Probabilistic prediction of segmental body composition in Iranian children and adolescents.

BACKGROUND: Adolescents' body composition is considered an important measure to evaluate health status. An examination of any of the segmental compartments by anthropometric indices is a more usable method than direct methods. OBJECTIVES: To propose a method based on the network approach for predicting segmental body composition components in adolescent boys and girls using anthropometric measurements. METHODS: A dual-energy X-ray absorptiometry (DXA) dataset in the south of Iran, including 476 adolescents (235 girls and 241 boys) with a range of 9-18 years, was obtained. Several anthropometric prediction models based on the network approach were fitted to the training dataset (TRD 80%) using bnlearn, an R add-in package. The best fitted models were applied to the validation dataset (VAD 20%) to assess the prediction accuracy. RESULTS: Present equations consisting of age, weight, height, body mass index (BMI), and hip circumference accounted for 0.85 (P < 0.001) of the variability of DXA values in the corresponding age groups of boys. Similarly, reasonable estimates of DXA values could be obtained from age, weight, height, and BMI in girls over 13 years, and from age, weight, height, BMI, and waist circumference in girls under 13 years, respectively, of 0.77 and 0.83 (P < 0.001). Correlations between robust Gaussian Bayesian network (RGBN) predictions and DXA measurements were highly significant, averaging 0.87 for boys and 0.82 for girls (P < 0.001). CONCLUSIONS: The results revealed that, based on the present study's predictive models, adolescents' body composition might be estimated by input anthropometric information. Given the flexibility and modeling of the present method to test different motivated hypotheses, its application to body compositional data is highly appealing.

Insulin resistance and high molecular weight adiponectin in obese and non-obese patients with Polycystic Ovarian Syndrome (PCOS).

BACKGROUND: Polycystic ovarian syndrome (PCOS) is the most common endocrinopathy among young women. Insulin resistance is a key feature in the pathogenesis of PCOS; also high molecular weight adiponectin is a marker of insulin resistance. The aim of this study was to evaluate the insulin resistance, metabolic and androgenic profiles and high molecular weight adiponectin in obese and non-obese PCOS patients. METHODS: In this cross-sectional study in outpatient endocrinology clinics of Shiraz University of Medical Sciences, 80 women aged 17-43 years old with PCOS were enrolled. Biochemical and hormonal assay was done on fasting blood sample on the third day of follicular phase. RESULTS: The individuals had a mean age of 28.39 ± 6.56 years, mean weight of 65.41 ± 12.59 Kg, mean BMI of 25.5 ± 4.9, and mean waist circumference of 88.0 ± 13.1 cm. Of all individuals 20% had frank insulin resistance with HOMA-IR > 3.8. Although the obese PCOS patients had lower levels of high molecular weight adiponectin (P = 0.03) than the normal weight PCOS individuals, the level of insulin and insulin resistance was not different in them (P = 0.13, 0.13). Patients with classic PCOS phenotype significantly had higher levels of insulin resistance and free androgen index (P < 0.001, 0.001). We found a significant correlation between the insulin level and free androgen index (correlation coefficient: 0.266 and P = 0.018) after adjusting for BMI. CONCLUSION: This cross-sectional study showed a high incidence of insulin resistance in PCOS patients independent of obesity, and determined BMI related lower level of high molecular weight adiponectin in obese PCOS individuals. More detailed studies are warranted for evaluation of insulin resistance and its pathophysiologic role in PCOS.

Prevalence and predictive factors of transient and permanent congenital hypothyroidism in Fars province, Iran.

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

Mobile-Based and Cloud-Based System for Self-management of People With Type 2 Diabetes: Development and Usability Evaluation.

