Efficacy and Safety of Long-Term Methimazole versus Radioactive Iodine in the Treatment of Toxic Multinodular Goiter

Fereidoun Azizi,Navid Saadat,Mir Alireza Takyar,Hengameh Abdi,Ladan Mehran,Atieh Amouzegar 대한내분비학회 2022 Endocrinology and metabolism Vol.37 No.6

Background: This study compared the degree of sustained control of hyperthyroidism in patients with toxic multinodular goiter(TMNG) treated with long-term methimazole (LT-MMI) or radioactive iodine (RAI). Methods: In this clinical trial, 130 untreated patients with TMNG were randomized to either LT-MMI or RAI treatment. Bothgroups were followed for 108 to 148 months, with median follow-up durations of 120 and 132 months in the LT-MMI and RAIgroups, respectively. Both groups of patients were followed every 1 to 3 months in the first year and every 6 months thereafter. Results: After excluding patients in whom the treatment modality was changed and those who were lost to follow-up, 53 patients inthe LT-MMI group and 54 in the RAI group completed the study. At the end of the study period, 50 (96%) and 25 (46%) patientswere euthyroid, and two (4%) and 25 (46%) were hypothyroid in LT-MMI and RAI groups, respectively. In the RAI group, four(8%) patients had subclinical hyperthyroidism. The mean time to euthyroidism was 4.3±1.3 months in LT-MMI patients and 16.3±15.0 months in RAI recipients (P<0.001). Patients treated with LT-MMI spent 95.8%±5.9% of the 12-year study period in a euthyroid state, whereas this proportion was 72.4%±14.8% in the RAI-treated patients (P<0.001). No major treatment-related adverseevents were observed in either group. Conclusion: In patients with TMNG, LT-MMI therapy is superior to RAI treatment, as shown by the earlier achievement of euthyroidism and the longer duration of sustained normal serum thyrotropin.

Thyroid Cancer Epidemiology in Iran: a Time Trend Study

Safavi, Ali,Azizi, Fereidoun,Jafari, Rozita,Chaibakhsh, Samira,Safavi, Amir Ali Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.1

Background: Considering the rising incidence of thyroid cancer worldwide, the aim of our study was to investigate the temporal trends in the incidence of this cancer in a large population of Iranian patients. Materials and Methods: We used the Iran Cancer Data System (ICDS) Registry to assess the thyroid cancer trend from 2004 to 2010 with regard to different genders, age groups, and morphologies. To do this we analyzed the data of 10,913 new cases of thyroid cancer that occurred during these years. Results: The incidence rate (per one year) of thyroid cancer was 2.20 per 100,000 persons between 2004 and 2010 in Iran. Papillary thyroid cancer was the most common histology type, with an annual rate of 0.29 in Iran. The highest rate of prevalence in thyroid cancer was observed at the age of 45 years at the time of diagnosis. We found a female-to-male ratio of 2 in Iran. A significant decrease was detected in the trend of thyroid cancer in children <19y, which was not correlated to the trend of older patients. Conclusions: As expected, the trend of thyroid cancer increased over the 7 years, primarily contributed by papillary thyroid cancer. A rising pattern of incidence was seen in all the age groups except patients aged under 19 years.

Potential Efficacy of Broccoli Sprouts as a Unique Supplement for Management of Type 2 Diabetes and Its Complications

Zahra Bahadoran,Parvin Mirmiran,Fereidoun Azizi 한국식품영양과학회 2013 Journal of medicinal food Vol.16 No.5

Functional foods and their nutraceutical components are now considered as supplementary treatments in type 2 diabetes and prevention of its long-term complications. Young broccoli sprouts as a functional food contain many bioactive compounds specially sulforaphane. In hyperglycemic and oxidative conditions, sulforaphane has the potential to activate the NF-E2–related factor-2 (Nrf2)–dependent antioxidant response-signaling pathway, induces phase 2 enzymes, attenuates oxidative stress, and inactivates nuclear factor kappa-B (NF-κB), a key modulator of inflammatory pathways. Interestingly, sulforaphane induces some peroxisome proliferator-activated receptors, which contribute to lipid metabolism and glucose homeostasis. In animal and in vitro models, sulforaphane also shows antihypertensive, anticancer, cardioprotective, and hypocholesterolemic capacity, and has bactericidal properties against Helicobacter pylori. Supplementation of type 2 diabetics with high sulforaphane content broccoli sprouts resulted in increased total antioxidant capacity of plasma and in decreased oxidative stress index, lipid peroxidation, serum triglycerides, oxidized low-density lipoprotein (LDL)/LDL-cholesterol ratio, serum insulin, insulin resistance, and serum high-sensitive C-reactive protein. Sulforaphane could prevent nephropathy, diabetes-induced fibrosis, and vascular complications. Potential efficacy of sulforaphane and probably other bioactive components of young broccoli sprouts makes it as an excellent choice for supplementary treatment in type 2 diabetes.

