Association of Maternal Dietary Components During Pregnancy and/or Lactation with Insulin-Dependent Diabetes Mellitus.

CONTEXT: Considering the increasing trend in the incidence of type 1 diabetes mellitus (T1DM), the identification of its environmental determinants, especially those related to the prenatal and lactation period, might ultimately result in primary prevention of the disease. We aimed to review the evidence of the association between mothers' dietary components during pregnancy and/or lactation with T1DM. EVIDENCE ACQUISITION: An electronic and comprehensive literature search was performed until August 2019 in the international databases, including Web of Science (ISI), PubMed, and Scopus, using the following keywords: type 1 diabetes mellitus, autoimmunity, mother, maternal, diet and lactation in different combinations. Papers related to the objectives of the study were selected. RESULTS: Based on our review, the maternal consumption of meat, especially processed meat, was associated with increased risk of T1DM, whereas the maternal use of vegetables, potato, low-fat margarine, and berries showed protective effects against the development of T1DM in offspring. There was no significant association between the use of multivitamins and mineral supplements with T1DM, according to the available data. The results of the reviewed studies regarding the association between the maternal use of vitamin D, fatty acids, and coffee during pregnancy with T1DM were not consistent and conclusive. CONCLUSIONS: Findings of this review indicate that the maternal consumption of some foods is associated with increased or decreased risk of T1DM. However, for some foods or dietary components, including coffee, vitamin D, and fatty acids, the results are not conclusive. We conclude that although maternal diet could influence the development of insulin autoantibodies (IA) and T1DM in offspring, there is no sufficient evidence for most nutrients, and available data are controversial, which should be dealt with in future cohort or interventional studies.

The effects of vitamin E and omega-3 PUFAs on endothelial function among adolescents with metabolic syndrome.

AIM: The present study aims to explore the effects of vitamin E and omega-3 on endothelial function indicators among adolescents with metabolic syndrome. METHOD: In a randomized, double blind, and placebo-controlled trial, 90 young individuals, aged 10 to 18 years, with metabolic syndrome were randomly assigned to receive either vitamin E tablets (400 IU/day) or omega-3 tablets (2.4 gr/day) or placebo. For assessing endothelial functional state, the serum level of vascular endothelial growth factor (VEGF) was measured by ELISA test. RESULTS: The use of omega-3 supplementation for eight weeks led to significant increase in serum HDL level compared with the group treated with vitamin E or placebo group. In this regard, no significant correlations were found between the change in VEGF and baseline levels of other markers including anthropometric indices and serum lipids. Omega-3 could significantly reduce VEGF with the presence of other baseline variables (Beta = -12.55; P = 0.012). CONCLUSION: The administration of omega-3 can effectively improve endothelial function in adolescents with metabolic syndrome by reducing the level of serum VEGF, as a major index for atherosclerosis progression and endothelial destabilization. Omega-3 can be proposed as a VEGF antagonist for improving endothelial function in metabolic syndrome. The clinical implications of our findings should be assessed in future studies.

Effects of vitamin D supplementation on insulin resistance and cardiometabolic risk factors in children with metabolic syndrome: a triple-masked controlled trial / Efeitos da suplementação de vitamina D sobre a resistência à insulina e fatores de risco cardiometabólico em crianças com síndrome metabólica: ensaio clínico triplo-cego controlado

OBJECTIVE: this triple-masked controlled trial aimed to assess the effects of vitamin D supplementation on insulin resistance and cardiometabolic risk factors in obese children and adolescents. METHODS: the study comprised 50 participants, aged 10 to16 years, who were randomly assigned into two groups of equal number. In this 12-week trial, one group received oral vitamin D (300,000 IU) and the other group received placebo. Cardiometabolic risk factors, insulin resistance, and a continuous value of metabolic syndrome (cMetS) were determined. Statistical analysis was conducted after adjustment for covariate interactions. RESULTS: overall, 21 patients in the vitamin D group and 22 in the placebo group completed the trial. No significant difference was observed in the baseline characteristics of the two groups. After the trial, in the vitamin D group, serum insulin and triglyceride concentrations, as well as HOM -IR and C-MetS decreased significantly, both when compared with the baseline and with the placebo group. No significant difference was observed when comparing total cholesterol, LDL-C, HDL-C, fasting blood glucose, and blood pressure. CONCLUSION: the present findings support the favorable effects of vitamin D supplementation on reducing insulin resistance and cardiometabolic risk factors in obese children. .

