International Journal of Endocrinology and Metabolism International Journal of Endocrinology and Metabolism Int J Endocrinol Metab http://www.endometabol.com 1726-913X 1726-9148 10.5812/ijem en jalali 2017 5 29 gregorian 2017 5 29 14 1
en 27274337 10.5812/ijem.29601 Prevalent Practices of Thyroid Diseases During Pregnancy Among Endocrinologists, Internists and General Practitioners Prevalent Practices of Thyroid Diseases During Pregnancy Among Endocrinologists, Internists and General Practitioners research-article research-article Results

There were minor differences in treatment preferences for Graves’ disease in pregnancy and tests to monitor antithyroid drugs between endocrinologists and generalists; the major difference being targeted free thyroxin, and also thyroxin, depicted in the upper end of normal range, by the majority of endocrinologist and within the normal range, by generalists. Compared to generalists, endocrinologists perform more targeted screening and are more familiar with its risk factors. Predominantly, endocrinologists increase levothyroxine dose in hypothyroid women, upon confirmation of pregnancy and also indicate full dose in a pregnant woman, diagnosed with overt hypothyroidism, and treat thyroid peroxidase antibody positive or negative pregnant women with thyroid stimulating hormone (2.5 - 5 mU/L), as compared to generalists.

Conclusions

There is wide variation in the clinical practices of screening and management of thyroid disorders during pregnancy in East-Asia, with many clinicians, in particular general practitioners, not adhering to clinical practice guidelines, unfortunately.

Objectives

The objective of this survey was to assess and compare the current practices of various East-Asian physicians in the screening and management of thyroid disease in pregnancy.

Materials and Methods

Completed survey questionnaires were collected from 112 physicians of six East-Asian countries. The survey was based on clinical case scenarios, asking questions about the clinical practices related to diagnosis and management of thyroid disease during pregnancy. Reponses from 76 endocrinologists and 33 internists and general practitioners (generalists) were analyzed.

Background

Maternal thyroid disease in pregnancy is associated with adverse impact on both mother and fetus. Both the American thyroid association and the endocrine society have recently published guidelines for the management of thyroid disease in pregnancy.

Results

There were minor differences in treatment preferences for Graves’ disease in pregnancy and tests to monitor antithyroid drugs between endocrinologists and generalists; the major difference being targeted free thyroxin, and also thyroxin, depicted in the upper end of normal range, by the majority of endocrinologist and within the normal range, by generalists. Compared to generalists, endocrinologists perform more targeted screening and are more familiar with its risk factors. Predominantly, endocrinologists increase levothyroxine dose in hypothyroid women, upon confirmation of pregnancy and also indicate full dose in a pregnant woman, diagnosed with overt hypothyroidism, and treat thyroid peroxidase antibody positive or negative pregnant women with thyroid stimulating hormone (2.5 - 5 mU/L), as compared to generalists.

Conclusions

There is wide variation in the clinical practices of screening and management of thyroid disorders during pregnancy in East-Asia, with many clinicians, in particular general practitioners, not adhering to clinical practice guidelines, unfortunately.

Objectives

The objective of this survey was to assess and compare the current practices of various East-Asian physicians in the screening and management of thyroid disease in pregnancy.

Materials and Methods

Completed survey questionnaires were collected from 112 physicians of six East-Asian countries. The survey was based on clinical case scenarios, asking questions about the clinical practices related to diagnosis and management of thyroid disease during pregnancy. Reponses from 76 endocrinologists and 33 internists and general practitioners (generalists) were analyzed.

Background

Maternal thyroid disease in pregnancy is associated with adverse impact on both mother and fetus. Both the American thyroid association and the endocrine society have recently published guidelines for the management of thyroid disease in pregnancy.

Thyroid;Guideline;Pregnancy;General Practitioners Thyroid;Guideline;Pregnancy;General Practitioners http://www.endometabol.com/index.php?page=article&article_id=29601 Fereidoun Azizi Fereidoun Azizi Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Ladan Mehran Ladan Mehran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P. O. Box: 19395-4763, Tehran, IR Iran. Tel: +98-2122409309, Fax: +98-2122402463 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P. O. Box: 19395-4763, Tehran, IR Iran. Tel: +98-2122409309, Fax: +98-2122402463 Atieh Amouzegar Atieh Amouzegar Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Shahram Alamdari Shahram Alamdari Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Medical Research Development Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Medical Research Development Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Imam Subetki Imam Subetki Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia Navid Saadat Navid Saadat Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Siamak Moini Siamak Moini Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Farzaneh Sarvghadi Farzaneh Sarvghadi Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
en 27335579 10.5812/ijem.22827 Hypothyroidism and Lipid Levels in a Community Based Study (TTS) Hypothyroidism and Lipid Levels in a Community Based Study (TTS) research-article research-article Background

Thyroid hormones play an important role in lipid metabolism. Overt hypothyroidism is known to be associated with increased lipid profiles, but the effect of subclinical hypothyroidism (SCH) on lipid profile remains controversial.

