BMI variability and incident diabetes mellitus, Tehran Lipid and Glucose Study (TLGS).

Previous epidemiologic studies debated the association of body mass index (BMI) trends with cardiovascular disease and mortality. This study aimed to evaluate the association of BMI variability and slope with the incidence of Type 2 diabetes mellitus (T2DM) in a sex-stratified 15.8-year follow-up in the population-based Tehran Lipid and Glucose Study (TLGS). Of 10,911 individuals aged 20-60 years, 4981 subjects were included and followed for 15.8-years. The slope coefficient of BMI in the linear regression model represented individuals' BMI trends up to the incidence of DM. The root mean squared error (RMSE) of the BMI linear trend was selected to reflect BMI variability through six follow-ups. Cox proportional hazards regression was used to investigate the association of the baseline BMI, BMI slope and RMSE with the incidence of T2DM among men and women. Multivariable-adjusted HRs of T2DM for each SD increment in BMI slope was 1.18 (95% CI: 0.94-1.48, p = 0.161) in normal weight men and 1.26 (95% CI: 1.10-1.44, p = 0.001) in overweight and obese men. However, in women, each SD increment in BMI slope increased the risk of T2DM with a HR of 1.19 (95% CI: 1.01-1.40, p = 0.039) in normal weight, and 1.14 (95% CI: 1.08-1.19, p < 0.001) in women with BMI ≥ 25 kg/m2. In men with a baseline BMI ≥ 25 kg/m2, BMI-RMSE was associated with a decreased risk of T2DM (HR: 0.71, 95% CI: 0.53-0.93, p = 0.015). Baseline BMI was not associated with the risk of diabetes in men and women. Positive BMI slope is associated with the development of diabetes in both sexes. The association of BMI variability with incident T2DM differs according to sex and baseline BMI. BMI variability is associated with a lower risk of T2DM in overweight and obese men. BMI variability in women and baseline BMI in both gender are not related to the risk of T2DM.

Comparison of Kidney Transplantation Outcomes Between Patients with and Without Pre-transplantation Bariatric Surgery: a Systematic Review.

This systematic review evaluated the impact of bariatric surgery, performed to improve eligibility for kidney transplantation, on post-transplantation outcomes. A systematic literature search was performed for articles published by 30 January 2022. A total of 31 studies were included. Among patients without pre-transplantation bariatric surgery, 18 studies reported 13.7% graft loss and 9.1% mortality within 5 years' post-transplantation. Among recipients with pre-transplantation bariatric surgery, 15 studies reported 8.7% graft loss and 2.8% mortality within 1 month to over 5 years' post-transplantation. Two case-control studies comparing post-transplantation outcomes between recipients with and without prior bariatric surgery demonstrated no significant differences between groups for graft loss, patient mortality, delayed graft function, wound complications and lymphocele. Non-randomized selection of patients and different lengths of follow-up limit the results of this study.

Efficacy and safety of acetylcysteine for the prevention of liver injury in COVID-19 intensive care unit patients under treatment with remdesivir.

Aim: The present double-blinded placebo-controlled randomized clinical trial evaluated prophylactic use of acetylcysteine for the prevention of liver injury in patients with severe COVID-19 pneumonia under treatment with remdesivir. Background: Liver injury is reportedly common in patients with severe COVID-19 pneumonia and can occur not only as a result of disease progression, but as an iatrogenic reaction to remdesivir. Methods: A total of 83 adult patients with severe COVID-19 pneumonia were randomly assigned in parallel groups to receive either acetylcysteine or placebo. All the patients received standard care according to institutional protocols, including remdesivir for a total of five days. One gram acetylcysteine was administered intravenously every 12 hours for 42 patients, and 41 patients received the same volume of 0.9% sodium chloride as placebo (Trial Registration: www.irct.ir identifier, IRCT20210726051995N1). Results: After 5 days, median aspartate transaminase (AST) and alanine transaminase (ALT) levels were significantly lower in the acetylcysteine than in the placebo group. Of those who received the placebo, 30 (73.2%), 4 (9.7%), and 3 (7.3%) patients had serum AST levels elevated between 1-2.5, 2.5-5, and over 5 times the upper limit of normal (ULN), respectively; while in the acetylcysteine group, 33 (78.6%) and 0 patients had AST levels between 1-2.5 and over 2.5 times ULN, respectively (p-value=0.037). In the acetylcysteine group, 23 (54.8%), 1 (2.4%), and 1 (2.4%) patient had serum ALT levels elevated between 1-2.5, 2.5-5, and over 5 times ULN, respectively; in the placebo group, however, 24 (58.5%), 7 (17.1%), and 1 (2.4%) patient had serum ALT levels between 1-2.5, 2.5-5, and over 5 times ULN, respectively (p-value=0.073). Conclusion: Intravenous administration of acetylcysteine significantly prevents liver transaminases elevation and liver injury in seriously ill COVID-19 patients treated with remdesivir.

