International Journal of Endocrinology and Metabolism最新文献

Objectives: The study aimed to compare the Modification of Diet in Renal Disease Study (MDRD) and the Epidemiology Collaboration (CKD-EPI) equations for the detection of cardiovascular risk.

Methods: Data of 9,970 Tehranian participants aged ≥ 20 years were analyzed. The prevalence of cardiovascular disease (CVD), its risk factors, and 10-year atherosclerotic cardiovascular disease (ASCVD) risk were compared across the categories of glomerular filtration rate based on the MDRD and CKD-EPI equations. Chronic kidney disease (CKD) was defined as the estimated Glomerular Filtration Rate (eGFR) < 60 mL/min/1.73 m² according to each equation.

Results: The prevalence of CKD weighted to the 2016 Tehranian urban population was 11.0% (95% confidence interval: 10.3 - 11.6) and 9.7% (9.1 - 10.2) according to the MDRD and CKD-EPI equations, respectively. Besides, 8.3% and 1.5% of the participants with CKD_MDRD and non-CKD_MDRD were reclassified to non-CKD_CKD-EPI and CKD_CKD-EPI categories, respectively. Participants with CKD_CKD-EPI but without CKD_MDRD were more likely to be male and older, and more frequently had diabetes, hypertension, dyslipidemia, and CVD, when compared to those without CKD according to both equations; they were also more likely to be male, older, and smokers, and had less dyslipidemia and more CVD, when compared to those with CKD by using both equations. In multivariate logistic regression analysis, compared to CKD_MDRD, the odds of CKD_CKD-EPI were significantly higher for older age and lower for the female gender.

Conclusions: Compared to MDRD, the CKD-EPI equation provides more appropriate detection of cardiovascular risk, which is caused by the reclassification of older individuals and fewer females into lower eGFR categories.

Background: Poor self-management behavior is one of the causes of the high number of patients with type 2 diabetes mellitus (T2DM) in Indonesia.

Objectives: The aim of this study was to measure the effectiveness of TPA-based community empowerment as a form of education in improving the blood glucose control practices of patients with T2DM in Yogyakarta.

Methods: This study used quantitative methods with a quasi-experimental non-equivalent pre-posttest control group design. The subjects of this study were "Prolanis member" patients with T2DM in the four primary health care centers in Sleman, Yogyakarta, Indonesia. Purposive sampling was done at four primary care in Sleman, Yogyakarta, Indonesia. From 138 T2DM patients, only 102 were eligible to become respondents. The questionnaires were adapted to the recommendations of endocrine experts' associations to measure the level of T2DM patients' knowledge, attitude and practices. Intervention was done for three months, from October to December 2019. Measurements were made before and after the TPA.

Results: Attitude and behavior scores showed a significant increase (P < 0.05) after TPA intervention. Meanwhile, the average score of knowledge after the TPA intervention showed no significant increase (P > 0.05). Good self-management behavior in patients with T2DM was observed in Sleman Regency. Education through TPA based community empowerment should be considered as an appropriate intervention to improve DM management practice. Patients can receive material that is delivered easily because of the relaxed and pleasant environment during TPA.

Conclusions: TPA-based community empowerment can create a relaxed and pleasant environment to improve blood glucose control practices in patients with T2DM.

Background: The burden of chronic kidney disease (CKD) is on the rise worldwide; diabetes and hypertension are mentioned as the main contributors.

Objectives: The current study aimed to investigate the multiplicative and additive interaction of diabetes and hypertension in the incidence of CKD.

Methods: In this population-based cohort study, 7342 subjects aged 20 years or above (46.8% male) were divided into four groups: no diabetes and hypertension; diabetes and no hypertension; hypertension and no diabetes; and both diabetes and hypertension. The multivariable Cox regression was used to determine the effect of diabetes, hypertension, and their multiplicative interaction on CKD. The following indices were used to determine the additive interaction of diabetes and hypertension: the relative excess risk of interaction, the attributable proportion due to interaction, and the synergism index.

Results: Diabetes and hypertension had no significant multiplicative interaction in men (hazard ratio of 0.93, P value: 0.764) and women (hazard ratio of 0.79, P value: 0.198); furthermore, no additive interaction was found in men (relative excess risk due to interaction of 0.79, P value: 0.199; attributable proportion due to interaction of 0.22, P value: 0.130; synergy index of 1.44, P value: 0.183) and women (relative excess risk due to interaction of -0.26, P value: 0.233, attributable proportion due to interaction of -0.21, P value: 0.266; synergy index of 0.48, P value: 0.254).

Conclusions: This study demonstrated no synergic effect between diabetes and hypertension on the incidence of CKD.

