Coronary heart disease (CHD) is primarily a disease of occidental culture, being more prevalent in populations that have adopted a high-fat, high-cholesterol diet, who smoke and do not engage in sufficient physical activity. 1 The Islamic religion prescribes fasting during Ramadan for all healthy Muslims for ostensibly moral and spiritual reasons. It may, however, be viewed as an effective model for CHD risk profile modulation.The effect of Ramadan fasting on cardiovascular risk factors is still a matter of debate. Energy intake decreases during Ramadan, 2-5 as do weight 2-5 and body fat percentage. 3,5 The effect of Ramadan fasting on serum lipid profile is not so clear, however. Numerous studies report improvements in serum lipoproteins, while a few report a deterioration in the LDL:HDL cholesterol ratio during Ramadan. 4 There seems to be a reduction in the number of hospitalizations for acute coronary events during the month of Ramadan, 6 although this cannot be entirely or necessarily attributed to the physical restrictions, which the faithful endure during this month.This study was performed to evaluate alterations in CHD risk profile during the holy month of Ramadan. Materials and MethodsNinety-one healthy volunteers aged 20.8±3.1 years from two seminary schools in Rey, south of Tehran, took part in this study during Ramadan 2000 (1442 in the lunar calendar). The sample consisted of 50 men (age 19.9±1.8 years) and 41 women (age 21.9±3.9 years). All participants had the same diet and level of physical activity. Participants fasted from sunrise to sunset for at least 25 days during Ramadan. Dietary intake was recorded using a semi-quantitative food frequency questionnaire on days zero and 14 of fasting. None of the students smoked or was taking any medication at the time of the study.Blood samples were collected twice: first, one week before Ramadan after a 12-hour overnight fast (baseline) and then on the 28 th day of Ramadan, just before sunset. Anthropometric measures were performed at the same time as blood sampling.Biochemical measurements took place at the laboratory of the Endocrine and Metabolism Research Centre, affiliated to the Tehran University of Medical Sciences.Blood samples were centrifuged and the supernatant plasma stored at -25°C. All blood samples were analyzed in a single batch to avoid day-to-day laboratory variation. Glucose, total cholesterol (T-C) and triglyceride (TG) levels were measured by auto-analyser (Hitachi 911, Böhringer Mannheim, Germany) with standard reagents supplied by the company. High-density lipoprotein cholesterol (HDL-C) was measured enzymatically from the supernatant obtained after precipitation of apolipoprotein B-containing lipoproteins (very low-density lipoprotein [VLDL] and LDL) by dextran sulphate and Mg ++ (HDL-Cholesterol kit, Sigma Diagnostics, USA). The intra-assay and inter-assay variation coefficients were less than 1%. Low-density lipoprotein (LDL-C) levels were then calculated using the Friedwald formula (all participants had TG values <400 mg/dl)....
Considerable prevalence of diabetes, susceptibility in progressing to diabetes and uncontrolled diabetes among individuals living in Kerman, suggested ineffective prevention and treatment of diabetes in urban areas in Iran. Successful experience regarding primary health-care in rural areas should be expanded to urban settings.
This study describes the impact of diabetic foot ulcers (DFUs) on health-related quality of life (HRQoL) using a generic instrument including 8 domains. Data were obtained from 54 patients with DFU who were compared with 78 patients who had diabetes without foot ulcer. HRQoL was measured using the Iranian version of Medical Outcome Study-Short Form (SF-36). The fasting plasma glucose, creatinine, glycosylated hemoglobin (HbA1c), and urine microalbumin as well as ankle-brachial pressure index (ABI) were measured for all participants in the 2 groups. In all, 51.9% of patients with DFU had ABI scores of <0.9 compared with only 11.8% of the control group (P < .001). No differences were found in any of the treatment characteristics (oral/insulin therapy) between the 2 groups (case/control). HRQoL evaluated by the SF-36 questionnaire, in particular in the areas of physical function, is lower in patients with diabetes with foot ulcers compared with patients with diabetes without foot ulcers (41.04 ± 22.69 vs 56.67 ± 25.57; P < .01). After adjusting by sex, 2 domains of physical functioning and bodily pain as well as the total HRQoL score in patients with DFU were lower than in patients with diabetes (P < .001). This study showed that physical functioning and bodily pain along with total score of HRQoL were important aspects that were lower in patients with DFU than in patients with diabetes. Gender was considered as a confounding factor, which was omitted in multivariate analysis.
