aged 25 to 65. Data of the Third National Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) was used. Anthropometric indices, blood pressure and biochemical measurements had been obtained. Ten-year risk of cardiovascular events was also calculated using different models. Median (interquartile range) and geometric means (95% CI) of hs-CRP were 5.1(3.9) and 4.1(4.38-4.85), respectively. Mean TC-HDL ratio±(SD) was 5.94±2.84 in men and 5.37±1.97 in women (P<0.001). In spite of risk scores (FRS and SCORE), no significant gender and age-related differences were observed in hs-CRP levels. Exclusion of CRP levels≥10 did not change the results. The proportion of high-risk categories using SCORE and FRS models were 3.6 % and 8.8 %, respectively. In comparison with other published data, greater means and median values of High-Sensitivity C-reactive protein were observed. Higher TC-HDL ratio and cardiovascular risk in men than in women were also demonstrated. The issue of screening for cardiovascular diseases has yet to be addressed due to considerable prevalence of elevated CRP and increased risk of cardiovascular events among various subgroups