Comparison of mid-term effectiveness and safety of one-anastomosis gastric bypass and sleeve gastrectomy in patients with super obesity (BMI ≥ 50 kg/m2).

PURPOSES: 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. METHODS: 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. RESULTS: 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 < 0.001) and the ΔBMI was 20.1 vs. 18.1 kg/m2 (P < 0.001), respectively. The resolution of diabetes mellitus, hypertension and dyslipidemia were similar after the two procedures. The operative time and length of hospital stay were longer in the OAGB group, and incidence of complications, requiring either readmission or reoperation, was significantly higher after OAGB, in comparison to SG. There was no significant difference in the postoperative weight loss results, resolution of comorbidities, or the incidence of complications between the OAGB-160 and OAGB-200 groups, with the exception of protein-calorie malnutrition requiring revision surgery, which was exclusively observed in the OAGB-200 group. CONCLUSION: Although OAGB provides superior mid-term weight loss, SG remains the first option for patients with super obesity, due to the safer surgical profile and comparable metabolic improvement.

Predictive Factors of Cholelithiasis After Prophylactic Administration of Ursodeoxycholic Acid Following Laparoscopic Bariatric Surgery: Tehran Obesity Treatment Study.

PURPOSE: Cholelithiasis is a well-known consequence of obesity as well as rapid weight loss especially after bariatric surgery. A routine postoperative course of ursodeoxycholic acid (UDCA) is recommended as a prophylactic measure against gallstone formation. However, the efficacy of UDCA after bariatric surgery and predictors of cholelithiasis despite prophylaxis are not well understood. We assessed the incidence and predictors of de novo cholelithiasis after bariatric surgery in patients who received UDCA prophylaxis. METHODS: Uniform data from 2629 consecutive patients who underwent either sleeve gastrectomy or gastric bypass between March 2013 and 2018 were collected prospectively. All patients received a 6-month course of UDCA 300 mg twice daily. Cholelithiasis was assessed with abdominal ultrasound at baseline as well as 6, 9, 12, 18, and 24 months postoperatively. The association between cholelithiasis and its predictors was examined by Cox proportional hazards models and restricted cubic spline regression. RESULTS: The cumulative rate of cholelithiasis in 24 months after surgery was 10.8% (n = 283) with the greatest incidence within the first year. After multivariate analysis, 6-month body mass index (BMI) loss was found to be the only independent predictor for postoperative cholelithiasis (HR = 1.10 [95% CI: 1.04-1.16]). The concordance index for predicting cholelithiasis was 0.60 (0.56-0.64) for 6-month BMI loss. CONCLUSION: Early postoperative rapid weight loss as represented by 6-month BMI loss is the main predictor of de novo cholelithiasis after bariatric surgery, although this parameter does not have enough power for discrimination of postoperative cholelithiasis.

Wrist circumference as a novel predictor of transition from metabolically healthy to unhealthy phenotype in overweight/obese adults: a gender-stratified 15.5-year follow-up.