Objectives

The aim of this study was to assess the association between thyroid disorders and serum lipid levels.

Materials and Methods

The present study was conducted within the framework of Tehran lipid and glucose study (TLGS). Serum concentrations of TSH and FT4, cholesterol, triglycerides and HDL-C were measured in 5786 randomly selected subjects. Serum LDL was calculated according to the Friedwald formula.

Results

The study assessed 5154 subjects including 42.5% males and 57.5% females, with a mean age of 39.71 ± 14.2 years (ranged 20 - 90 years). Serum cholesterol was significantly higher in overt hypothyroidism in comparison to subclinical hypothyroidism (P = 0.003). Serum cholesterol, HDL –C, LDL-C and TG did not differ between subclinical hypothyroid and control groups. Among euthyroid men, serum FT4 levels were inversely correlated with serum cholesterol and TG. In euthyroid women, serum FT4 levels were correlated positively with serum HDL-C and negatively correlated with TG and TG/HDL-C ratio and TSH levels were associated negatively with, HDL-C.

Conclusions

No differences existed in lipid profiles between subclinical hypothyroidism and euthyroid subjects. There are correlations between serum FT4 and TSH and lipid profiles.

Background

Thyroid hormones play an important role in lipid metabolism. Overt hypothyroidism is known to be associated with increased lipid profiles, but the effect of subclinical hypothyroidism (SCH) on lipid profile remains controversial.

Objectives

The aim of this study was to assess the association between thyroid disorders and serum lipid levels.

Materials and Methods

The present study was conducted within the framework of Tehran lipid and glucose study (TLGS). Serum concentrations of TSH and FT4, cholesterol, triglycerides and HDL-C were measured in 5786 randomly selected subjects. Serum LDL was calculated according to the Friedwald formula.

Results

The study assessed 5154 subjects including 42.5% males and 57.5% females, with a mean age of 39.71 ± 14.2 years (ranged 20 - 90 years). Serum cholesterol was significantly higher in overt hypothyroidism in comparison to subclinical hypothyroidism (P = 0.003). Serum cholesterol, HDL –C, LDL-C and TG did not differ between subclinical hypothyroid and control groups. Among euthyroid men, serum FT4 levels were inversely correlated with serum cholesterol and TG. In euthyroid women, serum FT4 levels were correlated positively with serum HDL-C and negatively correlated with TG and TG/HDL-C ratio and TSH levels were associated negatively with, HDL-C.

Conclusions

No differences existed in lipid profiles between subclinical hypothyroidism and euthyroid subjects. There are correlations between serum FT4 and TSH and lipid profiles.

Hypothyroidism;Lipid Profile;Tehran Thyroid Study (TTS);Thyroid Hypothyroidism;Lipid Profile;Tehran Thyroid Study (TTS);Thyroid http://www.endometabol.com/index.php?page=article&article_id=22827 Shahram Alamdari Shahram Alamdari Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Atieh Amouzegar Atieh Amouzegar Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Maryam Tohidi Maryam Tohidi Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Safoora Gharibzadeh Safoora Gharibzadeh Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences Tehran, IR Iran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences Tehran, IR Iran Pouyan Kheirkhah Pouyan Kheirkhah Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Parnian Kheirkhah Parnian Kheirkhah Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Fereidoun Azizi Fereidoun Azizi Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122432503, Fax: +98-2122402463 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122432503, Fax: +98-2122402463
en 27279831 10.5812/ijem.29687 Ramadan Fasting Decreases Body Fat but Not Protein Mass Ramadan Fasting Decreases Body Fat but Not Protein Mass research-article research-article Conclusions

Ramadan fasting resulted in weight loss even it was only a temporary effect, as the weight was quickly regained within one month after fasting. The catabolism catabolic state, which is related to protein loss, was not triggered during Ramadan fasting. Further research is needed to evaluate the effects of weight loss during Ramadan fasting in healthy individuals.

Results

By the 28th day of Ramadan, it was found that the body weight, BMI, body fat, water and mineral measures had decreased significantly (-0.874 ± 0.859 kg, P < 0.001; -0.36 ± 0.371 kg/m2, P < 0.001; -0.484 ± 0.597 kg, P < 0.001; -0.293 ± 0.486 kg, P = 0.001; -0.054 ± 0.059 kg, P < 0.001, respectively). Protein body mass and calorie intake did not significantly change (-0.049 ± 0.170 kg, P = 0.561; 12.94 ± 760.608 Kcal, P = 0.082 respectively). By 4 - 5 weeks after Ramadan, body weight and composition had returned to the same levels as on the first day of Ramadan.

Patients and Methods

The longitudinal study was performed during and after Ramadan fasting in 2013 (August to October). Fourty-three medical staff members (physicians, nurses and nutritionists) at the Internal Medicine Ward of the Dr. Cipto Mangunkusumo General Hospital were measured to compare their calorie intake, weight, body mass index, waist-to-hip ratio (WHR), and body composition, including body fat, protein, minerals and water, on the first and 28th days of Ramadan and also 4-5 weeks after Ramadan fasting. Measurements were obtained for all 43 subjects on the 28th day of Ramadan, but they were obtained for only 25 subjects 4 - 5 weeks after Ramadan.

