The positive association between number of children and obesity in Iranian women and men: results from the National Health Survey

BACKGROUND

To date, few studies have assessed the association between the number of children and obesity in couples. We aimed to investigate this association in men and women aged 20-75 years.

METHODS

Data from the National Health Survey were considered in this investigation. It included 2728 women and men (1364 couples) aged 20-75 years. Height and weight were actually measured rather than self-reported. A generalized estimating equation model was used to estimate the odds of obesity (body mass index (BMI > or = 30)) as a function of the number of children adjusted for age, sex, education, economic index, workforce, smoking and place of residence.

RESULTS

We infer that each additional child has at least 5% and at most 34% increase in the odds of obesity in men and at least 4% and at most 29% increase in the odds of obesity in women. Our test of interaction by sex showed that the association between the number of children and obesity was not different among men and women. Among women, factors that increased obesity included age, low education, having more children, being inactive workforce and being nonsmoker. Among men, these factors included high economic index, low education, having more children, and being nonsmoker.

CONCLUSION

Our results show an association between the number of children and obesity among men. We would recommend interventions to reduce the number of children to prevent obesity in men.

First detection of enterovirus 71 from an acute flaccid paralysis case with residual paralysis in Iran

In an attempt to determine the types of non-polio enteroviruses (NPEVs) in acute flaccid paralysis (AFP) cases in Iran, we detected enterovirus 71 (EV71) in an AFP case with residual paralysis for the first time. Cell culture detected no enteroviruses, while RT-PCR and subsequent sequencing revealed that the specimen was positive for EV71. EV71 is the causative agent of a variety of diseases from hand, foot and mouth disease to severe neurological complications and is now considered as an important cause of childhood acute flaccid paralysis.

Immobilization effect of Ruta graveolens L. on human sperm: a new hope for male contraception

AIM OF THE STUDY

Contraceptive plants which were introduced by folk in traditional remedies are investigated worldwide. In this study, the contraceptive effects of Ruta graveolens L., which has been mentioned for male contraceptive in Iranian traditional folk medicine, was experimented on human sperm.

MATERIALS AND METHODS

Different doses of lyophilized aqueous extract of Ruta graveolens L. were added to an amount of fresh semen, containing 10(6) cells in a 1:1 volumic ratio. Motility and viability of cells, DNA status, mitochondrial activity and sperm revival tests were carried out.

RESULTS

The sperm immobilization effects of the extract appeared immediately in a does-dependent manner and 100% of the sperms became immotile at a concentration of 100mg/ml but other parameters were intact. After washing the sperms, motility was returned in 30.8+/-3.2% of the sperms, besides coiled tails in 38.6+/-5.5% of the treated cells, in comparison to 12.5+/-2.0% of the control group (p=0.001). The part of the extract, responsible for immobilization of the sperms was stable upon boiling.

CONCLUSIONS

As the cells were alive and immotile, probably some ionic currents are blocked by a thermostable component of the plant which can be promising as a new male channel blocker contraceptive.

Determinants of traffic injuries in drivers and motorcyclists involved in an accident

Basic information on the risk factors of road traffic injuries in Iran is scarce. This case-control study was conducted to determine the association of potential risk factors with the incidence of injury among motor vehicle drivers and motorcyclists on Qazvin-Loshan Road. The cases were 175 drivers and motorcyclists who had a road traffic accident (RTA) and sustained an injury. The controls were 175 motorists who had a RTA, on the same road and over the same time period, without suffering any injury. The analyses were separately performed by comparing the controls with mildly and severely injured cases, using New Injury Severity Score (NISS) 15 as a threshold. The results showed that fire following collision was significant in the crude analysis of all 175 cases and controls. The severity of collision, vehicle type (motorcycle versus other vehicle crashes), and gender were significant in the multivariable analyses of both mildly and severely injured cases. Safety equipment use is only significant (adjusted odds ratio, AOR=0.44, 95% confidence interval, 95%CI=0.23-0.84) among mild cases. The number of collisions (AOR=3.87, 95%CI=1.64-9.10) and weather conditions (AOR=4.32, 95%CI=1.13-16.5) only associate significantly with the occurrence of road traffic injury in severe cases, in comparison with the controls.

Effects of administration of iron, iodine and simultaneous iron-plus-iodine on the thyroid hormone profile in iron-deficient adolescent Iranian girls

OBJECTIVE

To investigate whether iron supplementation can improve thyroid hormone function in iron-deficient adolescent girls.

DESIGN

A double-blind randomized intervention study.

SETTING

The study was performed from 2002 through 2003 in the Islamic Republic of Iran.