BACKGROUND: Individuals with transition from metabolically healthy overweight/obese (MHO) to metabolically unhealthy overweight/obese (MUO) phenotype are significantly predisposed to greater risks of cardiovascular events compared to those with a persistent MHO phenotype. The aim of this study was to evaluate the predictive performance of wrist circumference for this transition in adults over a 15.5-year follow-up. METHODS: We included 309 males and 821 females with the age of ≥18 years old, body mass index ≥25 kg/m2, and metabolically healthy status according to the criteria of the Joint Interim Statement. The incidence of MUO phenotype was evaluated for each gender, across tertiles wrist circumference, using Cox-proportional hazard models. RESULTS: The overall rate of transition from MHO to MUO phenotype was 87.1% in males and 77.5% in females. The hazard ratios (HRs) with 95% CI across second and third tertiles of wrist circumference were 0.89 (0.64-1.24) and 1.31 (0.99-1.73) in men (P for trend =0.027); and 1.34 (1.09-1.66) and 1.61 (1.30-2.00) in women (P for trend <0.001), respectively. After multivariable adjustment, HRs across second and third tertiles of wrist circumference were 0.92 (0.64-1.32) and 1.18 (0.83-1.67) in males (p for trend =0.352), and 1.32 (1.05-1.65) and 1.34 (1.06-1.96) in females (p for trend =0.025), respectively. CONCLUSIONS: Wrist circumference significantly predicts the transition from MHO to MUO phenotype in adults of both genders. However, it is an independent predictor of the transition only in females. Future studies are warranted to clarify the role of wrist circumference mechanisms on metabolic risk deterioration.

Sex disparity in laparoscopic bariatric surgery outcomes: a matched-pair cohort analysis.

Men have been historically considered to be higher-risk patients for bariatric surgery compared to women, the perception of which is suggested to be a barrier to bariatric surgery in men. The purpose of this study is to conduct a matched-pair analysis to evaluate sex disparities in laparoscopic bariatric surgery outcomes. Data on patients who underwent laparoscopic bariatric surgery from March 2013 to 2017 was collected prospectively. Then, 707 men and 707 women pair-matched for age, preoperative body mass index (BMI) and the procedure type (i.e., sleeve gastrectomy, Roux-en-Y, or one-anastomosis gastric bypass) were compared in terms of weight loss, remission of obesity-related comorbidities, and postoperative complications classified according to the Clavien-Dindo classification. There was no difference between the two sexes regarding the operation time, bleeding during surgery and length of postoperative hospital stay. We observed similar total weight loss, BMI loss, and percentage of excess BMI loss at 12, 24, and 36 months postoperatively between men and women, with no difference in remission of diabetes mellitus, hypertension and dyslipidemia at 12 months. The rate of in-hospital, 30-day and late complications according to Clavien-Dindo classification grades was similar between men and women. Our matched-pair cohort analysis demonstrated that bariatric surgery results in comparable short- and mid-term efficacy in men and women, and is associated with similar rate and severity of postoperative complications between sexes. These findings suggest bariatric surgeons not to consider sex for patient selection in bariatric surgery.

Holmium LASER in Comparison with Transurethral Resection of the Bladder Tumor for Non-muscle Invasive Bladder Cancer: Randomized Clinical Trial with 18-month Follow-up.

PURPOSE: To evaluate the safety and efficacy of holmium LASER resection of the bladder tumor (HoLRBT) vs. transurethral resection of bladder tumor (TURBT) as the first treatment modality for non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: Eighty-eight patients with primary non-muscle invasive bladder cancer were allocated randomly in two groups who were treated with HoLRBT or TURBT. The intraoperative and postoperative characteristics and complications of the HoLRBT and TURBT groups were compared. The data of operation time, obturator nerve reflex rate, bladder perforation, bladder irrigation, catheterization time, hospital stay, and 1, 3, 6, 12, 18 months recurrence free survivals were considered in two groups. RESULTS: There was not significant difference in operative duration among the two groups. Compared with the TURBT group, HoLRBT group had less intraoperative and postoperative complications, including obturator nerve reflex, transient hematuria and postoperative bladder irritation. There were no significant differences among the two groups in the transfusion rate and occurrence of urethral strictures. Patients in the HoLRBT group had less catheterization and hospitalization time in comparison to those in the TURBT group. There were no significant differences in the overall recurrence rate among the TURBT and HoLRBT groups. CONCLUSION: HoLRBT can be regarded as a safe and efficient method with several advantages over TURBT. HoLRBT can be used as an alternative procedure for TURBT in patients with non-muscle invasive bladder cancer.

Development of a risk prediction model for early discrimination between permanent and transient congenital hypothyroidism.