Background

Many studies have shown various results regarding the effects of Ramadan fasting on weight and body composition in healthy individuals. Objectives: This study aimed to evaluate the effect of Ramadan fasting on body composition in healthy Indonesian medical staff.

Objectives

In this study, we examined the influence of Ramadan fasting on body composition in healthy medical staff.

Conclusions

Ramadan fasting resulted in weight loss even it was only a temporary effect, as the weight was quickly regained within one month after fasting. The catabolism catabolic state, which is related to protein loss, was not triggered during Ramadan fasting. Further research is needed to evaluate the effects of weight loss during Ramadan fasting in healthy individuals.

Results

By the 28th day of Ramadan, it was found that the body weight, BMI, body fat, water and mineral measures had decreased significantly (-0.874 ± 0.859 kg, P < 0.001; -0.36 ± 0.371 kg/m2, P < 0.001; -0.484 ± 0.597 kg, P < 0.001; -0.293 ± 0.486 kg, P = 0.001; -0.054 ± 0.059 kg, P < 0.001, respectively). Protein body mass and calorie intake did not significantly change (-0.049 ± 0.170 kg, P = 0.561; 12.94 ± 760.608 Kcal, P = 0.082 respectively). By 4 - 5 weeks after Ramadan, body weight and composition had returned to the same levels as on the first day of Ramadan.

Patients and Methods

The longitudinal study was performed during and after Ramadan fasting in 2013 (August to October). Fourty-three medical staff members (physicians, nurses and nutritionists) at the Internal Medicine Ward of the Dr. Cipto Mangunkusumo General Hospital were measured to compare their calorie intake, weight, body mass index, waist-to-hip ratio (WHR), and body composition, including body fat, protein, minerals and water, on the first and 28th days of Ramadan and also 4-5 weeks after Ramadan fasting. Measurements were obtained for all 43 subjects on the 28th day of Ramadan, but they were obtained for only 25 subjects 4 - 5 weeks after Ramadan.

Background

Many studies have shown various results regarding the effects of Ramadan fasting on weight and body composition in healthy individuals. Objectives: This study aimed to evaluate the effect of Ramadan fasting on body composition in healthy Indonesian medical staff.

Objectives

In this study, we examined the influence of Ramadan fasting on body composition in healthy medical staff.

Metabolism;Fasting;Body Composition Metabolism;Fasting;Body Composition http://www.endometabol.com/index.php?page=article&article_id=29687 Ari Fahrial Syam Ari Fahrial Syam Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia; Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia. Tel: +6221-3153957, Fax: +6221-3142454 Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia; Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia. Tel: +6221-3153957, Fax: +6221-3142454 Cecep Suryani Sobur Cecep Suryani Sobur Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia Murdani Abdullah Murdani Abdullah Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia Dadang Makmun Dadang Makmun Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia
en 27279833 10.5812/ijem.33477 Thyroid and Pregnancy in Tehran, Iran: Objectives and Study Protocol Thyroid and Pregnancy in Tehran, Iran: Objectives and Study Protocol methods-article methods-article Background

Thyroid dysfunction is the second most common endocrine disease in females of reproductive age. There are controversial data on the adverse effect of subclinical thyroid dysfunctions on adverse feto-maternal outcomes.

Objectives

The current study aimed to identify the prevalence of thyroid dysfunction during pregnancy and to assess the effectiveness of treatment with levothyroxine on pregnancy outcomes of females with thyroid autoimmunity with or without subclinical thyroid dysfunction in Tehran, Iran.

Results

Results of the study provided reliable information regarding the prevalence of thyroid dysfunction among females in Tehran using universal thyroid screening, along with identification of the iodine status of their community. The study aimed to determine whether LT4 treatment exerts beneficial effects in females without overt thyroid dysfunction.

Patients and Methods

The study encompassed two phases: 1) a population based cross sectional study using a cluster sampling method that screened first trimester pregnant females for thyroid disorders, 2) a double-blind randomized clinical trial to determine the effectiveness of levothyroxine on adverse pregnancy outcomes in females with thyroid autoimmunity with or without subclinical thyroid dysfunction. Pregnant females were assessed at their first prenatal visit for serum TSH, T4, T-uptake, TPOAb and urinary iodine following which they were classified as: 1) normal, 2) subclinical TPOAb negative and 3) subclinical/euthyroid TPOAb positive. Females in groups two and three were randomly divided into two groups: group A was treated with levothyroxine (LT4), and group B did not receive any treatment. There was a follow-up program for participants and rates of adverse pregnancy outcomes in the treated and untreated groups were measured.

Background

Thyroid dysfunction is the second most common endocrine disease in females of reproductive age. There are controversial data on the adverse effect of subclinical thyroid dysfunctions on adverse feto-maternal outcomes.

