Secondary and tertiary preventions of thyroid disease.

INTRODUCTION: Secondary and tertiary preventions are concerned with the recognition of the disease process in a very early stage and delay in progression to complete disease and minimization of complications and the impact of illness. METHODS: All articles related to secondary and tertiary prevention of thyroid diseases were reviewed. Using related key words, articles published between 2001 and 2015 were evaluated, categorized, and analyzed. RESULTS: In secondary prevention, congenital hypothyroidism and subclinical hypo and hyperthyroidism are equally important. Routine screening of patients with multinodular goiter by either ultrasonography or calcitonin is a controversial issue, while calcitonin assessments in medullary cancer and RET in family members are recommended. Screening of thyroid disease in pregnancy is limited to those with risk factors. Views regarding the importance of thyroid autoimmunity in secondary prevention are also presented. In tertiary prevention, prescribing excessive doses of levothyroxine, in the elderly in particular and appropriate care of all patients to avoid progression and complications are the key issues. CONCLUSION: Optimization of management of thyroid diseases requires timely screening, prevention of progression to more sever disease, optimal medical care, and avoidance of iatrogenic conditions.

The Association Between Normal Range TSH and Lipid Profile.

Dyslipidemia in thyroid dysfunction is mostly attributed to thyrotropin (TSH) levels, especially in subclinical disorders, but the exact role of TSH in dyslipidemia has not been explained. A total of 3 020 subjects who remained euthyroid in 3 phases of the Tehran Thyroid study were enrolled and divided according to quartiles of TSH as: Q1 (0.32-1.02), Q2 (1.02-1.53), Q3 (1.53-2.27), and Q4 (2.27-5.06). General Linear model was used to determine whether there was a significant correlation between subjects' lipid profile and quartiles of TSH from 1st to 2nd and from 1st to 3rd phase. Mean TC, LDL-C level and median TG were significantly higher for Q1 in all study phases. All lipid parameters of participants after 6 years (3rd phase study) except LDL-C were significantly varied in different TSH groups. Highest levels of TC, TG and HDL-C were observed in Q4. Thus, irrespective of TC and LDL-C in Q1 and Q4 (participants with the lowest and highest limit of TSH within the normal range), the difference in lipid parameters in middle of normal TSH range was not significant. Normal range TSH levels have a statistically significant effect on lipid profile, but the effect size is not clinically significant.

Effect of Different Obesity Phenotypes on Incidence of Chronic Kidney Disease in Tehranian Adults.

BACKGROUND: The aim of this community-based study is to ascertain the effect of different obesity phenotypes on the incidence of chronic kidney disease in Iranian adults. STUDY DESIGN: A prospective cohort study, the Tehran Lipid Glucose Study (TLGS). SETTING AND PARTICIPANTS: Adults aged ≥ 20 years with a mean age of 40.38 years (54.8% female) who were free from chronic kidney disease (CKD) at baseline (phase 1) and were followed up at 3 time stages (phases 2, 3, and 4) for a mean duration of 9.4 years to assess the risk for CKD. PREDICTOR: Obesity phenotypes. OUTCOME: Incidence of chronic kidney disease. MEASUREMENTS: Glomerular filtration rate (GFR) was estimated from the simplified equation developed using data from the Modification of Diet in Renal Disease (MDRD) Study. RESULTS: CKD events occurred in 1162 participants. The prevalence of the 2 known obesity phenotypes (metabolically obese normal weight [MONW] and metabolically healthy but obese [MHO]) in the overall population was 3.5% and 8.8%, respectively. According to Kaplan-Meier curves, rates of freedom from CKD in the MHO and MONW obesity phenotypes were 75.3% and 60.6%, respectively (p < 0.0001). Age- and sex-adjusted (model 1) hazard ratios for participants with MHO or MONW obesity phenotype were 1.14 (95% confidence interval [CI], 0.91-1.43) and 1.43 (95% CI, 1.09-1.88), respectively. After further adjustment for confounder variables (model 2), multivariate-adjusted hazard ratios for CKD for participants with MHO or MONW obesity phenotypes were 1.23 (95% CI, 0.93-1.62) and 1.43 (95% CI, 1.08-1.90), respectively. CONCLUSION: Adults with the MONW obesity phenotype compared to those with MHO obesity phenotype have a higher risk for incidence of CKD. The results indicate that having a normal weight is not the only factor to protect against incidence of CKD.

