Papers by Fereidoun Azizi
Reproductive Biology and Endocrinology, 2011
Background There is no clear and contemporaneous method for screening of idiopathic hirsutism (IH... more Background There is no clear and contemporaneous method for screening of idiopathic hirsutism (IH) and polycystic ovary syndrome (PCOS) at the community level and current estimates regarding their prevalence are limited. We aimed to ascertain the prevalence of IH and PCOS in a randomly selected sample of reproductive aged female participants of the Tehran Lipid and Glucose Study (TLGS). Methods One thousand and two women, aged 18-45 years, were randomly selected from among reproductive aged women who participated in the TLGS. Those women with either hirsutism or menstrual dysfunction were assessed for biochemical hyperandrogenemia; whereas those participants with hirsutism per se were further assessed for subclinical menstrual dysfunction. PCOS were diagnosed using the National Institute of Health (NIH) criteria. IH was defined as hirsutism without clinical or sub clinical menstrual dysfunction or biochemical hyperandrogenemia (BH). Results The mean ± SD of age of study population w...
The Tehran Cardiometabolic Genetic Study (TCGS) is a large population-based cohort study with per... more The Tehran Cardiometabolic Genetic Study (TCGS) is a large population-based cohort study with periodic follow-ups, which created a comprehensive database of 20,367 participants born between 1911-2015 selected from 4 different longitudinal, ongoing, and family-based studies. The study aims to identify the potential targets for prevention and intervention for non-communicable diseases in mid-life and late life. The study focuses on cardiovascular, endocrine, metabolic abnormalities, cancers, and some inherited diseases. Since 2017, the cohort expanded the information by coding all health-related complications (hospitalization outcomes and self-reports) based on ICD11 coding and confirming the consanguineous marriage with genetic markers. This article presents an update on the rationale and design of the study. We also present a summary of our findings and our goals toward precision medicine.
PLOS ONE, 2015
Objective To see the changes of cardio-metabolic risk factors overtime in polycystic ovary syndro... more Objective To see the changes of cardio-metabolic risk factors overtime in polycystic ovary syndrome vs. control women. Methods This study was conducted on 637 participants (85 PCOS and 552 control reproductive aged, 18-45 years) of Tehran Lipid and Glucose Study (TLGS), an ongoing populationbased cohort study with 12 years of follow-up. The cardiovascular risk factors of these groups were assessed in three-year intervals using standard questionnaires, history taking, anthropometric measures, and metabolic/endocrine evaluation. Generalized estimating equation was used to analyze the data. Results Overall mean of insulin (3.55, CI: 0.66-6.45), HOMA-IR (0.63, CI: 0.08-1.18), and HOMA-β (45.90, CI: 0.86-90.93) were significantly higher in PCOS than in healthy women after adjustment for age, BMI, and baseline levels. However, the negative interaction (follow-up years × PCOS status) of PCOS and normal women converged overtime. Comparing third follow-up with first, insulin and HOMA-IR decreased 10.6% and 5%, respectively in PCOS women; and increased 6.7% and 14.6%, respectively in controls (P<0.05). The results did not show any significant result for other cardio-metabolic variables including WC, lipid profile, FPG, 2-h PG, SBP, and DBP.
Thyroid, 2013
Background: Accurate assessment of thyroid status during pregnancy is vital for maternal and feta... more Background: Accurate assessment of thyroid status during pregnancy is vital for maternal and fetal health. Because free thyroxine (FT4) values in pregnancy vary widely between methods, assessment of total T4 (TT4) and FT4 index (FT4I) may be superior to FT4 in pregnant women. However, trimester-specific reference intervals for FT4I have not yet been established. In this longitudinal self-sequential survey, we aimed at determining the trimester-specific reference range for FT4I in healthy Iranian women with singleton pregnancies. Methods: A total of 466 healthy pregnant women were evaluated. After exclusion of women with history, ultrasonographic, or laboratory evidence of any thyroid disorder or iodine deficiency and those who were positive for thyroid autoantibodies, 152 women entered the study. Serum thyrotropin (TSH), TT4, and triiodothyronine-resine uptake were measured by an immunoassay method. Reference intervals were defined as 5th and 95th percentiles, using the bootstrap-based procedure.
