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Objective:High salt intake is one of the leading diet-related risk factors for several non-communicable diseases. We aimed to estimate the prevalence of high salt intake in Iran.Design:A modelling study by the small area estimation method, based on a nationwide cross-sectional survey, Iran STEPwise approach to risk factor Surveillance (STEPS) 2016. The modelling estimated the prevalence of high salt intake, defined as a daily salt intake ≥ 5 g in all districts of Iran based on data from available districts. The modelling results were provided in different geographical and socio-economic scales to make the comparison possible across the country.Setting:429 districts of all provinces of Iran, 2016.Participants:18 635 salt intake measurements from individuals 25 years old and above who participated in the Iran STEPS 2016 survey.Results:All districts in Iran had a high prevalence of high salt intake. The estimated prevalence of high salt intake among females of all districts ranged between 72·68 % (95 % UI 58·48, 84·81) and 95·04 % (95 % UI 87·10, 100). Estimated prevalence for males ranged between 88·44 % (95 % UI 80·29, 96·15) and 98·64 % (95 % UI 94·97, 100). In all categorisations, males had a significantly higher prevalence of high salt intake. Among females, the population with the lower economic status had a higher salt consumption than the participants with higher economic status by investigating the concentration index.Conclusions:Findings of this study highlight the high salt intake as a prominent risk factor in all Iran regions, despite some variations in different scales. More suitable population-wide policies are warranted to handle this public health issue in Iran.

This study compared mortality rates and decline in life expectancy of Iranian patients with type 2 diabetes (T2DM) with the general population. A retrospective study of 2451 patients with T2DM was conducted in the Isfahan Endocrine and Metabolism Research Center, Iran, between 1992 and 2010. The mean (SD) of diabetes duration and median (Q1,Q3) of follow-up period were 15.5(8.0) and 8(5, 10) years. The main outcome was all-cause mortality. 732(29.87%) of patients died during the follow-up. Overall mortality rates (95%CI) per 1000 person-years in men and women were 56.3(52.0–62.1) and 27.3(24.5–30.4), respectively. The relative risks (95%CI) of all-cause mortality in males vs. females with T2DM aged 45–49, 50–54, 55–59, 60–64, 65–69, 70–74 were [3.02(1.49–6.11) vs. 2.09(0.96–4.57)], [4.05(2.73–6.01) vs. 2.29(1.52–3.45)], [4.13(3.26–5.24) vs. 1.70(1.23–2.35)], [2.42(1.90–3.07) vs. 1.82(1.46–2.27)], [2.36(2.02–2.76) vs. 1.49(1.25–1.78)] and [1.71(1.50–1.95) vs. 1.04(0.88–1.23)] times more than the general population, respectively. Men and women living with diabetes lost an average of 13.2(6.3) and 13.9(6.0) life-years from the year of diagnosis, respectively (p = 0.101). The estimated life-years lost were greater in younger patients and a gradual decline was observed with increasing the age at diagnosis. In conclusion, Iranians with diabetes had higher risk of death and lower life expectancy compared to the general population.

This study aimed to identify the patterns of changes in glycemic indices over time in prediabetics and to classify these subjects as either having a high or low risk for developing diabetes in future. This prospective 16-year cohort study was conducted among 1228 prediabetic subjects. Three measurements including first visit, mean values during the follow-up period, and last visit from fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1C), and area under the curve during an oral glucose tolerance test (OGTT AUC) were used to evaluate the patterns of changes by using the latent Markov model (LMM). The mean (standard deviation) age of subjects was 44.0 (6.8) years, and 73.6% of them were female. The LMM identified 2 latent states of subjects in terms of changes in FPG, HbA1c, OGTT AUC, and the combination of these glycemic measures: a low tendency to progress diabetes and a high tendency to progress diabetes with the latent state sizes (87, 13%), (94, 6%), (57, 43%), and (84, 16%), respectively. The LMM showed that the probability of transitioning from a low tendency to a high tendency to progress diabetes was higher than the probability of transitioning in the opposite direction. Based on a long-term evaluation of patterns of changes in glycemic indices, we classified prediabetic subjects into 2 groups (high or low risk to progress diabetes states in future). Also, the method used enabled us to estimate the transition probabilities from low- to high-risk states and vice versa. Our results reemphasized the values of all 3 glycemic measures in clinical settings for identifying prediabetic people with a high risk of progressing diabetes and the need for more effective prevention strategies, which should be conducted as urgently in prediabetic life as high-risk subjects.

Endocarditis is a potentially life-threatening infectious disease associated with significant morbidity and mortality and an escalating incidence in recent decades. In this study, as a part of the global burden of disease (GBD) 2019 study, we intend to report endocarditis burden in Iran at national and provincial levels from 1990 to 2019.This study was conducted using GBD 2019 study data on endocarditis from 1990 to 2019. We gathered incidence, prevalence, disability-adjusted life years (DALYs), and mortality rates in Iran and its 31 provinces by sex and age groups as epidemiological indices for endocarditis burden. Further decomposition analysis was also performed to delineate the endocarditis new cases trend.On the country scale, age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate were (16.5 (95% uncertainty interval 13.7 to 19.8), 3.4 (2.9 to 4.1), 0.6 (0.5 to 0.9), and 14.4 (12.0 to 21.1) in 2019, respectively. Decomposition analysis showed that only 59.2% of the overall new cases increase (114.1%) was caused by the incidence rate change. All estimated age-standardized rates were higher in men in 1990 and 2019 with a ratio of 1.1-1.5.The ASIR and ASPR of endocarditis increased, and the ASMR and age-standardized DALYs rate declined over the past 30 years in Iran, nearly all the provinces followed the same pattern with North Khorasan having the Highest ASIR, ASPR, ASMR, and DALYs rates in both years. High systolic blood pressure (SBP) had the greatest attributed burden among risk factors.

Background Coronary artery disease (CAD) is a universal public health challenge, more prominently so in the low- and middle-income countries. In this study, we aimed to determine prevalence and trends of CAD risk factors in patients with documented CAD and to determine their effects on the age of CAD diagnosis. Materials and methods We conducted a registry-based, serial cross-sectional study using the coronary angiography data bank of the Tehran Heart Center. Adult patients who had obstructive (> 50% stenosis) CAD were included in the study. The prevalence and 11-year trends of conventional CAD risk factors were analyzed by sex and age, and their adjusted effects on the age of CAD diagnosis were calculated. Results From January 2005 to December 2015, data for 90,094 patients were included in this analysis. A total of 61,684 (68.5%) were men and 28,410 (31.5%) were women. Men were younger at diagnosis than women, with a mean age of 60.1 in men and 63.2 in women (p Conclusion The major results of this study (lower age of CAD diagnosis in men, lower age of diagnosis associated with most risk factors, and lower prevalence of serum lipids over time) were expected. A prominent finding of this study is confirming opium use was associated with a much younger age of CAD onset, even after adjusting for all other risk factors. In addition to recommendations for control of the traditional risk factors, spreading information about the potential adverse effect of opium use, which has only recently been associated with higher risk of CAD, may be necessary.