Lipid Accumulation Product Is Associated with Insulin Resistance, Lipid Peroxidation, and Systemic Inflammation in Type 2 Diabetic Patients

Parvin Mirmiran,Zahra Bahadoran,Fereidoun Azizi 대한내분비학회 2014 Endocrinology and metabolism Vol.29 No.4

Background: Lipid accumulation product (LAP) is a novel biomarker of central lipid accumulation related to risk of diabetes and cardiovascular disease. In this study, we assessed the association of LAP with glucose homeostasis, lipid and lipid peroxidation, and subclinical systemic inflammation in diabetic patients. Methods: Thirty-nine male and 47 female type 2 diabetic patients were assessed for anthropometrics and biochemical measurements. LAP was calculated as [waist circumference (cm)–65]×[triglycerides (mmol/L)] in men, and [waist circumference (cm)–58]×[triglycerides (mmol/L)] in women. Associations of LAP with fasting glucose, insulin, insulin resistance index, lipid and lipoprotein levels, malondialdehyde, and high-sensitive C-reactive protein (hs-CRP) were assessed. Results: Mean age and LAP index were 53.6±9.6 and 51.9±31.2 years, respectively. After adjustments for age, sex and body mass index status, a significant positive correlation was observed between LAP index and fasting glucose (r=0.39, P<0.001), and homeostasis model assessment of insulin resistance (r=0.31, P<0.05). After additional adjustment for fasting glucose levels, antidiabetic and antilipidemic drugs, the LAP index was also correlated to total cholesterol (r=0.45, P<0.001), high density lipoprotein cholesterol (HDL-C) levels (r=–0.29, P<0.05), triglycerides to HDL-C ratio (r=0.89, P<0.001), malondialdehyde (r=0.65, P<0.001), and hs-CRP levels (r=0.27, P<0.05). Conclusion: Higher central lipid accumulation in diabetic patients was related to higher insulin resistance, oxidative stress and systemic inflammation.

Sugar-Sweetened Beverage Consumption Is Associated with Metabolic Syndrome in Iranian Adults: Tehran Lipid and Glucose Study

Hanieh-Sadat Ejtahed,Zahra Bahadoran,Parvin Mirmiran,Fereidoun Azizi 대한내분비학회 2015 Endocrinology and metabolism Vol.30 No.3

Background: Metabolic syndrome (MetS), a cluster of multiple metabolic abnormalities, is one of the major public health challenges worldwide. The current study was conducted to evaluate the association between sugar-sweetened beverage (SSB) consumption and MetS and its components in Iranian adults. Methods: This cross-sectional study was conducted among 5,852 men and women, aged 19 to 70 years, who participated in the fourth phase (2009 to 2011) of the Tehran Lipid and Glucose Study. Demographics, anthropometrics, biochemical measurements, and blood pressure (BP) were assessed and MetS was defined by National Cholesterol Education Program Adult Treatment Panel III definition. Frequency and quantity of SSB intakes including carbonated drinks and synthetic fruit juices were collected using a validated semiquantitative food frequency questionnaire. Results: Mean age of participants (43%, men) was 40.6±12.9 years. Significant positive associations between SSBs and waist circumference, triglyceride level, systolic and diastolic BP in the third and fourth quartile of SSBs were observed, after adjustment for all potential confounding variables. The odds of MetS in the third and fourth quartiles compared to the first quartile category of SSBs was 1.21 (95% confidence interval [CI], 1.01 to 1.45) and 1.30 (95% CI, 1.06 to 1.58), respectively (P for trend=0.03). The odds of MetS, abdominal obesity, low high density lipoprotein cholesterol and elevated BP had increasing trends across increasing of SSB consumption (P for trend <0.05). Conclusion: Higher intake of SSBs was associated with the higher odds of MetS in adults. It is suggested that reducing consumption of SSBs could be a practical approach to prevent metabolic abnormalities.