BACKGROUND: As the use of smartphones and mobile apps is increasing, mobile health (mHealth) can be used as a cost-effective option to provide behavioral interventions aimed at educating and promoting self-management for chronic diseases such as diabetes. Although many mobile software apps have been developed for this purpose, they usually lack a theoretical foundation and do not follow the guidelines suggested for evidence-based practice. Therefore, this study aimed to develop a theory-based self-management app for people with type 2 diabetes and provide an app based on a needs assessment analysis. OBJECTIVE: This paper describes the development and usability evaluation of a cloud-based and mobile-based diabetes self-management app designed to help people with diabetes change their health behavior and also enable remote monitoring by health care providers. METHODS: The development of this mHealth solution comprises 3 phases. Phase I: feature extraction of the Android apps that had a user rating of 4 stars or more and review of papers related to mHealth for diabetes self-management were performed followed by seeking expert opinions about the extracted features to determine the essential features of the app. Phase II: design and implementation included selecting which behavioral change and structural theories were to be applied the app and design of the website. Phase III: evaluation of the usability and user experience of the mobile app by people with diabetes and the portal by health care providers using the User Experience Questionnaire. RESULTS: The developed mobile app includes modules that support several features. A person's data were entered or collected and viewed in the form of graphs and tables. The theoretical foundation of behavioral intervention is the transtheoretical model. Users were able to receive customized messages based on the behavioral change preparation stage using the Kreuter algorithm. The clinician's portal was used by health care providers to monitor the patients. The results of the usability evaluation revealed overall user satisfaction with the app. CONCLUSIONS: Mobile- and cloud-based systems may be an effective tool for facilitating the modification of self-management of chronic care. The results of this study showed that the usability of mobile- and cloud-based systems can be satisfactory and promising. Given that the study used a behavioral model, assessment of the effectiveness of behavior change over time requires further research with long-term follow-up.

Prognosis of Methanol Poisoning in a Developing Setting.

BACKGROUND: Methanol-poisoning can be a challenging cause of mortality. Identifying the epidemiological, clinical, and para-clinical determinants of outcome in methanol-poisoning patients could be a step forward to its management. METHODS: In this hospital-based cohort study, 123 methanol-poisoning patients were included. Data on background variables, details of methanol consumption, and laboratory assessments were recorded for each patient. Patients underwent brain CT scans without contrast. We evaluated the association of all gathered clinical and para-clinical data with patients' outcome and length of hospital stay (LOS). Independent association of potential determinants of death, and LOS were modeled applying multivariable logistic, and Ordinary Least Square regressions, respectively. Odds ratio (OR), and regression coefficient (RC), and their 95% confidence intervals (CIs) were estimated. RESULTS: Most of the study population were male (n=107/123). The mean age of the participants was 30.3±9.1 years. Ninety patients (73.2%) were reported as being conscious on admission, and 34.3% of patients were identified with at least one abnormality in their CT scan. Level of consciousness (LOC) (OR: 42.2; 95% CI: 2.35-756.50), and blood pH (OR: 0.37; 95% CI: 0.22-0.65) were associated with death. Supratentorial edema (RC: 17.55; 95% CI: 16.95-18.16) were associated with LOS. CONCLUSION: Besides LOC, patients with any abnormality in their brain CT scan on admission were found to be at higher risk of death, and patients with supratentorial edema were at risk of longer LOS. Brain CT-scan on admission should be considered as a part of the routine procedure during the management of methanol-poisoning.

Prevalence of metabolically healthy obesity and healthy overweight and the associated factors in southern Iran: A population-based cross-sectional study.