Iranian Journal of Endocrinology and Metabolism, 2015
Introduction: Although for thyroid disorders are the second most prevalent endocrine abnormalitie... more Introduction: Although for thyroid disorders are the second most prevalent endocrine abnormalities among reproductive aged women, the signs and symptoms of thyroid disease can often be masked by the physiologic changes of pregnancy. The aim of this study was to identify physiological signs and symptoms common to both pregnancy and thyroid disorders among a community based sample of pregnant women without thyroid dysfunction. Materials and Methods: This population-based cross-sectional study was conducted on 1600 pregnant women. A comprehensive questionnaire including questions regarding the signs and symptoms of thyroid disease was completed for subjects and relevant clinical examinations were conducted. Blood samples were taken and serum thyroxine (T4), T-uptake, thyrotropin (TSH) and thyroid peroxidase antibodies (TPO-Ab) were measured. Results: Of study participants, 63.5% had normal thyroid function. The prevalence of overt hypothyroidism and hyperthyroidism were 3.8%, and 0.8%,...
Iranian journal of reproductive medicine, 2015
Pregnancy has a huge impact on the thyroid function in both healthy women and those that have thy... more Pregnancy has a huge impact on the thyroid function in both healthy women and those that have thyroid dysfunction. The prevalence of thyroid dysfunction in pregnant women is relatively high. The objective of this review was to increase awareness and to provide a review on adverse effect of thyroid dysfunction including hyperthyroidism, hypothyroidism and thyroid autoimmune positivity on pregnancy outcomes. In this review, Medline, Embase and the Cochrane Library were searched with appropriate keywords for relevant English manuscript. We used a variety of studies, including randomized clinical trials, cohort (prospective and retrospective), case-control and case reports. Those studies on thyroid disorders among non-pregnant women and articles without adequate quality were excluded. Overt hyperthyroidism and hypothyroidism has several adverse effects on pregnancy outcomes. Overt hyperthyroidism was associated with miscarriage, stillbirth, preterm delivery, intrauterine growth retardat...
Iranian Journal of Endocrinology and Metabolism, 2015
Introduction: Although for thyroid disorders are the second most prevalent endocrine abnormalitie... more Introduction: Although for thyroid disorders are the second most prevalent endocrine abnormalities among reproductive aged women, the signs and symptoms of thyroid disease can often be masked by the physiologic changes of pregnancy. The aim of this study was to identify physiological signs and symptoms common to both pregnancy and thyroid disorders among a community based sample of pregnant women without thyroid dysfunction. Materials and Methods: This population-based cross-sectional study was conducted on 1600 pregnant women. A comprehensive questionnaire including questions regarding the signs and symptoms of thyroid disease was completed for subjects and relevant clinical examinations were conducted. Blood samples were taken and serum thyroxine (T4), T-uptake, thyrotropin (TSH) and thyroid peroxidase antibodies (TPO-Ab) were measured. Results: Of study participants, 63.5% had normal thyroid function. The prevalence of overt hypothyroidism and hyperthyroidism were 3.8%, and 0.8%,...
Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 2018
Elevated blood pressure is still one of the major risk factors for diseases and disabilities and ... more Elevated blood pressure is still one of the major risk factors for diseases and disabilities and also a public health challenge worldwide. In the present longitudinal study, we aimed to evaluate the association between risk of hypertension and dietary advanced glycation end products (AGEs) as a recently discussed potential risk factor. Dietary assessment of 1775 participants in the third phase of Tehran lipid and glucose study to obtain dietary intake of AGEs was performed using a validated semi-quantitative food frequency questionnaire, and they were followed up for a mean duration of approximately 6 years. To determine the incidence of hypertension across quartiles of AGEs intake, logistic regression models with adjustment for potential confounding variables were used. All statistical analyses were conducted using SPSS, and < 0.05 was considered statistically significant. Higher hypertension occurrence risk was generally attributed to higher AGEs intake quartiles after adjustin...