OBJECTIVE: To develop a risk prediction model for early discrimination between transient and permanent congenital hypothyroidism (CH). DESIGN AND SETTING: In a retrospective cohort, 1047 confirmed CH neonates, from 15 randomly selected provinces in Iran, were entered to the study. Clinical and biochemical information of transient and permanent cases, distinct at the age of 3 years were retrospectively gathered. RESULTS: Among CH neonates, the overall prevalence of permanent CH was 57.1%. Using forward stepwise multivariable logistic regression analysis, confirmatory venous TSH, total T4 < 8.2 ng/dl, requiring levothyroxine dosage increase, venous TSH ≥ 10 mU/l between 6 and 12 months of age, parental consanguinity and family history of thyroid diseases were associated with increased risk of permanent CH. The prediction model achieved a very good power in discriminating patients with transient and permanent CH with an optimism-corrected area under the ROC curve of 0.86 (95% CI:0.84-0.88) with a very good calibration. Integrated discrimination improvement (IDI) test indicated significantly greater diagnostic performance of the model compared to serum TSH alone. CONCLUSIONS: Using several potential predictors for permanent CH, we developed a relatively powerful risk prediction model as a cost-saving screening tool in order to avoid unnecessary long-term treatment of transient cases which might empower clinicians for prognostication of the CH course and tailoring treatment up to 1 year of age.

Improving early urinary continence recovery after radical prostatectomy by applying a sutureless technique for maximal preservation of the intrapelvic urethra: A 17-year single-surgeon experience.

BACKGROUND: There is a growing concern about postsurgical outcomes of radical prostatectomy, especially in the younger population and patients with earlier tumor stages. Here, we present our 17 years' experience of sutureless vesico-urethral alignment after radical prostatectomy with a focus on postoperative functional urinary outcomes. METHODS: Data of 784 patients who underwent radical prostatectomy during 2001-2017 were evaluated retrospectively. Before surgery, patients' demographic information, pathologic stage, margin of surgery, prostate-specific antigen, and Gleason score were obtained. Then, serum prostate-specific antigen level, urinary continence, potency, and other functional outcomes of surgery were recorded after each postoperative visit. RESULTS: The mean age (±standard deviation) of patients was 61.3 (±6.30) years. The median (IQ25-75) duration of follow-up was 30 (12-72) months. Full continence was achieved in 90% and 95.9% of patients at 3 and 6 months post surgery and 96.4% of the patients were continent at the last follow-up visit. Bladder neck stricture occurred in 167 patients (21.3%). During the follow-up period, none of the patients complained of total incontinence and at the last visit, 36.6% of patients reported potency. The frequency of grade 2 continence was significantly higher in patients with high-stage tumors (T3/T4), high Gleason score (⩾8), high preoperative serum prostate-specific antigen (>20 ng/dL), and positive margin of surgery. Potency had a significant relationship with age, stage of the disease, and preoperative prostate-specific antigen. CONCLUSION: Maximal sparing of intrapelvic urethral length through sutureless vesico-urethral alignment technique results in excellent early urinary continence recovery after radical prostatectomy. A more advanced tumor stage (T1/T2), a higher Gleason score, high preoperative prostate-specific antigen, as well as positive surgical margin are risk factors of postoperative incontinence in patients who undergo radical prostatectomy.

Trends in the Prevalence of Severe Obesity among Tehranian Adults: Tehran Lipid and Glucose Study, 1999-2017.

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.

Comparing the Efficacy and Safety of Roux-en-Y Gastric Bypass with One-Anastomosis Gastric Bypass with a Biliopancreatic Limb of 200 or 160 cm: 1-Year Results of the Tehran Obesity Treatment Study (TOTS).