Since infectious foot ulcers represent one of the major causes of lower-limb amputation, it calls for an appropriate action for early detection and sufficient treatment of diabetic foot infection (DFI). The present study aimed at investigating the bacterial epidemiology and antimicrobial resistance (AMR) patterns of DFIs in Iran. We have conducted a systematic search in PubMed, Embase, Web of Science, Scopus, Google Scholar, and Scientific Information Database to identify all articles reporting the proportion of different kinds of bacteria isolated from Iranian DFI samples. Quality was assessed using Joanna Briggs Institute tool. A pooled estimate of proportion with a corresponding 95% confidence interval (95% CI) was calculated using the random effect method. Fifteen studies were eligible, of which 1970 bacterial isolates were obtained from 1316 patients. The most predominant isolates recovered from DFIs was Staphylococcus aureus with a pooled proportion of 24.29% (95% CI: 20.25%, 28.57%) from which 55% (95% CI: 38%, 72%) were methicillin-resistant S. aureus (MRSA). Among Gram-negative strains, Escherichia coli had the highest proportion (17.19%; 95% CI: 13.96%, 20.68%) followed by Pseudomonas aeruginosa, 7.54% (95% CI: 4.56%, 11.14%). The highest pooled estimates of resistance against cotrimoxazole and ciprofloxacin were found in S. aureus 66% (95% CI: 48%, 82%) and E coli isolates 68% (95% CI: 51%, 84%), respectively. Our study revealed that AMR is at a high level in Iran and clinicians should be aware of bacterial resistance patterns to prescribe appropriate antibiotic regimens.

BACKGROUNDThere is an ongoing controversy about harms and benefits of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in hypertensive patients with coronavirus disease 2019 (COVID-19). Given the unresolved debate, we investigated the association of ARBs with in-hospital outcomes of these patients.METHODSIn this retrospective observational study, we studied patients with COVID-19 who referred to Sina Hospital in Tehran, Iran, from 20 February to 29 May 2020. Patients with either positive real-time reverse-transcriptase polymerase-chain-reaction test of swab specimens, or high clinical suspicion according to the World Health Organization’s interim guidance were included. We followed-up patients for incurring death, severe COVID-19, and in-hospital complications.RESULTSWe evaluated 681 patients with COVID-19 of whom 37 patients were excluded due to incomplete medical records and 8 patients who used ACEIs which left 636 patients in the analysis. In this cohort, 108 (17.0%) patients expired and 407 (64.0%) patients incurred severe COVID-19. Of 254 (39.9%) patients with hypertension, 122 (48.0%) patients were receiving an ARB. After adjustment for possible confounders, we found no independent association between taking ARBs and in-hospital outcomes except for acute kidney injury (AKI), in patients with confirmed or clinically suspected COVID-19, either hypertensive or not-hypertensive. We found that discontinuation of ARBs during hospitalization was associated with a greater risk of mortality, invasive ventilation, and AKI (all P ˂ 0.002).CONCLUSIONSWe found that taking ARBs by patients with hypertension and confirmed or clinically suspected COVID-19 is not associated with poorer in-hospital outcomes after adjustment for possible confounders.

Background: Current reference values for thyroid function tests are derived from data from different ethnicities and geographical areas. In this article, we aim to select criteria from the guidelines proposed by the National Academy of Clinical Biochemistry (NACB) and to determine the TSH and T4 reference limits in the iodine-sufficient area of Isfahan, a metropolitan city in Iran. Materials and methods: This study was conducted within the framework of “Isfahan Thyroid Study (ITS)”, an ongoing prospective cohort that started in 2006 (n=2523) until 2011 (n=711) and included participants above the age of twenty. We measured TSH, total T4, thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb). Results: Recruitment was based on the NACB criteria, 1899 participants were included in 2006(58.5% male) and 377 in 2011(62.3% male). The mean± SD age was 39.66 ±12.71 and 48.96±12.35 years in 2006 and 2011, respectively. The mean± SD for TSH was 2.0±1.19 and 2.11±1.11 mU/L and T4 was 6.67±1.47 and 8.3±2.95 μg /dl in 2006 and 2011, respectively. In 2006, the 2.5th percentile of serum TSH levels was 0.4 mU/L (males: 0.4 mU/L, females: 0.5 mU/L) and the 97.5th percentile of serum TSH was 4.96 mU/L (males: 4.72 mU/L, females: 5. 3 mU/L). In 2011, the 2.5th percentile of serum TSH levels was 0.7 mU/L (males: 0.6 mU/L, females: 0.77 mU/L) and 97.5th percentiles of serum TSH was 4.9 mU/L (males: 5.7 mU/L, females: 5. 57 mU/L). Conclusion: This study determined age and sex specific TSH and T4 reference ranges in the Isfahanian population, which could theoretically enable clinicians to classify patients more accurately. (www.actabiomedica.it)

This study aimed to introduce and apply modern statistical techniques for assessing association and predictive value of risk factors in first-degree relatives (FDR) of patients with diabetes from repeatedly measured diabetes data.We used data from 1319 FDR's of patients with diabetes followed for 8 years. Association and predictive performance of weight (Wt), body mass index (BMI), waist and hip circumferences (WC and HC) and their ratio (WHR), waist-height ratio (WHtR) and a body shape index (ABSI) in relation to future diabetes were evaluated by using Cox regression and joint longitudinal-survival modeling.According to Cox regression, in total sample, WC, HC, Wt, WHtR and BMI had significant direct association with diabetes (all p 0.01) with the best predictive ability for WHtR (concordance probability estimate = 0.575). Joint modeling suggested direct associations between diabetes and WC, WHR, Wt, WHtR and BMI in total sample (all p 0.05). According to LPML criterion, WHtR was the best predictor in both total sample and females with LPML of -2666.27 and -2185.67, respectively. However, according to AUC criteria, BMI had the best predictive performance with AUC-JM = 0.7629 and dAUC-JM = 0.5883 in total sample. In females, both AUC criteria indicated that WC was the best predictor followed by WHtR.WC, WHR, Wt, WHtR and BMI are among candidate anthropometric measures to be monitored in diabetes prevention programs. Larger multi-ethnic and multivariate research are warranted to assess interactions and identify the best predictors in subgroups.

