International Journal of Endocrinology and Metabolism最新文献

Background: Obesity and type 2 diabetes (T2D) are associated with nitric oxide (NO) deficiency. L-citrulline (Cit), a substrate for NO synthesis, has been suggested as a treatment for obesity and T2D.

Objectives: This study aims to determine the effects of Cit on body weight, food intake, and water consumption in obese T2D male and female rats.

Methods: The T2D was induced using a high-fat diet (HFD) and a low dose of streptozotocin (STZ). Obese male (n = 30) and female (n = 30) rats with T2D were divided into five groups (n = 6/group) that received Cit (0, 1, 4, 7, and 10 g/L in drinking water for 8 weeks). Body weight, food intake, and water consumption were measured every week. Serum Cit and nitrite+nitrate (NOx) concentrations were measured at weeks 0, 4, and 8, and serum fasting glucose was measured at week 8.

Results: Compared to non-treated T2D rats, Cit-treated male rats had lower body weight (11.3%, 13.0%, and 11.6% at doses of 4, 7, and 10 g/L), lower food intake (4.7% and 5.5% at doses of 4 and 7 g/L), and water consumption (7% at dose 7 g/L). In female rats, Cit decreased body weight (7.2%, 8%, and 7.3% at doses of 4, 7, and 10 g/L), food intake (4.0% and 5.0% at doses of 4 and 7 g/L), and water consumption (5% and 6.6% at doses of 4 and 7 g/L; all P < 0.001). The body weight and food intake-lowering effects of Cit were higher in T2D male rats than females (all P < 0.05), but decreased water consumption was comparable between sexes. A Cit dose of 7 g/L was most effective in reducing all measured parameters in both sexes.

Conclusions: The Cit decreased body weight, food intake, and water consumption in obese T2D male and female rats. These effects were sex- and dose-dependent.

Context: The community readiness (CR) level is a critical factor affecting the success and sustainability of prevention programs.

Objectives: This study systematically reviews research utilizing the community readiness model (CRM) to assess CR for childhood obesity prevention programs, identifying readiness levels and summarizing their characteristics and outcomes.

Methods: A comprehensive electronic and manual search was performed across multiple databases, including PubMed, Scopus, Web of Science, PsycINFO, Pub Psych, ERIC, ProQuest, and CINAHL, as well as two key journals: Preventing chronic disease and health education and behavior. The search adhered to predetermined inclusion and exclusion criteria. Studies evaluating CR for obesity prevention in children and adolescents aged 0 to 19 years were included, with no restrictions based on gender, race, ethnicity, or language. Three reviewers conducted data extraction and assessed the risk of bias using two appraisal forms from the Joanna Briggs Institute.

Results: A total of 27 studies were included, with 24 conducted in high-income countries. Readiness levels across studies ranged from the first to the fifth stages. Communities generally reached the highest stage in the community effort dimension but were at the lowest stage regarding community climate and knowledge about the issue. The heterogeneity of the studies made it challenging to compare CR levels among different communities.

Conclusions: This study provides an overview of CR levels and objectives of CR assessments, highlighting the significance of bottom-up interventions in childhood obesity prevention. It emphasizes the necessity of conducting context-specific readiness assessments before implementing interventions.

Background: Given the significant contribution of dyslipidemia to cardiovascular disease (CVD) risk in women, effective educational interventions targeting lifestyle modifications are crucial for disease prevention and management.

Objectives: The present study was conducted with the aim of comparing the effectiveness of group discussion and short message service (SMS)-based education in improving nutrition, physical activity, and cholesterol levels in women with high blood cholesterol.

Methods: A randomized trial was conducted with 165 women aged 30 - 59, recruited from two urban health centers in Kermanshah, Iran. The study included participants with borderline high cholesterol levels (200 - 239 mg/dL) who were randomly assigned to one of three groups (n = 55 each): An SMS-based education group receiving text messages on nutrition and physical activity, a group discussion intervention with facilitated sessions on lifestyle modification, or a control group that received standard care without additional educational components. Participants were randomly assigned to one of three groups using permuted block randomization [block sizes of (e.g. 6, 9)], with allocation concealment ensured by sealed, opaque envelopes. With a statistical power of 80% and a confidence level of 95%, the minimum required sample size was calculated. Questionnaires were administered to evaluate dietary and physical activity habits before and three months after the interventions. Blood samples were also obtained at these time points. Statistical analysis was performed using SPSS version 16. The chi-square, Wilcoxon signed-rank, and Kruskal-Wallis tests were used for baseline, within-group, and between-group comparisons, respectively. A P-value of less than 0.05 was considered statistically significant.

Results: The two intervention groups showed a statistically significant increase in the mean score of nutritional status and physical activity and a decrease in the level of blood cholesterol after the intervention, compared to the control group (P < 0.001). There was no significant difference between the SMS and discussion groups in terms of physical activity and cholesterol levels, but the nutritional status score in the discussion group was significantly higher than in the SMS group.