Background and Aims: Obesity is considered a major growing threat to public health which could negatively affect the quality of life. The current cross-sectional study was conducted to investigate the population-based prevalence of metabolically healthy obesity (MHO) and healthy overweight (MHOW) and associated factors in southern Iran. Methods: Baseline data from the Pars Cohort Study was analyzed. Metabolically healthy participants were identified based on the definition of the American Heart Association for the metabolic syndrome. The prevalence of MHOW and MHO and their 95% confidence intervals were estimated. Poisson regression was applied for the calculation of prevalence ratios (PRs). Results: Gender- and age-standardized prevalences of MHOW and MHO were 6.3% (6.0%-6.6%) and 2.3% (2.1%-2.5%), respectively. The following factors were associated with being MHOW compared with those with normal weight: Being younger, female gender (1.31, 1.20-1.43), higher socioeconomic status, being noncurrent cigarette smoker (1.27, 1.11-1.45), low level of physical activity (1.14, 1.03-1.25), having normal overweight during adolescence, and overweight (1.35, 1.24-1.48) or obesity (1.68, 1.53-1.86) during young adulthood. We also found strong associations between MHO and younger age groups, female gender (2.87, 2.40-3.42), being married (1.57, 1.08-2.27), Fars ethnicity (1.25, 1.10-1.43), higher socioeconomic status, ever use of tobacco (1.14, 1.00-1.30), never use of opium (1.85, 1.19-2.86), lower physical activity (1.45, 1.20-1.72), being normal weight in 15-year body pictogram and being overweight (1.87, 1.59-2.20) or obese (3.20, 2.74-3.72) in 30-year body pictogram when considering those with normal weight or MHO. Conclusion: Potentially modifiable factors including physical activity should be more emphasized. Furthermore, our study issued that it would be more reasonable that the prevention of unhealthy obesity be initiated before the development of MHO, where there are more protective factors and they could be more effective.

The effects of powdered drinks enriched with curcumin and probiotics on lipid profile and atherogenic indices in patients with metabolic syndrome: A randomized, double-blinded, placebo-controlled clinical trial.

Cardiovascular disease is prevalent globally and is the most common complication of metabolic syndrome (MetS). Previous studies have suggested that curcumin and probiotics may improve the lipid profile, so we aimed to investigate the effects of the edible powder enriched with these substances on lipid profile level and atherogenic indices such as Atherogenic Coefficient (AC), Castelli Risk Index-I (CRI-I), Castelli Risk Index-II (CRI-II), and Atherogenic Index of Plasma (AIP). In the present parallel randomized double-blinded placebo-controlled clinical trial, 124 people with MetS with overweight or obesity were randomly allocated to 4 groups and were followed up for 8 weeks. The participants received a low-calorie diet and a daily sachet of enriched powder drink. The sachets contained either 109 CFU of probiotics or 1 g of curcumin, or probiotic + curcumin (pro + cur), or placebo, respectively. The fasting lipid profile and atherogenic indices were measured at the beginning and end of the study. One hundred and fourteen participants completed the study. At the end of the study, the within- and between-group comparisons showed no significant differences in lipid profile and atherogenic indices (p > .05). Based on the results of the current study, taking an oral powder containing 1 g curcumin and 109 CFU probiotics for 8 weeks had no effect on the lipid profile level and atherogenic indices; however, more studies are recommended.

Severe hypercalcemia due to metastatic pancreatic neuroendocrine tumor: a case report.

BACKGROUND: Hypercalcemia of malignancy, as a paraneoplastic syndrome, is the most common metabolic disorder that accounts for 30% of malignancies and usually has a poor prognosis. Neuroendocrine tumors are uncommon and arise from neuroendocrine cells throughout the body. Actually, paraneoplastic hypercalcemia in neuroendocrine tumors is unusual and mostly associated with parathyroid hormone-related protein (PTHrP) secretion. CASE PRESENTATION: We report a 51-year-old Iranian man who presented with nausea, vomiting, and significant weight loss for 1 month. Laboratory data revealed calcium of 26 mg/dl, accompanied by low level of PTH. Octreotide scan revealed a large donut-shaped octreotide avid lesion in the epigastric region at the right side of the mid-abdomen, with multiple varying size foci of abnormally increased radiotracer uptake in the epigastric region and both lobes of the liver. Endoscopic ultrasonography demonstrated a large heterogeneous mass lesion with irregular outline and good demarcation in the body of the pancreas with diffuse foci of calcification. Percutaneous biopsy of the liver mass demonstrated a well-differentiated neuroendocrine tumor (low grade) confirmed by immunohistochemistry with strongly positive chromogranin and synaptophysin stain. Hypercalcemia was treated with hydration, few sessions of hemodialysis, calcitonin, and denosumab injection. However, the patient developed symptomatic hypocalcemia. Oncology consultation led to prescription of long-acting octreotide 30 mg monthly and everolimus daily. CONCLUSION: Pancreatic neuroendocrine tumor could lead to malignant hypercalcemia; secretion of PTHrP is the most common cause, and signs and symptoms are usually milder than paraneoplastic syndrome due to hematologic and solid tumor. Generally, survival is better; however, its treatment is challenging, and primary debulking surgery is often required. A team approach to management is important at all points.