Background: Diabetes mellitus is among the most serious health challenges worldwide. We assessed the prevalence of pre-diabetes (pre-DM) and diabetes (DM), the effectiveness of diabetes management, the 5-year incidence rate, and associated variables in the adult population in southeastern Iran.Methods: In a random cluster household survey (2014–2018), 9,959 adult individuals aged 15–80 years were assessed for coronary artery disease risk factors, including diabetes mellitus in Kerman (KERCADRS, phase 2). Among these people, 2,820 persons had also participated in phase 1 of the study 5 years earlier (2009–2011). Univariable and multivariable survey logistic regression models were used to identify the potential predictors of diabetes and pre-diabetes.Results: The prevalence of pre-DM was 12% (males 13.2% vs. females 11.1%), steadily increasing from 7.1% in the 15–24 years group to 18.4% in the 55–64 years group. The prevalence of DM was 10.2% (male and female, 7.9 and 10.8%, respectively), of which 1.9% were undiagnosed. DM was diagnosed in 10.6% of educated and 15.1% of illiterate people. The prevalence of diagnosed DM was lower in smokers (5.2 vs. 8.7%) and dependent opium users (5.4 vs. 8.8%). The prevalence of uncontrolled DM (HbA1c > 7%) was 48.8%, increasing with age. The frequency of uncontrolled DM among people without and with treatment was 32 and 55.9%, respectively. Illiterate people had worse uncontrolled DM (55.6 vs. 39.6%). The 5-year incidence rate (persons/100 person-years) was 1.5 for pre-DM and 1.2 for DM, respectively. The lowest and the highest incidence rate of DM belonged to the 15–34 years old group (0.5) and dependent opium users (2.4). The incidence rate was found to have a direct relationship with BMI and a reverse relationship with physical activity.Conclusion: Pre-DM and DM affected 22.2% of the population. One-third of patients with diabetes had undiagnosed DM, and in 55.9% of people with diagnosed DM, treatment had been ineffective. Appropriate health interventions are needed to reduce the prevalence and health consequences of diabetes in the region.
abstract:Objectives: Oral and dental manifestations in diabetic patients can arise due to numerous factors, including elevated salivary secretory immunoglobulin A (s-IgA) levels. This study aimed to evaluate s-IgA concentrations in patients with type 2 diabetes mellitus (T2DM) and to investigate the association between s-IgA levels and oral and dental manifestations of T2DM. Methods: This cross-sectional descriptive study was carried out between October 2011 and September 2012 in Kerman, Iran, and included 260 subjects (128 patients with T2DM and 132 healthy controls). Unstimulated salivary samples were collected from all subjects and s-IgA levels were determined using the immunoturbidimetric method. The oral cavities and teeth of T2DM patients were evaluated for oral and dental manifestations. Results: Both diabetic and control subjects with higher concentrations of s-IgA had significantly higher numbers of decayed, missing or filled teeth (DMFT) and periodontal index (PDI) scores (P <0.050). s-IgA levels were significantly higher in subjects with oral candidiasis (P <0.050). Among diabetic patients, significantly higher s-IgA levels were concomitant with xerostomia and denture stomatitis (P ≤0.050). There were no significant differences between s-IgA concentrations and other oral or dental manifestations in either group. Conclusion: Individuals with a greater number of DMFT, a higher PDI score and oral candidiasis had significantly higher s-IgA levels. s-IgA levels were not significantly higher among diabetic patients in comparison to the control group. However, significantly higher s-IgA levels occurred with xerostomia and denture stomatitis in diabetic patients. In addition, s-IgA was significantly higher in patients with uncontrolled diabetes compared to those with controlled diabetes.
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