Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors, including dapagliflozin and empagliflozin, are widely used for glycemic control in type 2 diabetes but may affect the risk of urinary tract infection (UTI). Objectives: This study compared the incidence of UTIs among women with diabetes treated with dapagliflozin versus empagliflozin. Methods: In this randomized, double-blind clinical trial, 149 diabetic women aged ≥ 18 years were assigned to receive dapagliflozin 5 mg (n = 79) or empagliflozin 10 mg (n = 70) daily for three months. Fasting blood sugar (FBS), glycated hemoglobin (HbA1c), and serum creatinine (Cr) were measured at baseline and after treatment. Urinalysis and urine culture were used to confirm UTIs. Data were analyzed using SPSS version 28.0, with P < 0.05 considered statistically significant. Results: The mean age was 62.7 ± 9.7 years, with no baseline differences between groups. UTIs occurred in 12 patients overall: 2 (2.5%) in the dapagliflozin group and 10 (14.3%) in the empagliflozin group (OR = 0.16; 95% CI, 0.03 - 0.74; P = 0.009). No significant intergroup differences were observed in FBS, HbA1c, or Cr levels. Conclusions: Empagliflozin was associated with a higher short-term incidence of UTIs than dapagliflozin, despite similar metabolic outcomes. Monitoring for UTIs is recommended when prescribing SGLT2 inhibitors, particularly empagliflozin. Trial Registration: This trial is registered with the Iranian Registry of Clinical Trials (IRCT20250129064554N1).
Context: Reference values (RVs) are essential tools for medical decision-making, used to interpret an individual’s health status and playing a crucial role in patient care. In addition to age, sex, and inherent biological variability, multiple determinants, including ethnicity, genetic background, dietary habits, environmental factors, and lifestyle, which vary across different populations, play a significant role in the establishment of RVs. Thus, each population requires its own RVs to ensure their effectiveness. Evidence Acquisition: In this review, we summarize RVs reported in the Tehran Lipid and Glucose Study (TLGS) between 2010 and 2026, covering 20 analytes measured in apparently healthy participants, including 16 in adults and 4 in pediatrics. Relevant TLGS publications were identified, and their findings were compared with corresponding international data. Results: RVs were provided for 20 parameters, classified into three categories: (1) Glucose, insulin, insulin resistance/sensitivity indices, and lipid profile; (2) thyroid function tests [thyroid-stimulating hormone (TSH) and free thyroxine (T4)] and autoimmunity [thyroid peroxidase antibody (TPO-Ab)]; (3) other variables, including creatinine and minerals (serum zinc and magnesium), and serum nitric oxide metabolites. Conclusions: The RVs determined by the TLGS provide a population-specific framework for the Iranian population and may serve as a more accurate tool for classification and clinical interpretation than common global RVs. These data emphasize the importance of developing localized RVs to enhance diagnostic precision and improve population health outcomes.
Background:Type 2 diabetes mellitus (T2DM) progresses through prediabetes (PD), which is characterized by insulin resistance and β-cell dysfunction. More than 50% of T2DM cases remain undiagnosed, underscoring the need for specific molecular markers beyond standard diagnostic tests. Objectives:This study aimed to compare sociodemographic, biochemical, and molecular profiles among groups to improve risk stratification. Methods:This cross-sectional study recruited 90 participants, including healthy controls (HC), individuals with PD, and patients with T2DM (n = 30 each), at Smart Health Tower, Sulaymaniyah, Iraq, from January to June 2025. Approximately 6.0 mL of blood was collected from each participant and analyzed for glycated hemoglobin (HbA1C), random blood glucose (RBG), C-peptide, lipid profile, urea, and creatinine, as well as molecular markers, including micro-ribonucleic acids (miRNAs) such as miRNA-126 and miRNA-132. Variables were subsequently compared