Este ensaio clínico triplo-cego controlado visa investigar os efeitos da suplementação de vitamina D sobre a resistência à insulina e os fatores de risco cardiometabólico em crianças e adolescentes obesos. O estudo contou com 50 participantes com idade entre 10 e 16 anos, aleatoriamente divididos em dois grupos de igual número de participantes. Neste ensaio clínico de 12 semanas, um grupo recebeu vitamina D via oral (300000 IU) e o outro grupo recebeu placebo. Foram determinados fatores de risco cardiometabólico, resistência à insulina e valor contínuo da síndrome metabólica (cMetS). A análise estatística foi conduzida após o ajuste das interações covariáveis. No todo, 21 pacientes no grupo vitamina D e 22 no grupo placebo concluíram o ensaio clínico. Nenhuma diferença significativa foi encontrada nas características de base dos dois grupos estudados. Após o ensaio clinico, no grupo vitamina D, as concentrações séricas de insulina e triglicerídeos, bem como HOMA-RI e cMetS caíram significativamente em comparação ao início do estudo; e também em comparação ao grupo placebo. Nenhuma diferença significativa foi vista ao comparar o colesterol total, LDL-C, HDL-C, glicemia de jejum e pressão sanguínea. Nossas conclusões indicam efeitos favoráveis da suplementação de vitamina D sobre a redução da resistência à insulina e de fatores de risco cardiometabólico em crianças obesas.

Effects of vitamin D supplementation on insulin resistance and cardiometabolic risk factors in children with metabolic syndrome: a triple-masked controlled trial.

OBJECTIVE: This triple-masked controlled trial aimed to assess the effects of vitamin D supplementation on insulin resistance and cardiometabolic risk factors in obese children and adolescents. METHODS: The study comprised 50 participants, aged 10 to 16 years, who were randomly assigned into two groups of equal number. In this 12-week trial, one group received oral vitamin D (300,000 IU) and the other group received placebo. Cardiometabolic risk factors, insulin resistance, and a continuous value of metabolic syndrome (cMetS) were determined. Statistical analysis was conducted after adjustment for covariate interactions. RESULTS: Overall, 21 patients in the vitamin D group and 22 in the placebo group completed the trial. No significant difference was observed in the baseline characteristics of the two groups. After the trial, in the vitamin D group, serum insulin and triglyceride concentrations, as well as HOM -IR and C-MetS decreased significantly, both when compared with the baseline and with the placebo group. No significant difference was observed when comparing total cholesterol, LDL-C, HDL-C, fasting blood glucose, and blood pressure. CONCLUSION: The present findings support the favorable effects of vitamin D supplementation on reducing insulin resistance and cardiometabolic risk factors in obese children.

The effects of folic acid on markers of endothelial function in patients with type 1 diabetes mellitus.