Aims To study the incidence, risk factors, and pregnancy outcomes associated with gestational diabetes mellitus (GDM) diagnosed with one-step and two-step screening approaches. Methods 1000 pregnant women who were eligible and consented to participate underwent fasting plasma glucose testing at the first prenatal visit (6–14 weeks). The women free from GDM or overt diabetes were screened at 24–28 weeks using the 50-g glucose challenge test (GCT) followed by 100-g, 3-h oral glucose tolerance test (OGTT) (two-step method). Regardless of the GCT result, all women underwent a 75-g, 2-h OGTT within one-week interval (one-step method). Results GDM incidence using the one-step and two-step methods was 9.3% (95% CI: 7.4–11.2) and 4.2% (95% CI: 2.9–5.5). GDM significantly increased the risk of macrosomia, gestational hypertension, preeclampsia, and cesarean section and older age and family history of diabetes significantly increased the risk of developing GDM in both approaches. In two-step method, higher pre-pregnancy body mass index and lower physical activity during pregnancy along with higher earlier cesarean section also increased significantly the risk of developing GDM. Conclusions Despite a higher incidence of GDM using the one-step approach, more risk factors for and a stronger effect of GDM on adverse pregnancy outcomes were found when using the two-step approach. Longer follow-up of women with and without GDM may change the results using both approaches.

Aim To determine the progression rates from metabolically healthy or unhealthy normal weight, overweight and obese phenotype to type 2 diabetes (T2D) in a non-diabetic high risk population in Isfahan, Iran. Methods T2D incidence during a mean (SD) follow-up of 10.1 (2.3) years was examined among 1,982 non-diabetic first-degree relatives (FDR) of patients with T2D 30–70 years old. Participants were divided into 6 groups based on body mass index and metabolic syndrome component, except waist circumference, at baseline: metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW), metabolically unhealthy overweight (MUOW) and metabolically unhealthy obese (MUO). Results The MHO, MUOW, and MUO individuals at baseline were associated with incidence of T2D, independently of age and gender. MHO were 3 times (OR 2.96; 95% CI 1.07, 8.24) and MUOW were 2.75 times (95% CI 1.17, 6.45) more likely to develop T2D than those with MHNW. There was excess risk in MUO than MHO (OR 3.86; 95% CI 1.64, 9.11). Conclusions Obesity was a risk factor for T2D, even in the absence of any metabolic abnormalities. Metabolic abnormalities were a stronger predictor of incident T2D than obesity.

Background The incidence of type 2 diabetes, cardiovascular diseases, and obesity has been rising dramatically; however, their pathogenesis is particularly intriguing. Recently, dysbiosis of the intestinal microbiota has emerged as a new candidate that may be linked to metabolic diseases. We hypothesize that selective modulation of the intestinal microbiota by probiotic or synbiotic supplementation may improve metabolic dysfunction and prevent diabetes in prediabetics. In this study, a synthesis and study of synbiotics will be carried out for the first time in Iran. Methods/Design In a randomized triple-blind controlled clinical trial, 120 adults with impaired glucose tolerance based on the inclusion criteria will be selected by a simple random sampling method and will be randomly allocated to 6 months of 6 g/d probiotic, synbiotic or placebo. The fecal abundance of bacteria, blood pressure, height, weight, and waist and hip circumferences will be measured at baseline and following treatment. Also, plasma lipid profiles, HbA1C, fasting plasma glucose, and insulin levels, will be measured and insulin resistance (HOMA-IR) and beta-cell function (HOMA-B) will be calculated at baseline and will be repeated at months 3, 6, 12, and 18. The data will be compared within and between groups using statistical methods. Discussion The results of this trial could contribute to the evidence-based clinical guidelines that address gut microbiota manipulation to maximize health benefits in prevention and management of metabolic syndrome in prediabetes. Trial registration Iranian Registry of Clinical Trials: IRCT201511032321N2. Registered on 27 February 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1885-8) contains supplementary material, which is available to authorized users.

Obesity is well recognized to be an important risk factor for hypertension (HTN), but it is not clear which obesity indices have stronger association with HTN. To evaluate the ability of different obesity indices, including visceral adiposity index (VAI), hypertriglyceridemic-waist (HTGW) phenotype, a body shape index (ABSI), body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) as possible hypertension (HTN) predictor in a high-risk population. Seven years follow-up data in first-degree relatives of consecutive patients with type 2 diabetes aged 30–70 years without diabetes and HTN with at least one follow-up examination (n = 1417) were analysed. Discriminatory capabilities were examined using the receiver operating characteristic (ROC) curve. Logistic regression analysis was performed to determine the strength of association between obesity indices and HTN. Among the indices, the highest quintile compared with the lowest quintile of WHtR and WC was more strongly associated with HTN in age and sex adjusted models [odds ratio (95% CI); WHtR: 4.02 (2.36, 6.85) and WC: 3.26 (2.05, 5.20)]. Those with HTGW phenotype was 2.3 (1.54, 3.35) times more likely to develop HTN than those with normal WC normal triglyceride. On ROC curve analysis, WHtR (63.1%; 59.6, 66.7) and WC (61.7%, 58.0, 65.4) had the higher area under the ROC. Although higher values of VAI, BMI, WHR and HTGW were associated with the risk of HTN, WHtR and WC was more strongly associated with the development of HTN, while the ABSI showed weaker association.

The relationship between obesity and mortality rate among diabetic patients is a controversial topic. The aim of this study was to investigate the association between obesity and all-cause mortality risk in patients with type 2 diabetes. In this retrospective database study, 2383 patients with type 2 diabetes, who had been registered in the Isfahan Endocrine and Metabolism Research Center, Iran, were enrolled between 1992 and 2010. The mean (SD) of diabetes duration and follow-up period was 15.5 (8.0) and 7.8 (3.9) years. The main outcome was all-cause mortality. All-cause mortality rates were calculated for the body mass index (BMI) categories of underweight, normal, overweight and class I, II and III obese. Cox proportional hazard models were used to estimate the adjusted hazard ratio for BMI as categorical variable using BMI of 18.5–24.9 kg/m2 as the reference group. The mortality rate in patients with normal weight was higher than overweight patients (59.11 vs. 33.17 per 1000 person-years). The adjusted hazard ratios of all-cause mortality were 0.82 [95%CI 0.68–0.99; P = 0.037], 0.79 [95%CI 0.61–1.02; P = 0.069], 0.71 [95%CI 0.42–1.19; P = 0.191] and 1.36 [95%CI 0.55–3.33; P = 0.507] for overweight, class I, II and III obesity, respectively. When BMI was included in the Cox model as a time-dependent variable, the U-shaped relationship between BMI and all-cause mortality did not change. The results show a U-shaped association of BMI with all-cause mortality in patients with type 2 diabetes with the lowest risk observed among the overweight patients.

