Medical Journal of The Islamic Republic of Iran (MJIRI)

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  Background: Increase in prevalence of obesity and type 2 diabetes which are of the main risk factors of metabolic syndrome, is not only the result of changes in genetic, diet or physical activity, but also an imbalance of micro flora may play an important role. Therefore, alteration of micro flora using pre/probiotic is considered as a new strategy for treatment of metabolic disorders.

  Methods : The current study is a triple blind randomized controlled trial. 46 patients from both sexes, who fulfilled inclusion criteria, randomly categorized into intervention or placebo group. The intervention and placebo groups consumed 2 probiotic capsules or 2 placebo capsules during 3 months, respectively. Both groups received a weight loss diet, according to their adjusted ideal body weight. Anthropometric, body composition, blood pressure and nutritional measurements were done in the beginning, at 6th week, and at the end of the study. T-test and paired-t test were used for statistical analysis.

  Results : 40 patients completed the study. BMI, WC, HC, fat mass, lean mass and blood pressure were reduced in all participants (p<0.05). Systolic blood pressure in symbiotic group was less than placebo group, significantly (p<0.05). The trend of weight loss in symbiotic group continued at least for 12 weeks while it was stopped at week 6 in placebo group.

  Conclusion : Symbiotic supplement with the weight loss diet had synergistic effects on improvement in systolic blood pressure and anthropometric measurements. Based on our findings, symbiotic can postpone plateau phase of weight loss and it may prevent resistance to further weight loss.

 

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Background: Metabolic syndrome (MetS) is a serious public health concern worldwide; however, the pathogenesis of this disease has not been yet cleared. This study aimed to compare diet quality in obese/overweight participants with/without metabolic syndrome with normal weight controls.

  Methods: This was a comparative study on 147 Iranian adults under treatment at the Endocrinology Center of Tehran University of Medical Sciences. They were assigned into three groups (normal weight, obese weight with/without MetS) according to the inclusion- exclusion criteria. Metabolic syndrome was defined according to the NCEP ATPIII consensus criteria. Healthy Eating Index Data were obtained from the validated FFQ to determine the diet quality index scores, using the Healthy Eating Index-2010.

  Results: Our findings demonstrated that FBS, TG, SBP, WC and weight were higher among MetS patients compared to the both weight matched and non-weight matched participants, while HDL-c was lowest in this group (p<0.05). A statistically significant difference was found between healthy weight controls and obese/overweight participants with/without MetS in HEI-2010, and 9 of the 12 HEI-2010 components score (p<0.05).

  Conclusion: Our study revealed that low diet quality was a risk factor in developing MetS.

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  Background: Metabolic syndrome (MetS), a combination of coronary heart disease and diabetes mellitus risk factor, refer to one of the most challenging public health issues in worldwide. The aim of this study was to identify the subgroups of participants in a study on the basis of MetS components.

  Methods: The cross-sectional study took place in the districts related to Tehran University of Medical Sciences. The randomly selected sample consists of 415 subjects. All participants provided written informed consent. Latent class analysis was performed to achieve the study’s objectives. Analyses were conducted by using proc LCA in SAS 9.2 software.

  Results: Except systolic and diastolic blood pressure, the prevalence of all MetS components is common in female than male. Four latent classes were identified: (a) non MetS, (b) low risk, (c) high risk, and (d) MetS. Notably, 24.2% and 1.3% of the subjects were in the high risk and MetS classes respectively.

  Conclusion: Most of the study participants were identified as high risk and MetS. Design and implementation of preventive interventions for this segment of the population are necessary.

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Background: Metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) is a common public health problem. Visfatin is secreted by visceral adipose tissue and is an adipocytokine.

It could be a pro-inflammatory adipocytokine and is related to the metabolic syndrome and non-alcoholic fatty liver disease. This study evaluated the association between visfatin levels in patients with the metabolic syndrome with and without non-alcoholic fatty liver disease (NAFLD).

   Methods: In this cross-sectional study, 120 patients with metabolic syndrome were selected. They were categorized into two groups, patients with fatty liver (n=70) and without fatty liver disease (n=50). Laboratory and anthropometric options such as age, sex, systolic blood pressure, fasting blood sugar, lipid profile, liver enzymes, uric acid, visfatin, insulin, BMI, waist circumference, and TNF-α were measured. The chi-square test, Mann-Whitney, t test, Spearman and Pearson correlations were used for the data analysis.

   Results: There was a significant difference between the fatty liver and non-fatty liver disease with visfatin, BMI, FBS and lipid profile (p<0.05). The mean±SD level of visfatin was 37.1±1.7 ng/dl in the non-fatty liver and was 44.4±1.5 ng/dl in fatty liver participants (p=0.02). 59% of patients with metabolic syndrome had fatty liver in ultrasonography.