BACKGROUND: Endothelial dysfunction is considered as a fundamental and also preventable factor in the progression of vascular complications among type 1 diabetic patient. It occurs before the clinical manifestation of the mentioned complications. The aim of this study was to evaluate the effects of folic acid on endothelial function by measurements of adhesion molecules and von Willebrand factor (vWF) in patients with type 1 diabetes in Isfahan, Iran. METHODS: This double blind, placebo-controlled crossover trial included type 1 diabetic patients aged 5-20 years old. Selected patients were randomized into two groups of A and B to receive folic acid 5 mg daily or placebo for 8 weeks. After a 2-week washout period, patients in the two groups were swapped to receive placebo or folic acid, respectively, for another 8 weeks. Blood and urine samples were taken to evaluate glycosylated hemoglobin (HbAlc), folic acid, vWF, intracellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), and microalbuminuria levels. Results of these measurements were compared in the two groups before and after folic acid and placebo administrations. RESULTS: Fifty five type 1 diabetic patients aged 12.1 +/- 3.4 years with diabetes duration of 3.9 +/- 2.1 years were enrolled. Mean of folic acid level in the two studied groups was increased significantly (10.1 +/- 3.8 vs. 21.2 +/- 1.1 in group A and 15.5 +/- 1.9 vs. 19.9 +/- 2.8 in group B, p < 0.05). Mean of VCAM and microalbuminuria was decreased significantly after folic acid administration in the two groups (p < 0.05). Mean of HbA1c, ICAM and vWF did not significantly change after folic acid administration in the two groups (p > 0.05). CONCLUSION: Folic acid administration decreased the level of endothelial dysfunction measured by adhesion molecules, especially VCAM and microalbuminuria. However, it did not significantly affect vWF. Further studies with larger sample size and long-term administration of folic acid are necessary for making precise decisions in this field. Key words: endothelial function, Diabetes Mellitus, folic acid.

Thiocyanate status does not play a role in the etiology of residual goiter in school children of Isfahan, Iran.

BACKGROUND: Despite long standing iodine supplementation in Iran the prevalence of goiter remains high in some areas. In the present study we investigated the possible role of thiocyanate as a goitrogen in the etiology of goiter in Isfahan, Iran. METHODS: A total of 2331 (6-13 year old) school children were selected by multistage random sampling. Thyroid size was estimated in each child by inspection and palpation. Urinary iodine concentration (UIC) and urinary thiocyanate (USCN) were measured. RESULTS: Overall, 32.9% of the 2331 students had goiter. The median UIC was 195.5 µg/L. The mean ± SD of USCN in goitrous and nongoitrous subjects was 0.42 ± 0.28 mg/dL and 0.41 ± 0.32 mg/dL, respectively (P=0.86). USCN level in goitrous and nongoitrous boys was 0.41 ± 0.32 mg/dL and 0.43 ± 0.37 mg/dL, respectively (P=0.67). USCN level in goitrous and nongoitrous girls was 0.43 ± 0.26 mg/dL and 0.40 ± 0.28 mg/dL, respectively (P=0.43). CONCLUSIONS: Thiocyanate overload does not play a role in high prevalence of goiter in the studied population. We suggest the role of other goitrogenic factors should be investigated in this region.

Effect of zinc supplementation on markers of insulin resistance, oxidative stress, and inflammation among prepubescent children with metabolic syndrome.

OBJECTIVE: This trial aimed to evaluate the effects of zinc sulfate in comparison with placebo on markers of insulin resistance, oxidative stress, and inflammation in a sample of obese prepubescent children. METHODS: This triple-masked, randomized, placebo-controlled, crossover trial was conducted among 60 obese Iranian children in 2008. Participants were randomly assigned to two groups of equal number; one group received 20 mg of elemental zinc and the other group received placebo on a regular daily basis for 8 weeks. After a 4-week washout period, the groups were crossed over. In addition to anthropometric measures and blood pressure, fasting plasma glucose, lipid profile, insulin, apolipoproteins A-1 (ApoA-I) and B, high-sensitivity C-reactive protein (hs-CRP), leptin, oxidized low-density lipoprotein (ox-LDL), and malondialdehyde were determined at all four stages of the study. RESULTS: Irrespective of the order of receiving zinc and placebo, in both groups, significant decrease was documented for Apo B/ApoA-I ratio, ox-LDL, leptin and malondialdehyde, total and LDL-cholesterol after receiving zinc without significant change after receiving placebo. In groups, hs-CRP and markers of insulin resistance decreased significantly after receiving zinc, but increased after receiving placebo. In both groups, the mean body mass index (BMI) Z-score remained high, after receiving zinc, the mean weight, BMI, BMI Z-score decreased significantly, whereas these values increased after receiving placebo. CONCLUSION: These results are particularly important in light of the deleterious consequences of childhood obesity and early changes in markers of inflammatory and oxidative stress. We suggest exploring the direct clinical application of zinc supplementation in childhood obesity in future studies.