Incidence and potential risk factors of obesity among Tehranian adults.

AIM: Evaluating the incidence of obesity and its risk factors among Tehranian adults. MATERIAL & METHODS: In this population-based cohort, non-obese participants, aged ≥20years, were followed for development of obesity (Body Mass Index (BMI) ≥30). Incidence density and cumulative incidence rates of obesity were calculated for each sex. Cox proportional hazard regression was used to determine the association of potential obesity risk factors including: age, BMI, metabolic syndrome, waist circumference (WC), smoking, marital status, education, and physical activity. RESULT: A total of 7257 participants (3536 men) were followed for a median of 8years. At baseline, mean age, BMI and WC were 41.3±14.6years, 25.1±2.9kg/m(2) (24.9±3kg/m(2) men and 25.2±3kg/m(2) women), and 84.8±9.8cm (87.06±9.2cm men and 82.6±9.9cm women) respectively. During the follow-up, 1345 participants (876 women) developed obesity contributing to cumulative incidences of 31.3% (CI: 29.9%-32.7%), 38.1% (CI: 36.2%-40.1%), and 23.4% (CI: 21.6%-25.3%) for the whole population, women, and men, respectively. Corresponding incidence density rates per 1000 person-year were 25.9 (CI: 24.5-27.3), 33.67 (CI: 31.5-36.0), and 18.0 (CI: 16.5-19.7), respectively. Highest incidence rates were observed during their 40s and 20s for women and men, respectively. Participants with metabolic syndrome, lower educational level, higher BMI and WC, were at higher risk of obesity development in both sexes. CONCLUSION: High incidence of obesity was observed among Tehranian adults with higher incidence of obesity in women. Different modifiable variables may act as risk factors for obesity development which should be targeted to control the epidemic of obesity.

Can postpartum maternal urinary iodine be used to estimate iodine nutrition status of newborns?

I deficiency can lead to detrimental effects, particularly in neonates and young infants. The aim of this study was to explore whether postpartum maternal urinary I can be used to estimate the I status of newborns. In this cross-sectional study conducted in Tehran, lactating mothers and newborns, within 3-5 d postpartum, were randomly selected. Urine samples were collected from each mother and newborn, and a heel-prick blood sample was obtained from all newborns as part of the routine national newborn screening programme. According to the WHO criteria, median urinary I concentration (UIC) 5 mIU/l was considered as I insufficiency. A total of 147 postpartum women and neonates, aged 27·8 (SD 5·3) years and 4·2 (SD 0·6) d, respectively, completed this study. The median UIC was 68·0 (interquartile range (IQR) 39·4-133·5) and 212·5 (IQR 92·3-307·3) µg/l in postpartum mothers and newborns, respectively. The median neonatal TSH was 1·00 (IQR 0·50-1·70) mIU/l. There was no significant difference in the neonatal UIC and TSH of infants whose mothers had deficient and sufficient urinary I. In the multiple linear regression, neonatal UIC value was associated with maternal urinary I (P=0·048) and parity (P=0·039); a significant association was observed between neonatal TSH and infant sex (P=0·038) and birth weight (P=0·049). The findings of our study demonstrate that, despite postpartum mothers being mildly I deficient, I status of their infants was adequate as assessed by UIC and TSH values. It seems factors other than maternal urinary I may influence the I status in newborns.

Does a text messaging intervention improve knowledge, attitudes and practice regarding iodine deficiency and iodized salt consumption?