Probiotics and/or prebiotics could be a promising approach to improve metabolic disorders by favorably modifying the gut microbial composition. To assess the effects of probiotics and synbiotic on glycemic indices in prediabetic individuals who are at risk of type 2 diabetes and its complications. In a double-blind, randomized, placebo-controlled parallel-group clinical trial, 120 prediabetic adults participated and were randomly allocated to receive either probiotics or synbiotic or placebo supplements for 24 weeks. Anthropometric measurements, food record, physical activity and glycemic biomarkers including glycated hemoglobin (HbA1C), fasting plasma glucose (FPG), fasting insulin levels (FIL), homoeostasis model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and β-cell function (HOMA-B) were assessed at baseline and repeated at 12 and 24 weeks and compared within and between three groups using repeated measure ANOVA. Compared with the placebo, synbiotic supplementation resulted in a higher significant reduction in FPG (− 6.5 ± 1.6 vs. − 0.82 ± 1.7 mg/dL, P = 0.01), FIL (− 2.6 ± 0.9 vs. − 0.8 ± 0.8 µIU/mL, P = 0.028), and HOMA-IR (− 0.86 ± 0.3 vs. − 0.16 ± 0.25, P = 0.007), and a significant elevation in the QUICKI (+ 0.01 ± 0.003 vs. + 0.003 ± 0.002, P = 0.006). In addition, significant decreases in HbA1C was seen following the supplementation of probiotics and synbiotic compared with the placebo (− 0.12 ± 0.06 and − 0.14 ± 0.05 vs. +0.07 ± 0.06%, P = 0.005 and 0.008, respectively). HOMA-B was not found to be different between or within the three groups. Glycemic improvement by probiotics and particularly synbiotic supplements in prediabetic individuals has been supported by current study. However, further studies are required for optimal recommendations in this important area of patient treatment. Iranian Registry of Clinical Trials: IRCT201511032321N2, Date registered February 27, 2016.

Background: Better control of blood sugar and reduction of diabetes complications through insulin therapy could convince people to choose this method. However, patients might refuse insulin therapy due to its painful injection, limitations in daily activities, and hypoglycemia. Thus, insulin therapy could have both positive and negative effects on patients’ quality of life (QOL). Therefore, the aim of this study was to compare the QOL of insulin recipient and insulin refusal patients with type 2 diabetes. Materials and Methods: This study was a descriptive and comparative research conducted on 126 patients; 63 were insulin recipients and 63 had refused insulin therapy. Participants were under the care of the Endocrine and Metabolism Research Center of Isfahan, Iran. Data were gathered using the Diabetes Quality of Life (DQOL) questionnaire. In this tool, higher scores indicated lower QOL in patients. Data were analyzed using independent t-test, analysis of covariance, Mann–Whitney, Chi-square, and Pearson and Spearman’s correlation. Results: There was a significant difference (P < 0.001) between insulin recipient patients (mean = 2.02, SD = 0.31) and insulin refusal patients (mean = 1.74, SD = 0.41) in terms of mean QOL score. In addition, men and participants with higher educational levels reported a better QOL (P < 0.001). Conclusions: Results showed that insulin refusal patients had a better QOL. It seems that QOL is associated with the acceptance or refusal of insulin therapy. Therefore, enhancement of QOL could be related to all aspects of the disease, especially its treatment method and solving the therapeutic problems. Key words: Insulin therapy, Iran, quality of life, quality of life in type 2 diabetes, type 2 diabetes mellitus

OBJECTIVES: To evaluate the ability of low-level fasting high-density lipoprotein cholesterol (HDLC) to predict the incidence of type 2 diabetes (T2D) in an Iranian high-risk population. METHODS: Seven-year follow-up data (n = 1,775) in non-diabetic first-degree relatives (FDR) of consecutive patients with T2D aged 30-70 years were analyzed. The primary outcome was the diagnosis of T2D based on repeated oral glucose tolerance test (OGTT). We used Cox proportional hazard models to estimate the hazard ratio (HR) for the incidence of T2D across quartiles of HDLC, and plotted a receiver operating characteristic (ROC) curve to assess discrimination. RESULTS: The highest quartile compared with the lowest quartile of HDLC was associated with T2D in age- and gender-adjusted models (HR: 0.83, 95% CI: 0.73-0.95). Further adjustment for fasting plasma glucose and cholesterol attenuated the association for T2D incidence (HR: 0.93, 95% CI: 0.80-1.08). The area under the ROC curve for HDLC was 54.1% (95% CI: 50.2-58.0). CONCLUSIONS: HDLC level was a weak predictor of T2D in an Iranian high-risk population, independent of age and gender.

BACKGROUND: Little is known about the relationship between high baseline serum uric acid (SUA) and incident hypertension in patients with type 2 diabetes (T2D). OBJECTIVES: To evaluate the ability of baseline SUA to predict the incidence of hypertension in non-hypertensive patients with T2D. METHODS: The association between SUA and mean 20-year incidence of hypertension was examined in 1,666 non-hypertensive patients with T2D from Isfahan Endocrine and Metabolism Research Center outpatient clinics, Iran. The primary outcome was incident hypertension defined as systolic blood pressure (BP) of 140 mmHg or higher and/or diastolic BP 90 mmHg or higher and/or use of antihypertensive medications. The mean (standard error (SE)) age of participants was 49.4 years (0.25 years) with a mean (SE) duration of diabetes of 6.1 years (0.15 years) at initial registration. We used multiple logistic regression to estimate the odds ratio (OR) for the incidence of hypertension across quartiles of SUA, and plotted a receiver operating characteristic (ROC) curve to assess discrimination. RESULTS: The highest quartile of SUA was not associated with hypertension compared with the lowest quartile in multivariable adjusted models (OR: 1.22, 95% CI: 0.87, 1.73). The area under the ROC curve for SUA was 51.7% (95% CI: 48.9, 54.5). CONCLUSIONS: High initial SUA levels are not a predictor of incident hypertension in an Iranian T2D population.

