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The Tehran cardiometabolic genetic study (TCGS) is a large population-based cohort study that conducts periodic follow-ups. TCGS has created a comprehensive database comprising 20,367 participants born between 1911 and 2015 selected from four main ongoing studies in a family-based longitudinal framework. The study's primary goal is to identify the potential targets for prevention and intervention for non-communicable diseases that may develop in mid-life and late life. TCGS cohort focuses on cardiovascular, endocrine, metabolic abnormalities, cancers, and some inherited diseases. Since 2017, the TCGS cohort has augmented by encoding all health-related complications, including hospitalization outcomes and self-reports according to ICD11 coding, and verifying consanguineous marriage using genetic markers. This research provides an update on the rationale and design of the study, summarizes its findings, and outlines the objectives for precision medicine.

The association between obesity severity and duration with the transition from metabolically healthy obese/overweight (MHO) phenotype to metabolically unhealthy obese (MUO) phenotype is not well understood.This study includes the Tehran Lipid and Glucose Study participants who were initially classed as MHO. Cumulative excess weight (CEW) and cumulative excess waist circumference (CEWC) scores, which represent the accumulation of body mass index and waist circumference deviations from expected values over time (kg/mOver 15 years of follow-up in TLGS, general and central obesity accumulation was associated with the increased transition from MHO to MUO among women participants. More research with a larger sample size is needed to confirm and explain why the results are different for men and women.

Vitamin D metabolism is altered in obese individuals. Our findings indicated that in patients with severe obesity, a relatively low 25(OH)D concentration was required to suppress PTH. The PTH inflection point increased following surgery-induced weight loss, highlighting 25(OH)D different regulation mechanisms in patients with obesity.An optimal and sufficient concentration of 25-hydroxyvitamin D (25(OH)D) has been suggested as the level required to maximally suppress intact parathyroid hormone (iPTH). We evaluated the role of surgery-induced weight loss in determining the threshold(s) of 25(OH)D required to suppress iPTH.This study was conducted in the framework of the Tehran Obesity Treatment Study (TOTS). We prospectively analyzed 687 patients with severe obesity who participated in the TOTS and underwent bariatric surgery from March 2013 to March 2019. The patients were followed for 1 year after surgery. Anthropometric parameters and serum levels of iPTH, 25OHD, phosphorous, and calcium were measured. Nonlinear and piecewise linear regression was used to evaluate the relationship between 25(OH)D and iPTH and to determine the 25(OH)D-suppression point at which iPTH was maximally suppressed.Body mass index was 44.6 kg/mIn patients with severe obesity, PTH was suppressed at a relatively lower concentration of 25(OH)D; this threshold increased following surgery-induced weight loss. These findings suggest a role for bariatric surgery in regulating 25(OH)D metabolism in patients with obesity.

Background: Obesity has increasingly become a health threat in the Middle East and North Africa (MENA) countries. This study aimed to investigate the scientific publications on obesity in the MENA countries during 2008-2020. Methods: A longitudinal analysis of 13 years (2008-2020) of bibliographic data from obesity-related articles was performed. Web of Science core collection (WoS) was searched for bibliographic data. The bibliometric indicators including overall productivity and collaboration along with the prevalence of obesity and socioeconomic status were used to assess and compare the context of obesity research efforts in the MENA region. Results: The overall obesity-related articles of the MENA countries cumulated to 23680 publications. The MENA region accounted for a 6.5% global publication share in obesity research. Turkey contributed the highest rate of total publications (n=6162) followed by Iran (n=5302) and Israel (n=2847). Iran and Turkey had the lowest rates of international collaborations. The overall obesity research was not significantly associated with socio-demographic index (SDI) measure (r=-0.26, P=0.27). No significant association was found between Gross National Income (GNI) per capita and the overall production of obesity research (r=0.41, P=0.08). Additionally, obesity research was not significantly associated with the prevalence of obesity in the countries (r=0.24, P=0.30). Conclusion: This study observed an increased share of scientific productivity in the field of obesity from the MENA countries. Neither SDI, GNI per capita, nor obesity prevalence was not significantly associated with the overall productivity of the region.