Sustained Elimination of Iodine Deficiency Within the Third Decade After Compulsory Iodine Supplementation Policy in the South of Iran: A Population-Based Cross-Sectional Study.

Objectives: Recently, some studies in Iran have shown mild to moderate iodine concentrations in adult and pregnant women populations despite iodine sufficiency in children. This study aimed to evaluate the urine iodine status and salt intake among adult households in the city of Sadra, Fars province in southern Iran, and to assess its possible influencing factors. Method: Participant households for this cross-sectional study were selected using randomized cluster sampling in the city of Sadra, Fars province, southern Iran from 1 February, 2021 to 30 November, 2021. Two subjects >18 y of age from each household were invited. Ninety-two subjects (24 men, 68 women) were enrolled. The participants were asked to collect their 24 h urine. They were then examined for thyroid disorders and subjected to thyroid ultrasonography and thyroid function tests. Urine samples were tested for iodine, sodium, and creatinine concentrations. Household salt intake was also estimated. Results: Median urine iodine content (UIC) in the participants was 175 (IQR: 117, 250) µg/L, whereas the median salt consumption per person per day was 9.6 (IQR, 7.3-14.5) g. Sex, methods of salt storage, presence of goiter or thyroid nodules, the addition of salt in the cooking stage, and subclinical hypothyroidism had no effect on UIC, whereas individuals with hypertension and lower education had significantly lower iodine concentrations. UIC had a significant positive correlation with urine sodium and thyroid stimulating hormones (TSH) concentrations (P < 0.001, 0.046) and a negative correlation with thyroid volume and T4 (P = 0.029, 0.018). Conclusion: Iodine status in the adult population of Sadra city was categorized as sufficient, although the iodine concentrations reported in Tehran were insufficient. The contributing factor can be higher salt consumption or possible higher environmental iodine concentrations in Sadra city than Tehran.

Proximal muscle weakness as the sole manifestation of Cushing's disease, misdiagnosed as dermatomyositis: a case report.

BACKGROUND: Cushing's syndrome consists of signs and symptoms related to prolonged exposure to high levels of glucocorticoid, and should be considered in individuals with the discriminatory signs and symptoms. Proximal myopathy is an important discriminatory sign. CASE PRESENTATION: We report the case of a 36-year-old Iranian man who presented with proximal muscle weakness. He visited a rheumatologist in an outpatient clinic, and according to proximal muscle weakness and heliotrope rash (based on the rheumatologist's notes) with the impression of dermatomyositis, prednisolone and azathioprine were prescribed for him that did not improve his clinical status and he was gradually wheelchair dependent. He was admitted to the hospital for evaluation of paraneoplastic syndromes. Standard laboratory tests and imaging were unremarkable, other than a brain magnetic resonance imaging that demonstrated a 30 × 12 mm homogeneously enhancing mass in the sellar region with extension to the suprasellar area. He had serum cortisol of 295 ng/mL, and adrenocorticotropic hormone of 222 pg/mL (on 5 mg prednisolone twice daily), with a diagnosis of Cushing's disease. He underwent two sessions of trans-sphenoidal surgery 4 months apart. After the first surgery, the proximal muscle weakness improved dramatically and he was walking with the aid of a walker, and after the second surgery he is walking without any aids. CONCLUSION: This case report emphasizes the high diagnostic importance of proximal muscle weakness as the sole presenting manifestation of Cushing's syndrome/disease.