Background Studies reported that lipid-lowering treatment may increase the risk of diabetes, support the hypothesis that low-density lipoprotein cholesterol (LDLC) may be associated with type 2 diabetes (T2D). Objective The aim of this study was to assess the association between the LDLC levels and the incidence of T2D in an Iranian high-risk population not treated with lipid-lowering medications. Methods Mean 10-year follow-up data (1819) in non-diabetic first-degree relatives (FDR) of consecutive patients with T2D 30–70 years old, who were not treated with lipid-lowering drugs at baseline were examined. The diagnosis of T2D based on serial oral glucose tolerance test was the primary outcome. Cox proportional hazard model was used to estimate the hazard ratio (HR) for the incidence of T2D within tertiles of LDLC. Results A higher LDLC concentration was significantly associated with higher risk of T2D. Compared with the first tertile, the adjusted risk of T2D increased for the second (HR 1.20, 95% CI: 1.07, 1.35, P Conclusions While these results await confirmation, a higher LDLC level was significantly associated with higher risk of T2D, independent of age, gender, fasting plasma glucose, waist circumference or blood pressure, in high-risk individuals in Iran.

Purpose To study trends of urological cancers mortalities in Iran between 1990 and 2015 as a part of a larger project named national and subnational burden of diseases, injuries, and risk factors. Methods The primary dataset of this project comprises data of national death registration system. Cause-specific mortality fraction for each age, sex, province, and year group was calculated using a two-stage mixed effects and spatiotemporal models, and then these fractions were applied to all-cause mortality rates, obtained from a parallel study to estimate mortality rates attributable to each cause. Results In 2015, urological cancers constituted 8% of cancer-related deaths in Iran, and number of deaths due to prostate, bladder, testicular, and kidney and other urinary organs cancers were estimated as 2,128 (1,565-2,891), 297 (230-385), 301 (144-639), and 195 (143-267), respectively. Our estimates show that age-standardized death rates (ASDRs) of these cancers reached 6.8 (5-9.23), 0.47 (0.37-0.61), 0.96 (0.46-2.04), and 0.24 (0.18-0.33) deaths per 100,000 individuals in 2015, a reduction in the three latter cancers, from 4.09 (2.92-5.76), 13.04 (10.04-16.95), 1.23 (0.46-3.34), and 1.76 (1.28-2.42) deaths per 100,000 individuals in 1990, respectively. Conclusions In conclusion, despite disparities among different provinces, overall mortality rate of urological cancers decreased significantly since 1990s in Iran.

The aim of current study was to assess the relationship between serum TSH levels and hypothyroidism risk in the euthyroid population.In a population-based cohort study, a total of 615 individuals with a normal baseline TSH, from of total population (n=2254) in 2006, were followed up for 6years. TSH, total T4, thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) were measured. The relative risk (RR) and 95% confidence interval (95%CI) were calculated based on logistic regression. The Receiver Operating Characteristic (ROC) analysis along with area under the curve (AUC) was used to prediction of future hypothyroidism.TSH level in 2006 was a significant predictor for overt hypothyroidism, in the total population (RR=3.5) and female (RR=1.37) (all, P value0.05). A cutoff value of TSH at 2.05mIU/L [AUC: (CI95 %), 0.68 (0.44-0.92; P=0.05)] was obtained for differentiating the patients with overt hypothyroidism from euthyroid. However, this cut off was not observed when we included only negative TPO and TgAbs people in 2006. The RR of hypothyroidism increased gradually when TSH level increased from 2.06-3.6mIU/L to3.6mIU/L in the total population and both sexes. In women, the risk of overt hypothyroidism was significantly higher in subjects with TSH above 3.6 than those subject with THS levels≤2.05 [RR: (CI95 %), 20.57(2.-207.04), P value0.05].A cutoff value of TSH at 2.05mIU/L could predict the development of overt hypothyroidism in future. However, it was not applicable for people with negative TPOAb and negative TgAb.

Objective: Low testosterone, with or without symptoms, reported in diabetic men in some studies. We investigated the prevalence of hypogonadism in Iranian type 2 diabetic men. Materials and Methods: Total testosterone (TT) and sex hormone binding globulin (SHBG) concentrations were measured in 247 diabetic men >30 years who had symptoms of androgen deficiency, according to ADAMs questionnaire. The correlation between some parameters and total, free and bioavailable testosterone levels was determined using Pearson correlation coefficient. Free and bioavailable testosterone were calculated by electronic calculator. Four patients were excluded because of high testosterone level, due to unreported androgen use. Overt hypogonadism was defined as total testosterone ≤8 nmol/l or calculated bioavailable testosterone (cBT)≤2.5 nmol/l and borderline hypogonadism was considered as TT 8-12 nmol/l or cBT 2.5-4nmol/l. Results: The mean and SD of age was 59 (9.3) years. The mean TT, calculated free testosterone (cFT), and cBT and SHBG levels were 4.81 (1.7) nmol/l, 0.11 (0.06) nmol/l, 2.42 (1.17) nmol/l and 36.15 (18.3) nmol/l, respectively. According to TT and cBT, overt hypogonadism observed in 7.4% and 61.6% of men, respectively, and the prevalence of borderline hypogonadism was 9.9% and 36%, respectively. cFT ≤0.16 nmol/l found in 227 diabetic men (96%). Hypogonadism (TT ≤12 nmol/l) was not correlated with obesity, smoking, age, duration of diabetes, blood pressure, and HbA1c. Conclusion: Hypogonadism is highly prevalent in type 2 diabetes men.

Background: The aim of this study is to investigate the need for diabetes primary prevention program in isolated impaired fasting glucose (i-IFG) of the first degree relatives of type 2 diabetics. Methods: In a cross sectional study, 793 individuals with prediabetes [543 with i-IFG and 250 with isolated impaired glucose tolerance (i-IGT)] who were the first degree relatives of type 2 diabetic patients, were enrolled. Isolated IFG was considered as fasting plasma glucose between 100-125 mg/dl and 2 hour plasma glucose < 140 mg/dl and isolated IGT as FPG < 100 mg/dl and 2 hour plasma glucose between 140-199 mg/dl during an overnight fasting 75 g oral glucose tolerance test. Mean of the age, weight, waist circumference, body mass index, systolic and diastolic blood pressure, plasma glucose, HbA1C, and lipid profile were compared between two groups (i-IFG and i-IGT). The prevalence of cardiometabolic risk factors (BMI ≥ 25 kg/m2, hypertension, cholesterol ≥ 200 mg/dl, LDL-C ≥ 100 mg/dl, HDL-C ≤ 40 mg/dl, and triglyceride ≥ 150 mg/dl) adjusted by age, sex and BMI were compared. Results: The prevalence of cardiometabolic risk factors is higher in i-IFG group than i-IGT. The mean level of LDL-C is significantly higher in i-IFG than i-IGT group. Conclusions: First degree relatives of T2DM with isolated impaired fasting glucose should probably be included in the primary preventive program for diabetes. However, longitudinal cohort study is required to show high progression of i-IFG to T2DM.