among the groups. Results:Glycemic markers differed markedly among groups, with HbA1C and RBG highest in T2DM (P < 0.050). In PD, C-peptide (3.04 ± 1.33 ng/mL, P < 0.010) and high-density lipoprotein (HDL) (48.2 ± 12.3 mg/dL, P = 0.028) were highest. Renal markers showed the lowest creatinine level in T2DM (0.72 ± 0.18 mg/dL, P < 0.010), whereas urea levels were comparable among groups (P > 0.05). In patients with T2DM, correlations were observed between RBG and HbA1C (r = 0.792, P < 0.001), C-peptide and triglycerides (r = 0.598, P < 0.001), and HbA1C and creatinine (r = -0.452, P = 0.012). In the PD group, RBG correlated with C-peptide (r = 0.387, P = 0.035). In contrast, miRNA-132 expression was lowest in HC (0.90 ± 0.63; 95% CI, 0.67 - 1.14), significantly increased in PD (2.50 ± 1.86; 95% CI, 1.74 - 3.26), and highest in T2DM (3.56 ± 2.04; 95% CI, 2.80 - 4.32), with highly significant differences between HC and PD and between HC and T2DM (P < 0.001), as well as between PD and T2DM (P = 0.045). Additionally, miRNA-126 expression was lowest in HC (1.22 ± 0.52; 95% CI, 1.03 - 1.42), moderately elevated in T2DM (1.29 ± 0.85; 95% CI, 0.97 - 1.61), and highest in PD (1.70 ± 0.74; 95% CI, 1.41 - 1.98), with significant differences between PD and HC (P = 0.021) and between PD and T2DM (P = 0.029), while no significant difference was observed between HC and T2DM (P = 0.252). Conclusions:The identified interconnections among glycemic, lipid, and renal indicators underscore the importance of early identification, comprehensive biochemical evaluation, and timely care during the PD phase to prevent progression to overt DM and its associated complications.
Background:Post-transplant diabetes mellitus (PTDM) is a serious complication after heart transplantation, with reported incidence rates ranging from 2% to 53% among solid organ transplant recipients. Comprehensive epidemiological data on prediabetes (Pre-DM) and diabetes mellitus (DM) in heart transplant populations remain limited, particularly in Middle Eastern populations. Objectives:This decade-long study investigated the prevalence of DM and Pre-DM among heart transplant recipients and evaluated selected intraoperative risk factors. Methods:This retrospective cohort study included 250 heart transplant recipients who received post-transplant care at Dr. Masih Daneshvari Hospital, Tehran, Iran, between 2010 and 2020. Overall, 244 patients were included in the final analysis. Data included anthropometric measurements, cardiovascular parameters, and metabolic profiles. Pre-DM and DM were diagnosed according to the American Diabetes Association criteria. Statistical analyses were performed using SPSS version 26. Results:The study population comprised 192 males (78.7%) and 52 females (21.3%), with a mean age of 38.46 ± 12.69 years. At transplantation, 36.5% of recipients had established DM, 29.1% had Pre-DM, and 34.4% had normal glucose metabolism. Among patients with DM, 58.4% (52 of 89) were unaware of their diagnosis before transplantation. New-onset PTDM occurred in 6.8% of previously normoglycemic patients by 6 months. The prevalence of hypertension differed markedly by glucose status (P < 0.001): 100% of the normal group had normal blood pressure, 97.2% of patients with Pre-DM had stage 1 hypertension, and 87.6% of patients with DM had stage 2 hypertension. Dyslipidemia, particularly low high-density lipoprotein (HDL), was present in all groups. Pre-transplant hyperglycemia was associated with a numerically higher, but nonsignificant, mortality risk (hazard ratio [HR] = 1.371; 95% CI, 0.891 - 2.132; P = 0.162), which reversed after age adjustment (HR = 0.676; P = 0.083), consistent with negative confounding. Conclusions:Pre-transplant metabolic dysfunction was highly prevalent, and 58.4% of diabetic recipients were unaware of their diagnosis. Although the association with mortality was nonsignificant and reversed after adjustment for age, these findings underscore the need for systematic pre-transplant metabolic screening, post-transplant glucose monitoring, and multidisciplinary care in heart transplant recipients.