Aimed to evaluate the effects of biliopancreatic limb (BPL) length on weight loss, postoperative complications, and remission of comorbidities in OAGB.. An extensive search was conducted in PubMed, Scopus, EMBASE, and Google Scholar databases to find related OAGB articles. Both BPL length 200 cm (by - 17.79, 95% CI - 19.23, - 16.34) and BPL length ≥ 200 cm (by - 14.93, 95% CI - 15.66, - 14.20) significantly decreased BMI. Regarding the effect of BPL length on comorbidities and postoperative complications, it was shown that BPL length 200 cm is safer and more effective. Therefore, standardization of BPL length 200 cm is suggested. Bypassing ≥ 200 cm of the small bowel does not ameliorate weight loss or resolve comorbidities significantly, and it is related to more frequent postoperative complications and nutritional deficiencies. Registration number in PROSPERO: PROSPERO 2021 CRD42021225499.

There is no consensus regarding the optimal bariatric procedure in patients with super obesity [body mass index (BMI) ≥ 50 kg/m2]. This study compared the outcomes of one-anastomosis gastric bypass (OAGB) with those of sleeve gastrectomy (SG) in these patients. This retrospective study was conducted based on the prospectively maintained data in a cohort of 557 patients with super obesity, who underwent either SG (n = 348) or OAGB with a 200-cm BPL (n = 154) or a 160-cm BPL (n = 55) by the same surgical team from March 2013 to 2017. Patients undergoing OAGB had greater weight loss in comparison to those managed by SG during the first, second, and third years of follow-up. Comparing the OAGB and SG groups within 3 years after surgery, the total weight loss was 36.5 vs. 33.2% (P

The Tehran Cardiometabolic Genetic Study (TCGS) is a large population-based cohort study with periodic follow-ups, which created a comprehensive database of 20,367 participants born between 1911-2015 selected from 4 different longitudinal, ongoing, and family-based studies. The study aims to identify the potential targets for prevention and intervention for non-communicable diseases in mid-life and late life. The study focuses on cardiovascular, endocrine, metabolic abnormalities, cancers, and some inherited diseases. Since 2017, the cohort expanded the information by coding all health-related complications (hospitalization outcomes and self-reports) based on ICD11 coding and confirming the consanguineous marriage with genetic markers. This article presents an update on the rationale and design of the study. We also present a summary of our findings and our goals toward precision medicine.

Background Waist circumference (WC) is representative of abdominal visceral fat, which is strongly associated with cardiovascular disease (CVD) and its’ outcomes. We aimed to define WC thresholds predicting incident CVD and all-cause mortality within each body mass index (BMI) categories in Tehran Lipid and Glucose Study. Methods In this prospective cohort study, a total of 3344 men and 4068 women were followed up for 18 years. Participants were categorized based on BMI into BMI 30. The sex-specific WC cut-points within each group were estimated by the maximum value of Youden’s index based on incident CVD and all-cause mortality prediction. Results 667 and 463 CVD incidents (incident rate 3.1 to 4.5 in men and 1.1 to 2.6 in women per 1,000 person-years within BMI categories) and 438 and 302 mortalities (incident rate 2.1 to 2.7 in men and 1.2 to 1.4 in women per 1,000 person-years within BMI categories) were happened in men and women, respectively. WC thresholds were 82, 95, and 103cm based on incident CVD and 88, 95, and 103cm based on all-cause mortality among men in BMI 30, respectively. The respective values for women were 82, 89, and 100cm based on incident CVD and 83, 90, and 99cm based on all-cause mortality in BMI

This study investigates the trajectory of the risk factors of prediabetes progression to overt diabetes.The study retrospectively investigated 1610 prediabetic individuals. The trajectory of metabolic indicators was investigated using the generalized estimated equation method with autoregressive working correlation structure through a linear model with the identity link function.During 15 years of follow-up, the trajectories of metabolic risk factors changed from 3 years before diabetes occurrence for fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG), 6 years for waist circumference (WC), 9 years for high-density lipoprotein cholesterol (HDL-C), and earlier for body mass index, triglyceride (TG), and TG:HDL ratio. It was shown that the differences in the trajectory of WC and HDL were stable after adjustment for other metabolic risk factors. The trajectories of FPG and 2hPG remained stable after considering multiple insulin resistance markers.Deterioration of metabolic risk factor status can be a predictor of diabetes many years before its occurrence, but the abrupt change in plasma glucose is evident 3 years before diabetes mellitus onset. It seems that the HDL-C and WC trajectories are two independent predictors for diabetes incidence. It was also found that when the rising trend in plasma glucose starts, preventive strategies to lessen insulin resistance might not be efficient.背景: 本研究探讨糖尿病前期的危险因素向显性糖尿病发展的轨迹。 方法: 对1610例糖尿病前期患者进行回顾性调查。采用具有自回归工作相关结构的广义估计方程法, 通过具有同一性链接函数的线性模型, 对代谢指标的运动轨迹进行了研究。 结果: 在15年的随访中, 代谢危险因素从糖尿病发生前3年就开始发生改变, 包括空腹血糖(FPG)和2小时血糖(2hPG), 发病前6年腰围(WC)出现改变, 发病前9年高密度脂蛋白胆固醇(HDL-C)出现变化, 以及更早就会变化的体重指数(BMI), 甘油三酯(TG)和甘油三酯(TG)/高密度脂蛋白胆固醇(TG/HDL)。结果表明, 在调整其他代谢危险因素后, WC和HDL的轨迹差异是稳定的。在考虑多个胰岛素抵抗标志物后, 空腹血糖和2hPG的轨迹保持稳定。 结论: 代谢危险因素状态恶化可作为糖尿病发病前多年的预测指标, 但血糖的突然变好在糖尿病发病前3年明显。似乎HDL-C和WC轨迹是糖尿病发病率的两个独立预测因子。研究还发现, 当血糖开始上升时, 减轻胰岛素抵抗的预防性策略可能并不有效。.