SUBJECTS

103 iron-deficient non-anaemic girls who fulfilled all inclusion criteria were included, and 94 subjects successfully completed the study.

INTERVENTIONS

Patients were randomly assigned to one of four groups and treated with a single oral dose of 190 mg iodine plus 300 mg ferrous sulphate 5 times/week (n=24), 300 mg ferrous sulphate 5 times/week (n=23), a single oral dose of 190 mg iodine (n=25), or a placebo (n=22) for 12 weeks.

RESULTS

All groups were comparable at baseline. After the intervention, there was a significant increase in ferritin and transferrin saturation in the iron+iodine group (17.6 vs 8.7 microg/dl, and 18.8 vs 7.2%, respectively, P<0.001 for both) and in the iron group (P<0.001 for both). Urinary iodine doubled in the iron+iodine group and in the iodine group (P<0.001 for both). Thyroid indices tT4, tT3 and T3RU increased and reverse RT3 decreased in the iron+iodine group (10 vs 8.9 microg/dl, P< 0.001; 143 vs 138 microg/dl, P<0.05; 32.3 vs 28.4%, P<0.001 and 24.8 vs 44.2 ng/dl, P<0.001, respectively) and in the iron group. These two groups did not differ for any of the four indices, but both differed significantly from the iodine and placebo groups.

CONCLUSIONS

Our results indicate that improvement of iron status was accompanied by an improvement in some indices of thyroid hormones.

SPONSORSHIP

This study was supported by the Dean of Research Affairs of the Tehran University of Medical Sciences.

Evaluation of suppressive therapy for cold thyroid nodules with levothyroxine: double-blind placebo-controlled clinical trial

OBJECTIVE

To study the efficacy of levothyroxine suppressive therapy in the management of benign thyroid nodules.

METHODS

We performed a double-blind clinical trial comparing levothyroxine treatment (1.5 to 2.0 mg/kg of body weight daily) (N = 32) with placebo (N = 30) for a 1-year period in patients with a benign, cold thyroid nodule confirmed by biopsy and 99mTc-pertechnetate scanning, who were randomly assigned to the treatment or control group. High-resolution sonography was used to measure the size of the nodules before and after the treatment. Suppression of thyrotropin was evaluated by the administration of thyrotropin-releasing hormone to 10 patients randomly in each group.

RESULTS

The mean volume of the thyroid nodules decreased significantly after 6 months in both the levothyroxine group (from 12.8 +/- 11.9 mL to 9.4 +/- 9.8 mL; P = 0.003) and the placebo group (from 13.2 +/- 10.2 mL to 11.5 +/- 8.0 mL; P = 0.003). After 12 months, however, the volume of the nodules had increased. Thus, no significant decrease was found in the mean nodule volume in either study group at 1 year in comparison with the mean volume at baseline (final mean volume: 12.4 +/- 16.7 mL in the levothyroxine group and 11.7 +/- 13.6 mL in the placebo group).

CONCLUSION

Suppressive therapy with levothyroxine for a period of 12 months proved to be ineffective in significantly reducing the size of the thyroid nodules in our patients despite effective suppression of the thyrotropin level.

Prevalence of overweight and obesity in adolescent Tehrani students, 2000-2001: an epidemic health problem

OBJECTIVE

Overweight has become a public health problem in most developing countries. Evidence suggests that adolescence is a critical period in determining adulthood obesity and its complications. The present study was carried out to assess the prevalence of overweight and obesity among secondary school students.

DESIGN AND SETTING

This descriptive study was conducted in Tehran city, 2000-2001. Body weight and height were measured and body mass index (BMI) values were calculated. Underweight, overweight and obesity were defined as <5th, > or = 85th and > or = 95th percentile, respectively, of age- and sex-specific BMI values from the National Center for Health Statistics/Centers for Disease Control and Prevention (2000).

SUBJECTS

Using a multistage sampling method, 2321 students (1068 males and 1253 females) aged 11-16 years were assessed in Tehran, the capital city of Iran.

RESULTS

The overall prevalences of overweight and obesity were 21.1 and 7.8%, respectively. The prevalence of overweight among girl students (i.e. 23.1%; 95% confidence interval (CI) 20.8-25.4) was significantly higher than that among boys (i.e. 18.8%; 95% CI 16.5-21.1, P=0.01) even after adjustment for age (odds ratio 1.26, 95% CI 1.03-1.55, P=0.02). No significant risk of obesity associated with age was found in girls or boys. In both sexes, median values of age-specific BMI in this study were statistically higher than corresponding values collected in Tehrani adolescents 10 years ago (P=0.03). Similarly, a significant difference was seen between girl students in this study and the reference population (P=0.03).