Effects of a lifestyle modification trial among phenotypically obese metabolically normal and phenotypically obese metabolically abnormal adolescents in comparison with phenotypically normal metabolically obese adolescents.

This study aimed to assess the effects of a 2-month lifestyle modification trial on cardio-metabolic abnormalities and C-reactive protein (CRP) among obese adolescents with metabolic syndrome [phenotypically obese metabolically abnormal (POMA)] and obese adolescents without a cardio-metabolic disorder [phenotypically obese metabolically normal (POMN)], as well as in normal-weight adolescents with at least one cardio-metabolic disorder [phenotypically normal metabolically obese (PNMO)]. The study comprised 360 adolescents assigned in three groups of equal number of POMN, POMA and PNMO. They were enrolled in a trial consisting of aerobic activity classes, diet and behaviour modification, and were recalled after 6 months. Overall, 94.7% of participants completed the 2-month trial, and 87.3% of them returned after 6 months. The mean CRP was not significantly different between the POMA and PNMO groups, but was higher than in the POMN group. After the trial, body mass index (BMI) and waist circumference (WC) decreased in obese participants, and the mean body fat mass decreased in all groups. At 2 months, the mean total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and CRP decreased in the POMA and PNMO groups. After 2 and 6 months, the decrease in mean TC, LDL-C, TG, CRP and systolic blood pressure was greater in the POMA than in the POMN group. The magnitude of decrease in CRP correlated with that of BMI, WC, fat mass, TG, TC and LDL-C. Lifestyle modification programmes for primordial/primary prevention of chronic diseases would be beneficial at the population level and should not be limited to obese children.

Association between serum ferritin and goitre in Iranian school children.

Despite long-standing supplementation of iodine in Iran, the prevalence of goitre among general people remains high in some regions. The study investigated the role of iron status in the aetiology of goitre in school children in Isfahan, Iran. Two thousand three hundred and thirty-one school children were selected by multi-stage random sampling. Thyroid size was estimated by inspection and palpation. Urinary iodine concentration (UIC) and serum ferritin (SF) were measured. Overall, 32.9% of the children had goitre. The median UIC was 195.5 microg/L. The mean +/- SD of SF in the goitrous and non-goitrous children was 47.65 +/- 42.51 and 44.55 +/- 37.07 microg/L respectively (p=0.52). The prevalence of iron deficiency in goitrous and non-goitrous children was 9.6% and 3.1% respectively (p=0.007). Goitre is still prevalent in school children of Isfahan. However, their median UIC was well in the accepted range. Iron deficiency is associated with goitre in a small group of goitrous children. The role of goitrogens should also be investigated in this region.

Effect of zinc supplementation on insulin resistance and components of the metabolic syndrome in prepubertal obese children.

OBJECTIVE: Zinc, an essential trace element and a component of many enzymes, is involved in the synthesis, storage and release of insulin. The aim of the present study was to assess the effect of zinc supplementation on insulin resistance and components of the metabolic syndrome in prepubertal obese children. DESIGN: This triple-masked, randomized, placebo-controlled cross-over trial was conducted among 60 obese Iranian children in 2008. Pertinent clinical findings, fasting serum glucose, insulin and lipid profile were assessed. Participants were randomly assigned to two groups of equal number; one group received 20mg elemental zinc and the other group received placebo on a regular daily basis for eight weeks. After a 4-week wash-out period, the groups were crossed over. RESULTS: The mean age of participants was 9.1 +/- 1.1 years. After receiving zinc, the mean fasting plasma glucose (FPG), insulin and HOMA-IR decreased significantly, while body mass index (BMI), waist circumference (WC), LDL-C and triglycerides (TG) did not significantly change. After receiving placebo, the mean FPG, insulin and HOMA-IR increased significantly, while BMI, WC, LDL-C and TG showed a non-significant increase. CONCLUSION: Besides lifestyle modification, zinc supplementation might be considered as a useful and safe additional intervention treatment for improvement of cardiometabolic risk factors related to childhood obesity.