To identify the impact of sodium-glucose co-transporter-2Clinical trials investigating the safety and efficacy of SGLT2 inhibitors in overweight or obese adults were sought in PubMed, Scopus, Google Scholar, and EMBASE databases. The overall intervention effect was estimated using a random-effect meta-analysis. Jadad scale was used to assess the risk of bias. The heterogeneity of the studies was assessed using the Cochran's test (Of the five clinical trials that were included in the meta-analysis, five, four, three, and two clinical trials met the eligibility criteria for evaluating the efficacy of SGLT2 inhibitors on the weight, waist circumference (WC) and blood pressure, body mass index (BMI), and lipid and glucose profile, respectively. According to the results, SGLT2 inhibitors lowered BMI (WMD = -0.47 [95% CI: -0.63, -0.31];The SGLT2 inhibitors appear to ameliorate some anthropometric and metabolic markers. There is, however, a limited number of studies, and further research is required for a firm conclusion.CRD42022306415.

Aim: To offer high-quality healthcare services, individuals need to utilize high-quality information. The present study aims to evaluate the data quality in the hospital information system (HIS) at a selected educational hospital. Method: This descriptive and cross-sectional study was conducted in 2018. The statistical population consisted of 202 users of the hospital HIS at Amiralmomenin Hospital in Zabol. The respondents were selected using stratified random sampling. Data were collected using a researcher-made questionnaire. Then, they were analyzed through SPSS-20 and descriptive statistics. Results: It was found that 45 of the respondents stated in the comprehensibility of the hospital information, while 76 considered the hospital information not very understandable. Moreover, 34.7% believed that the hospital information would be rapidly accessible when needed. The average scores of the dimensions were found to be 5-8.5, and there were significant, positive relationships between all the dimensions under the study (P-value

The increasing use of bariatric surgery in adolescents has raised some concerns regarding the postoperative outcomes and the optimal time of surgery at young ages. However, no study has yet compared the weight loss and comorbidity resolution following bariatric surgery between adolescents and young adults. This study was conducted on a case group of adolescents (aged 11–18) and a control group of young adults (aged 19–29) undergoing bariatric surgery (sleeve gastrectomy or gastric bypass). The two groups were matched in terms of gender, body mass index (BMI), and surgery type and were assessed regarding the surgical outcomes at 1 year after surgery. The baseline characteristics of the adolescents (n = 118, mean age: 17.0 ± 1.6 years) and young adults (n = 236, mean age: 25.2 ± 3.2 years) were similar, as well as surgery-associated complications. The mean loss of BMI (− 15.4 ± 3.6 vs. −15.8 ± 4.6 kg/m2) and 12-month percentage of excess weight loss (80.4 ± 20.1 vs. 80.2 ± 20.1%) were similar in the two groups. Both groups showed parallel reductions in the cardiovascular risk factors. The remission of hypertension, diabetes mellitus, and dyslipidemia was similar between the groups. The increase in the hemoglobin level and copper deficiency was greater in young adults, whereas the increase in ferritin deficiency was greater in adolescents. Similar to young adults, bariatric surgery is an effective and safe method to achieve weight loss, resolve obesity-related comorbidities, and improve cardiovascular risk factors in the adolescents.