Objectives

The current study aimed to identify the prevalence of thyroid dysfunction during pregnancy and to assess the effectiveness of treatment with levothyroxine on pregnancy outcomes of females with thyroid autoimmunity with or without subclinical thyroid dysfunction in Tehran, Iran.

Results

Results of the study provided reliable information regarding the prevalence of thyroid dysfunction among females in Tehran using universal thyroid screening, along with identification of the iodine status of their community. The study aimed to determine whether LT4 treatment exerts beneficial effects in females without overt thyroid dysfunction.

Patients and Methods

The study encompassed two phases: 1) a population based cross sectional study using a cluster sampling method that screened first trimester pregnant females for thyroid disorders, 2) a double-blind randomized clinical trial to determine the effectiveness of levothyroxine on adverse pregnancy outcomes in females with thyroid autoimmunity with or without subclinical thyroid dysfunction. Pregnant females were assessed at their first prenatal visit for serum TSH, T4, T-uptake, TPOAb and urinary iodine following which they were classified as: 1) normal, 2) subclinical TPOAb negative and 3) subclinical/euthyroid TPOAb positive. Females in groups two and three were randomly divided into two groups: group A was treated with levothyroxine (LT4), and group B did not receive any treatment. There was a follow-up program for participants and rates of adverse pregnancy outcomes in the treated and untreated groups were measured.

Thyroid Dysfunction;Pregnancy;Clinical Trial;Tehran Thyroid;Pregnancy Study Thyroid Dysfunction;Pregnancy;Clinical Trial;Tehran Thyroid;Pregnancy Study http://www.endometabol.com/index.php?page=article&article_id=33477 Sima Nazarpour Sima Nazarpour Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Fahimeh Ramezani Tehrani Fahimeh Ramezani Tehrani Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122439982, Fax: +98-2122439784 Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122439982, Fax: +98-2122439784 Masoumeh Simbar Masoumeh Simbar Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Maryam Tohidi Maryam Tohidi Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Fereidoun Azizi Fereidoun Azizi Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
en 27279830 10.5812/ijem.26707 Stata Modules for Calculating Novel Predictive Performance Indices for Logistic Models Stata Modules for Calculating Novel Predictive Performance Indices for Logistic Models research-article research-article Results

The command is addpred for logistic regression models.

Conclusions

The Stata package provided herein can encourage the use of novel methods in examining predictive capacity of ever-emerging plethora of novel biomarkers.

Materials and Methods

We have written a Stata command that is intended to help researchers obtain cut point-free and cut point-based net reclassification improvement index and (NRI) and relative and absolute Integrated discriminatory improvement index (IDI) for logistic-based regression analyses.We applied the commands to a real data on women participating the Tehran lipid and glucose study (TLGS) to examine if information of a family history of premature CVD, waist circumference, and fasting plasma glucose can improve predictive performance of the Framingham’s “general CVD risk” algorithm.

Objectives

Lack of user-friendly statistical software has restricted implementation of novel model assessment methods while examining novel biomarkers. We intended, thus, to develop a user-friendly software that could be used by researchers with few programming skills.

Background

Prediction is a fundamental part of prevention of cardiovascular diseases (CVD). The development of prediction algorithms based on the multivariate regression models loomed several decades ago. Parallel with predictive models development, biomarker researches emerged in an impressively great scale. The key question is how best to assess and quantify the improvement in risk prediction offered by new biomarkers or more basically how to assess the performance of a risk prediction model. Discrimination, calibration, and added predictive value have been recently suggested to be used while comparing the predictive performances of the predictive models’ with and without novel biomarkers.

Results

The command is addpred for logistic regression models.

Conclusions

The Stata package provided herein can encourage the use of novel methods in examining predictive capacity of ever-emerging plethora of novel biomarkers.

Materials and Methods

We have written a Stata command that is intended to help researchers obtain cut point-free and cut point-based net reclassification improvement index and (NRI) and relative and absolute Integrated discriminatory improvement index (IDI) for logistic-based regression analyses.We applied the commands to a real data on women participating the Tehran lipid and glucose study (TLGS) to examine if information of a family history of premature CVD, waist circumference, and fasting plasma glucose can improve predictive performance of the Framingham’s “general CVD risk” algorithm.

Objectives

Lack of user-friendly statistical software has restricted implementation of novel model assessment methods while examining novel biomarkers. We intended, thus, to develop a user-friendly software that could be used by researchers with few programming skills.

Background

Prediction is a fundamental part of prevention of cardiovascular diseases (CVD). The development of prediction algorithms based on the multivariate regression models loomed several decades ago. Parallel with predictive models development, biomarker researches emerged in an impressively great scale. The key question is how best to assess and quantify the improvement in risk prediction offered by new biomarkers or more basically how to assess the performance of a risk prediction model. Discrimination, calibration, and added predictive value have been recently suggested to be used while comparing the predictive performances of the predictive models’ with and without novel biomarkers.