OBJECTIVE: To determine the effectiveness of implementation of a prevention programme via mobile phone text messaging in enhancing knowledge, attitudes and practice concerning iodine deficiency and iodized salt consumption. DESIGN: In a randomized controlled trial, participants were subjected to a brief tele-educational support regarding iodine deficiency and the importance of iodized salt consumption. The intervention group received daily text messages via mobile phone for 6 weeks. Knowledge, attitude and practice scores, urinary iodine concentration and salt iodine content were assessed at baseline and 8 weeks after the intervention. SETTING: Participants were recruited from health-care centres in Tehran, the capital city of Iran. SUBJECTS: For the present study 205 females aged ≥18 years were randomly assigned to the intervention (n 95) and control (n 110) groups. RESULTS: A significant difference was found in median knowledge scores between the intervention and control groups at follow-up (P = 0.004). There was also a significant difference in median attitude scores between the intervention and control groups (P = 0.02). The intervention group did not differ significantly in median practice score, urinary iodine concentration and salt iodine content from the control group. CONCLUSIONS: Text messaging interventions are effective in improving individuals' knowledge and attitudes regarding preventive health-care topics.

Iodine nutrition in pregnant and breastfeeding women: sufficiency, deficiency, and supplementation.

Iodine is a micronutrient used by the thyroid gland to produce thyroid hormones, which manage different aspects of body metabolism. Humans depend on exogenous sources of iodine to maintain the normal concentration of thyroid hormones. Pregnancy alters iodine turnover and is associated with significant changes in thyroid function. Daily iodine requirement during pregnancy increases to 250 µg, compared with 150 µg for nonpregnant women. According to recent guidelines of scientific organizations, to improve maternal thyroid status and to prevent child neurocognitive defects, all pregnant and breastfeeding women should take 150 µg of iodine supplementation, not only in iodine-deficient regions but also in iodine-sufficient areas. However, some recent studies have confirmed that iodine supplementation of mildly iodine-deficient pregnant women has no clear benefits as concerns maternal thyroid function or child neurodevelopment.

Isolated Hypothyroxinemia in Iranian Pregnant Women, the Role of Iodine Deficiency: A Population-Based Cross-Sectional Study.

Background: Thyroid disorders such as subclinical hypothyroidism and isolated maternal hypothyroxinemia are understudied in pregnant women, despite their possible adverse effects on the health of mother and child. Also, the role of iodine deficiency in developing such disorders has not yet been fully understood. Methods: The present national population-based cross-sectional study was conducted on 1080 randomly recruited pregnant women, aged 20-40 from 12 provinces of Iran from 2013 to 2014. Serum concentrations of thyrotropin, T4, thyroid peroxidase antibody (TPOAb), and triiodothyronine (T3) resin uptake values were measured in fasting blood samples, and urinary iodine concentration (UIC) was measured in three separate urine samples. Multinomial logistic regression was run to analyze the possible risk factors regarding thyroid disorders. To clarify the role of iodine in thyroid status specifically, the determinants of UIC and its correlations with thyroid function tests were investigated independently and through subgroup analysis. Results: Isolated hypothyroxinemia was the most common thyroid disorder (9.9%), followed by subclinical hypothyroidism (8%). In comparison to euthyroid pregnant women, isolated hypothyroxinemia was more likely in pregnant women older than 30 years (odds ratio [OR] = 1.6), in the second and the third trimesters (OR = 2.62 and 2.12 respectively), with history of multiparity (OR = 1.72), residing in rural areas (OR = 1.57) and in the capital province of the country (OR = 3.3). Subclinical hypothyroidism was more likely in TPOAb positive pregnant women (OR = 2.56). All the mentioned ORs were statistically significant (p < 0.05). The UIC did not correlate significantly with any of the thyroid function tests in the study population. Subgroup analysis showed a significant correlation between UIC and T4 in pregnant women with subclinical hypothyroidism (p < 0.05). Conclusion: Isolated maternal hypothyroxinemia was the most prevalent thyroid disorder in Iranian pregnant women and its associated risk factors were identified. Although the calculated prevalence of thyroid disorders was expected in a moderately iodine deficient setting, no correlations between UICs and thyroid function tests were found at the individual level. The contribution of iodine deficiency to thyroid condition for each pregnant woman may be more evident in pregnant women with certain thyroid disorders or those with long-term iodine deficiency.

Trend of lipid and thyroid function tests in adults without overt thyroid diseases: A cohort from Tehran thyroid study.