Bariatric surgery alters the anatomic and physiological structure of the gastrointestinal tract, predisposing patients to the malabsorption of nutrients. The purpose of this study was to determine the prevalence and determinants of secondary hyperparathyroidism (SHPT) in the patients undergoing either one-anastomosis gastric bypass (OAGB) or sleeve gastrectomy (SG).A total of 517 patients (without SHPT at the baseline) who had undergone OAGB or SG were prospectively assessed 1 year after the surgery. Anthropometric parameters, calcium, intact parathyroid hormone (iPTH), and 25(OH)D levels were compared according to the surgery type before and 1 year after surgery. Multiple logistic regression models were used to evaluate possible SHPT predictors after bariatric surgery.The overall prevalence of SHPT was 12.6% after surgery, significantly different between the OAGB and SG groups (17.1 vs. 9.9%, respectively). The serum levels of albumin-corrected calcium and 25(OH)D were not significantly different between the two groups. The patients undergoing OAGB had significantly higher serum levels of ALP (198.2 vs. 156.6) compared to the subjects undergoing SG. Higher iPTH levels preoperatively, lower 1-year excess weight loss%, and OAGB surgery seemed to be independent predictors for SHPT 1 year after surgery.Morbidly-obese patients undergoing OAGB had a higher risk of SHPT than their counterparts undergoing SG, whereas 25(OH)D deficiency and calcium levels did not differ between the two groups. The OAGB procedure, preoperative iPTH levels, and 1-year weight loss were predictors of postoperative SHPT development.

The current gold standard diagnostic method for Cushing disease (CD) is bilateral inferior petrosal sinus sampling (BIPSS) after corticotropin-releasing hormone (CRH) stimulation. Due to shortages of CRH, BIPSS has been performed with desmopressin (DDAVP) instead. The objective of this systematic review and meta-analysis was to estimate the diagnostic accuracy of BIPSS using DDAVP or CRH for the differential diagnosis of Cushing's syndrome (CS). A literature review was done in PubMed, Scopus, EMBASE, and google scholar databases to derive summary estimates of the overall diagnostic sensitivity and accuracy of BIPSS using DDAVP or CRH in Cushing's syndrome. Pooled sensitivity, specificity, diagnostic odds ratio and summary receiver operating characteristic curves (SROC) for differential diagnosis of Cushing's syndrome in the random-effects models, were computed. Overall, 11 different studies with a total of 612 participants, were eligible for the analysis. Five articles with data on BIPSS using DDAVP, 5 papers on BIPSS using CRH, and another one evaluated the results of stimulation using DDAVP, with or without CRH, for differential diagnosis of Cushing's syndrome. The pooled (95% CI) sensitivity and specificity of BIPSS using DDAVP, were 96% (91-98%) and 1.00 (0.00-1.00), respectively. The area under the SROC curve was 0.95. The pooled (95% CI) sensitivity and specificity of BIPSS using CRH, were 98% (92-99%) and 1.00 (0.00-1.00), respectively, and the area under the SROC curve was 0.98. The I

Background: A rise in the global prevalence of severe obesity (body mass index; BMI of ≥35 kg/m2 ) has been reported. In this study, we investigated the trends in the prevalence of severe obesity among Tehranian adults over the past two decades. Methods: A representative sample of 10,045 Tehranians aged ≥19 years were followed from 1999 to 2017. The trends in the prevalence of severe obesity were investigated over six cross-sectional phases with 3.6-year intervals using generalized estimating equations. Results: In this cohort, the overall prevalence of severe obesity increased from 4.6% (1.8% in males and 6.7% in females) in 1999 to 10.1% (4.7% in males and 14.3% in females) in 2017. The persisted rising in prevalence in the youngest age-group in both genders, with the most rapid increase among females aged 19–29 years, plateaued in the older ages and remained unchanged among males aged over 50 years. After age-sex standardized analysis by using Tehranian urban population data, the prevalence rates of severe obesity in Tehranian men and women were estimated to be 1.9% and 5.7% in 1996, and 4.5% and 10.9% in 2016, respectively. Conclusion: A high prevalence of severe obesity among Tehranian adults has been stabilized over the past two decades. Preventive interventions should be focused on the younger and middle-aged population, to mitigate the subsequent burden of severe obesity on Tehranian population and the healthcare system.