Context: Thyroid dysfunction and type 2 diabetes mellitus (T2DM) are common endocrine disorders with substantial public health implications. Increasing evidence suggests that alterations in thyroid function may influence glycemic regulation and the risk of T2DM. However, long-term population-based evidence on this relationship remains limited. Therefore, this study aimed to summarize the association between thyroid function and T2DM using findings from the Tehran Thyroid Study (TTS), a large community-based cohort with nearly 2 decades of follow-up. Evidence Acquisition: A literature search was performed in PubMed, Scopus, Web of Science, and the library of the Research Institute for Endocrine Sciences to identify articles within the TTS framework. The retrieved articles were categorized according to their primary predictors and outcomes, including T2DM, thyroid function, thyroid hormone sensitivity, and insulin resistance. Results: Over 18 years, a longitudinal analysis of 1938 adults showed that each unit increase in log-transformed thyroid-stimulating hormone (TSH) was associated with a 25% lower risk of developing T2DM (HR, 0.75; 95% CI, 0.64 - 0.90), whereas higher free thyroxine (FT4) levels were associated with a slightly increased risk of T2DM. Cross-sectional data indicated that overt and subclinical hyperthyroidism significantly increased the odds of hyperglycemia, with the highest prevalence (31.3%) observed in subclinical hyperthyroidism. In studies of thyroid hormone sensitivity, a 1-SD increase in the thyroid feedback quantile-based index (TFQI) was associated with higher odds of T2DM, whereas higher central sensitivity indices were associated with lower odds of prediabetes. Lower FT4 levels were independently associated with higher insulin resistance in euthyroid men but not in women. Patients with diabetes had a higher prevalence of subclinical hyperthyroidism but a lower incidence of thyroid dysfunction compared with controls. Conclusions: Trends toward lower TSH or relatively higher FT4 levels are associated with an increased incidence of T2DM. Both overt and subclinical hyperthyroidism are associated with hyperglycemia. Current evidence supports targeted metabolic monitoring in individuals with thyroid hormone excess or altered thyroid sensitivity indices but does not justify routine thyroid-directed therapy solely to prevent T2DM.
Context: The current study aimed to review the studies that investigated the association of cardiovascular risks and emotional states in men and women participating in the Tehran Lipid and Glucose Study (TLGS). Evidence Acquisition: A comprehensive search of PubMed, Scopus, and Web of Science was conducted to identify crosssectional and prospective studies published through February 2026, based on predetermined inclusion and exclusion criteria. Cardiovascular risk factors were defined as weight status, blood pressure, and insulin resistance, while emotional states encompassed depression, anxiety, and stress. Given the heterogeneity in study designs and outcomes, the findings were synthesized narratively, and a meta-analysis was not performed. Results: Six eligible studies (four cross-sectional and two prospective) were included. Their findings indicated that hypertension and insulin resistance were associated with increased emotional distress, particularly among women with diagnosed hypertension. Long-term weight analyses showed that higher stress levels in males were associated with progression to overweight and obesity from childhood. Severe obesity was associated with greater mental distress in both sexes. Studies on obesity phenotypes indicated that higher anxiety and stress scores were observed among metabolically unhealthy obese women, a pattern also observed in metabolically unhealthy men regardless of weight status. Conclusions: Evidence from the TLGS indicated a sex-dependent association between cardiovascular risks and emotional states, with a significant association observed specifically in women.
Context: We summarized findings from the Tehran Lipid and Glucose Study (TLGS) on cardiovascular disease (CVD) mortality and its predictors over nearly two decades. Evidence Acquisition: A review was undertaken to retrieve TLGS publications related to CVD mortality and predictors from the January 1999 to August 5, 2025. Results: Across TLGS studies, the crude incidence rate of CVD mortality ranged from 1.7 to 4.1 per 1000 person-years in adults aged ≥ 30 years, with higher rates observed among men than women. CVD mortality was associated with traditional risk factors such as diabetes, hypertension, metabolic syndrome (MetS), and dyslipidemia, as well as emerging markers including continuous MetS severity score, anthropometric indices, dynamic weight change, kidney function decline, resting pulse rate, and adherence to cardiovascular health metric. Evidence also highlighted differential associations by age, sex, and diabetes status. Subgroup analyses indicated that elderly participants and those with metabolic abnormalities had higher CVD and sudden cardiac death (SCD) risks. Conclusions: Tehran Lipid and Glucose Study studies have provided comprehensive insights into the epidemiology and predictors of CVD mortality in the Iranian population, emphasizing both traditional and emerging risk factors. These findings can inform tailored prevention and intervention strategies, though further research incorporating dynamic risk models, omics data, and sex-specific analyses is warranted.