   Conclusion: According to this study, there was a correlation between visfatin levels and fatty liver disease.

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Background: Schizophrenia is associated with increased cardiovascular morbidity. Asymmetric dimethylarginine (ADMA) has been suggested as a cardiovascular biomarker. Treatment with atypical antipsychotics can increase some traditional risk factors of coronary artery disease. In addition to traditional risk factors, this study is carried out as a comparison of serum levels of ADMA and non-traditional factors among patients who take two types of atypical antipsychotics.
   Methods: In this clinical study, 57 schizophrenic patients with multiple episodes and 20 healthy voluntaries that fulfilled inclusion and exclusion criteria were entered into the study. The patients were divided into 3 groups (18 patients received risperidone alone, 20 patients received clozapine alone and 19 patients did not receive any drug). Plasma concentrations of ADMA, high-sensitivity C-reactive protein (hs-CRP) and homocysteine were measured through enzyme-linked immunosorbent assay (ELISA), and traditional risk factors of metabolic syndrome were measured.
   Results: Mean age of participants was 46.08±12.54 years. Moreover, the traditional (High-density lipoprotein (HDL), total cholesterol, waistline, and Body Mass Index (BMI)) and non-traditional factors (Homocysteine, hs-CRP) and ADMA were higher in patients with schizophrenia compared to healthy group (p≤ 0.05). Also, in the clozapine group, all mentioned non-traditional factors and ADMA were significantly higher than other groups (p≤ 0.05).
   Conclusion: In the clozapine group, levels of non-traditional factors and ADMA were significantly higher which indicates these patients are at risk of cardiovascular disease.
 
 

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Background: The metabolic syndrome is highly prevalent among patients with schizophrenia. This study was conducted to determine the prevalence of metabolic syndrome and the risk of cardiovascular disease in the next 10 years among schizophrenic patients.
   Methods: This cross sectional study was performed on 100 Iranian patients with schizophrenia in 2016. The prevalence of metabolic syndrome was determined by adult treatment panel III criteria, and 10-year cardiovascular risk was calculated by Framingham Risk Score. SPSS software was used to perform statistical analysis. Chi-square and Fisher's exact or extended Fisher's exact tests were used to compare dichotomous variables. Also, Mann-Whitney U test was applied to compare the quantitative variables. Significance level was considered to be less than or equal to 0.05.
   Results: In this study, 83 participants (83%) were male and 17 (17%) were female. The prevalence of metabolic syndrome was 27% (21.7% in males and 52.9% in females, p=0.015). Among all components of metabolic syndrome, low HDL-C in men and abdominal obesity in females were the most common disorders. Based on Framingham Risk Score, 76%, 16%, and 8% of patients had low, intermediate, and high level of risk, respectively. A significant difference was observed between the level of risk among participants with and without metabolic syndrome (p=0.042).
   Conclusion: In this study, patients with schizophrenia showed a high prevalence of metabolic syndrome, but most of them had low risk of developing cardiovascular disease. These results suggest regular screening and early interventions to modify the risk factors of metabolic syndrome.
 

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    Background: The prevalence of metabolic syndrome has been rising worldwide in recent decades. Determining the associations between metabolic syndrome and its components in midpregnancy with neonatal anthropometric indices and outcomes is a major challenge in both public health and clinical care.
   Methods: This prospective cohort study was performed on 238 pregnant women at 24-28 weeks of gestation. Metabolic syndrome was recognized with 3 or more of the following criteria: triglyceride ≥ 247 mg/dL; HDL < 61 mg/dL; GCT ≥ 140 mg/dL; prepregnancy body mass index ≥ 30 kg/m2; and blood pressure ≥ 130/85 mmHg. Statistical analysis was performed through descriptive statistics, including mean, standard deviation, frequency, and percentage, Mann-Whitney test, Chi-square test, Fisher’s exact test, linear and logistic regression in SPSS 21.0. P values < 0.05 were considered significant.
   Results: There was a significant association between blood hypertriglyceridemia in weeks 24-28 and anthropometric indices, including weight, height, and jaundice, in the first 24 hours of birth. Metabolic syndrome also had a significant relationship with jaundice (P=0.002). The results of linear regression analysis revealed that metabolic syndrome was positively associated with birth weight (B=0.18, P=0.003) and height (B=0.18, P=0.009). Among the components of metabolic syndrome, the results showed a direct relationship between increased blood triglyceride of the mother and newborn’s weight (B=0.11, P=0.011) and height (B=0.14, P=0.007). Also, increased BMI had a significant direct relationship with the newborn’s weight (B=0.11, P=0.023) and height (B=0.12, P=0.023). Moreover, decreased HDL had a significant reverse relationship with the newborn’s weight (B=0.09, P=0.042).
   Conclusion: Presence of metabolic syndrome and its components in midpregnancy may influence neonatal outcomes, especially anthropometric indices. However, more studies should be conducted to further investigate these relationships.
 