PURPOSE: One-anastomosis gastric bypass (OAGB) has raised concerns about nutritional complications possibly attributed to the biliopancreatic limb (BPL) length. We aimed to assess the results of a conservative approach of OAGB compared with the original OAGB and Roux-en-Y gastric bypass (RYGB) in a 1-year follow-up study. MATERIALS AND METHODS: This retrospective study was conducted based on prospectively maintained data in a cohort of patients who underwent either RYGB with a Roux limb of a 150 cm and a BPL of 50 cm (n = 145), OAGB with a 200-cm BPL (n = 272), or OAGB with a 160-cm BPL (n = 383), from March 2013 to 2017 at three university hospitals by a single surgical team. RESULTS: Groups were comparable regarding age and sex. Mean preoperative body mass indexes of the RYGB, OAGB-160, and OAGB-200 groups were 44.5 ± 5.8, 45.6 ± 6.3, and 46.7 ± 6.4 kg/m2, respectively. One-year follow-up rates were 83.4%, 85.3%, and 82.5% for the RYGB, OAGB-200, and OAGB-160 groups, respectively. One-year percent total weight loss values were 33.8 ± 6.7 after OAGB-160 and 35.3 ± 6.9 after OAGB-200 (P = 0.056), which were significantly greater compared with 30.9 ± 8.9 after RYGB (P < 0.001). All groups were comparable regarding remission of type 2 diabetes mellitus, hypertension, dyslipidemia, and fatty liver. Mean operative time was longer with RYGB than with either OAGB techniques. Groups were comparable for postoperative complications except for the incidence of protein-calorie malnutrition (PCM), occurring in 11 patients (4.7%) after OAGB-200, 7 of whom required revisional surgery, in one patient (0.3%) after OAGB-160 who responded to parenteral alimentation, but in no patients after RYGB. CONCLUSION: After 1 year, OAGB with a 160-cm BPL was as effective as OAGB with a 200-cm BPL and RYGB, but safer than OAGB-200. This approach also avoided the need for revisional surgery following postoperative malnutrition.

Factors Predicting Prostate Specific Antigen Failure Following Radical Prostatectomy: Experience with 961 Patients.

OBJECTIVE: To determine disease-related predictors for the occurrence of prostate specific antigen (PSA) failure in Iranian prostate cancer patients who underwent radical prostatectomy. METHODS: In this cohort study, we enrolled eligible patients with prostate cancer who underwent radical prostatectomy at our center between 2001 and 2018. The primary endpoint was the incidence of postoperative biochemical failure, defined as two consecutive PSA levels >= 0.2 ng/dl. Patients with TNM stage >= III, Gleason score >=8, or baseline PSA above our calculated cut-off level were considered as high risk. Kaplan-Meier survival method and Cox proportional hazards regression analysis were used for determining the biochemical relapse-free survival and its predictors. RESULTS: Data of 959 patients (age=61.2 ± 6.4 years) were analyzed with a median follow up of 36 months (range 6 months to 18 years). A total of 97 patients (10.1%) developed biochemical failure at the time of analysis who had a significantly older age and longer follow-up duration (P=0.024 and P<0.001, respectively). Preoperative PSA level of 8.85 mg/dl could predict the occurrence biochemical failure with a sensitivity of 83.2% and specificity of 39.2% (Area under the curve=0.601, 95% CI: 0.541-0.662; P=0.001). In the multivariate analysis, higher preoperative PSA, Gleason score?8, and high-risk TNM stage were independent predictors for biochemical relapse (P=0.029, P=0.001, and P=0.008, respectively). CONCLUSION: Preoperative PSA, Gleason score, and TNM stage were independent predictors for biochemical failure following radical prostatectomy in prostate cancer patients. We also determined a lower cut-point for PSA that could predict biochemical failure.

The Relationship Between Preoperative Kidney Function and Weight Loss After Bariatric Surgery in Patients with Estimated Glomerular Filtration Rate ≥ 30 mL/min: Tehran Obesity Treatment Study.