Associations between Dietary Acid-Base Load and Cardiometabolic Risk Factors in Adults: The Tehran Lipid and Glucose Study

Zahra Bahadoran,Parvin Mirmiran,Hadise Khosravi,Fereidoun Azizi 대한내분비학회 2015 Endocrinology and metabolism Vol.30 No.2

Background: In this study we investigated the associations of dietary acid-base load, identified by potential renal acid load (PRAL) and protein to potassium (Pro:K) ratio, with cardiometabolic risk factors in Tehranian adults. Methods: A cross-sectional study was conducted within the framework of the fourth phase of the Tehran Lipid and Glucose Study (2009 to 2011) on 5,620 men and women aged 19 to 70 years. Dietary data were collected by a trained dietitian using a validated, 147-food item, semi-quantitative food frequency questionnaire, and dietary PRAL and Pro:K ratio were calculated. Multiple linear regression models with adjustment for potential confounding variables were used to evaluate the associations of dietary acid-base load with anthropometric measures, blood pressure, serum triglycerides, high density lipoprotein cholesterol (HDL-C), serum creatinine, and fasting blood glucose. Results: The mean±SD age of the participants was 39.8±12.8 years and 54% of participants were women. Mean ±SD PRAL was –22.0±29.1; mean PRAL was –15.6 in men and –26.8 in women. Dietary PRAL was associated with weight (β=0.098, P<0.001), waist circumference (β=0.062, P<0.01), serum triglycerides (β=0.143, P<0.01), HDL-C (β=–0.11, P<0.01), diastolic blood pressure (β=0.062, P<0.01), and serum creatinine (β=0.142, P<0.001). Pro:K ratio was associated with weight (β=0.055, P<0.001), waist circumference (β=0.04, P<0.01), serum HDL-C (β=–0.06, P<0.01), serum triglycerides (β=0.03, P<0.05), diastolic blood pressure (β=0.026, P<0.05), and serum creatinine (β=0.07, P<0.01). Conclusion: A more acidic dietary acid-base load may be a risk factor for the development of metabolic disorders.

Dietary Sodium to Potassium Ratio and the Incidence of Chronic Kidney Disease in Adults

Parvin Mirmiran,Pantea Nazeri,Zahra Bahadoran,Sajjad Khalili-Moghadam,Fereidoun Azizi 한국식품영양과학회 2018 Preventive Nutrition and Food Science Vol.23 No.2

The aim of this study was to explore the association of dietary sodium to potassium (Na/K) ratio and the risk of chronic kidney disease (CKD) in general Iranian adults. In this prospective cohort study, 1,780 adults, free of baseline CKD with complete follow-up data, were selected from among participants of the Tehran Lipid and Glucose Study and followed for 6.3 years for development of CKD. Dietary sodium and potassium were assessed using a valid and reliable 168-item food frequency questionnaire. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease Study equation, and CKD was defined as eGFR <60 mL/min/1.73 ㎡. Mean dietary intakes of sodium and potassium were 4,547±3,703 and 3,753±1,485 mg/d, respectively, and their ratio was 1.35±1.29. No significant association was found between dietary intakes of sodium and potassium and the risk of CKD after 6.3 y of followup, whereas in the case of dietary Na/K ratio, participants in the highest compared to lowest tertile (2.43 vs 1.61) had a significantly increased risk of CKD (odds ratio=1.52, 95% confidence interval=1.01∼2.30); an increasing trend in the risk of CKD across tertiles of dietary sodium to potassium ratio was also observed (P for trend=0.05). Present findings demonstrate that the dietary Na/K ratio is a stronger predictor of CKD than the dietary sodium or potassium per se. Decreased dietary Na/K ratio may be considered as an effective dietary approach to modify the risk of kidney dysfunction.

Helicobacter pylori Stool Antigen Levels and Serological Biomarkers of Gastric Inflammation are Associated with Cardio-Metabolic Risk Factors in Type 2 Diabetic Patients

Zahra Bahadoran,Parvin Mirmiran,Maryam Zarif-yeaganeh,Homayoun Zojaji,Fereidoun Azizi 대한내분비학회 2015 Endocrinology and metabolism Vol.30 No.3