Journal of pediatric endocrinology & metabolism : JPEM, Jan 31, 2018
Background It has been suggested that thyroid hormone concentration at birth may have some role i... more Background It has been suggested that thyroid hormone concentration at birth may have some role in regulating foetal growth. The aim of this study was to provide seminal data regarding any association between thyrotropin (TSH) concentration within the normal range and growth parameters at birth in full-term newborns. Methods In this cross-sectional study conducted in Tehran, Iran, 314 mother-newborn pairs were randomly selected from health care centres responsible for congenital hypothyroidism screening. Neonatal TSH concentration was measured using a heel-prick blood sample taken from all neonates 3-5 days after birth, as part of the routine neonate screening. Anthropometrics, including birth weight, length and head circumference were obtained from the birth record of each neonate. The z-score values for weight-for-age, weight-for-length, length-for-age and head-for-age were calculated using the World Health Organisation growth standards. Results The median interquartile range neon...
BMC Pediatrics, 2018
Background: To investigate the association between markers of insulin metabolism and carotid inti... more Background: To investigate the association between markers of insulin metabolism and carotid intima-media thickness(cIMT) among overweight and obese children and adolescents. Methods: A total of 378 children and adolescents aged from 6 to 13 years, with WHO body mass index Z-Scores ≥2 were enrolled in this study. We measured fasting serum insulin and glucose, conducted a homeostatic model assessment of insulin resistance(HOMA-IR), and calculated the quantitative insulin sensitivity check index(QUICKI). Carotid intima-media thickness was measured in the common carotid artery with high-resolution ultrasonography. Results: The study participants consisted of 198 boys and 180 girls with a mean(±SD) age of 9.3 ± 1.7 years, 18.3% being pre-pubertal. In boys, after controlling for confounders, a one-SD increase in fasting insulin and HOMA-IR were associated with 0.351 mm(P < 0.001) and 0.350 mm(P < 0.001) increases in cIMT, respectively. However, a one-SD increase in QUICKI was associated with a − 0.305 mm(P = 0.001) decrease in cIMT. When categorizing into tertiles, a one-SD increase in fasting insulin and HOMA-IR were associated with 87 and 81% increases in the odds of higher categories of cIMT(both P < 0.05). However, a one-SD increase in QUICKI was associated with 37% lower odds of higher categories of cIMT(P = 0.022). No significant associations were found among girls. Conclusion: This study demonstrated that insulin resistance and sensitivity markers were independent predictors of cIMT in overweight and obese boys, but not in girls, highlighting the importance of chronically elevated insulin levels for predisposing these boys to alterations in their vascular structure.
BMJ open, Jan 5, 2018
Cardiovascular mortality in Western Asia is high and still rising. However, most data documented ... more Cardiovascular mortality in Western Asia is high and still rising. However, most data documented on risk prediction has been derived from Western countries and few population-based cohort studies have been conducted in this region. The current study aimed to present the process of pooling data and cardiovascular disease (CVD) mortality incidences for four Iranian cohorts. From the Iran Cohort Consortium, the Golestan Cohort Study (GCS), Tehran Lipid and Glucose Study, Isfahan Cohort Study (ICS) and the Shahroud Eye Cohort Study (ShECS) were eligible for the current study since they had appropriate data and follow-up visits. Age-standardised CVD mortality rates were estimated for ages 40-80 and 40-65 years. Cox regression was used to compare mortalities among cohorts. Adjusted marginal rates were calculated using Poisson regression. Overall, 61 291 participants (34 880 women) aged 40-80 years, free of CVD at baseline, were included. During 504 606 person-years of follow-up, 1981 CVD ...
Menopause (New York, N.Y.), Jan 7, 2018
The associations of body mass index (BMI) and obesity with ovarian reserve are controversial. Thi... more The associations of body mass index (BMI) and obesity with ovarian reserve are controversial. This systematic review and meta-analysis was conducted to investigate the associations in reproductive-aged women. PubMed and Scopus were searched up to December, 2016. Original studies on the association of BMI with ovarian reserve markers, anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), inhibin β, and antral follicle count (AFC), either according to BMI categories or a continuous variable, were selected. Analyses were stratified into three groups based on polycystic ovary syndrome (PCOS) and fertility status of women. Of 4,055 records identified, 45 studies were eligible for inclusion. Comparing the obese with nonobese, the pooled mean differences (MDs) and 95% confidence intervals (CIs) were -1.08 (95% CIs -1.52, -0.63) ng/mL for AMH, -0.22 (95% CIs -0.39, -0.06) mIU/mL for FSH, -0.09 (95% CIs -0.60, 0.42) for AFC, and -21.06 (95% CIs -41.18, -0.85) pg/mL for inhibin β ...