CONCLUSION

According to this study, overweight, especially in girls, should be considered an epidemic health problem among adolescent students in Tehran.

Serum antibodies to the major proteins found in cow's milk of Iranian patients with Type 1 diabetes mellitus

The purpose of this study was to assess the humoral immune response to cow's milk proteins in Iranian children with Type 1 diabetes mellitus (T1DM). Eighty children aged 4-17 yr with T1DM from two centres in Iran (the Iranian Association of Diabetes in Tehran and Center for Diabetes Research in Hamedan), 37 apparently healthy siblings of diabetic patients (related controls), 82 apparently healthy age- and sex- matched controls (unrelated controls), and 32 patients aged 11-15 yr with auto-immune thyroiditis were examined for specific whole antibodies (Igs), IgG, and IgM to the major proteins found in cow's milk or to ovo-albumin by enzyme-linked immunosorbent assay (ELISA). A crude extract was made from 2.5% fat pasteurized cow's milk. This extract, together with individual commercial major proteins of cow's milk, was then used as antigen to evaluate the humoral immune response of the subjects to the individual proteins found in cow's milk or to cow's milk as a whole. A questionnaire on medical history, duration of exclusive and non-exclusive breast-feeding and daily intake of dairy products was completed before blood sampling. Diabetic children had significantly higher serum levels of Igs, IgG and IgM to the proteins found in cow's milk than unrelated healthy controls (p<0.001). Healthy siblings of diabetic patients, compared to unrelated controls, had significantly higher levels of serum Igs and IgG to cow's milk proteins (p<0.05 and p<0.01, respectively). Serum levels of Igs and IgG to the cow's milk proteins showed a significantly negative correlation with duration of non-exclusive breast-feeding but positive correlation with daily intake of dairy products. These correlations were stronger when calculated just within the T1DM group. In this group, serum levels of IgM to cow's milk proteins also showed a positive correlation with daily intake of dairy products. Though serum levels of IgG to casein were insignificantly higher in diabetic children than in healthy controls, there was a significant negative correlation between serum levels of IgG to casein and duration of non-exclusive breast-feeding. Again in the T1DM group, this correlation was stronger. There was no significant difference in serum levels of Igs, IgG or IgM to other major proteins of cow's milk or to ovo-albumin between groups. It was concluded that though high levels of Igs or IgG were found to cow's milk proteins, especially casein, it seems unrelated to the early introduction of cow's milk into an infant diet and the onset of T1DM in Iranian subjects.

Association of body mass index with educational level in Iranian men and women

OBJECTIVE

Investigation of the relationship between educational level, body mass index (BMI), waist-to-hip ratio (WHR), physical activity and parity in a group of Iranian men and women living in Tehran.

DESIGN

A cross-sectional study in a group of Iranian men and women. The subjects were classified into two educational levels: low education (< or =12 y schooling) and high education (>12 y schooling); and BMI, WHR, physical activity and parity (in women) were compared in two groups in men and women, separately.

SETTING

Metabolic Unit of Tehran University of Medical Sciences in Tehran.

SUBJECTS

Three hundred and fifteen men aged 33.1 (22-46) and 403 women aged 27.9 (22-45).

RESULTS

After controlling for age and smoking, women with a higher level of education showed a significantly lower mean BMI than less educated women (24.8+/-4.2 vs 28.3+/-4.9, P <0.01), while more educated men had a higher mean BMI than less educated men (28.4+/-4.3 vs 26.7+/-4.5). In multiple regression analysis, physical activity in leisure time in men and years of education in women were the only determinants of BMI. After controlling for BMI, WHR was not related to the level of education in either men or women.

CONCLUSION

The present data indicated an educational difference in BMI for the study population. In Iranian women, like the women in developed countries, the level of education was negatively related to BMI, while in men the association was positive.

SPONSORSHIP

This work was financially supported by the Institute of Public Health, Tehran University of Medical Sciences.

A randomized controlled comparison of three quadruple therapy regimens in a population with low Helicobacter pylori eradication rates

BACKGROUND AND AIM

We sought to compare the efficacy and tolerability of an omeprazole/clarithromycin/bismuth/tetracycline-based quadruple therapy to that of a ranitidine/metronidazole/bismuth/tetracycline-based quadruple therapy of 2 or 3 weeks duration in a population with a high prevalence of metronidazole-resistant Helicobacter pylori and low triple therapy eradication rates.