CONTEXT: While the role of overt hypothyroidism in lipid disorders is clear, the association between dyslipidemia and subclinical thyroid diseases remains unclarified. OBJECTIVE: To examine lipid trends based on thyroid function over a 10-year period. DESIGN: This is a prospective population based cohort study. SETTING: General community. PARTICIPANTS: 2383 euthyroid participants, as well as those with subclinical thyroid diseases, in all residents of district 13 of Tehran were examined. Subjects who were on levothyroxine, anti-hyperthyroid drugs, and glucocorticoids, those with a history of thyroid surgery or RAI and pregnant women were excluded. MAIN OUTCOME MEASURES: Lipid trends in Model 1 were adjusted for age and follow up duration, and in Model 2 gender-specific multivariate adjustments were performed for thyroid status, diabetes mellitus, smoking status, education, BMI, lipid lowering medications, age and follow up duration by using generalized estimating equations. RESULTS: In every four years of assessments, there were significant decreases in levels of all lipid parameters (all Ps <0.001) except for HDL-C, in which a decrescendo-crescendo trend was observed. The results did not change after adjusting for thyroid status, consumption of lipid lowering drugs during the follow-up period, or other variables. There were significant decreases in the prevalence of hypercholesterolemia and hypertriglyceridemia (all Ps <0.001) during the follow-up period. CONCLUSION: During a 10 year follow-up, decrescendo trends were observed in levels of total cholesterol, triglycerides, which were not be accounted for by the consumption of lipid lowering drugs and thyroid status.

Correction: Trend of lipid and thyroid function tests in adults without overt thyroid diseases: A cohort from Tehran thyroid study.

[This corrects the article DOI: 10.1371/journal.pone.0216389.].

Evaluation of the congenital hypothyroidism screening programme in Iran: a 3-year retrospective cohort study.

OBJECTIVE: To evaluate the newborn screening programme for congenital hypothyroidism (CH) in Iran from diagnosis to management and follow-up for 3 years from 2011 to 2014. DESIGN: Retrospective cohort. SETTING AND PATIENTS: Seventeen university districts were randomly selected from 30 provinces. Central data in each district were gathered and collectively analysed. Congenital hypothyroid subjects were followed for 3 years. MAIN OUTCOME MEASURES: Programme coverage, screening and treatment age, recall rate, compliance to follow-ups. RESULTS: The total number of births in 2011 was 501 726, of which 452 918 neonates (90.3%) were screened and 15 671 (3.46%) were recalled; 1085 (1:462, 0.22%) were confirmed as having CH (57.1%: permanent, 42.9%: transient) and followed for 3 years. Positive predictive value (PPV) for the first screening test was 6.9%. After the second screening, recall rate was reduced to 0.69% and PPV increased to 31.3%. Median age at screening was 6 (3-9) days and for 90.6% of patients treatment was initiated before 40 days of age with a median levothyroxine dosage of 25 µg/day; 131 (13.4%) were lost to follow-up. Mean number of follow-up visits over 3 years was 5.7 (95% CI 5.5 to 5.9) and 23% (n=225) had total compliance to all follow-ups. Median time for thyroid stimulating hormone normalisation was 45 days, 95% CI (41.1 to 48.8). CONCLUSION: In Iran, despite well-established protocols of screening and detecting CH subjects, stricter implementation of a structured system for monitoring and surveillance is needed to promote the management of patients and to reduce rates of loss to follow-up. Determining and addressing the causes of high false positive rates must be prioritised.

Review of Iodine Nutrition in Iranian Population in the Past Quarter of Century.