Context: Polycystic ovary syndrome (PCOS) affects an increasing number of reproductive-aged women and has been progressively associated with a spectrum of metabolic disturbances. Understanding its long-term cardiometabolic consequences, both in affected women and in their offspring, is critical for informing early prevention and targeted intervention strategies. This study provides a comprehensive synthesis of published data from the Tehran lipid and glucose study (TLGS) on women with PCOS, offering insights into epidemiological patterns, risk factors, and potential intergenerational impacts in this population. Evidence Acquisition: This narrative review provides a comprehensive summary of TLGS-based publications addressing cardiometabolic disorders associated with PCOS. Relevant studies were identified through a comprehensive search of PubMed (including Medline), Web of Science, and Scopus. Results: Data from the TLGS indicate a rising prevalence of PCOS over approximately a decade, increasing from 8.5% based on the National Institutes of Health (NIH) criteria to 13.6% (NIH), 17.8% (androgen excess (AE)-PCOS Society), and 19.4% (Rotterdam criteria). Women with PCOS in early adulthood demonstrated elevated levels of insulin resistance (IR) as reflected by higher HOMA-IR and fasting insulin values, and subsequently experienced a heightened likelihood of developing type 2 diabetes mellitus (T2DM), hypertension, metabolic syndrome (MetS), and obesity, with adjusted hazard ratios ranging from approximately 0.58 to 2.08 across multiple publications. Notably, the prevalence of certain cardiometabolic disorders appeared to decline after the age of 40 years. Longitudinal data showed that trajectories of HOMA-IR and fasting insulin differed depending on obesity status in women with PCOS, and that cardiometabolic risk burden varied across diagnostic phenotypes. Interestingly, PCOS was not associated with an increased risk of silent coronary artery disease. Nevertheless, the Framingham risk score (FRS) showed good predictive performance for cardiovascular disease (CVD) in the PCOS population, with a 38% increase in CVD risk per 1-unit increment in FRS among affected women. Intergenerational analyses further highlighted that the offspring of women with PCOS carry a higher predisposition to metabolic disorders. Daughters of affected women were found to have increased risks of T2DM, overweight, and MetS. At the same time, sons exhibited significantly elevated risk of pre-diabetes mellitus, with adjusted hazard ratios ranging from approximately 1.3 to 2.4. These findings underscore both the individual and transgenerational cardiometabolic disorders of PCOS. Conclusions: Publications from the TLGS provide consistent evidence that PCOS is associated with a spectrum of early cardiometabolic disturbances in affected women with potential adverse impacts extending to their offspring. These observations underscore the importance of implementing age-specific metabolic screening and preventive interventions for women with PCOS and their offspring. Furthermore, they highlight the need for long-term, prospective follow-up studies to elucidate underlying causal pathways and identify targeted strategies for timely intervention.
Background: Hypoglycemia is a common and serious complication in type 2 diabetes management, often leading to adverse health and social consequences. Education aimed at improving patient knowledge and self-care behaviors may prevent recurrence of hypoglycemic episodes. Objectives: This study investigated the effect of a motion graphics-based educational intervention on knowledge, practice, and recurrence of hypoglycemia among patients with type 2 diabetes in Yazd, Iran. Methods: In this quasi-experimental study, 122 patients with type 2 diabetes who referred to the Diabetes Center and had at least one hypoglycemic episode in the previous three months were randomly assigned to an intervention group (n = 60) or a control group (n = 62). The intervention group received standard care plus an educational video clip covering hypoglycemia definition, causes, symptoms, treatment, and prevention. Knowledge and practices (as primary outcomes) were assessed by validated questionnaires before and three months after the intervention, and the recurrence of hypoglycemia (as secondary outcome) was determined by patient self-report. Statistical analyses included McNemar's test and logistic regression to compare within-and between-group differences. Results: Post-intervention, the intervention group showed significant improvements in knowledge about testing (from 76.7% to 91.7%, P = 0.022), treatment (61.7% to 90.0%, P = 0.0 01), and prevention (46.7% to 85.0%, P = 0.001) of hypoglycemia. Practice improvements included increased consultation with doctors (533% to 68.3%, P = 0.035) and implementation of preventive measures (41.7% to 66.7%, P = 0.001). Hypoglycemia recurrence decreased markedly from 100% to 35.0% (P = 0.001). Between-group comparisons confirmed statistically significant differences in key knowledge, practice, and hypoglycemia recurrence outcomes. Conclusions: Motion graphics educational content effectively enhanced hypoglycemia-related knowledge and preventive practices, leading to a significant reduction in hypoglycemic episodes among type 2 diabetic patients. Incorporating such interventions into diabetes care programs is recommended. It is worth noting that this study is limited by its reliance on self-reported hypoglycemia.