Subjects: This cross-sectional study enrolled 2 523 of adult general population (age > 20 years) of Isfahan city. History taking and thyroid exam was performed by seven trained general practitioners. The concentration of TSH was measured in all, TgAb and TPOAb in approximately one in six and urinary iodine concentration in one fourth of them, randomly. We recalled people with any suspicious abnormality in thyroid exam or whose TSH levels were not normal at present or past. They were re-visited by an endocrinologist to confirm or rule out the diagnosis and second serum sample was obtained to measure T4, T3, T3RU and TSH. Results: Thyroid nodule was identified in 62 (17 men and 45 women) out of 2 523 participants (2.5%; 95% CI: 2-3). Single and multiple nodules were found in 56 (2.2%; 95% CI: 1-2.5) and 6 (0.24%; 95% CI: 0.07-0.5) out of 2523 persons, respectively. The prevalence of nodule was higher in females (3.5%) than in males (1.3%) (OR=2.72, 95% CI, 1.53-5.06, P=0.001). It was significantly higher in patients older than 35 years in comparison with younger people (3.3% vs. 1.3%; OR=2.5; 95% CI, 1.3-4.7; P = 0.002). Conclusion: The prevalence of thyroid nodule in our study is less than what has been reported in other countries. It is due to lower prevalence in female population. Its prevalence in males is similar to other studies. It seems that geographical and racial differences or higher prevalence of deeper location of some nodules in female Isfahani population could explain this finding.

BACKGROUND AND AIMS Vitamin D deficiency is one of the major health problems and unexpectedly has a high prevalence in sunny countries (e.g. Middle East). In this study we determined the prevalence of vitamin D deficiency in pregnant women and their newborns in Isfahan, a sunny city in Iran. METHODS In a cross-sectional study, 88 newborns born in Beheshty hospital, affiliated to Isfahan University of Medical Sciences (August-September, 2005) and their mothers were studied. Their data were collected by questionnaires and blood sampling was done to measure serum alkaline phosphatase (ALP), calcium, phosphorus, 25 (OH) vitamin D and parathormone (PTH). Vitamin D deficiency defined as levels of 25 (OH) D < 20 and < 12.5 ng/ml for mothers and newborns, respectively and local cut-offs defined as levels in which mean serum PTH started to increase. RESULTS The prevalence of vitamin D deficiency according to 25 (OH) D < 20 ng/ml in mothers and < 12.5 ng/ml in newborns was 5.7% and 4.5%, respectively. According to local cut-offs (35 ng/ml for mothers and 26 ng/ml for newborns) 26.1% of mothers and 53.4% of newborns were vitamin D deficient. CONCLUSION According to local definition, vitamin D deficiency is a health problem in pregnant women and their newborns in this sunny city.

Background: Despite long-standing iodine supplementation in Iran, the prevalence of goiter remains high in some areas. This suggests other nutritional deficiencies may be considered as responsible factors for goiter persistence. In the present study we investigated the possible role of vitamin A deficiency (VAD) and low vitamin A status in the etiology of endemic goiter in Semirom, Iran. Materials and Methods: In this cross-sectional study, 1,828 students from 108 primary schools of urban and rural areas of Semirom were selected by multistage random cluster sampling. Thyroid size was estimated in each child by inspection and palpation. Urinary iodine concentration (UIC) and serum retinol (SR) were measured. Results: Overall, 36.7% of schoolchildren had goiter. The median UIC was 18.5 μg/dL. The mean±SD of SR in goitrous and nongoitrous children was 38.84± 10.98 and 39.17±10.85 μg/dL respectively (p=0.82). There were two children with VAD (SR less than 20 μg/dL); one in the goitrous and one in the nongoitrous group. The prevalence of subjects with low vitamin A status (SR less than 30 μg/dL) in the goitrous and nongoitrous groups was 26.2 and 21.5% respectively (p=0.42). Conclusion: Goiter is still a public health problem in this region. Iodine deficiency, VAD or low vitamin A status is not among the contributors of goiter persistence in schoolchildren of Semirom. The role of other micronutrient deficiencies or goitrogens should be investigated.

Background: Iodine deficiency produces the spectrum of iodine deficiency disorders (IDDs): endemic goiter, hypothyroidism, cretinism, and congenital anomalies. Other factors, including goitrogens and micronutrient deficiencies, may influence the prevalence and severity of IDDs and response to iodine supplementation. This cross-sectional, descriptive study was performed in 2003 on elementary school children of Semirom, a mountainous region of Iran, where goiter was hyper-endemic in 1994, but the goiter prevalence had not decreased as expected many years after salt iodization and iodine injection. Some possible risk factors associated with goiter in that area were evaluated, and the results of iron study are presented here. Methods: 1,869 cases were selected by a multistage cluster sampling procedure. Grade 2 goitrous children were compared with equal number of nongoitrous children for serum iron, ferritin, transferrin, thyroxin, TSH and urine iodine concentrations (UIC). Results: 210 children (105 goiter grade 0 and 105 goiter grade 2) entered this sub-study. Of 210 participants, 70 children had low transferrin saturation, 13 had low serum ferritin and 9 children had both problems. There was no significant difference in goiter rate between children with low iron indices and others.There was no significant correlation between serum iron, ferritin or transferrin saturation with other variables including T4, UIC and goiter stage. Conclusion: The present study reveals that in the area studied, iron deficiency cannot explain the high prevalence of goiter, so other responsible factors should be investigated.