Conclusions: Both group discussion and SMS interventions can be effective strategies for promoting healthy lifestyle changes in women with high cholesterol. Group discussions appear to have a broader impact, as they also improve nutritional status. Healthcare providers can consider incorporating these methods into their interventions to help women manage their cholesterol levels and improve their overall health.

Introduction: Hydatid cysts caused by Echinococcus granulosus are zoonotic infections endemic to pastoral regions. While hepatic (50 - 70%) and pulmonary (20 - 30%) involvement dominate, primary thyroid hydatidosis is exceptionally rare (< 1% of cases), posing diagnostic and therapeutic challenges. This case underscores the importance of considering parasitic etiologies in thyroid nodules, particularly in endemic zones.

Case presentation: A 26-year-old female patient presented with complaints of pain and swelling in the anteroposterior region of the neck, predominantly on the right side. Fine needle aspiration (FNA) from the nodule seen on ultrasound (US) of the thyroid gland was reported to be suspicious for papillary thyroid carcinoma (PTC), and the patient underwent bilateral total thyroidectomy. In the postoperative histopathological examination, a hydatid cyst was confirmed in the thyroid gland.

Conclusions: Thyroid hydatid cysts, though rare, require high clinical suspicion in endemic regions. Imaging (US/MRI) and serology are pivotal for preoperative diagnosis, while FNA is contraindicated. Complete surgical excision with adjuvant albendazole ensures optimal outcomes. Public health measures, including dog deworming and community education, are critical to disrupting the parasite's lifecycle.

Background: Diabetes is a major global health issue, affecting over 8.5% of adults worldwide and significantly increasing the risk of cardiovascular diseases (CVDs). However, the association between diabetes-related macrovascular complications, such as coronary artery disease (CAD), and pulmonary function remains unclear.

Objectives: The present study was designed to investigate the association between obstructive and restrictive lung patterns and the severity of coronary artery involvement.

Methods: A cross-sectional study was conducted at Shahid Beheshti Hospital, Qom, Iran, between April 2019 and August 2021. A total of 211 diabetic patients who underwent coronary angiography (CAG) were selected. They were divided into two groups: Sixty-nine patients in group 1 (non-significant CAD) and 142 patients in group 2 (significant CAD). Spirometry was performed to assess forced expiratory volume (FEV), forced vital capacity (FVC), and FEV/FVC ratio, with values adjusted for age and sex in the two groups.

Results: Among the 211 participants, 142 (67.3%) exhibited significant coronary artery involvement. Comparative analysis revealed no statistically significant differences in spirometric parameters [forced expiratory volume in one second (FEV₁), FVC, FEV₁/FVC ratio] between the groups. Notably, advancing age demonstrated a significant negative correlation with both FEF50% (β = -0.32, P < 0.01) and FVC values (β = -0.28, P < 0.05). Multivariate regression analysis identified inverse relationships between age and peak expiratory flow (PEF; β = -0.41, P < 0.001), HbA1C levels and PEF (β = -0.23, P < 0.05). Additionally, sex emerged as a significant modifier of %FEV₁/FVC (β = 0.19, P < 0.05), with female participants showing lower ratios.

Conclusions: This study failed to find an association between spirometry findings and coronary artery involvement. However, a significant relationship between small airway involvement and glycemic control was observed.

Background: Clinical features of hypothyroidism and adrenal insufficiency (AI) often overlap.

Objectives: To assess the morning serum cortisol levels of treatment-naïve patients with severe hypothyroidism.

Methods: In this prospective, case-control study, treatment-naïve adults with severe hypothyroidism [thyroid-stimulating hormone (TSH) > 100 mIU/mL] were compared with age- and sex-matched euthyroid controls. Morning (08:00 AM) serum cortisol, TSH, triiodothyronine (T3), and thyroxine (T4) levels were measured. AI was defined clinically and biochemically as cortisol levels < 4 µg/dL. Correlation coefficients between T3, T4, and cortisol levels were calculated.

Results: The case group (n = 71; women, 88.7%; mean age, 30.0 ± 9.0 years) had significantly lower serum cortisol levels than controls (n = 40; 8.6 ± 4.2 vs 16.0 ± 2.22 µg/dL; P < 0.0001). Six patients (8.5%) in the case group met criteria for AI. Patients with AI had significantly lower T3 and T4 levels than those without AI (P = 0.018 and P = 0.005, respectively). A negative correlation was observed between T3 and cortisol levels (r = -0.243, P = 0.041), while T4 showed no significant correlation (r = -0.103, P = 0.391).

