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AbstractBackground:Obesity is a rapidly progressing pandemic and a central feature of the metabolic syndrome. There is no solid evidence on the recent trends of obesity in Iran. In this study we present the secular trends of overweight and obesity among Iranian adults (25–64 years old) within an 8-year period (1999–2007).Methods:The analyses were performed on the datasets of three cross-sectional national surveys: The National Health Survey–1999 (n= 21,576), National Surveys of Risk Factors for Non-Communicable Diseases (SuRFNCD)–2005 (n= 70,945), and SuRFNCD–2007 (n= 4,186).Results:The overall prevalence of obesity increased from 13.6% in 1999 to 19.6% in 2005 and 22.3% in 2007 [odds ratio (OR) = 1.08 per year; P< 0.001]. For overweight subjects, the rates were, respectively, 32.2%, 35.8% and 36.3% (OR = 1.02 per year; P< 0.001). During these years, the mean body mass index (BMI) (kg/m2) increased from 25.03 in 1999, to 26.14 in 2005, and 26.47 and 2007 (P< 0.001). The increase in prevalence of obesity was seen in both males (OR = 1.09 per year; P< 0.001) and females (OR = 1.07 per year; P< 0.001) and both urban (OR = 1.07 per year; P< 0.001) and rural (OR = 1.10 per year; P< 0.001) residents.Conclusions:In conclusion, the present study highlighted the rapid growth of obesity during recent years in Iran. Our findings indicate the crucial necessity of primary prevention programs to counteract this undesired condition. [ABSTRACT FROM AUTHOR]

Background:Leptin is correlated with several features of metabolic syndrome; however, possible confounders (eg, obesity) of this association are not known. This study evaluated the relationship between leptin, metabolic syndrome, and insulin resistance in an Iranian population and further investigated whether this relationship is confounded by obesity or central obesity.Methods:A total of 387 participants (18–65 years old) who referred to a large university general hospital for routine health examinations were categorized into 2 groups with (n 130) and without (n 257) metabolic syndrome. Fasting plasma glucose, insulin, lipids, and leptin levels were measured and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria.Results:Age- and sex-adjusted leptin levels were significantly higher in patients with than those without metabolic syndrome (29.62 ± 1.67 vs. 18.50 ± 1.21 ng/mL, P< 0.001). After adjustment for age, sex, and body mass index (BMI), leptin values were significantly correlated with HOMA-IR (P< 0.001), metabolic syndrome, and its components (P< 0.05). After adjustment for waist circumference, however, these associations were no longer statistically significant.Conclusions:We demonstrated that high leptin levels are associated with insulin resistance and metabolic syndrome independent of BMI but these associations are significantly mediated through the effects of central obesity. [ABSTRACT FROM AUTHOR]

Abstract  Gastroesophageal reflux disease (GERD) refractory to conventional medical treatment is frequently associated with gastroparesis, a complex condition with no definitive treatment to date. We first developed a scoring system to assess the severity and frequency of both reflux- and gastroparesis-related symptoms. We then tested, for the first time, the hypothesis that endoscopic pyloric botulinum toxin injection alleviates both of these symptom types. Eleven patients (four males) with GERD (confirmed by esophageal pH monitoring) plus gastroparesis (confirmed by gastric emptying study) underwent toxin injection. Patients had no concomitant disease and were not allowed to use prokinetics before or after treatment. Injection significantly improved both gastroparesis- and reflux-related symptoms in the majority of patients but the duration of symptom relief was relatively short. Responders to treatment had significantly higher total reflux symptom scores (before injection) than nonresponders. All but one of the patients in whom gastroparesis symptoms improved also showed response in reflux symptoms, which supports our hypothesis. We believe that response to toxin injection is a reliable predictor of response to subsequent surgery following the recurrence of symptoms. [ABSTRACT FROM AUTHOR]