Background: Dopamine is an essential neurotransmitter involved in motivation and reward. In obesity, altered dopaminergic responses to food may drive excess energy intake, implicating dopamine in the pathophysiology of obesity. Additionally, dopamine may act as an anti-incretin, potentially facilitating the development of type 2 diabetes. Objectives: This retrospective study investigated associations between urinary dopamine, weight, Body Mass Index (BMI), plasma glucose, and hemoglobin A1c (HbA1c). Methods: Twenty-four-hour urinary dopamine concentrations measured with liquid chromatography tandem mass spectrometry between January 2000 and October 2020 were retrieved from the University Hospitals Leuven clinical database. Records with dopamine disruption disorders or medications, psychiatric conditions, prior bariatric surgery, active malignancies, diabetes mellitus other than type 2 diabetes, chronic renal insufficiency, or urinary creatinine concentration outside the reference range were excluded, yielding 178 records. Spearman correlations and multiple linear regression models were performed; statistical significance was set at P < 0.05. Results: Twenty-four-hour urinary dopamine concentrations positively correlated with body weight and negatively with HbA1c, but these correlations became non-significant when corrected for age, sex, and estimated glomerular filtration rate (eGFR). The only remaining significant correlation was between age and twenty-four-hour urinary dopamine (β = -1.2, P = 0.030). Conclusions: No significant correlations were found between twenty-four-hour urinary dopamine and weight, BMI, or glucose homeostasis, potentially due to the absence of dietary control. As dopamine measurements came from a clinical database, generalizability is limited. Prospective dedicated studies are needed to disentangle the role of peripheral dopamine in the pathophysiology of obesity.
Background: The achievement of sustained euthyroidism in patients with Graves’ hyperthyroidism may reduce the risk of mortality and cardiovascular events. Objectives: We compared the time to euthyroidism and the time remaining in euthyroidism following total thyroidectomy and long-term methimazole (LT-MMI) treatment. Methods: In this prospective cohort study, two hundred and eight patients with diffuse toxic goiter, 104 (84 women) with total thyroidectomy, and 104 (84 women) on LT-MMI were compared. All patients received adequate levothyroxine treatment after thyroidectomy. Data on serum free thyroxine (fT4), triiodothyronine (T3), and thyrotropin (TSH) every 6 months until the end of follow-up were analyzed. The time to normalization of serum thyroid hormones and TSH concentrations and the percentage of time that thyroid hormones and TSH levels remained within the normal range during a mean follow-up of 11 years were compared between the two study groups using t-test, Mann-Whitney U, chi-square, and Fisher exact tests. Results: The mean time to euthyroidism was 4.74 ± 2.42 and 4.48 ± 2.54 months in the thyroidectomy and LT-MMI groups, respectively. During follow-up, the percentage of time spent in euthyroidism was 82.67 ± 7.33% vs 94.21 ± 6.98% in the thyroidectomy and LT-MMI groups, respectively (P < 0.001). Patients with thyroidectomy spent more time in subclinical and clinical hypo- and hyperthyroidism compared to LT-MMI patients. Permanent hypocalcemia and vocal cord paralysis occurred in 2 and 1 patients, respectively. Conclusions: Treatment of hypothyroidism after total thyroidectomy was accompanied by less sustained euthyroidism during long-term follow-up compared with LT-MMI therapy. This difference may be important for the risk of mortality and cardiovascular events, demanding long-term studies for comparison of these outcomes in patients treated with total thyroidectomy and LT-MMI treatment.