Selenium deficiency as a possible contributor of goiter in schoolchildren of Isfahan, Iran.

The prevalence of goiter still remains high in some areas of Iran in spite of iodine supplementation. In the present study, we investigated the role of selenium (Se) deficiency in the etiology of goiter in Isfahan. Two thousand three hundred thirty-one schoolchildren were selected by multistage random sampling. Thyroid size was estimated in each child by inspection and palpation. Urinary iodine concentration (UIC) and plasma Se were measured. Overall, 32.9% of the 2,331 children had goiter. The median UIC was 19.55 microg/dl. Plasma Se was measured in 96 goitrous and 72 nongoitrous children. The mean +/- SD of plasma Se in goitrous and nongoitrous children was 66.86 +/- 21.82 and 76.67 +/- 23.33 microg/l, respectively (P = 0.006). Goitrous girls had lower plasma Se level than nongoitrous girls (65.62 +/- 21.64 vs. 76.51 +/- 22.61 microg/dl, P = 0.02). Goitrous boys had lower plasma Se level than nongoitrous boys (68.45 +/- 22.21 vs. 76.91 +/- 24.76 microg/l, P = 0.14). The prevalence of Se deficiency was significantly higher in goitrous boys and girls than nongoitrous children. Se deficiency is among the contributors of goiter in Isfahan goitrous schoolchildren. However, the role of other micronutrient deficiencies or goitrogens should be investigated in this region.

Zinc status in goitrous school children of Semirom, Iran.

BACKGROUND: Iodine deficiency produces the spectrum of iodine deficiency disorders (IDDs) including endemic goiter, hypothyroidism, cretinism and congenital anomalies. Other factors, including goitrogens and micronutrient deficiencies may influence the prevalence and severity of IDDs and response to iodine supplementation. An association between zinc and goiter has previously been reported. METHODS: A cross sectional study investigating an association between goiter and serum zinc status was performed in 2003 in a mountainous region of Iran. One thousand eight hundred twenty-eight children were selected by multistage cluster sampling. Goiter staging was performed by inspection and palpation. Serum zinc, total thyroxine, thyroid stimulating hormone and urinary iodine concentration were measured in a group of these children. RESULTS: Thirty six and seven tenth percent of subjects were classified as goitrous. Serum zinc level in goitrous and nongoitrous children was 82.80 ± 17.85 and 83.38 ± 16.25 µg/dl, respectively (p = 0.81). The prevalence of zinc deficiency (serum zinc ≤65 µg/dl) in goitrous and nongoitrous children did not differ significantly (9.3 % vs. 10.8%, p = 0.70). CONCLUSIONS: Goiter is still a public health problem in Semirom. According to the present study zinc status may not play a role in the etiology of goiter in Semirom school children. However, the role of other goitrogens or micronutrient deficiencies should be investigated in this region.

Endemic goiter in Semirom; there is no difference in vitamin A status between goitrous and nongoitrous children.