INTRODUCTION: Severe obesity can lead to progressive kidney injury and chronic kidney disease (CKD). The current study aimed at determining whether preoperative kidney function level in patients with estimated glomerular filtration rate (eGFR) ≥30 mL/min affects weight loss after bariatric surgery. METHODS: A total of 1958 bariatric patients underwent laparoscopic sleeve gastrectomy and gastric bypass from March 2013 to March 2017. The patients were categorized according to preoperative eGFR (30-59, 60-89, 90-124, and ≥ 125 mL/min). Changes in body mass index (BMI), percentage of total weight loss (TWL%), and percentage of excess weight loss (EWL%) were compared across the eGFR categories. Moreover, multivariable logistic regression analysis was used to evaluate the relationship between eGFR and insufficient weight loss (defined as not achieving 50% EWL at 12 months after surgery). RESULTS: Preoperative eGFR was positively associated with unadjusted ΔBMI (P trend < 0.001), TWL% (P trend < 0.001), and EWL% (P trend = 0.007) after 12 months of surgery. However, these associations were no longer significant after multivariable adjustment. Further, univariate analysis demonstrated a positive relationship between preoperative eGFR and insufficient weight loss (odds ratio [OR] 1.38; 95% confidence interval [CI] 1.11-1.71; P = 0.004). By contrast, preoperative eGFR was not a predictor of insufficient weight loss in multivariable logistic regression analysis (OR 0.98; 95% CI 0.46-1.24; P = 0.886). CONCLUSION: Although patients with lower preoperative eGFR experience less weight loss after bariatric surgery, preoperative kidney function does not appear to have an independent impact on postoperative weight loss in patients with eGFR ≥ 30 mL/min.

Predictive performance of lipid accumulation product and visceral adiposity index for renal function decline in non-diabetic adults, an 8.6-year follow-up.

BACKGROUND: Lipid accumulation product (LAP) and visceral adiposity index (VAI) are surrogates for visceral adiposity dysfunction. Our aim was to evaluate potential association of these two indices with the incidence of renal function decline. METHODS: We included 6693 non-diabetic adults age ≥ 18 years, with estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2, from the Tehran Lipid and Glucose Study 2002-2005 survey. Natural logarithmic transformation (Ln) was applied for LAP and VAI measures. The incidence of renal function decline, defined as eGFR < 60 ml/min/1.73 m2, was evaluated for each gender, across tertiles of Ln LAP, Ln VAI, body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR) and waist to hip ratio (WHR), using Cox-proportional hazard models. RESULTS: Over a median 8.6 years of follow-up, 1670 new cases of renal function decline were identified (incidence rate 3.2%). After multivariable adjustment, the hazard ratios (HRs) with 95% CI across second and third tertiles of Ln LAP were 1.14 (0.86-1.50) and 1.33 (1.00-1.78) in men (P trend = 0.132); and 1.16 (0.90-1.50) and 1.24 (0.96-1.61) in women (P trend = 0.263), respectively. Multivariable adjusted HRs across second and third tertiles of Ln VAI were 1.40 (1.08-1.83) and 1.35 (1.02-1.78) in men (P trend = 0.031); and 0.93 (0.75-1.15) and 1.15 (0.93-1.41) in women (P trend = 0.072), respectively. HRs across tertiles of BMI, WC, WHtR and WHR were not significant for renal function decline among both genders in any adjustment models. CONCLUSION: Among the adiposity indices assessed in this study, VAI seems to be an independent predictor of renal function decline only in males.

Comparison of the Modification of Diet in Renal Disease Study and Chronic Kidney Disease Epidemiology Collaboration Equations for Detection of Cardiovascular Risk: Tehran Lipid and Glucose Study.

OBJECTIVES: The study aimed to compare the Modification of Diet in Renal Disease Study (MDRD) and the Epidemiology Collaboration (CKD-EPI) equations for the detection of cardiovascular risk. METHODS: Data of 9,970 Tehranian participants aged ≥ 20 years were analyzed. The prevalence of cardiovascular disease (CVD), its risk factors, and 10-year atherosclerotic cardiovascular disease (ASCVD) risk were compared across the categories of glomerular filtration rate based on the MDRD and CKD-EPI equations. Chronic kidney disease (CKD) was defined as the estimated Glomerular Filtration Rate (eGFR) < 60 mL/min/1.73 m2 according to each equation. RESULTS: The prevalence of CKD weighted to the 2016 Tehranian urban population was 11.0% (95% confidence interval: 10.3 - 11.6) and 9.7% (9.1 - 10.2) according to the MDRD and CKD-EPI equations, respectively. Besides, 8.3% and 1.5% of the participants with CKDMDRD and non-CKDMDRD were reclassified to non-CKDCKD-EPI and CKDCKD-EPI categories, respectively. Participants with CKDCKD-EPI but without CKDMDRD were more likely to be male and older, and more frequently had diabetes, hypertension, dyslipidemia, and CVD, when compared to those without CKD according to both equations; they were also more likely to be male, older, and smokers, and had less dyslipidemia and more CVD, when compared to those with CKD by using both equations. In multivariate logistic regression analysis, compared to CKDMDRD, the odds of CKDCKD-EPI were significantly higher for older age and lower for the female gender. CONCLUSIONS: Compared to MDRD, the CKD-EPI equation provides more appropriate detection of cardiovascular risk, which is caused by the reclassification of older individuals and fewer females into lower eGFR categories.

