Background Subclinical hypothyroidism is defined as elevated TSH levels while T4 or FT4 levels are normal. Elevated TSH levels are linked with obesity in adults. In a recent meta-analysis in Iran, 6.1% of children below 18 had obesity. Due to the low number of studies on the subject in children we, designed the study to assess the relation between BMI Z-score and TSH levels in children and adolescence. Method This cross-sectional study was performed in a pediatric endocrinology clinic in Shiraz. Children aged between 2 to 18 years that came to the clinic for routine growth assessment follow up from January till April 2018 were considered. 850 children including 365 boys and 485 girls were included. Results Prevalence of subclinical hypothyroidism is increased in higher BMI groups. 9.9, 13.8, 17.2 and 20.5% of underweight, healthy weight, overweight and obese had subclinical hypothyroidism respectively. Obese and overweight participants had higher odds of subclinical hypothyroidism than those who were not (OR:1.649, P = 0.010, CI95% 1.126–2.413). On the other hand, Subclinical hypothyroid participants had higher odds of overweight or obesity than those who were euthyroid (OR:1.650, P = 0.010, CI95% 1.128–2.413). When TSH is set as a dependent value, TSH level is increased (β = 0.126, r = 0.125, P = 0.001) with an increase in BMI Z-score. When BMI Z-score is set as a dependent value, BMI Z-score is increased (β = 0.113, r = 0.243, P = 0.001) with an increase in TSH level. Conclusion BMI Z-score and elevated TSH levels are positively correlated however studies should be performed on establishing the causality.

Background Heart disease has been the leading cause of death for decades in the US population. Dyslipidemia is the most important risk factor for cardiovascular disease (CVD), and it often starts during childhood. Methods This cross-sectional study was performed in a growth assessment clinic in the city of Shiraz to determine the relation between body mass index (BMI) and dyslipidemia among children and teenagers aged 2–18 years. Nine hundred and eighty-nine children including 422 boys and 567 girls were selected. Results Adjusted for age and gender, total cholesterol (TC) (r = 0.172, p = 0.000), low-density lipoprotein cholesterol (LDL-c) (r = 0.176, p = 0.000), non-high-density lipoprotein cholesterol (non-HDL-c) (r = 0.227, p = 0.000) and triglycerides (TG) (r = 0.253, p = 0.000) showed a significant positive correlation with BMI Z-score, and HDL-c showed a significant negative correlation with BMI Z-score (r = −0.131, p = 0.000). Adjusted for age and gender, overweight and obese children were 1.882 times more likely to have high TC levels (p = 0.009), 2.236 times more likely to have high non-HDL-c levels (p = 0.000) and 3.176 times more likely to have high TG levels (p = 0.000) in comparison with children who had a healthy weight. Obese children had the highest percentage of isolated TG dyslipidemia (23.1%) and underweight children had the highest percentage of isolated HDL dyslipidemia (15.6%). Conclusions There is a strong link between atherosclerotic cardiovascular disease (ASCVD) and the level of blood lipids and between blood lipids and BMI Z-score. The first step in preventing ASCVD is the reduction of blood lipids, preventing weight gain and loss of extra weight.

Background: Zinc and vitamin D are essential factors required for growth. Recently, studies have shown a possible link between serum zinc and vitamin D levels. Objectives: This study was designed to evaluate this link and its possible affecting growth factors in children and adolescents in Iran. Methods: This cross-sectional study was performed on the data obtained from children aged 2 to 18 years old referring to a growth assessment clinic for routine growth follow-ups in the city of Shiraz from April to August 2019. A total of 454 children who were checked for 25-hydroxyvitamin D and zinc simultaneously were included. Results: Vitamin D was negatively correlated with body mass index (BMI) z-scores, while zinc was positively correlated with vitamin D and height z-scores. Subjects with vitamin D levels ≤ 8.6 ng/mL were 2.081 times more likely to have a zinc deficiency. Vitamin D insufficiency was significantly higher in overweight and obese children. Mean vitamin D and zinc levels were significantly lower, and vitamin D insufficiency was significantly higher in boys than girls. While mean zinc levels were significantly lower in short children, the prevalence of zinc deficiency was not statistically different between short and normal height statures. Conclusions: Very low vitamin D levels are likely to be accompanied by zinc deficiency, possibly caused by malnutrition and the modulatory effect of serum vitamin D on zinc absorption. Unlike zinc deficiency, vitamin D insufficiency is much more prevalent in Iranian children than in children from other countries. Vitamin D and zinc are associated with BMI and height z-scores, respectively.

Introduction There is no data on the number as well as the prevalence of congenital hypothyroidism (CH) in the Fars province. Hence, we designed this study to analyze the latest data and the possible predictive factors on transient and permanent CH in this province. Method This cross sectional study is based on the Fars province screening data from 2013 to 2016. A total of 294,214 newborns were screened with 938 confirmed cases of CH, which were included in this study. After recall and completion of the missing data, follow-up data for 642 CH cases with thyroid stimulating hormone (TSH) concentrations and levothyroxine doses for ten outpatient visits and final transient vs. permanent CH diagnosis were included. Results The incidence rate was 1:313.66, and out of the 642 CH cases, 66.04 % had permanent CH, while 33.96 % had transient CH. TSH level trend during the outpatient visits were not statistically different between the two groups (P = 0.312). A cutoff point of > 2.25 levothyroxine µg/kg (sensitivity: 76.11 %, specificity: 58.52 %) at the third year and a TSH concentration of > 43.35 mIU/L at the venous sampling (initial TSH) (sensitivity: 31.66 %, specificity: 90.32 %) were the predictive factors for permanent CH. Conclusion Fars province has one of the highest incidence rate of CH in Iran. Levothyroxine dose at the 3rd year and the 1st venous TSH sample are the predictive factors for permanent CH in the Iranian population; however, TSH concentrations during follow ups are unreliable predictors.

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