This paper suggests a new PSOHHC algorithm for solving the economic dispatch (ED). This algorithm was created by integrating two algorithms: PSO (particle swarm optimization) algorithm, an evolutionary algorithm based on collective intelligence, and a new search algorithm for HHC (Hybrid Hill Climbing) which is based on searching. The aim of presenting this algorithm is to improve the performance of the PSO algorithm in terms of convergence to achieve the best possible solution with the required accuracy. This new algorithm is able to improve the responses obtained from the PSO algorithm with a controllable local search. The most important goal of economic dispatch is the optimal allocation of each generator's contribution to provide the load and reduce the costs of active units in the power system. This is generally due to the nonlinear factors and limitations, such as: the effect of steam inlet valve (valve point effect (VPE)), the balance between the production and consumption of the system, the prohibited operating zones (POZS), production limits, slope rate, and lines' losses. This algorithm is implemented on 3 test systems of 13 units, 31 units and 40 units with different operating conditions, independently and also in combination with the PSO evolutionary algorithm, and simulation results illustrate the efficiency of this algorithm in solving ED problems.

Objective Obesity and related health risk in different obesity phenotypes has always been a controversial subject. The present study was conducted with the aim of investigating the risk of kidney function decline (KFD) incidence in different abdominal obesity phenotypes. Methods In this prospective observational cohort study, 7002 individuals (56.1% female), aged ≥20 years, were followed for the incidence of KFD defined as 40% decline in eGFR. Abdominal obesity was defined based on waist circumference cut-offs ≥89/91 cm for men/women, respectively. Metabolic health was defined as ≤1 criterion of the metabolic syndrome criteria, according to the Joint Interim Statement (JIS) definition. Results At baseline 4273 individuals (61.0%) were abdominally obese, among whom, 1188 (27.8%) belonged to the metabolically healthy abdominal obese (MHAO) phenotype. Totally, 251 incidences of KFD was indicated throughout the 12-year follow-up. After adjusting for the confounding variables, MHAO phenotype was not associated with increased risk of KFD in both males and females. Furthermore, results indicated that hazard ratios (HRs) for incidence of KFD did not increase in males with unhealthy obesity phenotypes. However, females with metabolically unhealthy abdominal obese (MUAO) phenotype had increased risk of KFD. Conclusion Findings of this study indicated that MHAO phenotype was not associated with KFD incidence, regardless of the participants gender. Furthermore, MUAO phenotype was associated with higher risk of KFD only in females. Further studies with longer follow up and larger sample size are needed to shed more light upon the regarded relationship and the influential role of gender.

This study aimed at assessing nutrient adequacy after 1 year in patients who had undergone gastric bypass (GB) surgery or sleeve gastrectomy (SG) and to investigate the association of nutrient adequacy with anthropometric indices. A total of 180 severely obese patients (BMI ≥ 35 kg/m2) were selected among the participants of Tehran Obesity Treatment Study. Nutritional assessments were performed over 3 days of 24-h dietary recall. To evaluate the nutrient adequacy ratio (NAR), the subject’s nutrient intake was divided by the dietary reference intakes. The mean adequacy ratio (MAR) was also determined as the sum of NARs divided by the number of involved nutrients (n = 11). The mean age of SG (67%) and GB (32%) patients was 39.2 ± 12 and 41.4 ± 10 years, respectively. SG patients had more postoperative fat-free mass (52.0 ± 12 kg) than GB patients (49.7 ± 8 kg) (P 80%) and total fat (> 70%) intake was reported. The MAR score showed that almost 45% of the patients had possibly adequate intakes of some nutrients. The adequacy of nutrients was positively associated with fat-free mass (β = 8.67, P

Background and Aim Increased adiposity is associated with insulin resistance and glycemic disturbances. We aimed to determine whether childhood overweight or obesity are independent factors in predicting adulthood dysglycemia (prediabetes or type 2 diabetes). Methods and Results In this population-based cohort study, 1290 normoglycemic subjects aged 3–11 years were followed for incidence of dysglycemia. Cox-proportional hazard models were employed to evaluate the association of obesity and overweight with incidence of dysglycemia by adjustments for age, sex, parental risk factors and baseline individual risk factors. The participants, with a mean age of 7.7 ± 2.5 years, were followed for a median of 14.9 years. During follow up, 158 subjects developed dysglycemia (18 type 2 diabetes, 140 prediabetes), contributing to a total cumulative incidence of 24.7%. The unadjusted HR for developing adult dysglycemia were 1.6 (95% CI; 1.0–2.4) and 1.7 (95% CI; 1.0–3.0) in overweight and obese children, respectively. Further adjustments for age, sex, parental risk factors and baseline individual risk factors changed the results in both overweight and obese children. Conclusion These findings show that overweight or obesity in childhood have no independent role for developing adulthood dysglycemia.