BACKGROUND: Despite long-standing iodine supplementation in Iran, the prevalence of goiter remains high in some areas. This suggests other nutritional deficiencies may be considered as responsible factors for goiter persistence. In the present study we investigated the possible role of vitamin A deficiency (VAD) and low vitamin A status in the etiology of endemic goiter in Semirom, Iran. MATERIALS AND METHODS: In this cross-sectional study, 1,828 students from 108 primary schools of urban and rural areas of Semirom were selected by multistage random cluster sampling. Thyroid size was estimated in each child by inspection and palpation. Urinary iodine concentration (UIC) and serum retinol (SR) were measured. RESULTS: Overall, 36.7% of schoolchildren had goiter. The median UIC was 18.5 microg/dL. The mean+/-SD of SR in goitrous and nongoitrous children was 38.84+/- 10.98 and 39.17+/-10.85 microg/dL respectively (p=0.82). There were two children with VAD (SR less than 20 microg/dL); one in the goitrous and one in the nongoitrous group. The prevalence of subjects with low vitamin A status (SR less than 30 microg/dL) in the goitrous and nongoitrous groups was 26.2 and 21.5% respectively (p=0.42). CONCLUSION: Goiter is still a public health problem in this region. Iodine deficiency, VAD or low vitamin A status is not among the contributors of goiter persistence in schoolchildren of Semirom. The role of other micronutrient deficiencies or goitrogens should be investigated.

High prevalence of goiter in an iodine replete area: do thyroid auto-antibodies play a role?

INTRODUCTION: Despite long standing iodine supplementation in Iran the prevalence of goiter remains high in some areas. This may suggest that causes other than iodine deficiency, such as autoimmune thyroid diseases, should also be considered. We therefore assessed the prevalence of anti-thyroid antibodies in children living in an inland area in Iran and correlated these findings with prevalence of goiter within this region. METHODS: In a cross-sectional study, 1948 students were selected by multistage random cluster sampling from the 108 primary schools (age, 7-13 year-old) of the urban and rural areas of Semirom. After obtaining written consent from their parents, the children were examined by endocrinologists for goiter grading. Grade 2 goitrous children (108 cases) were compared with non-goitrous children (111 children as control group) for anti-thyroid antibodies. RESULTS: Overall, 36.7% of 1948 students had goiter. The mean urinary iodine excretion level was 1.49+/-0.7 micromol/L. This was within normal limits. Of 219 children studied, 4.3% presented with subclinical hypothyroidism, and 7.3% had positive anti-thyroid antibodies. There was non-significant difference of positive thyroperoxidase antibody (anti-TPO) (Odds Ratio= 3.2, p= 0.13) but significant difference of anti Tg between goitrous and non goitrous children (Odds Ratio: 5.6, 95% CI: 1.18-26.0, p: 0.015). CONCLUSION: This study suggests that autoimmunity may be one of the mechanisms responsible for goiter persistence after iodine replenishment in this iodine deficient region, but the role of other factors should also be considered.

Iron deficiency in goitrous schoolchildren of Semirom, Iran.

BACKGROUND: Iodine deficiency produces the spectrum of iodine deficiency disorders (IDDs): endemic goiter, hypothyroidism, cretinism, and congenital anomalies. Other factors, including goitrogens and micronutrient deficiencies, may influence the prevalence and severity of IDDs and response to iodine supplementation. This cross-sectional, descriptive study was performed in 2003 on elementary school children of Semirom, a mountainous region of Iran, where goiter was hyper-endemic in 1994, but the goiter prevalence had not decreased as expected many years after salt iodization and iodine injection. Some possible risk factors associated with goiter in that area were evaluated, and the results of iron study are presented here. METHODS: 1,869 cases were selected by a multistage cluster sampling procedure. Grade 2 goitrous children were compared with equal number of nongoitrous children for serum iron, ferritin, transferrin, thyroxin, TSH and urine iodine concentrations (UIC). RESULTS: 210 children (105 goiter grade 0 and 105 goiter grade 2) entered this sub-study. Of 210 participants, 70 children had low transferrin saturation, 13 had low serum ferritin and 9 children had both problems. There was no significant difference in goiter rate between children with low iron indices and others. There was no significant correlation between serum iron, ferritin or transferrin saturation with other variables including T4, UIC and goiter stage. CONCLUSION: The present study reveals that in the area studied, iron deficiency cannot explain the high prevalence of goiter, so other responsible factors should be investigated.