Fertility and sterility, Dec 1, 2017
To study the incidence rate and hazard ratios of diabetes and prediabetes between women with PCOS... more To study the incidence rate and hazard ratios of diabetes and prediabetes between women with PCOS and healthy subjects. Prospective population-based study. Not applicable. Women with PCOS (n = 178) and eumenorrheic, nonhirsute, healthy women as controls (n = 1,524), all followed for a median time of 12.9 years. None. Incidence rate and hazard ratios of diabetes and prediabetes between women with PCOS and healthy controls. We analyzed the participants on two pathways. First, for detecting new diabetes mellitus (DM) events, we selected participants who were free of DM at baseline (n = 39). Second, for detecting new pre-DM events, we selected participants who were free of pre-DM and DM at baseline (n = 222) from the baseline population. The rest of the population were included for final analysis to calculate the incidence rates and hazard ratio of diabetes and prediabetes events. The incidence rates of diabetes were 12.9 and 4.9 per 1,000 person-years for PCOS and controls, respectivel...
International journal of impotence research, Jan 15, 2017
Polycystic ovary syndrome (PCOS) appears to be related to sexual dysfunction, especially if assoc... more Polycystic ovary syndrome (PCOS) appears to be related to sexual dysfunction, especially if associated with obvious clinical and hormonal signs of hyperandrogenism. The objective of this study was to determine the correlation of PCOS and its hormonal and clinical parameters with sexual function. This prospective, cross-sectional study conducted on 18-45-year-old PCOS women (according to the Rotterdam criteria), who were referred to the Reproductive Endocrinology Research Center, Iran, was invited to participate from January 2012 to December 2015. The Female Sexual Function Index (FSFI) was used to evaluate sexual function, and serum levels of total and free testosterone, androstenedione, and sex hormone-binding globulin (SHBG) were determined and employed to calculate free androgen index (FAI) values. Univariate and multiple logistic regression analyses were performed to examine the association between sexual dysfunction and independent variables. In all, 783 participated in the stu...
Journal of pediatric endocrinology & metabolism : JPEM, Jan 26, 2018
Diffuse toxic goiter accounts for about 15% of all childhood thyroid diseases. There is great con... more Diffuse toxic goiter accounts for about 15% of all childhood thyroid diseases. There is great controversy over the management of Graves' disease in children and adolescents. This article reports our experience in 304 children and juvenile patients with Graves' disease. Between 1981 and 2015, 304 patients aged 5-19 years with diffuse toxic goiter were studied, of whom 296 patients were treated with antithyroid drugs (ATD) for 18 months. Patients with persistent or relapsed hyperthyroidism who refused ablative therapy with surgery or radioiodine were managed with continuous methimazole (MMI) treatment. In 304 patients (245 females and 59 males), the mean age was 15.6±2.6 years. After 18 months of ATD therapy, 37 remained in remission and of the 128 who relapsed, two, 29 and 97 patients chose surgery, continuous ATD and radioiodine therapy, respectively. Of the 136 patients who received radioiodine, 66.2% became hypothyroid. Twenty-nine patients received continuous ATD therapy ...
International journal of endocrinology and metabolism, 2017
Primordial and primary preventions of thyroid diseases are concerned with avoiding the appearance... more Primordial and primary preventions of thyroid diseases are concerned with avoiding the appearance of risk factors, delaying the progression to overt disease, and minimizing the impact of illness. Using related key words, 446 articles related to primordial and primary, preventions of thyroid diseases published between 2001-2015 were evaluated, categorized and analyzed. Prevention and elimination of iodine deficiency are major steps that have been successfully achieved and maintained in many countries of the world in last 2 decades. Recent investigations related to the effect of cigarette smoking, alcohol consumption, and autoimmunity in the prevention of thyroid disorders have been reviewed. The cornerstone for successful prevention of thyroid disease entails timely implementation of its primordial and primary preventions, which must be highly prioritized in related health strategies by health authorities.