Audit of the Congenital Hypothyroidism Screening Program in 15 Provinces of Iran.

BACKGROUND: The newborn screening (NBS) program for congenital hypothyroidism (CH) was launched on a national scale in Iran since 2005; we evaluated the program in 15 provinces, from 2011 to 2014. METHODS: Fifteen provinces, including 17 districts, were included in the study. Aggregated data of screening, diagnosis, and management of all neonates born in each district in 2011 were retrospectively gathered and collectively analyzed. RESULTS: Program coverage ranged from 77 to 100% in different districts. The positive predictive value was low and widely ranged from 1.3 to 15.5. Transient congenital hypothyroidism (TCH) distribution values were over 5 mU/L in more than 3% of the population and were reported in 9 out of 17 districts. Repeated screening test due to inappropriate sampling varied from 0.9% in Lorestan to 36% in Zabol. Recall rate varied from 0.16 in Ardebil to 1.58 in Zanjan. CH incidence was high, with the highest value being observed in Zanjan (1:241 newborns). Screening age at 3-5 days from birth were highly observed in Gonabad (95.2%) and Zanjan (94.5%), with the lowest values observed in Giroft, Zabol, Kerman and Tehran. CH treatment was initiated before 40 days of age in 90.6% of cases. Survival time for TSH normalization event varied among the districts from 25 to 163 days. After withholding treatment at 3 years of age, TCH was identified in 30%-60% of hypothyroid cases. CONCLUSION: Main indicators of the screening program have reached the optimal goals defined by the Ministry of Health and Medical Education. However, high false positive rate and non-optimal neonatal TSH distribution values necessitate readdressing these challenging issues.

Protein-Calorie Malnutrition Requiring Revisional Surgery after One-Anastomosis-Mini-Gastric Bypass (OAGB-MGB): Case Series from the Tehran Obesity Treatment Study (TOTS).

INTRODUCTION: One-anastomosis-mini-gastric bypass (OAGB-MGB) is the second most popular gastric bypass procedure with remarkable weight loss results and comorbidity resolution rates. However, some concerns remain regarding its postoperative complications, including protein-calorie malnutrition (PCM). We hereby report our experience with patients who returned with severe PCM after OAGB-MGB. METHODS: Patients with severe obesity presenting to our referral bariatric center underwent OAGB-MGB surgery using a 200-cm biliopancreatic limb (BPL) by a single surgical team at three university hospitals from March 2014 to February 2016. RESULTS: From 189 patients undergoing OAGB-MGB, seven patients (3.7%), all female, with a mean age of 46.4 ± 8.2 years and initial body mass index (BMI) of 44.2 ± 4.7 kg/m2, were readmitted for signs of PCM. Lower extremity edema, fatigue, excessive weight loss, hypoalbuminemia, anemia, and pancytopenia were the presenting symptoms and lab findings. Revisional surgery was performed at a mean 19 ± 9.7 months after OAGB-MGB after failure of supportive measures. The mean BMI at the time of revision was 22.5 ± 2.6 kg/m2 with an excess weight loss of 109.2 ± 22.1%. After revisional surgery, one patient developed profound liver failure and expired. Another patient developed severe steatohepatitis but ultimately recovered. In the remaining five, edema and fatigue completely resolved at 1 month and hypoalbuminemia and anemia normalized at 2 months. CONCLUSION: A one-fits-all BPL length of 200 cm is increasingly being questioned as it may result in an inadequate absorptive area and PCM in a subset of patients with shorter total bowel lengths, potentially placing them in danger and depriving them of bariatric surgery benefits.