Background: Helicobacter pylori infection and subsequent gastric inflammation have been proposed as risk factors for the development of insulin resistance and cardiovascular disease. In this study we assessed the possible association of H. pylori bacterial load, and serum biomarker of gastric inflammation with cardiometabolic risk factors in diabetic patients. Methods: In this cross-sectional study, 84 H. pylori-infected type 2 diabetic patients were assessed for anthropometrics, biochemical and clinical measurements. Pearson correlation test, linear, and logarithmic regression curve estimation models were used to assess the association of H. pylori stool antigen (HpSAg) levels, and pepsinogen I (PGI) to pepsinogen II (PGII) ratio with fasting serum glucose, insulin, serum lipid and lipoprotein parameters, malondialdehyde, high-sensitive C-reactive protein (hs-CRP), systolic and diastolic blood pressure, body weight, waist circumference and lipid accumulation product (LAP) index. Results: The mean age of participants was 54±10 years, and 44% were men. Mean HpSAg levels and PGI/PGII ratio were 0.24±0.23 μg/mL and 9.9±9.0, respectively. Higher HpSAg as well as lower PGI/PGII was correlated with higher anthropometric measures and LAP. A significant negative correlation between PGI/PGII ratio and blood pressure (r=–0.21 and r=–0.22, systolic and diastolic, respectively, P<0.05), serum insulin (r=–0.17, P=0.05), and hs-CRP (r=–0.17, P=0.05) was observed. A significant linear association between PGI/PGII ratio with serum triglycerides (β=–0.24, P<0.05), serum high density lipoprotein cholesterol (HDL-C; β=0.43, P<0.01), and triglycerides/HDL-C ratio (β=–0.28, P<0.05) were observed. Conclusion: Higher H. pylori bacterial load and lower PGI/PGII ratio was associated with higher levels of cardiometabolic risk factors in H. pylori infected type 2 diabetic patients.

Association between Dietary Acid Load and Insulin Resistance

Sajjad Khalili Moghadam,Zahra Bahadoran,Parvin Mirmiran,Maryam Tohidi,Fereidoun Azizi 한국식품영양과학회 2016 Preventive Nutrition and Food Science Vol.21 No.2

In the current study, we investigated the longitudinal association between dietary acid load and the risk of insulin resistance (IR) in the Tehranian adult population. This longitudinal study was conducted on 925 participants, aged 22∼80 years old, in the framework of the third (2006∼2008) and fourth (2009∼2011) phases of the Tehran Lipid and Glucose Study. At baseline, the dietary intake of subjects was assessed using a validated semi-quantitative food frequency questionnaire, and the potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores were calculated at baseline. Fasting serum insulin and glucose were measured at baseline and again after a 3-year of follow-up; IR was defined according to optimal cut-off values. Multiple logistic regression models were used to estimate the risk of IR according to the PRAL and NEAP quartile categories. Mean age and body mass index of the participants were 40.3 years old of 26.4 ㎏/㎡, respectively. Mean PRAL and NEAP scores were −11.2 and 35.6 mEq/d, respectively. After adjustment for potential confounders, compared to the lowest quartile of PRAL and NEAP, the highest quartile was accompanied with increased risk of IR [odds ratio (OR)=2.81, 95% confidence interval (CI)=1.32∼5.97 and OR=2.18, 95% CI=1.03∼4.61, respectively]. Our findings suggest that higher acidic dietary acid-base load, defined by higher PRAL and NEAP scores, may be a risk factor for the development of IR and related metabolic disorders.

Association between Dietary Acid Load and Insulin Resistance: Tehran Lipid and Glucose Study

Moghadam, Sajjad Khalili,Bahadoran, Zahra,Mirmiran, Parvin,Tohidi, Maryam,Azizi, Fereidoun The Korean Society of Food Science and Nutrition 2016 Preventive Nutrition and Food Science Vol.21 No.2

In the current study, we investigated the longitudinal association between dietary acid load and the risk of insulin resistance (IR) in the Tehranian adult population. This longitudinal study was conducted on 925 participants, aged 22~80 years old, in the framework of the third (2006~2008) and fourth (2009~2011) phases of the Tehran Lipid and Glucose Study. At baseline, the dietary intake of subjects was assessed using a validated semi-quantitative food frequency questionnaire, and the potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores were calculated at baseline. Fasting serum insulin and glucose were measured at baseline and again after a 3-year of follow-up; IR was defined according to optimal cut-off values. Multiple logistic regression models were used to estimate the risk of IR according to the PRAL and NEAP quartile categories. Mean age and body mass index of the participants were 40.3 years old of $26.4kg/m^2$, respectively. Mean PRAL and NEAP scores were -11.2 and 35.6 mEq/d, respectively. After adjustment for potential confounders, compared to the lowest quartile of PRAL and NEAP, the highest quartile was accompanied with increased risk of IR [odds ratio (OR)=2.81, 95% confidence interval (CI)=1.32~5.97 and OR=2.18, 95% CI=1.03~4.61, respectively]. Our findings suggest that higher acidic dietary acid-base load, defined by higher PRAL and NEAP scores, may be a risk factor for the development of IR and related metabolic disorders.