International Journal of Endocrinology and Metabolism, 2017
Purpose and Methods: Hereditary vitamin D resistant rickets (HVDRR) is a rare disease that presen... more Purpose and Methods: Hereditary vitamin D resistant rickets (HVDRR) is a rare disease that presents with signs and symptoms of rickets, alopecia, and growth retardation during the early years of life. The disease is caused by mutations in the vitamin D receptor (VDR) gene, which leads to unresponsiveness of the mutant receptor to 1-25(OH) 2 D3. The disease is transmitted as an autosomal recessive disorder and is found with equal frequency in males and females. The disease is rarely encountered and only about 100 cases are reported so far. The current paper reported the clinical and laboratory characteristics of 2 Iranian siblings with this disorder. Results and Conclusion: They presented with rickets, growth retardation, muscle weakness, hypocalcemia and alopecia totalis since early childhood, and were followed up for 27 years. Sequencing of the DNA extracted from the peripheral white blood cells showed a missense G to A mutation in exon number 4 (g.30994 G > A) that led to the methionine substitution for the naturally occurring valine at position 26 in the DNA binding domain (DBD) of the VDR.
European journal of endocrinology / European Federation of Endocrine Societies, Jan 28, 2015
Debate about the need for universal screening of thyroid dysfunction in pregnancy is ongoing. The... more Debate about the need for universal screening of thyroid dysfunction in pregnancy is ongoing. The present study aimed to compare universal screening with targeted high-risk case findings for early diagnosis of thyroid disorders in Iranian pregnant women. This cross-sectional prospective study was carried out on 1600 pregnant women in their first trimester. A checklist, including all related risk factors recommended by The American Thyroid Association, was completed for all participants. Serum concentrations of thyroxine (T4), T-uptake, thyrotropin (TSH) and thyroid peroxidase antibody (TPOAb) were measured and thyroid status was documented, based on hormonal measurements and clinical examinations. There were 656 women (44.3%) that had at least one risk factor for thyroid diseases and were eligible for the targeted high-risk case finding (high-risk group) approach, while 55.7% had no risk factors (low-risk group). Using the universal screening approach, there were 974 women (65.8%) w...
International journal for vitamin and nutrition research. Internationale Zeitschrift für Vitamin- und Ernährungsforschung. Journal international de vitaminologie et de nutrition, 2003
Following previous reports of impaired physical and intellectual growth, hearing deficit, hypothy... more Following previous reports of impaired physical and intellectual growth, hearing deficit, hypothyroidism, and hyperendemic goiter in Kiga, and the administration of iodized oil injection, this study was conducted to evaluate whether or not the effect of the injection could be sustained by iodized salt supplementation. In 1989, one mL of iodized oil solution containing 480 mg of iodine was injected in 198 schoolchildren aged 8 to 14 years. Four years later, in 1993, iodized salt consumption was begun and has since been continued. Serum thyroid hormones, RT3 uptake and thyroid-stimulating hormone (TSH) were measured before, and three, four, and six years after intervention (1989, 1992, 1993, and 1995). Assessment of urinary iodine was performed by the Foss method at the same intervals mentioned above. Prior to the injection, 94% had grade 2 goiters; four years after injection, 26% and 41% had grades 2 and 1 respectively, and 30% had no goiter (p < 0.001). Two years after the introd...
Appetite, 2015
Despite women playing a pivotal role in shaping nutritional patterns in their families, it is the... more Despite women playing a pivotal role in shaping nutritional patterns in their families, it is the men whose ideas and preferences, after children, influence the selection and consumption of daily foods among Iranian families. This study focused on exploring the main barriers to healthy eating as experienced by male participants of the Tehran Lipid Glucose Study (TLGS). A grounded theory approach was used for analyzing participants' experiences and their perceptions regarding these barriers. Participants were 98 men, aged 25-65 years, selected and recruited from the TGLS cohort. Data collection was conducted through fourteen semi-structured focus group discussions, between 2008 and 2009. All interviews and focus group discussions were audio recorded and transcribed verbatim. Constant comparative analysis of the data was conducted manually according to the Strauss and Corbin analysis method. The most important barriers to healthy eating were: (i) Personal factors, which included two subthemes-lack of knowledge and personal taste, (ii) Communication and modeling included two subthemes-other individuals and media/advertisements; (iii) Modernization included two subthemes-nutrition transition and women's role; and (iv) Lack of access to healthy foods, which included four subthemes-Inadequate confidence, perceived risk, high cost and time limitations. Appropriate attention and prioritized policy-making to modify the socio-environmental barriers to healthy eating were explored in the current study, along with effective educational programs that could help to promote healthy eating among Iranian families.
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Papers by Fereidoun Azizi