CONTEXT: Iodine deficiency is one of the most important health problems worldwide. The overall aim of this study was a narrative review of the past and present status of iodine nutrition in the Iranian population to gather and provide valuable background data in this field for future studies. EVIDENCE ACQUISITION: For this narrative literature review study, published internal (SID, Iran doc, Iran medex) and international (Web of knowledge, Pubmed, SCOPUS) source studies were searched using the following medical subject heading terms: Iodine, IDD (iodine deficiency disorders), UIC (urinary iodine concentration), Goiter, IQ (intelligence quotient), thyroid hormone, Iodine and pregnancy, Iodine and breast feeding, as well as Iodized salt, reporting the prevalence of iodine deficiency and iodine nutrition status of different target populations in Iran over 25 years, between 1988 - 2014, were assessed. We found 185 abstracts by literature search, of which, 161 papers that were as case reports, animal study, with lack of regional or national data were excluded after full text evaluation. Finally 24 full papers covering regional or national data on iodine nutrition of the study population were eligible for our review. RESULTS: Iodine deficiency, as a nutritional problem, had been identified in Iran since 1968. In the years 1987 - 1989, a few studies were done to define the prevalence of iodine deficiency in the country. The first nation-wide survey was performed in 14 provinces. Based on this survey all provinces were suffering of endemic goiter. In 1989, iodine deficiency was recognized as a major problem for community health. In 1990, salt factories began to produce iodized salt and in 1996, the second national survey was performed in 26 provinces. This survey indicated that 40% of boys and 50% of girls have goiter, with a median urinary iodine excretion of 205 µg/L. The 3rd national survey in 2001 showed that the total goiter rate is 9.8% and median UIC of 165 µg/L. In 2007, the 3th national survey was conducted 17 years after iodized salt consumption by Iranian households. In this study the total goiter rate and median urinary iodine was 5.7% and 145 µg/L, respectively. The 5th national survey conducted in 2013, showed household consumption of iodized salt for all provinces was 98% and the median urinary iodine of school children was 161 µg/L. Following the 5th national survey, the 1st national survey of the iodine status and thyroid function of pregnant women, conducted in 10 provinces in the different region of the country, documented a median UIC for pregnant women of 87.3 µg/L, results of this national survey clarified that despite iodine sufficiency of school children in Iran, pregnant women have moderate iodine deficiency and need iodine supplementation. CONCLUSIONS: The success of iodine deficiency control program depends on well designed programmatic steps and mandatory iodized salt consumption in certain situations. The iodine intake of school children is sufficient, however, Iranian pregnant women are suffering from moderate iodine deficiency and need iodine supplementation.

The Effects of Iodine Fortified Milk on the Iodine Status of Lactating Mothers and Infants in an Area with a Successful Salt Iodization Program: A Randomized Controlled Trial.

Iodine deficiency during the first two years of life may cause irreversible brain damage and mental retardation. The aim of the present study was to investigate, for the first time, the effect of iodine fortified milk on the iodine status of lactating mothers and their infants. In this multicenter randomized controlled trial, 84 lactating mother-infant pairs from health care centers were randomly selected. After meeting the inclusion criteria, lactating mothers were randomly assigned to two groups: the iodine fortified milk group and the control group (n = 42 each). Maternal and infant urine and breast milk samples were collected at 3-5 (baseline), 7, 10, 14 days, and 1 month postpartum, for a measurement of the iodine concentration. A total of 84 lactating mothers, with a mean age of 28.2 ± 4.5 years, and 84 infants, with a mean age of 4.2 ± 0.7 days, were included in the study. Compared to mothers of the control group, mothers receiving iodine fortified milk had higher urinary (p < 0.001) and breast milk (p < 0.001) iodine concentrations. Urinary iodine levels in infants revealed no significant differences between the two groups. The findings of this study indicate that supplementation with daily iodine fortified milk provides iodine nutrition adequacy among lactating mothers. However, it had no effect on the iodine status of infants, who were previously iodine sufficient.

Primordial and Primary Preventions of Thyroid Disease.

BACKGROUND: Primordial and primary preventions of thyroid diseases are concerned with avoiding the appearance of risk factors, delaying the progression to overt disease, and minimizing the impact of illness. SUMMARY: Using related key words, 446 articles related to primordial and primary, preventions of thyroid diseases published between 2001-2015 were evaluated, categorized and analyzed. Prevention and elimination of iodine deficiency are major steps that have been successfully achieved and maintained in many countries of the world in last 2 decades. Recent investigations related to the effect of cigarette smoking, alcohol consumption, and autoimmunity in the prevention of thyroid disorders have been reviewed. CONCLUSIONS: The cornerstone for successful prevention of thyroid disease entails timely implementation of its primordial and primary preventions, which must be highly prioritized in related health strategies by health authorities.