Concomitant uveal melanoma and papillary thyroid carcinoma: a case report.

BACKGROUND: Melanoma develops in the cells that produce melanin; ocular melanoma accounts for 3-4% of all malignant melanomas. Thyroid tumors are the most common endocrine neoplasms, with more than 95% of cases arising from follicular cell origin. Previous studies have reported associations between malignant melanoma and a wide variety of malignancies. CASE PRESENTATION: We report a 54-year-old Iranian woman who was diagnosed with ocular melanoma based on a mushroom-shaped filling defect with homogeneous echo pattern arising from the anterior third of the temporal side of the globe detected on ocular sonography during routine ophthalmological examination. She underwent right globe enucleation and implant replacement. During tumor surveillance, fluorodeoxyglucose positron emission tomography/computed tomography scan showed low-grade metabolically active tumoral involvement in the anterolateral aspect of the right lobe of thyroid. The patient subsequently underwent thyroidectomy and submandibular lymphadenectomy. Pathologic report demonstrated micropapillary carcinoma (9 × 8 mm2), tall cell variant without lymphovascular or perineural invasion in the base of lymphocytic thyroiditis. CONCLUSION: This case illustrates the importance of precise active surveillance in case of papillary carcinoma of thyroid or malignant melanoma to avoid missing other associated pathologies and emphasizes the simultaneous treatment of two tumors.

Non-linear association of body composition and its components with bone density in Iranian children and adolescents.

Peak bone mass is established during childhood. This study aimed to evaluate the associations of the components of overall body mass with areal bone mineral density Z-score in children. The findings of this study showed that children with greater overall body mass had higher aBMD Z-score. PURPOSE: Peak bone mass is established during childhood and adolescence. One of the important factors influencing predicted bone mass tracking in childhood and adolescence is alteration in the body composition during this growth period. This study aimed to evaluate the associations of the components of overall body mass with areal bone mineral density Z-score in children and adolescents. METHODS: In this cross-sectional study, 478 healthy Iranian children and adolescents (237 girls and 241 boys) who had DXA measures participated. We evaluated the linearity of associations using generalized additive models. RESULTS: Children's mean age was14 years with a range of 9-18 years, and 49.6% were girls. We found an increase in aBMD Z-score with increasing overall body mass (r = 0.25, p < 0.001). We observed this association with fat-free mass and total fat mass up to the 60th (~30 Kg) and 75th percentile (~12.5 Kg) [0.051 (95% CI, 0.027-0.075) increase in aBMD Z-score per 1 Kg increase in fat-free mass and 0.079 (95% CI, 0.044-0.114) increase in aBMD Z-score per 1 Kg increase in the total fat mass]. The correlation between Z-score of overall body mass and its components with aBMD Z-score was strongly positive. (P value < 0.001 for all) CONCLUSION: The findings of this study showed that children with greater overall body mass had higher aBMD Z-score. In addition, this study adds to a growing literature, suggesting that the relationship between body composition and BMD may be influenced by the pattern of fat and fat-free mass distribution in population.

Incidence, Risk Factors, and Follow-Up of Diabetes Mellitus After Liver Transplant: A Prospective Study From Iran.