Background: Muslims fast during the month of Ramadan by abstinence from food and drink every day from dawn to sunset. Studies have reported contradictory results with respect to the changes in body weight and biochemical parameters. No study has been conducted on the association between fasting and body weight and biochemical parameters in the Indian setting on healthy Muslim subjects.

Objectives: To assess the effect of fasting during Ramadan on biochemical parameters such as lipid profile, liver function test, renal function test, antioxidant status, random blood sugar, hemoglobin, body composition, and blood pressure in a sample of healthy individuals.

Methods: In this study, 52 healthy free-living participants (25 males, 27 females, 21-64 years) who met the inclusion and exclusion criteria and completed both follow-ups (before and after Ramadan) were studied. Participants were fasting 12 hours a day for at least 21 days, including menstruating women. It was a free-living study with no dietary restrictions. Anthropometry, lipid profile, liver and renal function tests were measured by standard methods. Body composition was analyzed by bioelectrical impedance.

Results: Significant beneficial changes in albumin, alanine aminotransferase, creatinine, and high-density lipoprotein (HDL) were observed, while total cholesterol, random blood sugar, aspartate aminotransferase, and alkaline phosphatase enzymes remained unchanged after Ramadan. Fasting did bring in some changes in body composition; among both men and women, mean weight loss ranged from 0.81 - 1.4 kg in majority of the subjects, which was due to loss in muscle mass. Moderate changes in intra- and extracellular water content was observed after fasting.

Conclusions: Significant improvements were observed in HDL levels and liver function tests, which can be attributed to the loss of body weight. Improvement in liver function tests may be related to the changes in cytokines and alteration in sleep patterns. Ramadan-like fasting, along with the nutritional education prior to fasting, may be beneficial and effective in the spiritual and overall well-being.

Background: Noonan syndrome is an autosomal dominant condition with an incidence of 1:1000 to 1:2500. The disorder is associated with distinct dysmorphic features, cardiac anomalies, developmental delay and delayed puberty. Short stature is a recognised feature of Noonan syndrome.

Objectives: The aim of this study is to assess the effect of growth hormone treatment in patients with Noonan syndrome.

Methods: Retrospective data was collected from patients with Noonan syndrome treated with growth hormone. The results were analysed with variables expressed as mean values and standard deviation scores.

Results: Twelve Noonan syndrome patients (M: F = 10:2) treated with growth hormone were identified. The mean age of starting growth hormone was 8 years, with baseline height standard deviation score of -2.96 (range: -1.64 to -5.54). The height standard deviation score significantly improved to -2.50 (P = 0.0035) and then -2.22 (P = 0.0025), following one and two years of treatment, respectively. The average height velocity for the patients prior to starting treatment was 5.16cm/year (range: 2.4 - 8.2 cm/year), which significantly improved to 7.76cm/year (ranging from 4.1 to 12.8 cm/year) after one year of growth hormone treatment (P = 0.020) and to 6.51cm/year at the end of two years.

Conclusions: Our study has shown that growth hormone treatment significantly improves the height standard deviation score of patients with Noonan syndrome over a two-year course of growth hormone therapy without any side effects. Further research is required to analyse the long-term effect of growth hormone therapy in patients with Noonan syndrome, including the impact on final adult height.

Background: Thyroid cancer is the fourth most common cancer in the world. Papillary thyroid carcinoma (PTC) accounts for 80% of all types of thyroid neoplasm. Epigenetic alterations such as DNA methylation are known as the main cause of different types of cancers through inactivation of tumor suppressor genes.

Objectives: In the present study, the expression and methylation of suggested gene namely nucleolar protein 4 (NOL4) in PTC in comparison to multi nodular goiter (MNG) have been studied.

Methods: Forty-one patients with PTC and 38 patients affected by MNG were recruited. Thyroid tissues were obtained during thyroidectomy. RNA and DNA were extracted from thyroid tissues. Quantitative RT-PCR assay was performed for determining the mRNA level of NOL4 while methylation-sensitive high resolution methylation was applied for assessing the methylation status with designing six pairs primers for six regions on gene promoter which were named from NOL4 (a) to NOL4 (f).

Results: Methylation assessment of 81 CpG islands in the promoter region of NOL4 gene revealed that NOL4 (f), the nearest region to the start codon, was significantly hypermethylated in PTC cases compared to MNG cases. NOL4 level in PTC cases in comparison with MNG cases were downregulated. The methylation status and mRNA level of NOL4 (f) were associated with age of diagnosis (Age of the patient at the time of diagnosis), lymph node metastasis, and advanced stages of disease.

Conclusions: These data suggested an aberrant promoter hyper-methylation of NOL4 in PTC cases may be linked with its downregulation. Therefore, NOL4 gene can be proposed as a potential tumor suppressor gene in PTC tissues.