ABSTRACT IMPACT: By restoring the gut microbiota in patients with acute myeloid leukemia exposed to antibiotics, we will reduce infections during and after curative-intent chemotherapy. OBJECTIVES/GOALS: Infection is a leading cause of death in acute myeloid leukemia (AML). Antibiotics disrupt the gut microbiota, promoting secondary infections. Through a double-blind randomized placebo-controlled phase 2 trial, we will determine whether microbiota restoration using fecal microbiota transplantation (FMT) prevents infections in AML patients. METHODS/STUDY POPULATION: 72 intensively treated AML patients at our institution are randomized in a 2:1 ratio to FMT (arm A) or placebo (arm B). After completing each course of antibacterial antibiotics, patients receive one study treatment. Up to 3 study treatments are administered over 3 months. FMT is delivered as a third-party oral product containing microbiota (˜5x10^11 bacteria) in 4-6 capsules. Stool samples are collected before and after each study treatment. The primary endpoint is 4-month overall infection rate. 16S rRNA gene sequencing of stool samples is used to determine specific taxa that are under- or over-represented in samples preceding infections and compare the two arms for key microbiome features including diversity and composition. Bloodstream infection within 7 days after FMT counts towards stopping rule. RESULTS/ANTICIPATED RESULTS: Five patients have been enrolled: 4 have received 1 dose and 1 received 2 doses. The only adverse event (possibly related to study treatment) has been grade 1 abdominal pain in 1 patient. Notably, no bloodstream infection has occurred. All planned samples have been collected and are sequenced in batches. We expect arm A patients to experience fewer infections and fewer intestinal blooms of pathobionts, and both arms to experience intestinal blooms before specific infections. An interim efficacy analysis will be performed at half total enrollment. DISCUSSION/SIGNIFICANCE OF FINDINGS: Current supportive care during intensive chemotherapy is fundamentally anti-microbial and results in dysbiosis, with detrimental consequences. We will establish the evidence for FMT as a restorative strategy in AML patients. This is the first randomized placebo-controlled trial of repeated FMT, with potential implications to other cancers.

The activity of the renin–angiotensin–aldosterone system (RAAS) plays an important role in the development and progression of diabetic nephropathy. However, the effect of angiotensin-converting enzyme (ACE) inhibition on the RAAS appears to be modulated by a number of factors including the I/D polymorphism of the ACE genotype. In this study, we attempted to find independent correlates of ACE activity in 121 macroalbuminuric type 2 diabetic Iranian patients under chronic ACE inhibition. Both univariate and multivariate analyses were used. The presence of the D allele was independently associated with significantly higher levels of ACE activity (with the II genotype as reference, P B = 27.3, 95% CI = 17.6–37.1), and this association was not eliminated by potentially confounding variables. In conclusion, the D allele is a significant independent correlate of ACE activity in macroalbuminuric type 2 diabetic Iranian patients under long-term ACE inhibition. [ABSTRACT FROM AUTHOR]

Background. Observations on the association between the ACE gene polymorphism and hypertension have been inconsistent, which might be due to ethnic and geographical variations. Moreover, the relationship between insertion/deletion (I/D) polymorphism and hypertension in the diabetic population has not been sufficiently studied. The aim of this study was to evaluate for the first time the possible association between I/D polymorphism and hypertension in an Iranian diabetic adult population. Methods. A total of 82 consecutive patients with type 2 diabetes and hypertension (Group A) and 87 patients with type 2 diabetes but without hypertension (Group B) were included. Patients who had a history of hypertension before the onset of diabetes and those with findings suggesting secondary hypertension were excluded. The following variables were determined for each patient: age, sex, body mass index (BMI), diabetes duration and the drugs used, history of coronary artery disease and its complications, blood pressure (systolic and diastolic), fasting blood sugar (FBS), haemoglobin A1c (HbA1c), total cholesterol (Chol), low-density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides (TG), plasma creatinine (Crt) and 24 h urine albumin excretion. Polymerase chain reaction (PCR) was used to detect the I/D alleles. Univariate (chi-squared and t-test) and multivariate (multivariate binary logistic regression with adjusted odds ratios) analyses were applied to determine the association between I/D polymorphism (with genotype II as reference) and hypertension. P Results. In univariate analysis, the groups were statistically similar in all variables except for diabetes duration (156.05 ± 73.54 months in Group A vs 121.74 ± 65.53 months in Group B; P = 0.002), Crt (1.04 ± 0.25 mg/dl in Group A vs 0.93 ± 0.23 mg/dl in Group B; P = 0.003), albuminuria (486.25 ± 484.60 mg/d in Group A vs 316.50 ± 459.56 mg/d in Group B; P = 0.021) and the frequency of DD genotype (27 cases in Group A vs 11 cases in Group B; P = 0.026). Multivariate logistic regression (using age, sex and BMI as clinically significant variables and diabetes duration, Crt, albuminuria and genotype as statistically significant variables) was then used to determine independent associations and adjusted odds ratios (OR). The DD genotype was the strongest independent predictor of hypertension [P = 0.029, OR = 3.122, 95% confidence interval (CI) = 1.127–8.647], followed by log (albuminuria) (P = 0.042, OR = 1.183, 95% CI = 1.006–1.391). Considering albuminuria as a categorical variable did not change the results significantly. Conclusion. The DD polymorphism in the ACE gene is independently associated with hypertension in the diabetic population. [ABSTRACT FROM AUTHOR]