OBJECTIVES: Diabetes mellitus is one of the metabolic consequences of solid-organ transplant. Most reports on this condition are from cross-sectional or retrospective studies. In this prospective study, we evaluated the incidence, risk factors, and short-term follow-up of diabetes mellitus in recipients of liver transplant at the Shiraz Liver Transplant Center (Shiraz, Iran). MATERIALS AND METHODS: Recipients of liver transplant who were ≥ 16 year old and were seen from February 2017 until February 2018 were included. Anthropologic measurements and diabetes history were taken between 2 and 4 weeks after transplant. Fasting blood sugar and 75-g oral glucose tolerance test were measured. We diagnosed patients with diabetes mellitus and patients with impaired fasting glucose or impaired glucose tolerance test based on American Diabetes Association criteria. These patients were promptly followed for at least 6 months. RESULTS: Of the 397 recipients who were included in this study, 35.5% were female and 64.5% were male. Overall, the most common reason for transplant was primary sclerosing cholangitis (22.5%). We had 42 living donors and 355 deceased donors, with none being unrelated donors. At first visit (3.8 ± 1.6 wk posttransplant), 20.4% of recipients did not have diabetes, 24.2% were diagnosed with preexisting diabetes mellitus, 31.2% had impaired fasting blood sugar or oral glucose tolerance test, and 24.2% were determined to have posttransplant diabetes mellitus. At last visit (13.6 ± 4.9 mo posttransplant), prevalence for posttransplant diabetes mellitus was 10.8%. Multivariate regression analysis showed that age correlated with development of impaired glucose tolerance test or posttransplant diabetes mellitus (odds ratio 1.060; 95% confidence interval, 1.026-1.095; P < .001). CONCLUSIONS: In this prospective cohort study, we followed recipients posttransplant and reevaluated the prevalence of posttransplant diabetes mellitus. We found significant recovery for this type of diabetes mellitus. Further larger and multicenter studies are necessary to monitor and manage diabetes mellitus posttransplant.

Impacts of diabetes mellitus on clinical and para-clinical parameters among COVID-19 patients.

PURPOSE: Diabetes has several adverse effects on patients with coronavirus disease 2019 (COVID-19); however, the determinants of this effect are still poorly understood. It is tried in current study to evaluate impacts of type 2 diabetes, with and without other comorbidities, on the clinical, para-clinical, and outcome parameters among COVID-19 patients. METHODS: A case series was applied, which involved 406 COVID-19 patients admitted in the city of Shiraz, south-central Iran, from February 20 to April 29, 2020. Demographic data, medical history, laboratory finding, chest computed tomography (CT) scan reports, and clinical outcomes of patients with and without type 2 diabetes were compared. RESULTS: Results of the above-mentioned comparison showed that comorbidities such as HTN (35.5% vs. 13.7%, p < 0.001) and CVDs (26.2% vs. 13.4%, P = 0.002) were significantly more prevalent among the diabetic patients. Also, there was not any considerable difference between the chest CT severity parameters of both groups. After excluding all of the comorbidities except diabetes, it was found that the diabetic COVID-19 patients without other comorbidities had lower oxygen saturation level (P < 0.001), higher AST level (P = 0.037), higher BUN (P = 0.005), higher WBC counts (P = 0.025), lower lymphocyte counts (P = 0.029), and longer ICU admission duration (0.72 ± 2.83 vs. 1.71 ± 4.68, P = 0.046). CONCLUSION: The diabetic COVID patients are at higher risks of hypoxemia, longer ICU stays, and more renal and hepatic dysfunction. These achievements could be useful in order to prevent the deterioration of clinical conditions among diabetic COVID-19 patients; also, they have to be considered in the management strategies.

HLA, Immune Response, and Susceptibility to COVID-19.

The severe acute respiratory syndrome caused by Coronavirus 2 (SARS-CoV-2) that appeared in December 2019 has precipitated the global pandemic Coronavirus Disease 2019 (COVID-19). However, in many parts of Africa fewer than expected cases of COVID-19, with lower rates of mortality, have been reported. Individual human leukocyte antigen (HLA) alleles can affect both the susceptibility and the severity of viral infections. In the case of COVID-19 such an analysis may contribute to identifying individuals at higher risk of the disease and the epidemiological level to understanding the differences between countries in the epidemic patterns. It is also recognized that first antigen exposure influences the consequence of subsequent exposure. We thus propose a theory incorporating HLA antigens, the "original antigenic sin (OAS)" effect, and presentation of viral peptides which could explain with differential susceptibility or resistance to SARS-CoV-2 infections.

Revised reference curves of bone mineral density according to age and sex for Iranian children and adolescents.