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Background: There are many factors related to etiology of metabolic syndrome (MetS) including obesity. Spexin, a peptide hormone released from adipose tissue, is the most down-regulated gene in obese, compared to non-obese adipose tissue. Hence, it potentially contributes to the progression and development of metabolic diseases. This study was designed to evaluate serum concentration of spexin in patients with MetS compared to weight-matched and normal-weight controls. 
   Methods: In this case-control study, 153 participants (51 per group) were collected from October 2014 to June 2016. The study groups were all matched for age and sex and included overweight/obese individuals with MetS and 2 control groups without MetS (including weight-matched and normal-weight participants). Body composition and serum concentration of spexin and leptin were measured.
   Results: Serum leptin and spexin levels were significantly higher and lower, respectively, in normal-weight compared to overweight/obese groups with/without MetS (p< 0.02). No significant difference was observed in serum leptin and spexin concentrations between the overweight/obese groups with/without MetS (p≥ 0.05). Also, spexin, with cutoff value of 4.6, had 78% sensitivity and 82% specificity for diagnosing overweight/obese from normal-weight participants. Spexin had 78% sensitivity and specificity, with cutoff value of 4.35, in diagnosing MetS participants from normal-weight group.
   Conclusion: This study found no correlation between the circulating level of spexin and MetS development. Higher serum concentration of spexin in normal-weight adults compared to the obese participants illustrated the potential role of this novel peptide in obesity.
 

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    Background: The association between Metabolic syndrome (MetS), its components and mortality has not been clearly established. The aim of this study was to determine the effects of Mets and its components on all cause and cause-specific mortality and to examine whether MetS or its components were better predictors of mortality.
   Methods: In this retrospective cohort study, we used data from the Zanjan Healthy Heart Study performed in 2003 on 4000 persons. Based on the definitions provided by the NCEP- ATPIII, 1051 participants with MetS and 1219 with none or one of its components at study entry were enrolled. Information regarding the mortality and morbidity of 502 participants with MetS and 523 controls was collected in 2013 by telephone. Cause of death was defined as Cardio-Vascular Disease (CVD) or non-CVD. Data were analyzed using the Cox Proportional Hazards model to estimate the hazard ratios predicted by MetS and its individual components.
   Results: The median duration of follow-up was 104±10.7 months. Thirty-five deaths occurred, including 18 cardiovascular deaths. The proportion of those with CVD, hypertension, diabetes or hospital stay was statistically higher in MetS patients than controls (p<0.0001). The hazard ratios of all-cause and cardiovascular mortality for those with MetS were 1.75 (%95CI: 0.88-3.47) and 3.66 (%95CI: 1.2-11.1) higher than controls, respectively. Among the components of MetS, only hypertension predicted a higher risk of all-cause and CVD mortality after adjusting for age and sex.
   Conclusion: The results of this study indicated that MetS was associated with a higher risk of CVD mortality, morbidity, and hospital stay. Among the components of MetS, the association of hypertension was stronger compared to MetS as a whole. Therefore, this study confirms that MetS is a risk factor for CVD mortality, but not beyond the risk associated with its individual components.
 

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    Background: The prevalence of metabolic syndrome (MS) is rapidly increasing in the world. Thus, the aim of the present study was to identify the latent subgroups of  Iranian male adults based on MS components and investigate the effect of abnormal alanine aminotransferase (ALT) and aspartate aminotransferase (AST), high total cholesterol (TC), and low-density lipoprotein  (LDL) on the odds of membership in each class.
   Methods: In the present study, we used the data of a population-based screening program conducted on 823 urban adult men aged 25 years and older in city of Qom in 2014.  Abdominal obesity, fasting blood sugar (FBS), blood pressure, and serum lipid profile were measured in participants after for at least 8 hours. MS was defined according to the Adults Treatment Panel III criteria. Latent class analysis was used to achieve the aims of study. Analyses were conducted using PROC LCA in SAS 9.2 software. In all analysis, p value < 0.05 was considered statistically significant.
   Results: There were 3 different latent classes among participants. Latent class 1, non-MS, 55.1%; latent lass 2, at risk, 21.3%; and finally latent class 3, MS, with 23.6% of the participants. Age (OR=0.98, 95% CI: 0.98-0.99, high LDL (OR=0.27, 95% CI: 0.13-0.56), high TC (OR=8.12, 95% CI: 4.40-15.00), and abnormal ALT (OR=2.25, 95% CI 1.49-3.41) were associated with at risk class. Also, only age (OR=1.02, 95% CI: 1.01-1.04) was associated with MS class. The most prevalent components among the participants were having low HDL (34.0%) and high WC (33.9%).
   Conclusion: Notable percent of samples fell in “at risk” and “MS” classes, which stress the necessity of designing preventive interventions for these specific stratums of population.