Added Predictive Ability, Calibration, Integrated Discrimination Improvement, Net Reclassification Improvement, Software, Stata Added Predictive Ability, Calibration, Integrated Discrimination Improvement, Net Reclassification Improvement, Software, Stata http://www.endometabol.com/index.php?page=article&article_id=26707 Mahnaz Barkhordari Mahnaz Barkhordari Department of Mathematics, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, IR Iran Department of Mathematics, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, IR Iran Mojgan Padyab Mojgan Padyab Centre for Population Studies, Ageing and Living Conditions, Umea University, Umea, Sweden Centre for Population Studies, Ageing and Living Conditions, Umea University, Umea, Sweden Farzad Hadaegh Farzad Hadaegh Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Fereidoun Azizi Fereidoun Azizi Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Mohammadreza Bozorgmanesh Mohammadreza Bozorgmanesh Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P. O. Box 19395-4763, Tehran, IR Iran. Tel: +98-2122409301-5, Fax: +98-2122402463 Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P. O. Box 19395-4763, Tehran, IR Iran. Tel: +98-2122409301-5, Fax: +98-2122402463
en 27279834 10.5812/ijem.33835 Effects of Concentrated Pomegranate Juice on Subclinical Inflammation and Cardiometabolic Risk Factors for Type 2 Diabetes: A Quasi-Experimental Study Effects of Concentrated Pomegranate Juice on Subclinical Inflammation and Cardiometabolic Risk Factors for Type 2 Diabetes: A Quasi-Experimental Study research-article research-article Patients and Methods

In a quasi-experiment trial, 40 type 2 diabetic patients were asked to consume 50 g of CPJ daily for 4 weeks. Anthropometric indices, dietary intake, blood pressure measurements, and fasting blood samples were conducted at baseline and 4 weeks after the intervention.

Results

The intake of CPJ produced a significant increase in both total and high-density lipoprotein cholesterol (HDL-C) (4.7% and 3.9%, respectively) from baseline (P < 0.05). However, changes that were observed in serum triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose, and blood pressure were not statistically significant. Administration of CPJ caused significant reduction in serum interleukin-6 (IL-6) (P < 0.05), but tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP) remained unchanged during the study. The mean value of serum total antioxidant capacity (TAC) was substantially increased (~ 75%) from 381.88 ± 114.4 at baseline to 1501 ± 817 after 4 weeks of CPJ consumption.

Conclusions

Consumption of CPJ (50 g/day) appears to have favorable effects on some markers of subclinical inflammation, and to increase plasma concentrations of antioxidants in patients with type 2 diabetes.

Objectives

This study aimed to investigate the effects of CPJ on metabolic risk factors, including inflammatory biomarkers, in patients with type 2 diabetes mellitus.

Background

The health benefits of pomegranate juice have been reported in several studies. However, limited clinical trials have examined the effects of concentrated pomegranate juice (CPJ) on inflammatory factors.

Patients and Methods

In a quasi-experiment trial, 40 type 2 diabetic patients were asked to consume 50 g of CPJ daily for 4 weeks. Anthropometric indices, dietary intake, blood pressure measurements, and fasting blood samples were conducted at baseline and 4 weeks after the intervention.

Results

The intake of CPJ produced a significant increase in both total and high-density lipoprotein cholesterol (HDL-C) (4.7% and 3.9%, respectively) from baseline (P < 0.05). However, changes that were observed in serum triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose, and blood pressure were not statistically significant. Administration of CPJ caused significant reduction in serum interleukin-6 (IL-6) (P < 0.05), but tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP) remained unchanged during the study. The mean value of serum total antioxidant capacity (TAC) was substantially increased (~ 75%) from 381.88 ± 114.4 at baseline to 1501 ± 817 after 4 weeks of CPJ consumption.

Conclusions

Consumption of CPJ (50 g/day) appears to have favorable effects on some markers of subclinical inflammation, and to increase plasma concentrations of antioxidants in patients with type 2 diabetes.

Objectives

This study aimed to investigate the effects of CPJ on metabolic risk factors, including inflammatory biomarkers, in patients with type 2 diabetes mellitus.

Background

The health benefits of pomegranate juice have been reported in several studies. However, limited clinical trials have examined the effects of concentrated pomegranate juice (CPJ) on inflammatory factors.

Concentrated Pomegranate Juice;TNF-α;IL-6;TAC;LDL-C;HDL-C;type 2 Diabetes;hs-CRP Concentrated Pomegranate Juice;TNF-α;IL-6;TAC;LDL-C;HDL-C;type 2 Diabetes;hs-CRP http://www.endometabol.com/index.php?page=article&article_id=33835 Farideh Shishehbor Farideh Shishehbor Nutrition and Metabolic Disease Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Nutrition and Metabolic Disease Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Majid Mohammad shahi Majid Mohammad shahi Hyperlipidemia Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Hyperlipidemia Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Mehdi Zarei Mehdi Zarei Department of Food Hygiene, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, IR Iran Department of Food Hygiene, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, IR Iran Azadeh Saki Azadeh Saki Department of Biostatistics and Epidemiology, School of health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Department of Biostatistics and Epidemiology, School of health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Mehrnoosh Zakerkish Mehrnoosh Zakerkish Health Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Health Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Fatemeh Shirani Fatemeh Shirani Nutrition Paramedical School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Nutrition Paramedical School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Maryam Zare Maryam Zare Nutrition Department, Arvand International Division, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran; Nutrition Department, Arvand International Division, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel: +98-31333359090, Fax: +98-3133373733 Nutrition Department, Arvand International Division, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran; Nutrition Department, Arvand International Division, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel: +98-31333359090, Fax: +98-3133373733
en 27279832 10.5812/ijem.32586 Leptin Resistance: A Possible Interface Between Obesity and Pulmonary-Related Disorders Leptin Resistance: A Possible Interface Between Obesity and Pulmonary-Related Disorders review-article review-article Evidence Acquisition