The Impact of Iodine Status on the Recall Rate of the Screening Program for Congenital Hypothyroidism: Findings from Two National Studies in Iran.

Back ground: Iodine deficiency is one of the important factors in increasing the recall rate in congenital hypothyroidism (CH) screening programs. The present study assessed whether the iodine status of the general population may predict the recall rate or vice versa. METHODS: In the current national study, among 1,382,229 live births delivered between March 2010 and March 2011, 1,288,237 neonates were screened for detecting CH by TSH (thyroid stimulating hormone) measurement via heel prick sampling. Simultaneously, a total of 11,280 school-aged children, aged 7-8 years, were selected using random multi-cluster sampling for measurement of urinary iodine. RESULTS: A negative correlation was found between median urinary iodine (MUI) and the recall rate (r = -0.33, p = 0.03). No correlation was found between MUIC (median urinary iodine concentration) and the incidence rate of CH. Linear regression analysis showed a 0.1% increase in the recall rate for a one unit decrease in MUIC (ß = -0.11, 95% CI: -0.2, -0.1, p = 0.03). MUIC, at a cut-off point of 144.7 µg/L, was predictive for a recall rate < 3% (p = 0.05). CONCLUSION: Frequencies of TSH ≥ 5 mU/L may be a more sensitive indicator for iodine status during pregnancy rather than in the general population. As higher recall rates reflect inadequate iodine nutrition, sufficient iodine supplementation is needed to reduce the recall rate in such communities.

Effects of energy-dense nutrient-poor snacks on the incidence of metabolic syndrome: a prospective approach in Tehran Lipid and Glucose Study.

OBJECTIVES: Increased consumption of energy-dense, nutrient-poor snacks is one of the major, growing concerns in relation to the alarming trend of overweight, obesity, and metabolic disorders worldwide. The aim of this study was to investigate whether consumption of energy-dense snacks could affect the occurrence of metabolic syndrome after 3 y of follow-up in adults. METHODS: This longitudinal study was conducted within the framework of the Tehran Lipid and Glucose Study between 2006 and 2008 and 2009 and 2011, on 1466 adults, ages 19 to 70 y. The usual intake of participants was measured using a validated semiquantitative food frequency questionnaire at baseline. Biochemical and anthropometric measurements were assessed at baseline and 3 y later. Multiple logistic regression models were used to estimate the occurrence of metabolic syndrome (MetS) in each quartile of energy-dense snacks. RESULTS: Participants in the highest quartile of energy-dense snack consumption were significantly younger (33.8 versus 43.1 y; P < 0.01). There were non-significant increased risks for MetS in the highest quartile of biscuits and cakes (odds ratio [OR], 1.13; 95% confidence interval [CI], 0.77-1.66), and candies and chocolates (OR, 1.31; 95% CI, 0.88-1.94). The risk for MetS in participants with highest consumption of salty snacks increased more than 50% (OR, 1.56; 95% CI, 1.01-2.40). Consumption of soft drinks had a borderline effect on the risk for MetS. More than 361 kcal/d from total energy-dense snacks independently increased the occurrence of MetS in the fourth compared the first quartile category (OR, 1.53; 95% CI, 1.03-2.29). CONCLUSION: The findings of this study demonstrated that higher consumption of energy-dense snacks could be a dietary risk factor for development of MetS.

Comparison of two guidelines on management of thyroid nodules and thyroid cancer during pregnancy.