METHODS

Two hundred and twenty-one patients who presented endoscopically proven duodenal ulcers and a positive rapid urease test were randomized to receive either: (i) omeprazole 20 mg b.i.d., clarithromycin 250 mg b.i.d., bismuth subcitrate 240 mg b.i.d. and tetracycline 500 mg b.i.d (OCBT) for 2 weeks; (ii) ranitidine 300 mg b.i.d., metronidazole 500 mg b.i.d, bismuth subcitrate 240 mg b.i.d. and tetracycline 500 mg b.i.d. (RMBT2) for 2 weeks; or (iii) ranitidine 300 mg b.i.d., metronidazole 500 mg b.i.d, bismuth subcitrate 240 mg b.i.d. and tetracycline 500 mg b.i.d. (RMBT3) for 3 weeks. Patients were interviewed 2 weeks after the completion of therapy to review compliance and side-effects. Eradication of H. pylori was assessed 8 weeks after the completion of therapy with the use of a 14C-urea breath test.

RESULTS

The per-protocol eradication rate was significantly higher with OCBT (88%) than RMBT2 (73%) or RMBT3 (71%) (P<0.05). The intent-to-treat eradication rate was numerically higher with OCBT (80%) than RMBT2 (68%) or RMBT3 (68%), although this difference did not reach statistical significance (P=0.09). Per-protocol or intent-to-treat eradication rates were similar with RMBT2 and RMBT3. There were significantly greater side-effects with the RMBT2 regimen.

CONCLUSIONS

The omeprazole/clarithromycin/bismuth/tetracycline-based quadruple therapy provides higher H. pylori eradication rates than the ranitidine/metronidazole/bismuth/tetracycline-based quadruple therapy when administered per protocol. The prolongation of the latter regimen from 2 to 3 weeks did not increase eradication rates.

Furazolidone versus metronidazole in quadruple therapy for eradication of Helicobacter pylori in duodenal ulcer disease

OBJECTIVE

Furazolidone, an old but cheap antibiotic, was shown to be a good alternative to metronidazole in triple therapy for Helicobacter pylori eradication in areas where metronidazole resistant bacteria are common, but randomized studies are lacking.

AIM

A randomized controlled trial to determine the efficacy and safety of furazolidone compared to metronidazole in classic quadruple therapy for eradication of H. pylori infection in duodenal ulcer patients.

METHODS

Patients with endoscopically proven duodenal ulcer and positive urease test were randomized to receive ranitidine 300 mg, amoxycillin 1000 mg and bismuth subcitrate 240 mg b.d, with either furazolidone 200 mg b.d (RABF), or metronidazole 500 mg b.d. (RABM) for 2 weeks. Compliance and side-effects were monitored and recorded by table diary. H. pylori eradication was assessed at least 4 weeks after the completion of therapy with 14C-urea breath test.

RESULTS

A total of 106 patients were enrolled and 101 (59 male, 42 female, mean age=40 +/- 11 years) completed the study. Endoscopic findings and demographic data were comparable in both groups. Intention-to-treat eradication rates were 75% and 55% (P=0.03) and per protocol eradication rates were 82 and 56% (P=0. 006) in the RABF and RABM groups, respectively. Side-effects were reported by 13 patients (27%) in the RABF group (one stopped treatment) compared to five patients (10%) in the RABM group (P=0. 04).

CONCLUSION

Quadruple therapy containing furazolidone, instead of metronidazole, results in a significantly higher H. pylori eradication rate in Iranian duodenal ulcer patients.

Prognostic factors in bone marrow transplantation for beta thalassemia major: experiences from Iran

This study concerns the effects of several pre-transplant features on outcome for patients with beta thalassemia major who underwent bone marrow transplantation (BMT). Seventy patients with beta thalassemia major underwent bone marrow transplantation during the period 1991-1997 in Shariati Hospital in Tehran, Iran. The survival and rejection curves levelled off at 8 and 18 months after transplantation at 82.6% and 11.4%, respectively. Pre-transplant clinical features (age, serum ferritin, portal fibrosis, hepatomegaly and quality of chelation therapy) were examined for their effects on survival and recurrence of thalassemia in this group of patients who were less than 16 years old. Increasing age, presence of portal fibrosis and increasing serum ferritin were significantly associated with reduced probability of survival (P = 0.0047, P = 0.016 and P = 0.024, respectively). Hepatomegaly and inadequate pre-transplant chelation therapy which were documented as poor prognostic factors in previous studies, were not evaluable in this study. We also showed the benefits of transplanting more than 5.5 x 10(8)/kg cells in this group of patients with no increase in complications.