Background The Beck Depression Inventory (BDI) has been frequently employed as a measure of depression in studies of obesity, with the majority of studies reporting an improvement in scores following weight loss after bariatric surgery. However, the effects of different bariatric techniques on depression score improvement is uncertain. Method The study included 685 obese patients who underwent laparoscopic sleeve gastrectomy (SG) (n = 443) or gastric bypass (GB) (n = 242) and completed BDIs at baseline and 1 year after surgery. Results Mean age of the patients was 38.7 ± 10.9 (84.8% female), and mean body mass index (BMI) was 45.1 ± 6.0 kg/m2. One year after surgery, excess weight loss (EWL %) in the GB group was more than the SG group (65.4% vs 62.8% P = 0.02). At baseline, 29.9% of patients had BDI scores in the normal range (0–9), and respectively 32.4 %, 28.3 % and 9.3 % had mild (10–18), moderate (19–29) and sever (+30) depression score; these corresponding values after 1 year were 60.6, 23.2, 11.8 and 4.4%. Overall, BDI scores fell in both surgery groups after 1 year, in the GB group it was 17.2 ± 10.5 vs 11.1 ± 9.6, and for the SG group 16.1 ± 10.2 vs 9.6 ± 8.9. However BDI score change (ΔBDI) was not significantly different between two surgery groups (−6.04 ± 10.6 vs −6.4 ± 9.5, P = 0.149). Conclusion Bariatric surgery had a beneficial effect on weight reduction and BDI score regardless of its type. Further studies with longer follow-up and more samples are needed to clarify the differences between bariatric procedures.

Discrepant results have been demonstrated regarding the cardiovascular (CV) risk of populations with metabolically healthy overweight/obesity (MHO) who were transitioned into metabolically unhealthy states. So, the objective of this systematic review and meta-analysis was to estimate the risk of cardiovascular diseases (CVD) incidence in individuals with transitional MHO phenotype.A literature review was done in PubMed, Scopus, EMBASE, and google scholar databases. Pooled HRs for all fatal and nonfatal CV events were computed using random-effect models for transitional MHOs in general as well as for each sex subgroup separately. This systematic review and meta-analysis included a total of 7 prospective observational studies with a total of 7,720,165 participants, published between 2018 and 2020. The mean follow-up duration of participants was 11.7 (5.5) years. Overall, the transitional MHO individuals had a significant risk of CVD incidence [HR = 1.42, 95% CI (1.24-1.60)]. In addition, in both male and female subgroups, unstable MHO phenotype demonstrated a significant CVD risk and HRs for incident CVD in males and females were 1.51 (1.07-1.96) and 1.71 (1.08-2.34), respectively.Transition from MHO to unhealthy state throughout follow-up elevated the risk of CVD in both male and female groups. This can explain the association between MHO and incidence of CV events especially with longer follow up period.CRD42021270225.

Bariatric surgery has been associated with iron, folate, and vitamin B12 deficiencies, which can lead to anemia. This study compares the incidence of anemia between sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB).Patients from a prospectively collected database of patients with morbid obesity undergoing a primary bariatric procedure from April 2013 to September 2018 were included. Statistical analysis was performed using the general estimation equation. Patients were followed for 6, 12, 24, and 36 months post-surgery.The present study included 2618 patients, of whom 72.3% underwent SG and 27.6% underwent OAGB. The majority of the study population were women (75.7%), and the mean age of the participants was 39.5 ± 11.7 years. At the end of the follow-up, the excess weight loss percentage was 66.15 in the SG group and 75.41 in the OAGB group (P 0.05). The incidence of anemia at 12-, 24-, and 36-month was 16.2, 19.7, and 24.3% in the SG group and 28.4, 37.6, and 56.5% in the OAGB group, showing significantly higher incidence in the OAGB than the SG group ([Formula: see text] 0.001). However, there was no significant difference between the SG and OAGB groups regarding the incidence of iron and vitamin B12 deficiency.The patients undergoing bariatric surgery, especially OAGB, should be closely monitored post-surgery regarding the incidence of anemia, and supplementation in developing countries could be continued even after the first year.