Elevated serum leptin levels are regarded as an established marker of obesity. It is also reported that obese asthmatic patients have maximum serum leptin levels compared to other groups such as non-obese asthmatics, and normal obese and non obese subjects without asthma. In addition to having an appetite suppressing effect, leptin also regulates certain acute-phase protein expressions including α-1 antitrypsin (A1AT) in the liver.

Conclusions

On the basis of prior studies, it could be hypothesized that, in obese asthmatic patients, the highest degree of leptin failure/resistance might lead to the creation of an imbalance between NE and its inhibitor A1AT. To ascertain this, large scale prospective studies are warranted to assess the comparative serum leptin and A1AT levels and NE activity in asthmatic non-obese and obese patients, simultaneously. Such studies might help to devise novel interventional therapies for the treatment of pulmonary-related problems including asthma, chronic obstructive pulmonary disorder (COPD), and other lung defects in susceptible obese subjects in the future.

Results

A1AT is a protease inhibitor that counterbalances the activity of the neutrophil elastase (NE) enzyme. A1AT reductions in obese-leptin resistant subjects lead to increased NE activity. The overactivity of NE degrades lung tissue proteins, which may lead to pulmonary disorders including asthma.

Context

Under normal physiological conditions, leptin regulates body weight by creating a balance between food intake and energy expenditure. However, in obesity, serum leptin levels increase and become defective to retain energy balance.

Evidence Acquisition

Elevated serum leptin levels are regarded as an established marker of obesity. It is also reported that obese asthmatic patients have maximum serum leptin levels compared to other groups such as non-obese asthmatics, and normal obese and non obese subjects without asthma. In addition to having an appetite suppressing effect, leptin also regulates certain acute-phase protein expressions including α-1 antitrypsin (A1AT) in the liver.

Conclusions

On the basis of prior studies, it could be hypothesized that, in obese asthmatic patients, the highest degree of leptin failure/resistance might lead to the creation of an imbalance between NE and its inhibitor A1AT. To ascertain this, large scale prospective studies are warranted to assess the comparative serum leptin and A1AT levels and NE activity in asthmatic non-obese and obese patients, simultaneously. Such studies might help to devise novel interventional therapies for the treatment of pulmonary-related problems including asthma, chronic obstructive pulmonary disorder (COPD), and other lung defects in susceptible obese subjects in the future.

Results

A1AT is a protease inhibitor that counterbalances the activity of the neutrophil elastase (NE) enzyme. A1AT reductions in obese-leptin resistant subjects lead to increased NE activity. The overactivity of NE degrades lung tissue proteins, which may lead to pulmonary disorders including asthma.

Context

Under normal physiological conditions, leptin regulates body weight by creating a balance between food intake and energy expenditure. However, in obesity, serum leptin levels increase and become defective to retain energy balance.

Leptin Resistance;Obesity;Asthma;Chronic Obstructive Pulmonary Disorder (COPD);α-1 Antitrypsin (A1AT);Neutrophil Elastase (NE) Leptin Resistance;Obesity;Asthma;Chronic Obstructive Pulmonary Disorder (COPD);α-1 Antitrypsin (A1AT);Neutrophil Elastase (NE) http://www.endometabol.com/index.php?page=article&article_id=32586 Abdul Rehman Khan Abdul Rehman Khan Diabetes and Cardio-Metabolic Disorders Laboratory, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan; Obesity and Diabetes Research Laboratory, Department of Chemistry, University of Azad Jammu and Kashmir, Muzaffarabad, Pakistan; Obesity and Diabetes Research Laboratory, Department of Chemistry, University of Azad Jammu and Kashmir, Muzaffarabad, Pakistan. Tel: +92-3335742975 Diabetes and Cardio-Metabolic Disorders Laboratory, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan; Obesity and Diabetes Research Laboratory, Department of Chemistry, University of Azad Jammu and Kashmir, Muzaffarabad, Pakistan; Obesity and Diabetes Research Laboratory, Department of Chemistry, University of Azad Jammu and Kashmir, Muzaffarabad, Pakistan. Tel: +92-3335742975 Fazli Rabbi Awan Fazli Rabbi Awan Diabetes and Cardio-Metabolic Disorders Laboratory, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan Diabetes and Cardio-Metabolic Disorders Laboratory, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
en 27279835 10.5812/ijem.34400 Effect of JYTK on Antioxidant Status and Inflammation in Patients With Type 2 Diabetes: A Randomized Double-Blind Clinical Trial Effect of JYTK on Antioxidant Status and Inflammation in Patients With Type 2 Diabetes: A Randomized Double-Blind Clinical Trial research-article research-article Conclusions

JYTK combined with metformin improves some antioxidant indices (SOD and MDA), and decreases inflammation in patients with T2DM, suggesting that it can reduce the risk of diabetic complications.