Background and purpose: Vitamin A deficiency has been observed in both developed and developing countries, including the Middle East. In this study, the prevalence of vitamin D deficiency was investigated in Isfahani male and female high school students in 2004.Materials and methods : In a cross-sectional study, 318 students (153 boys & 165 girls) aged 14-18 years were selected by multistage random sampling. Data were collected by interview and serum 25-hydroxy vitamin D was measured. Vitamin D deficiency was defined as serum 25-hydroxy vitamin D

Background and Aims: Vitamin D is important for calcium absorption and bone growth. Hypovitaminosis and vitamin D deficiency have been observed in developed and developing countries including several in the Middle East. The prevalence of vitamin D deficiency was investigated in Isfahani male and female high school students in Iran in 2004. Methods: In a cross-sectional study, 318 students (153 boys and 165 girls) aged 14–18 years were selected by multistage random sampling. Data were collected by interview and serum 25-hydroxyvitamin D (25-OHD) and parathyroid hormone (PTH) levels were measured. Vitamin D deficiency was defined as serum 25-OHD Results: The prevalence of vitamin D deficiency according to 25-OHD Conclusions: Vitamin D deficiency is common in high school students, especially in girls. Avoidance of sunshine or inadequate dietary intake of vitamin D may be the main causes.

Background: Tis paper presents the protocol and primary fndings of pregnancy cohort population?based study in Isfahan, Iran. Materials and Methods: In this cohort, 418 pregnant and 438 nonpregnant women were enrolled. In the frst phase, serum concentrations of thyroid?stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid peroxidase antibody, and urinary iodine concentration (UIC) were measured. Furthermore, the thyroid ultrasound was also performed. According to the results of thyroid function tests in the frst phase, local reference range for TSH, FT4, and FT3 in pregnant and nonpregnant women are determined. Te 2.5 th and 97.5 th percentiles are determined as limits of the reference ranges. In the second phase, all pregnant women underwent prenatal care visits in each trimester and they followed for 7 days after delivery and the pregnancy outcomes data are reported. Results: Te mean ± standard deviation for TSH, FT4, FT3, and UIC in the frst trimester of gestation was 1.84 ± 1.32 mIU/L, 1.01 ± 0.15 ng/dL, 4.50 ± 0.64 pmol/L, and 172.0 ± 90.29 ? g/L, respectively. In nonpregnant women, these values for TSH, FT4, FT3, and UIC were 2.58 ± 1.77 mIU/L, 1.10 ± 0.21 ng/dL, 4.49 ± 0.57 pmol/L, and 190.0 ± 109.6 ? g/L, respectively. Conclusions: Te results of the present study could contribute to establish a local thyroid function tests reference ranges in the frst trimester of pregnancy. It could possibly be e?ective on making a local reference value to prevent of thyroid disease misdiagnosis during pregnancy and adverse pregnancy outcomes.

Objective: To determine the urinary iodine excretion of neonates (28 days of age or younger) and their mothers in Isfahan, a centrally located city in Iran, in 1997 after 8 years of iodized salt distribution in an effort to ameliorate iodine deficiency. Methods: Through a cross-sectional study and by means of convenient sampling, 146 mother-neonate pairs were selected among neonates born in Shahid Sadoughi Hospital in Isfahan. In order to eliminate the effect of povidone-iodine on breast milk and urinary iodine, Savlon antiseptic solution was used in normal vaginal delivery and on the umbilical cord. Normal values of urinary iodine concentration for the mothers and their neonates were ≥10.0 µg/dL and >5.0 µg/dL, respectively. The data were analyzed and compared by the Student t test and Pearson correlation coefficient in SPSS software. P values

Background: The link between autoimmune thyroid diseases and Vitamin D deficiency has been reported. However, there are controversies in this regard. We conducted a double-blind randomized placebo-controlled clinical trial to investigate the effect of Vitamin D deficiency treatment on thyroid function and autoimmunity marker (thyroid peroxidase antibody [TPO-Ab]) in patients with Hashimoto's thyroiditis. Materials and Methods: Fifty-six patients with Hashimoto's thyroiditis and Vitamin D deficiency (25-hydroxyvitamin D level ≤20 ng/mL) were randomly allocated into two groups to receive Vitamin D (50000 IU/week, orally) or placebo for 12 weeks, as Vitamin D-treated (n = 30) and control (n = 26) groups, respectively. TPO-Ab, thyroid-stimulating hormone (TSH), parathormone, calcium, albumin, and creatinine concentrations were compared before and after trial between and within groups. The data were presented as mean (standard error [SE]) and analyzed by appropriate tests. Results: Mean (SE) of Vitamin D was increased in Vitamin D-treated group (45.5 [1.8] ng/mL vs. 12.7 [0.7] ng/mL, P = 0.01). Mean (SE) of TPO-Ab did not significantly change in both groups (734 [102.93] IU/mL vs. 820.25 [98.92] IU/mL, P = 0.14 in Vitamin D-treated and 750.03 [108.7] [IU/mL] vs. 838.07 [99.4] [IU/mL] in placebo-treated group, P = 0.15). Mean (SE) of TSH was not changed in both groups after trial, P = 0.4 and P = 0.15 for Vitamin D-treated and control groups, respectively. No significant difference was observed between two study groups in none studied variables (P > 0.05). Conclusion: Vitamin D treatment in Vitamin D deficient patients with Hashimoto's thyroiditis could not have significant effect on thyroid function and autoimmunity.

Insulin resistance is defined as reduction of insulin-stimulated glucose uptake in skeletal muscles and inadequate suppression of the production of endogenous glucose. The aim of this study was to assess the effect of vitamin D intake on insulin resistance in aged patients.This interventional study was carried out on residents of Sadeghieh Nursing Home in Iran. The participants were healthy adults aged ≥ 65. For eight weeks, the participants took pills containing 50,000 IU vitamin D(3) per week. Insulin resistance was defined as homeostasis model assessment of insulin resistance (HOMA-IR)2.5. We used McNemar's test, Wilcoxon test, chi-square, and Pearson correlation coefficient and SPSS software (v. 12) to analyse the collected data.The average age of the 76 participants was 78.7 ± 8 years and 52 of the participants were female. Before and after the study, 37 and four participants had vitamin D deficiency, respectively (p0.001). Impaired fasting plasma glucose (FPG) and insulin resistance was not more prevalent in the participants with vitamin D deficiency. In this study, vitamin D intake had no significant effect on FPG level (p = 0.9), but it increased the prevalence of insulin resistance significantly (p0.001).In our study, before and after the intervention, vitamin D deficiency had no relationship with FPG level and insulin resistance. Vitamin D intake had no significant effect on FPG level, but it increased the prevalence of insulin resistance significantly. We believe that performing more studies, with a longer timespan and larger sample size, as double-blind clinical trials, is necessary.