Context: Understanding the different reproductive factors and their link to non-communicable diseases (NCDs) is crucial in a community-based cohort study. The present study provides a comprehensive synthesis of published findings derived from the Tehran lipid and glucose study (TLGS) pertaining to women, offering insights into the epidemiological patterns of reproductive lifespan and its impact on cardiometabolic parameters. Evidence Acquisition: We conducted a thorough review of all studies on reproductive lifespan conducted within the TLGS framework. Results: Overall, the mean (SD) age at menarche among participants was 13.35 (1.5) years, whereas the mean (SD) age at menopause was 50.16 (5.7) years. Early menarche was identified as a significant factor associated with later metabolic impairments, including higher odds of prediabetes (OR: 2.7; 95% CI: 1.1 - 6.6), type 2 diabetes mellitus (DM) (OR: 3.6; 95% CI: 1.2 - 10.7), and metabolic syndrome (MetS) (OR: 2.3; 95% CI: 1.1 - 5.4) in fully adjusted models. Comparisons between surgical and natural menopause revealed that the incidence of MetS was nearly tenfold higher among women who experienced surgical menopause, accompanied by elevated mean fasting plasma glucose (FPG) and 2‑hour post‑load glucose concentrations. Furthermore, each additional year in age at natural menopause was associated with a 10% increase in the incidence of chronic kidney disease (CKD), whereas prolonged exposure to endogenous estrogen appeared to confer protective effects, reducing the incidence of hypertension, cardiovascular disease (CVD), CKD, and osteoporotic fractures. In addition, lactation was found to markedly lower the risk of MetS among women with a prior history of gestational diabetes, emphasizing its potential long‑term cardiometabolic benefits. Conclusions: The reproductive milestones significantly shape women’s long‑term cardiometabolic health, supporting the integration of reproductive history into preventive care models and longitudinal risk assessment frameworks.
Context:Metabolic syndrome (MetS) and increased carotid intima-media thickness (CIMT) in children and adolescents are critical early warning signs for the development of non-communicable disorders in adulthood. Identifying modifiable risk factors such as the Dietary Inflammatory Index (DII) is therefore essential for implementing early public health interventions to prevent irreversible long-term health consequences. Objectives:This systematic review aimed to evaluate the association of DII with MetS and CIMT in children and adolescents. Data Sources:Using three literature databases (PubMed, Web of Science, and Scopus), we searched for studies published between 1 January 2000 and 1 August 2024, which assessed the association of DII with MetS or CIMT among children and adolescents. Study Selection:Two reviewers screened and assessed the quality of studies using the Newcastle-Ottawa Scale. Data Extraction:Given the heterogeneity of study designs, a narrative synthesis approach was employed (PROSPERO: CRD420250643107). Results:Out of 23,393 records identified, two prospective cohorts and five cross-sectional studies met our inclusion criteria, including four and three studies focused on MetS and CIMT as the outcome, respectively. The included studies investigated a combined population of over 13,000 participants, comprising both sexes, aged 6 to 19 years. Two studies, one cross-sectional (odds ratio: 1.20; 95% confidence interval: 1.01, 1.43) and one prospective (β: 0.12; 0.003, 0.22), showed a harmful association between DII and MetS, while two other studies did not find any statistically significant association. Regarding the association between DII and CIMT, two studies noted null associations, while another study observed a positive association with high CIMT [odds ratio = 2.46 (1.15, 5.24)]. Conclusions:In light of the inconsistent associations between the DII with MetS or CIMT reported in the literature, the suggestive evidence of harm from a small number of studies highlights a critical gap.