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Background: Metabolically healthy obese (MHO) individuals appear to be protected or more resistant to the progression of obesity-related metabolic disorders. Hormonal regulation associated with adipose or muscular tissues such as irisin and leptin may facilitate the healthy metabolic profile of MHO cases. In this case-control study, the differences between serum level of irisin was investigated in metabolically unhealthy obese (MUO) and metabolically healthy obese (MHO) individuals.
   Methods: The study participants included obese individuals with metabolic syndrome (MetS) (n=51) and 2 control groups that included weight matched cases without MetS (n=51) and normal weight cases without MetS (n=51). Diagnosis of MetS was made based on the Adult Treatment Panel III (ATPIII) criteria. Serum levels of leptin and irisin were determined by enzyme-linked immune-sorbent assay (ELISA) kit. Receiver Operator Characteristic (ROC) curve, multiple linear regression, and one-way ANOVA analysis were used in SPSS 16 software. Significant level was set at 0.05.
   Results: Based on the statistical analysis, serum levels of irisin were 2.91±1.6, 3.14±1.4, and 4.47±3.23 (ng/mL) in MUO, MHO, and nonobese metabolically healthy participants, respectively (P = 0.001). Also, serum levels of leptin were 14.06±12.4, 11.2±9.3, and 7.09±7.1 (ng/mL) in MUO, MHO, and nonobese metabolically healthy cases, respectively (p=0.002). After adjusting for demographic variables, a significant association was found between irisin and study groups (β = 0.77, P = 0.001), weight (β=-0.03, p=0.014), BMI (β=-0.11, p=0.006), TG (β=-0.003, p=0.025), fat mass (β=-0.04, p=0.046), and fat free mass (β=0.08, p=0.014).
   Conclusion: Obese patients with/without MetS had lower level of irisin than normal weight participants.

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Background: Metabolic syndrome (MetS) and osteoporosis are two of the world's major healthcare issues. There are several studies which explored the association between MetS and bone mineral density (BMD), but all of them are cross-sectional. These studies cover all populations, including expatriated, which did not determine the actual problem among Saudi women. This is the first case-control study that determines the causal relationship between MetS and BMD. The objective of this study is to determine the relationship between metabolic syndrome and bone mass density among Saudi menopausal women in Eastern Province - Saudi Arabia.
   Methods: It’s a case-control study and 380 menopausal Saudi women were selected through simple random sampling. They were divided into 190 cases with osteoporosis and 190 without osteoporosis. Bone Mineral Density (BMD) at the total hip was determined using dual-energy X-ray absorptiometry (DEXA). T score was calculated. The association between the risk factors of MetS and bone mineral density was determined by binary logistic regression analysis using SPSS (statistical package of social science) software.
   Results: Among women, the prevalence of MetS was substantially higher in those with osteoporosis. The Mets is positively correlated with bone mineral density. (r=0.08, p=0.051). The occurrence of MetS was associated with increased osteoporosis among Saudi women (B=0.004; p=0.005) after adjustment of confounders. The existence of obesity was significantly associated with increased odds of Bone marrow density among women (OR 2.56; 95 % CI, 2.22-3.44; p=0.030) after adjustment of confounders.
   Conclusion: The incidence of MetS was associated with osteoporosis in Saudi women. 

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Background: Human immunodeficiency virus (HIV) resulted in considerable morbidity and mortality. Following antiretroviral therapy (ART), the life expectancy of HIV-infected patients increased; however, they were more at risk of developing chronic diseases such as endocrinopathies. This study aimed to determine the prevalence of dysglycemia, dyslipidemia, and metabolic syndrome among patients with HIV infection.
   Methods: This cross-sectional study was conducted on HIV-infected patients referring to Loghman Hakim Hospital (Tehran, Iran) between April 2020 and April 2021. We examined demographic features, medical history, and laboratory tests indicating the metabolic status of the patients. Eventually, collected data were processed using SPSS version 23. 
   Results: The mean age of 68 confirmed HIV patients was 39.85±10.54 years and 64.7% were male. BMI (MD = 2.57, 95% CI = [0.25, 4.88], P = 0.035), cholesterol (MD = 22.73, 95% CI = [4.70, 40.76], P = 0.014), HDL (MD = 8.54, 95% CI = [2.06, 15.02], P = 0.011), and LDL of women was significantly higher than men (MD = 22.43, 95% CI = [7.60, 37.27], P = 0.004). Additionally, 30 patients (44.1%) suffered from metabolic syndrome. The prevalence of metabolic syndrome differed significantly between men (34.1%) and women (62.50%) (P = 0.024).
   Conclusion: Dysglycemia, dyslipidemia, and metabolic syndrome are common among HIV-infected patients. Thus, periodic evaluation of the patients can be advantageous in early diagnosis and timely treatment.