Considering the different patterns of growth in various societies, an anthropometric evaluation of 6-18-year-old female students was carried out in 1997 in Isfahan, Iran with the goal of establishing height and weight values for use in clinical settings. 4638 female Isfahani students aged 6-18 years were selected by a random cluster sampling. Their height (cm) and weight (kg) were measured and the related percentiles were determined. The results were compared with previous studies in Iran using Student's t-test. Findings show an increase of 6-12 cm in height and of 1-4 kg in weight of Isfahani female 6-18-year-old students as compared with a similar study in 1975. The height curves can be approximately superposed on those of NCHS growth charts, but American girls are significantly heavier than Isfahani girls after the age of 14. The growth parameters among Isfahani female students have improved compared with those of their compatriots and also their fellow citizens 22 years earlier. Improvements in nutrition, health services or other unknown environmental factors may have contributed to an increase in the growth indexes.

Determination of vitamin D status in different age-groups in a community and in different climates of a country is necessary and has important implications for general health. The study was conducted to determine the prevalence of vitamin D deficiency among the adult population of Isfahan, a centrallylocated city in Iran. In this cross-sectional study, 1,111 healthy people-243 men and 868 women-aged 41.4 (mean 14 and range 20-80) years, who attended a single-consultation outpatient clinic, were selected. Serum 25-hydroxy vitamin D (25-OHD), parathyroid hormone (PTH), calcium and phosphorus concentrations were measured. Mild, moderate and severe vitamin D deficiencies were defined as 25-OHD values of 20-30 ng/mL, 10-20 ng/mL, and

This cross-sectional study investigated the prevalence of goitre in Isfahan, a centrally-located city in Iran, 15 years after the initiation of universal salt iodization. In total, 2,523 Isfahani adults (1,275 males, 1,248 females) aged >20 years were selected by multi-stage cluster-sampling method. Goitre rate, serum thyroidstimulating hormone (TSH), thyroxine (T4), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), and urinary iodine concentration (UIC) were measured and compared between the goitrous (n=478) and the non-goitrous (n=2,045) participants. The total goitre rate was 19% (n=478) of the 2,523 adults. The rate of Grade I and II goitre was 12.4% (n=312) and 6.6% (n=166) respectively. The total goitre rate, Grade I and II goitre were more prevalent among women than among men. Hypothyroidism was observed in 6.4% (130/2,045) and 18.6% (89/478) of the non-goitrous and goitrous participants respectively [odds ratio (OR)=3.6, 95% confidence interval (CI) 2.7-4.9, p=0.001]. Hyperthyroidism was present in 0.8% (17/2,045) and 5.2% (29/478) of the non-goitrous and goitrous adults respectively (OR=9.0, 95% CI 4.9-16.6, p=0.001). Hypothyroidism was more prevalent in Grade II than in Grade I goitre and among those without goitre (31.3%, 14.1%, and 6.4% respectively) (p=0.001). Positive TPOAb was observed in 24% (n=50) of the non-goitrous and 33.5% (n=84) of the goitrous subjects (p=0.03). Positive TPOAb was observed in 24.6% (35 of 142) of the Grade I and 45% (49 of 109) of the Grade II goitrous adults (p=0.001). Positive TgAb was observed in 21.6% (n=45) of the non-goitrous and 35.9% (n=90) of the goitrous adults (p=0.001). Positive TgAb was observed in 30.3% (43 of 142) of the Grade I and 43.1% (47 of 109) of the Grade II goitrous adults (p=0.04). The median UIC was 18 μg/dL (range 1-80 μg/dL). It was 17.9 μg/dL and 19 μg/dL in the non-goitrous and goitrous adults respectively. After 15 years of successful universal salt iodization in Isfahan, goitre is still endemic, which may be due to thyroid autoimmunity. However, other environmental or genetic factors may have a role. Key words: Autoimmunity; Cross-sectional studies; Goitre; Hypothyroidism; Hyperthyroidism; Impact studies; Iodine; Iodine deficiency; Iran DOI: 10.3329/jhpn.v28i4.6041 J HEALTH POPUL NUTR 2010 Aug;28(4):351-358

The aim of this study was to investigate the current status of sonographic characteristics of thyroid nodules in Isfahan, a previously iodine deficient area in central Iran.In a cross-sectional study conducted in 2006, 2523 adult people (age20 years) were selected by a multistage clustering sampling method. Of these people, 263 volunteered persons were underwent sonographic evaluation. Thyroid examination was done by two expert sonographers. Serum T(3), T(3), T3RU, TSH, TPO Ab and Tg Ab, and urinary iodine were measured.Forty-six per cent of the 263 people were women. Their mean age was 35.5 years with a range of 20-64 years. Median urinary iodine was 19.4 microg/dL. The prevalence of thyroid nodules on sonography was 22.4% in the whole group; 30% in women and 16.3% in men (OR = 2.2, P = 0.01). The prevalence of thyroid nodules increased with age (P = 0.006). The prevalence of thyroid nodules was higher in hypothyroid people than in euthyroid people (35.1% v. 20.5%, OR = 2.1, P = 0.04). Neither urinary iodine nor autoantibody concentrations correlated with the prevalence of thyroid nodules in sonography.The prevalence of thyroid nodule by sonography is still high despite relatively normal urinary iodine in this population.

Congenital hypothyroidism (CH) is a relatively common metabolic disease in neonates. Until recent years the disorder was usually regarded as occurring in a sporadic manner. Over the past few years, however, a considerable proportion of familial cases have been identified, and possible roles of autoimmune factors suggested. The aim of the present study was to evaluate abnormality of thyroid function tests in first-degree relatives of CH neonates and compared this to the normal population.From 2002 until 2007 thyroid function tests (T4 and thyroid-stimulating hormone [TSH]) were done in randomly selected CH and normal neonates (n= 194 and n= 350, respectively) and their first-degree relatives. Most mothers of the CH neonates and control groups were also evaluated for thyroid peroxidase antibody (TPOAb).Thyroid function test in first-degree relative of neonates with CH (361 parents, 136 siblings) were compared with those in control groups (665 parents, 478 siblings). Abnormal thyroid function tests were found in 85 patients in the CH group versus 96 patients in the control group; hypothyroidism was found in 75 (15.1%) and 57 subjects (5%) person in the CH and control groups, respectively (P0.05). Positive TPO antibody was found in 22 mothers (17.3%) of CH neonates in comparison with 65 mothers (32.5%) of control groups (P0.05). Frequency of hyperthyroidism in parents of control group had trend to be higher than parents of CH neonates (P= 0.05)Familial and genetic components play a role in inheritance of CH, but maternal thyroid autoimmunity may not play an important role in the development of CH in Iran.