Results

All 112 patients, including 59 in the treatment group (JYTK + metformin) and 52 controls (metformin only) completed the 26-week clinical trial. JYKT plus metformin treatment increased IL-6 (36.4 ± 11.5 ng/L; P < 0.05), TNF-α (17.5 ± 11.3 vs. 22.5 ± 12.9 ng/L; P < 0.05), and MDA (1.9 ± 0.9; P < 0.05) levels compared to the control (2.2 ± 0.6 mM/mL), whereas total SOD level decreased (98.1 ± 30.4 vs. 78.5 ± 29.3 U/mL; P < 0.05). There were no changes in GPX and hs-CRP levels. There were no adverse effects associated with JYTK treatment.

Objectives

The present randomized clinical trial was carried out to evaluate the effects of JYTK on oxidative stress and inflammation in patients with type 2 diabetes mellitus (T2DM).

Patients and Methods

The parallel, randomized, double-blinded, placebo-controlled clinical trial included 150 newly diagnosed T2DM patients receiving metformin treatment (1.5 g/day), some of whom also received JYTK (4.5 g/day) in tablet form. The control group received 4.5 g/day placebo plus 1.5 g/day metformin. Body mass index (BMI), fasting plasma glucose, urinary albumin-to-creatinine ratio, and complete blood count as well as antioxidant and inflammation indices such as tumor necrosis factor (TNF)-α, interleukin (IL)-6, superoxide dismutase (SOD), malonaldehyde (MDA), glutathione peroxidase (GPX), and high sensitivity C-reactive protein (hs-CRP) levels were assessed at baseline and at different time points during the treatment.

Background

Diabetes is a metabolic disorder caused by oxidative stress and inflammation. JianYuTangKang (JYTK), as a potential Chinese integrative medicine, is an antioxidant used in Chinese medicine with potential anti-inflammatory properties.

Conclusions

JYTK combined with metformin improves some antioxidant indices (SOD and MDA), and decreases inflammation in patients with T2DM, suggesting that it can reduce the risk of diabetic complications.

Results

All 112 patients, including 59 in the treatment group (JYTK + metformin) and 52 controls (metformin only) completed the 26-week clinical trial. JYKT plus metformin treatment increased IL-6 (36.4 ± 11.5 ng/L; P < 0.05), TNF-α (17.5 ± 11.3 vs. 22.5 ± 12.9 ng/L; P < 0.05), and MDA (1.9 ± 0.9; P < 0.05) levels compared to the control (2.2 ± 0.6 mM/mL), whereas total SOD level decreased (98.1 ± 30.4 vs. 78.5 ± 29.3 U/mL; P < 0.05). There were no changes in GPX and hs-CRP levels. There were no adverse effects associated with JYTK treatment.

Objectives

The present randomized clinical trial was carried out to evaluate the effects of JYTK on oxidative stress and inflammation in patients with type 2 diabetes mellitus (T2DM).

Patients and Methods

The parallel, randomized, double-blinded, placebo-controlled clinical trial included 150 newly diagnosed T2DM patients receiving metformin treatment (1.5 g/day), some of whom also received JYTK (4.5 g/day) in tablet form. The control group received 4.5 g/day placebo plus 1.5 g/day metformin. Body mass index (BMI), fasting plasma glucose, urinary albumin-to-creatinine ratio, and complete blood count as well as antioxidant and inflammation indices such as tumor necrosis factor (TNF)-α, interleukin (IL)-6, superoxide dismutase (SOD), malonaldehyde (MDA), glutathione peroxidase (GPX), and high sensitivity C-reactive protein (hs-CRP) levels were assessed at baseline and at different time points during the treatment.

Background

Diabetes is a metabolic disorder caused by oxidative stress and inflammation. JianYuTangKang (JYTK), as a potential Chinese integrative medicine, is an antioxidant used in Chinese medicine with potential anti-inflammatory properties.