Conclusions: Treatment-naïve patients with severe hypothyroidism may exhibit biochemical evidence of AI. Routine screening for AI in these patients is recommended to avoid missed diagnoses and guide appropriate therapy.

Background: Adrenocortical carcinoma (ACC) is a very rare and aggressive disease with limited systemic therapeutic options.

Objectives: Treatment with adjuvant mitotane is common after resection of ACC; however, high-risk patients often experience early recurrence. The risk factors for recurrence after surgery were analyzed in patients with non-metastatic ACC.

Methods: We retrospectively reviewed the medical records of 20 patients who were treated for ACC between 1994 and 2023 at Kansai Medical University Hospital or Kansai Medical University Medical Center in Osaka, Japan. We studied the recurrence-free survival (RFS) rates of a subset of 15 patients with non-metastatic ACC [European network for the study of adrenal tumors (ENSATs) stage I-III]. Statistical analyses included the Kaplan-Meier survival analysis and the Cox proportional hazard model.

Results: Of the 15 patients with non-metastatic ACC, nine patients (60%) experienced recurrence. The median RFS was seven months, and all recurrences occurred within 24 months. In all cases, the site of recurrence was the lungs or liver. Univariate analysis showed that ENSAT stage III classification [hazard ratio (HR) 6.974, P = 0.007] was the only factor that made a statistically significant difference to RFS. Although five of the six ENSAT stage III patients took adjuvant mitotane, all experienced recurrence.

Conclusions: In patients with non-metastatic ACC, a diagnosis of ENSAT stage III is the only factor that significantly affects RFS. In these patients, adjuvant mitotane is likely insufficient to prevent recurrence.

Background: Primary hyperaldosteronism (PHA) is a common cause of secondary arterial hypertension (AH), characterized by autonomous aldosterone secretion. It is frequently underdiagnosed and may persist even after surgical intervention.

Objectives: The present study aimed to identify preoperative factors that could predict whether hypertension would persist or normalize following surgery and to outline relevant diagnostic characteristics.

Methods: We conducted a descriptive, analytic, retrospective cohort study at a single center. The study included patients with PHA who were followed up at the Department of Endocrinology, Diabetology, and Nutrition in a hospital affiliated with Mohamed the First University of Oujda (CERBO), admitted between December 2014 and August 2023. Data were retrospectively collected from patient records over a 9-year period, involving 27 patients with PHA confirmed by an elevated aldosterone-to-renin ratio (ARR). Persistent disease was defined by persistent hypokalemia and hypertension (blood pressure > 140/90 mm Hg) after six months. Patients were divided into two groups: Those with complete resolution of hypertension (group A) and those with persistent hypertension (group B). Data were analyzed using SPSS version 21.

Results: The mean age of patients was 48.47 ± 10.87 years, with a female predominance (66.7%). The etiological assessment identified Conn's adenoma in 70.4% (n = 19) of cases and bilateral adrenal hyperplasia in 29.6% (n = 8). Surgery was performed in 51.9% (n = 14) of cases, with 50% (n = 7) maintaining persistent hypertension post-surgery, while 28.6% (n = 4) showed a reduction in antihypertensive medications. Two predictive factors for persistent hypertension were identified: Age > 50 years and hypertension duration > 5 years. Predictive factors for normalization of hypertension post-surgery included systolic blood pressure (SBP) < 140 mm Hg, diastolic blood pressure (DBP) < 90 mm Hg, glomerular filtration rate (GFR) > 90 mL/min/1.75 m², and a low incidence of diabetes and dyslipidemia.

Conclusions: This study demonstrates that PHA can lead to resistant hypertension, highlighting the necessity for further research in this area.

Introduction: MELAS syndrome is a mitochondrial disorder typically characterized by brain dysfunction and endocrinopathies, but it rarely presents with hypoparathyroidism (HP).

Case presentation: Here, we report the case of a child who initially presented with vomiting and convulsions. Blood gas analysis revealed significant hyperlactatemia and hypocalcemia. The child's urinary calcium level was markedly decreased, measured at 0.15 mmol/24h, well below the normal range. A brain CT scan showed symmetrical calcification in the bilateral basal ganglia. Endocrine testing confirmed low parathyroid hormone (PTH) levels. During hospitalization, the child received treatment for recurrent seizures, including midazolam and levetiracetam. One month post-discharge, the child was readmitted due to elevated lactate levels. Genetic testing confirmed the diagnosis of MELAS syndrome, identifying the m.3243A > G mutation in the MT-TL1 gene. Under symptomatic treatment, the child has not experienced any further convulsions and has been regularly followed up at our hospital.

Conclusions: This case underscores the importance of considering MELAS syndrome in patients presenting with hypoparathyroidism. Effective management of epileptic seizures and maintaining an appropriate calcium-to-phosphorus balance are crucial for minimizing brain damage and improving the patient's prognosis.