Context:Thyroid dysfunction and metabolic syndrome (MetS) share similar pathophysiological features, suggesting a bidirectional relationship between these two prevalent endocrinological disorders. This review summarizes findings from 18 years of follow-up in the Tehran Thyroid Study (TTS), a large community-based prospective cohort, focusing on the association between thyroid function and MetS. Evidence Acquisition:We systematically reviewed TTS publications (until 2025) on thyroid function and MetS. Exposures included thyroid-stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibody (TPOAb), and thyroid feedback indices [Thyroid Feedback Quantile-Based Index (TFQI), Thyrotroph T4 Resistance Index (TT4RI), and TSH Index (TSHI)]. Outcomes were MetS and its components. Study designs ranged from cross-sectional and prospective cohort to joint longitudinal/time-to-event models. Results:Cross-sectional TTS analyses showed an inverse association between FT4 (but not TSH) and the prevalence of MetS. Among 3,755 euthyroid adults, a 1-unit increase in FT4 was associated with lower odds of MetS (OR 0.96, 95% CI: 0.92 - 0.99). Across thyroid functional states, overt hypothyroidism had the highest MetS prevalence (41.6%); in men, overt hypothyroidism was associated with higher odds of MetS versus euthyroidism (OR 2.9, 95% CI: 1.04 - 8.40). Prospective TTS analyses supported a modest thyroid-to-MetS direction. In a 10-year cohort of 2,393 participants without MetS at baseline, declining FT4 over follow-up predicted incident MetS in non-obese adults (OR 0.57, 95% CI: 0.34 - 0.96) and was associated with lower odds of incident abdominal obesity and hypertriglyceridemia. In joint longitudinal-time-to-event models (n = 1,436; median 9-year follow-up), higher time-varying TSH was associated with higher MetS risk (HR 1.17, 95% CI: 1.01 - 1.28), while higher FT4 predicted lower MetS risk (HR 0.54, 95% CI: 0.29 - 0.97). In the reverse direction, baseline MetS did not independently predict incident thyroid dysfunction over 9 years (n = 4,905; adjusted HR, 0.95; 95% CI: 0.77 - 1.18). Thyroid hormone sensitivity indices were not associated with MetS overall, although higher TFQI was associated with hypertension (OR 1.14, 95% CI: 1.05 - 1.23). Conclusions:Eighteen years of follow-up in TTS suggest a modest, mostly one-way thyroid-MetS association. Higher (or high-normal) TSH and lower FT4 modestly increase MetS risk, whereas baseline MetS did not significantly increase the risk of later thyroid dysfunction.
Background:Glycosylated hemoglobin (HbA1c) is widely used for the diagnosis and long-term monitoring of diabetes mellitus (DM). However, its accuracy may be compromised by conditions and medications that alter erythrocyte lifespan or hemoglobin structure. Dapsone, commonly used in the treatment of Hansen's disease, has been reported to cause spuriously low HbA1c values, but systematic data on its prevalence and underlying mechanisms remain limited. Objectives:The objectives of this study were to (1) determine the prevalence of discordantly low HbA1c levels in patients receiving dapsone therapy, including individuals with and without DM; (2) explore associations between discordant HbA1c and markers of hemolysis and methemoglobinemia; and (3) compare measured HbA1c values obtained by high-performance liquid chromatography (HPLC) with expected HbA1c values derived from fructosamine using the glycosyl gap. Methods:This retrospective cross-sectional study included 30 patients receiving oral dapsone for Hansen's disease and 10 healthy controls. HbA1c was measured using ion-exchange HPLC and compared with expected HbA1c values calculated from serum fructosamine. Parameters related to hemolysis and methemoglobinemia were assessed. Discordant HbA1c was defined by a negative glycosyl gap. Subgroup analyses were exploratory. Results:Among patients receiving dapsone, 16 had DM and 14 were normoglycemic. Discordantly low HbA1c was observed in 27 of 30 patients (90%), including 15 of 16 patients with DM and 12 of 14 without diabetes. Markers of hemolysis and methemoglobinemia showed trends consistent with biological plausibility but did not demonstrate statistically significant differences sufficient to establish causality. Conclusions:A high prevalence of discordantly low HbA1c was observed among patients receiving dapsone therapy, highlighting an important clinical pitfall in the interpretation of HbA1c. While hemolysis and methemoglobinemia remain biologically plausible contributors, these findings should be considered hypothesis-generating. Clinicians should exercise caution when interpreting HbA1c in patients treated with dapsone and consider alternative glycemic markers such as fructosamine.
Background and Objective:Body composition is increasingly recognized as an important factor associated with bone health; however, evidence focusing on individuals with metabolic syndrome (MetS) remains limited, particularly in Southeast Asian populations. Methods:This cross-sectional study included 128 adults with MetS recruited from two medical centers in Vietnam between October 2017 and September 2024. All participants underwent dual-energy X-ray absorptiometry (DEXA) to assess regional body composition and bone mineral density (BMD). Associations between lean mass, fat distribution, and BMD across multiple skeletal sites were evaluated using Pearson correlation analysis. Results:Lean mass indices, including Lean Mass Index (LMI) and Appendicular Skeletal Muscle Index (ASMI), were positively associated with BMD across multiple skeletal sites, with the strongest associations observed in the appendicular skeleton and whole body (r = 0.17 - 0.73, P < 0.001). In contrast, central adiposity, reflected by the android-to-gynoid (A/G) fat ratio and regional fat percentages, showed inverse associations with BMD, particularly at the spine and long bones (r = -0.20 to -0.29, P < 0.05). Conclusions:In adults with MetS, lean mass was positively associated with BMD, whereas central adiposity showed inverse associations with skeletal health. These findings highlight the importance of body composition, beyond BMI alone, in the assessment of bone health in this high-risk population. DEXA-based body composition assessment may provide clinically relevant information to support patient evaluation.