Context Although it is well-acknowledged that gestational diabetes mellitus (GDM) is associated with the increased risks of adverse pregnancy outcomes, the optimal strategy for screening and diagnosis of GDM is still a matter of debate. Objective This study was conducted to demonstrate the noninferiority of less strict GDM screening criteria compared with the strict International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria with respect to maternal and neonatal outcomes. Methods A cluster randomized noninferiority field trial was conducted on 35 528 pregnant women; they were scheduled to have 2 phases of GDM screening based on 5 different prespecified protocols including fasting plasma glucose in the first trimester with threshold of 5.1 mmol/L (92 mg/dL) (protocols A, D) or 5.6 mmol/L (100 mg/dL) (protocols B, C, E) and either a 1-step (GDM is defined if one of the plasma glucose values is exceeded [protocol A and C] or 2 or more exceeded values are needed [protocol B]) or 2-step approach (protocols D, E) in the second trimester. Guidelines for treatment of GDM were consistent with all protocols. Primary outcomes of the study were the prevalence of macrosomia and primary cesarean section (CS). The null hypothesis that less strict protocols are inferior to protocol A (IADPSG) was tested with a noninferiority margin effect (odds ratio) of 1.7. Results The percentages of pregnant women diagnosed with GDM and assigned to protocols A, B, C, D, and E were 21.9%, 10.5%, 12.1%, 19.4%, and 8.1%, respectively. Intention-to-treat analyses satisfying the noninferiority of the less strict protocols of B, C, D, and E compared with protocol A. However, noninferiority was not shown for primary CS comparing protocol E with A. The odds ratios (95% CI) for macrosomia and CS were: B (1.01 [0.95-1.08]; 0.85 [0.56-1.28], C (1.03 [0.73-1.47]; 1.16 [0.88-1.51]), D (0.89 [0.68-1.17]; 0.94 [0.61-1.44]), and E (1.05 [0.65-1.69]; 1.33 [0.82-2.00]) vs A. There were no statistically significant differences in the adjusted odds of adverse pregnancy outcomes in the 2-step compared with the 1-step screening approaches, considering multiplicity adjustment. Conclusions The IADPSG GDM definition significantly increased the prevalence of GDM diagnosis. However, the less strict approaches were not inferior to other criteria in terms of adverse maternal and neonatal outcomes.

Background: The prevalence of metabolic syndrome (MetS) during adolescence has shown an increasing trend. This study aimed to investigate the association of MetS and metabolic phenotypes with a high carotid intima-media thickness (CIMT) in early adulthood in the framework of a large cohort study. Methods: MetS was defined as proposed by Cook, de Ferranti, the National Cholesterol Education Program (NCEP), and the pediatric International Diabetes Federation (IDF). Metabolic phenotypes were defined based on the binary clustering of cardiovascular risk factors. The participants were followed up for 18.2 years. Multivariate-adjusted odds ratios (ORs) were calculated for a high CIMT incidence (≥95th percentile).Results: In this study, 862 adolescents (52.3% males), with the mean age of 13.4±2.2 years, were included. The presence of MetS, based on the definitions proposed by Cook (OR=1.90, 95% CI: 1.01-3.57, P=0.046) and de Ferranti (OR=1.74; 95% CI: 1.04-2.90, P=0.033), was associated with the increased risk of a high CIMT in early adulthood. Metabolic phenotypes, including high waist circumference (WC)/hypertension (HTN), high WC/low high-density lipoprotein-cholesterol (HDL-C), and high triglyceride (TG)/high WC, showed higher risks of a high CIMT. However, these positive associations become insignificant after adjusting for the adulthood BMI, except for the high WC/low HDL-C phenotype (OR=2.04, 95% CI: 1.02-4.11, P=0.044). Conclusion: The high WC/low HDL-C phenotype had a better predictive value and could be used as a simpler alternative for MetS to identify adolescents with a higher risk of high CIMT during early adulthood.

Ideal cardiovascular health (CVH) is associated with a lower risk of developing cardiovascular diseases. This study aims to investigate the association of CVH metrics with carotid intima-media thickness (cIMT) as a marker of subclinical atherosclerosis in young adults. A cross-sectional study was performed on 1295 adults, average age of 29.7 ± 4.0 years, selected among the participants of the Tehran Lipid and Glucose Study (TLGS). The participants were divided into two CVH groups: Ideal CVH and poor/intermediate CVH. Multivariate-adjusted linear regression was used to determine the association of ideal CVH score with cIMT. Multivariate-adjusted odd ratios (ORs) were calculated for high cIMT (≥95%percentile). Also, the independent effects of each ideal CVH metric on cIMT were analyzed. The prevalence of ideal CVH was 9.3% in the studied population, and the mean of cIMT was 0.55±0.09 mm. A 1-point increase in CVH score was associated with a decrease of 0.128 mm (Beta [SE] = -0.128 [0. 002], p