Context: Menstrual cycle is considered the fifth vital sign among women. This study aimed to summarize the menstrual disturbances in different endocrine disorders.

Evidence acquisition: In this narrative review, relevant studies (up to December 2019) were searched based on the MeSH keywords diabetes, polycystic ovary syndrome, Cushing's syndrome, thyroid dysfunction, hyperprolactinemia, menstrual cycle, uterine bleeding, and menstruation. Databases used for searching articles included Google Scholar, Scopus, PubMed, and Web of science for observational, experimental, and review studies.

Results: Endocrine disorders trigger the onset of menstrual disturbance across the reproductive lifespan of women. Endocrine glands (pituitary, thyroid, pancreas, adrenal, and ovaries) have a functional role in endocrine regulation of the menstrual cycle. According to available evidence, oligomenorrhea (cycles longer than 35 days) is the most common menstrual disturbance among endocrine disorders (thyrotoxicosis, hypothyroidism, polycystic ovary syndrome, Cushing's syndrome, and diabetes). Complex endocrine pathways play an essential role in a women's menstrual calendar.

Conclusions: The menstrual cycle length and amount of bleeding can be indicative of endocrine disorders. Further studies are needed to identify the unknowns about the association between endocrine disorders and the menstrual cycle.

Background: Studies on knowledge, attitude, and practice (KAP) can be valuable for public health to help in developing targeted educational programs and assessing the effectiveness of interventional programs.

Objectives: This study was designed to determine the level of current knowledge, attitude, and practice (KAP) regarding cardiovascular diseases (CVDs), CVD risk factors and symptoms in adults attending health care centers in Tehran province.

Methods: A cross-sectional study was performed using a self-administered questionnaire with score of 0 - 100 on adults aged > 20 years attending ten health care centers in Tehran province, Iran. Descriptive and multivariate logistic regression analyses were used in data analysis.

Results: A total of 300 adults (51.3% females) with a mean age of 39.71 ± 12.1 years participated in this study. The median (IQR) score for knowledge about CVD was 91.7 (16.7); approximately 80% of respondents' awareness was highly satisfactory and hypertension was the commonest identified risk factor followed by obesity. Furthermore, the median (IQR) score for attitude was 89 (18); 70% of respondents had a highly satisfactory attitude about CVD. Regarding physical activity and nutrition/smoking behaviors, just 10.7% and 32% had highly satisfactory behavior, respectively. In the multivariate logistic regression analysis, attending university education and age ≥ 40 years were independent factors of a better level of CVD knowledge; attending university education, and having a family history of chronic disease were independent factors of a better level of CVD attitude. Regarding a higher physical activity behavior, being a man, and for a better nutrition & smoking behavior, attending university education were the only independent factors.

Conclusions: Although more than half of the current study participants had high knowledge and attitude about CVD, their behaviors is not satisfactory. Therefore, it is necessary to establish more effective educational interventions aimed at promoting positive health behaviors and explaining to the public that knowledge and action regarding the reduction of risk factors are linked to reduced CVD and mortality.

Context: Despite several studies documenting that obesity affects female and male fertility and leads to multiple adverse reproductive outcomes, the mechanisms involved are not elucidated. We aimed to summarize the potential adverse effects of female and male obesity, as well as the impact of weight loss on their fertility status.

Evidence acquisition: This review summarizes papers investigating the potential adverse effects of female and male obesity and the impact of weight-loss interventions on fertility among reproductive age populations. PubMed, Scopus, Web of Science, and Google Scholar databases were searched for retrieving studies published up to November 2019 on obesity/overweight among reproductive age populations.

Results: The review of 68 studies revealed that female and male obesity/overweight increases the risk of sub-fecundity and infertility. The destructive effects of female obesity on reproduction are attributed to a variety of ovarian and extra-ovarian factors. In women with overweight or obesity, the time taken to conceive is longer, and they have a decreased fertility rate, increased requirement for gonadotropins, and higher miscarriage rate when compared to those with normal weight. Male obesity may lead to subfertility, mainly because of the disruption of the hypothalamus-pituitary-gonadal (HPG) axis, increased testicular temperature, impairment of the physical and molecular structure of sperm, decreased sperm quality, and erectile dysfunction due to peripheral vascular disease. Most studies recommend lifestyle interventions as first-line therapy in the general population of women and men with obesity and infertility.

Conclusions: This study shows the negative effects of female and male overweight and obesity on fertility. Therefore, educational interventions on the adverse effects of obesity and the benefits of weight reduction, such as increasing pregnancy rate, should be considered for couples seeking fertility.