Background:Neonatal hypoglycemia is a common and serious condition in infants born to diabetic mothers (IDMs), particularly those with gestational diabetes mellitus (GDM). Objectives:This study aimed to explore neonatal glycemic status and its associated maternal and neonatal factors in babies born to diabetic mothers. Methods:A prospective cohort study was conducted in the Neonatal Intensive Care Unit of Dr. Jamal Ahmad Rashid Pediatrics Teaching Hospital and Sulaimani Maternity Teaching Hospital on 105 neonates born to mothers with type 1, type 2, or GDM. Neonatal blood glucose levels were measured at multiple time intervals (0, 1, 3, and 6 hours). Maternal and neonatal characteristics, including sociodemographic data, clinical characteristics, and delivery outcomes, were analyzed and correlated to neonatal glycemic status. Results:Most pregnant women (61%) were aged 30 - 39 years, Kurdish (92.4%), had completed high school (33.3%), lived in urban areas (69.5%), had > 3 children (58.1%), were diagnosed with GDM (87.6%), used oral medications (54.3%), had well-controlled blood sugar levels (64.8%), and experienced cesarean section (81.9%). Type 1 diabetes mellitus (T1DM) was significantly associated with neonatal blood glucose levels over time (P = 0.003). Glycemic control demonstrated a non-significant rise in blood glucose from birth to 6 hours in all patterns. Fetal weight was inversely and significantly correlated with blood glucose at birth and at 1 hour, but not at 3 or 6 hours. Gestational age showed no significant correlation with blood glucose at birth, 1, or 3 hours, but exhibited a significant correlation at 6 hours (P = 0.030). Conclusions:Maternal T1DM, more specifically, and fetal weight with gestational age were directly correlated to neonatal glycemic status in infants of diabetic mothers, but in different time periods. Thus, early monitoring and intervention for neonatal hypoglycemia are crucial, especially for neonates with poor maternal glycemic control.
Context:Evidence supports that adverse pregnancy outcomes (APOs) might affect women's health in later life. This review summarizes the findings of the Tehran Lipid and Glucose Study (TLGS) on the association between APOs and long-term chronic diseases over the past two decades. Evidence Acquisition:This narrative review was conducted on TLGS-published articles on the association between APOs and long-term chronic disease over the last decades. The search for articles was performed on PubMed from 1999 to September 2025. Results:As of September 2025, nine peer-reviewed English-language articles have been published from the TLGS dataset. Studies showed that a history of hypertensive disorders of pregnancy (HDP) was associated with a twofold increased risk of hypertension, a threefold risk of diabetes, and a 1.3 times risk of dyslipidemia. Moreover, women with a history of preeclampsia were 3.62 times more likely to experience hypertension progression. Women with a history of gestational diabetes mellitus (GDM) had a 2.23 times risk of diabetes and a 1.85 times risk of cardiovascular disease (CVD). Having a history of preterm delivery increased the risk of chronic kidney disease (CKD) 2.68 times more than that of women without such a history. The risk of metabolic syndrome (METS) was increased by 8% in women with a history of pregnancy loss. Moreover, a history of one, two, or three APOs was associated with an increased risk of developing CVD, with the risk rising progressively as the number of APOs increased. Conclusions:Over the past two decades, the TLGS has published a number of peer-reviewed articles that collectively provide a unique perspective on the long-term health consequences of APOs. These studies indicate that pregnancy is not only an obstetric event but also a vital period for assessing women's long-term health. Women with a history of APOs require early preventive evaluations and ongoing monitoring to identify and treat chronic conditions linked to increased risks of premature mortality.