Ideal cardiovascular health (CVH) is associated with a lower risk of developing cardiovascular diseases. This study aims to investigate the association of CVH metrics with carotid intima-media thickness (cIMT) as a marker of subclinical atherosclerosis in young adults. A cross-sectional study was performed on 1295 adults, average age of 29.7 ± 4.0 years, selected from the participants of the Tehran Lipid and Glucose Study. The participants were divided into three groups based on the overall CVH score: ideal, intermediate, and poor CVH. Multivariate-adjusted linear regression was used to determine the association of the CVH score with cIMT. Multivariate-adjusted odds ratios (ORs) were calculated for high cIMT (≥ 95% percentile). Also, the independent effects of each ideal CVH metric on cIMT were analyzed. The prevalence of ideal CVH was 6.4% in men and 12.4% in women, and mean cIMT was obtained 0.53 ± 0.09 mm in men and 0.57 ± 0.08 mm in women. A 1-point increase of the CVH score in men and women was associated with a cIMT decrease of 0.009 and 0.011 mm (men: Beta [SE] = − 0.009 [0.003]; women: − 0.011 [0.007], p

Objective To examine the effects of age, period, and birth cohort on weight and waist circumference (WC) changes among the participants of the Tehran Lipid and Glucose Study from 1999 to 2015. Methods This prospective cohort study included 4895 participants aged ≥ 20 years (41.3% men), who were divided based on sex into eleven 10-year age groups. Analyses were conducted to explicitly assess the effects of age vs. period on weight and WC changes. We also implicitly assessed weight and WC variations regarding different cohorts and period-specific experiences across various age groups. Results Upon 15 years of follow-up, the mean weight of men increased from 75.2 ± 12.3 to 80.5 ± 14.3 kg, and this trend was accompanied by an increase in WC from 88.8 ± 10.9 to 97.8 ± 10.4 cm. Men in all age cohorts tended to have a rise in their weight with aging throughout the follow-up period (coefficient for age: 0.69, 95% CI: 0.45–0.93). Considering WC changes, all age cohorts had a rising trend throughout the follow-up period with aging (coefficient for age: 0.77, 95% CI: 0.57–0.96). Women in all age cohorts tended to have a rise in their weight throughout the follow-up period with aging (coefficient for age: 1.48, 95% CI: 1.28–1.68). Considering the changes of WC, all age cohorts had an ascending trend throughout the follow-up period with aging (coefficient for age: 1.32, 95% CI: 1.14–1.50). Conclusion The rise in weight and WC was strongly age-dependent in both sexes. The men born in the recent birth cohorts and the women born in earlier birth cohorts had the most alarming weight and WC gains. More efforts must be spent on obesity prevention policies, especially for younger men.

BackgroundRegarding the inconclusive results of previous investigations, this study aimed to determine the association between pathology, as a possible predictor, with remission outcomes, to know the role of pathology in the personalized decision making in acromegaly patients.MethodsA retrospective cohort study was performed on the consecutive surgeries for growth hormone (GH) producing pituitary adenomas from February 2015 to January 2021. Seventy-one patients were assessed for granulation patterns and prolactin co-expression as dual staining adenomas. The role of pathology and some other predictors on surgical remission was evaluated using logistic regression models.ResultsAmong 71 included patients, 34 (47.9%) patients had densely granulated (DG), 14 (19.7%) had sparsely granulated (SG), 23 (32.4%) had dual staining pituitary adenomas. The remission rate was about 62.5% in the patients with SG and DG adenomas named single staining and 52.2% in dual staining groups. Postoperative remission was 1.53-folds higher in the single staining adenomas than dual staining-one (non-significant). The remission rate was doubled in DG group compared to two other groups (non-significant). By adjusting different predictors, cavernous sinus invasion and one-day postoperative GH levels decreased remission rate by 91% (95% CI: 0.01–0.67;p = 0.015) and 64% (95% CI: 0.19–0.69;p ConclusionVarious pathological subtypes of pituitary adenomas do not appear to have a predictive role in estimating remission outcomes. Cavernous sinus invasion followed by one-day postoperative GH is the strongest parameter to predict biochemical remission.