Type 2 Diabetes;JYTK;Chinese Integrative Medicine;Antioxidant Status;Inflammation Type 2 Diabetes;JYTK;Chinese Integrative Medicine;Antioxidant Status;Inflammation http://www.endometabol.com/index.php?page=article&article_id=34400 Yuan Hu Yuan Hu Centre of Pharmacy, Chinese PLA General Hospital, Beijing, China Centre of Pharmacy, Chinese PLA General Hospital, Beijing, China Xin Zhou Xin Zhou Centre of Pharmacy, Chinese PLA General Hospital, Beijing, China Centre of Pharmacy, Chinese PLA General Hospital, Beijing, China Dai-Hong Guo Dai-Hong Guo Centre of Pharmacy, Chinese PLA General Hospital, Beijing, China; Centre of Pharmacy, Chinese PLA General Hospital, Fuxing Road, Beijing 100853, China. Tel: +86-1066939673, Fax: +86-1088270160 Centre of Pharmacy, Chinese PLA General Hospital, Beijing, China; Centre of Pharmacy, Chinese PLA General Hospital, Fuxing Road, Beijing 100853, China. Tel: +86-1066939673, Fax: +86-1088270160 Ping Liu Ping Liu Centre of Pharmacy, Chinese PLA General Hospital, Beijing, China Centre of Pharmacy, Chinese PLA General Hospital, Beijing, China
en 27335580 10.5812/ijem.34726 Chemical Composition and the Effect of Walnut Hydrosol on Glycemic Control of Patients With Type 1 Diabetes Chemical Composition and the Effect of Walnut Hydrosol on Glycemic Control of Patients With Type 1 Diabetes research-article research-article Conclusions

WH may control the glycemic level in people with diabetes, but it may be associated with minor and major side effects. Further in vitro studies, using these seven compounds, are recommended to determine the efficacy and complications of WH in people with diabetes.

Results

The average daily BS level and insulin dose decreased in seven subjects. Two subjects developed generalized pruritic erythematous skin rash. One patient presented hypoglycemic coma. She had no other coma risk factor. Seven compounds were identified in the walnut essential oil and the rate of monoterpenoid and sesquiterpenes hydrocarbons were 53.45% and 5.95%, respectively. The main constituents of the oil were carvacrol (33.21%), thymol (16%) and homoveratrole (15.83%).

Background

Walnut hydrosol (WH) is used extensively by Iranian people with diabetes in order to control blood sugar (BS). There are few data regarding the effect of walnut on controlling diabetes.

Objectives

A pilot study to determine the efficacy and safety of WH in patients with type 1 diabetes.

Materials and Methods

Eight patients with diabetes mellitus (DM) type 1 were enrolled in the study. They did not use any medicine except insulin. They were advised to drink 250 mL WH after meals twice a day for four weeks. Their BS level was measured and their insulin dose was changed according to their BS. After four weeks, they discontinued WH use and their BS level was checked for two weeks. Descriptive statistics was used to analyze the data. Also, the essential oil of the sample was extracted using a liquid extractor and then analysis of the constituents was performed.

Conclusions

WH may control the glycemic level in people with diabetes, but it may be associated with minor and major side effects. Further in vitro studies, using these seven compounds, are recommended to determine the efficacy and complications of WH in people with diabetes.

Results

The average daily BS level and insulin dose decreased in seven subjects. Two subjects developed generalized pruritic erythematous skin rash. One patient presented hypoglycemic coma. She had no other coma risk factor. Seven compounds were identified in the walnut essential oil and the rate of monoterpenoid and sesquiterpenes hydrocarbons were 53.45% and 5.95%, respectively. The main constituents of the oil were carvacrol (33.21%), thymol (16%) and homoveratrole (15.83%).

Background

Walnut hydrosol (WH) is used extensively by Iranian people with diabetes in order to control blood sugar (BS). There are few data regarding the effect of walnut on controlling diabetes.

Objectives

A pilot study to determine the efficacy and safety of WH in patients with type 1 diabetes.

Materials and Methods

Eight patients with diabetes mellitus (DM) type 1 were enrolled in the study. They did not use any medicine except insulin. They were advised to drink 250 mL WH after meals twice a day for four weeks. Their BS level was measured and their insulin dose was changed according to their BS. After four weeks, they discontinued WH use and their BS level was checked for two weeks. Descriptive statistics was used to analyze the data. Also, the essential oil of the sample was extracted using a liquid extractor and then analysis of the constituents was performed.

Diabetes Mellitus;Walnut;Alternative Medicine;Complementary Medicine;Juglans regia L. Diabetes Mellitus;Walnut;Alternative Medicine;Complementary Medicine;Juglans regia L. http://www.endometabol.com/index.php?page=article&article_id=34726 Hossein Moravej Hossein Moravej Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran; Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-9171058371, Fax: +98-7136474298 Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran; Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-9171058371, Fax: +98-7136474298 Alireza Salehi Alireza Salehi Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran Zahra Razavi Zahra Razavi School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran Mahmood Reza Moein Mahmood Reza Moein Department of Pharmacognosy, Medicinal Plants Processing Research Centre, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Pharmacognosy, Medicinal Plants Processing Research Centre, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran Hamed Etemadfard Hamed Etemadfard Department of Pharmacognosy, Medicinal Plants Processing Research Centre, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Pharmacognosy, Medicinal Plants Processing Research Centre, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran Forough Karami Forough Karami Central Research Laboratory, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran Central Research Laboratory, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran Forough Ghahremani Forough Ghahremani Bushehr University of Medical Sciences, Bushehr, IR Iran Bushehr University of Medical Sciences, Bushehr, IR Iran