BACKGROUND: Some hormonal and metabolic changes may stimuli normal or neoplastic thyroid cells. Thyroid tumors discovered during pregnancy present unique challenges to both the clinician and the mother. The aim of this article is to compare American Thyroid Association (ATA) guidelines to Endocrine Society guidelines for management of thyroid tumors during pregnancy. METHOD: We reviewed the section of thyroid nodules and cancer of ATA and Endocrine Society guidelines which have been published recently. Both organizations have discussed and given recommendations related to maternal and fetal aspects of thyroid nodules and cancer.  Each topic from either guidelines was compared together and that recommendation which was more complete included in 4 tables. RESULTS: There is a high degree of similarity between these two guidelines. Both organizations have discussed and given recommendations related to maternal and fetal aspects of thyroid tumors. Regarding their similarity any of these two guidelines can be used for safe and proper management of women with thyroid tumors during pregnancy. CONCLUSION: Regarding their similarity any of these two guidelines can be used by clinicians for safe and proper management of pregnant women with thyroid nodules and cancer.

White rice consumption is a risk factor for metabolic syndrome in Tehrani adults: a prospective approach in Tehran Lipid and Glucose Study.

BACKGROUND: Consumption of white rice has been proposed as a dietary risk factor for development of metabolic disorders and type 2 diabetes, especially in populations who consume white rice as a staple food. In this study, we investigated the association between consumption of white rice and the occurrence of metabolic syndrome in Tehrani adults after 3 years of follow-up. METHODS: This longitudinal study was conducted within the framework of the Tehran Lipid and Glucose Study on 1476 adults, aged 19-70 years. Dietary intakes were measured using a validated semi-quantitative food frequency questionnaire at baseline. Biochemical and anthropometric measurements were assessed and documented at baseline (2006-2008) and again 3 years later (2009-2011). Multiple logistic regression models were used to estimate the occurrence of the MetS in each quartile of white rice consumption. RESULTS: The mean age of participants was 37.8 ± 12.3 years, and mean BMI was 26.0 ± 4.5 Kg/m2 at baseline. Participants in the highest quartile of white rice consumption were significantly younger, had lower HDL-C levels, and higher systolic and diastolic blood pressures at baseline (P < 0.01). Higher consumption of white rice was also accompanied by higher increase in serum triglyceride levels after the 3-year follow-up (9.9 ± 2.3 vs. 8.2 ± 2.3%, P < 0.01). After adjustment for all potential confounders, the risk of metabolic syndrome in the highest quartile of white rice consumption compared with the lowest, was 1.66 (95% CI: 1.04-2.66). Moreover, participants with central obesity, low physical activity or low-fiber diet had greater risk of metabolic syndrome if white rice constituted ≥25.6% of total energy. CONCLUSION: We demonstrated that higher consumption of white rice may be a risk factor for development of metabolic syndrome among Iranian adults.

Alterations in food group intakes and subsequent weight changes in adults: tehran lipid and glucose study.

BACKGROUND: The extent of weight change is varied for specific foods. This highlights the effect of dietary quality and food choices on weight control. OBJECTIVES: The aim of this study was to examine the association between alterations in food group intake and weight change over a 3 years follow-up period. MATERIALS AND METHODS: This longitudinal study was conducted on 851 adults in the framework of Tehran Lipid and Glucose Study. Intakes of various foods were measured at baseline and after 3 years using a validated semi-quantitative food frequency questionnaire. Dietary data was grouped into 13 food groups. Alterations in food group intakes were categorized in tertiles; middle tertile of intake changes was considered as the reference category and the first and last tertiles of changes as increased and decreased intakes, respectively. Weight change per year of follow-up was the outcome of interest. Weight gain was defined as ≥ 0.5 kg/y, weight loss as ≤ -0.5 kg/y and stable weight as > -0.5 to < 0.5 kg/y. Multinomial logistic regression was used with stable weight as the reference group. RESULTS: IN MEN, WEIGHT LOSS WAS SIGNIFICANTLY PREDICTED ONLY BY DECREASED INTAKE OF ADDED SUGARS (OR: 2.21, 95% CI: 1.06-4.63). In women, weight gain was significantly predicted by decreased intake of whole grains (OR: 1.92, 95% CI: 1.11-3.31) and weight loss was predicted by decreased intake of vegetables (OR: 0.44, 95% CI: 0.21-0.91). CONCLUSIONS: Alterations in consumption of whole grains, vegetables, and added sugars are associated with body weight change, suggesting that it could be helpful in weight control.