Bone health evaluation in children requires an appropriate reference database. We have shown higher curves for spine aBMD in Iranian subjects than Americans, but lower curves for femoral neck and total body. These results can be used as reference values to assist Iranian clinicians in interpreting and monitoring bone densitometry results. PURPOSE: Bone health evaluation requires an appropriate reference database that can identify the bone deficit according to age, sex, puberty, and race. The aim of this study was to determine bone mineral density Z-scores in Iranian children and adolescents and their comparability with other reference data. METHODS: A sample of 476 healthy children and adolescents, aged 9-18 years, from Kawar (an urban community, 50 km east of Shiraz, Iran) was selected and bone mineral measurements of the lumbar spine, femoral neck, and total body (less head) were done. Sex-specific height-for-age, weight-for-age, and BMI-for-age Z-scores, as well as bone mineral density Z-scores, were calculated. RESULTS: Extended reference curves for bone mineral content (BMC) and areal bone mineral density (aBMD) of the total body less head, lumbar spine, and femoral neck, for ages 9-18 years were constructed relative to sex and age. We found that median, - 2SD, and + 2SD curves for the lumbar spine aBMD were higher in Iranian subjects than in the American participants, but the curves of the femoral neck and total body were lower. Also, we showed that subjects with a lower height-for-age Z-score had a lower BMC and aBMD Z-score in the lumbar spine, femoral neck, and total body (p < 0.001). CONCLUSIONS: Relevant differences in bone mineral density and its curves exist between Iranian children and adolescents and other databases, revealing a significant potential for misdiagnosis. However, our results can be used to provide reference databases to assist clinicians in interpreting, assessing, and monitoring bone densitometry.

Prevalence of Fracture in Healthy Iranian Children Aged 9-18 Years and Associated Risk Factors; A Population Based Study.

OBJECTIVE: To determine the prevalence of fractures and associated risk factors in healthy Iranian children and adolescents. METHODS: In this cross sectional population based study, 478 healthy Iranian children and adolescents aged 9-18 years old participated. Baseline data and bone mineral content and density have been determined. One questionnaire was completed for all individuals including previous history of fracture, its location, and level of trauma. Albumin, calcium, phosphorus, alkaline phosphatase, and vitamin D levels were measured. RESULTS: We found a prevalence of 12.9% for fracture. (34.5% for girls and 65.5% for boys); about 71% suffered long bone fracture with distal forearm as the most common site. Totally 58% of the boys and 54% of the girls had fracture with low-energy trauma. The fracture group had lower bone mineral apparent density in the lumbar spine (0.19±0.04 vs. 0.20±0.03, p=0.04), lower serum albumin (4.6±0.5 vs 4.8±0.4, p=0.02), and higher serum alkaline phosphatase level (446±174 vs. 361±188, p=0.02) compared with non-fracture subjects. By logistic regression analysis, we found a significant association for sex, and bone mineral content of the lumbar spine with fracture (p=0.003, p=0.039). CONCLUSION: Compared to other studies, our subjects had lower rate of fracture. We found an association between low bone density and fracture in children and adolescents. This finding has important implications for public health. Further research may contribute to recognition of preventive measures.

Investigating the Prevalence of Low Bone Mass in Children of Southern Iran and Its Associated Factors.

BACKGROUND: Improving peak bone mass and bone strength in the first years of life and enhancing it during young adulthood could prevent osteoporosis and fractures in the last years of life. We evaluated the prevalence of low bone mass in the lumbar and femoral neck and its associated factors in southern Iranian children. METHODS: This is a cross-sectional study on healthy Iranian children aged 9 - 18 years old during 2011 - 2012. Dual energy X-ray absorptiometry (DEXA) was used for measuring bone mineral density (BMD). BMD Z-score ≤ -2 was considered as low. Anthropometric data, physical activity, sun exposure, puberty, and mineral biochemical parameters were assessed. Data were analyzed using SPSS v.15. RESULTS: 477 normal children, including 236 (49.5%) girls and 241 (50.5%) boys, aged 13.8 ± 2.7 years were enrolled. Prevalence of low bone mass (LBM) in the femoral and lumbar region was 10.7% and 18.7%, respectively. The prevalence of LBM in femur of girls is twice more than boys. Fat mass index, BMI Z-score, and physical activity were associated with lumbar low bone mass. BMI Z-score and physical activity were associated with femoral low bone mass. CONCLUSIONS: High prevalence of low bone mineral density in children 9 to 18 years in south of the country is concerned and is needed to plan for prevention and treatment. BMI-Z score, fat mass index, and physical activity were the 3 most important preventive factors in developing low bone mass in children.

Relative Importance of Lean and Fat Mass on Bone Mineral Density in Iranian Children and Adolescents.

BACKGROUND: Body weight is made up of lean and fat mass and both are involved in growth and development. Impression of these two components in bone density accrual has been controversial. OBJECTIVES: The aim of this study was to evaluate the relationship between fat and lean mass and bone density in Iranian children and adolescents. PATIENTS AND METHODS: A cross-sectional study was performed on 472 subjects (235 girls, 237 boys) aged 9-18 years old in Fars Province. The participants' weight, height, waist circumference, stage of puberty, and level of physical activity were recorded. Bone Mineral Content (BMC), Bone Mineral Density (BMD), total body fat and lean mass were measured using dual-energy X-ray absorptiometry. RESULTS: Results showed that 12.2% of boys and 12.3% of girls were overweight and 5.5% of boys and 4.7% of girls were obese. Obese individuals had greater total body BMD (0.96 ± 0.11) than normal-weight ones (0.86 ± 0.11) (P < 0.001). We found the greatest correlation between total body BMD and total body lean mass (R = 0.78. P < 0.001) and the least correlation with total body fat percentage (R = 0.03, P = 0.44). Total lean mass in more active boys was 38.1 ± 10.9 and in less active boys was 32.3 ± 11.0 (P < 0.001). The results of multiple regression analysis showed that age and total body lean mass were independent factors of BMD in growing children and adolescents. CONCLUSIONS: These findings suggest that lean mass was the most important predictor of BMD in both genders. Physical activity appears to positively impact on lean mass and needs to be considered in physical education and health-enhancing programs in Iranian school children.

Body composition reference percentiles of healthy Iranian children and adolescents in southern Iran.

BACKGROUND: The prevalence of childhood obesity has risen greatly worldwide. However, assessment of obesity among children and adolescents is further complicated by the changes occurring in the body composition during the growth. The aim of this study is to create gender-specific percentile curves for total body fat percentage (TBFP), total body fat mass (TBFM), fat mass index (FMI), and fat free mass index (FFMI) in healthy Iranian children and adolescents. METHODS: In this cross-sectional study, 472 healthy Iranian children and adolescents (234 girls and 238 boys) aged 9-18 years old participated. TBFP and TBFM were measured by Dual-Energy X-ray Absorptiometry (DEXA). Weight, height, and waist circumference (WC), pubertal stage and level of physical activity were also recorded. RESULTS: Mean TBFM, TBFP and FMI in girls were significantly more than boys (P < 0.001). The median TBFM in boys increased from 4.8 Kg to 7.5 Kg and in girls from 6.0 Kg to 15.6 Kg. The percentile curves of TBFP in boys were down sloping compared with that in girls (19% increase in girls and 21% decrease in boys from 9-18 years of age). We showed TBFP and FMI had a more complicated relationship with BMI depending on gender and level of BMI, but FFMI consistently increased with BMI in both genders. Also, we found that waist circumference -as a marker of metabolic syndrome-had the greatest correlation with FMI (P < 0.001) between DEXA measured parameters. CONCSLUSION: This study presents normative data for body composition in healthy Iranian children and adolescents and would be useful in adiposity assessment. Our study showed that Iranian children and adolescents had lower total body fat in all age groups and percentiles in comparison with those reported from western children.