Top

Journal of Diabetes & Metabolic Disorders

Published in:

Open Access 01-12-2014 | Review article

Growing burden of diabetes in Pakistan and the possible role of arsenic and pesticides

Authors: Haji Bahadar, Sara Mostafalou, Mohammad Abdollahi

Published in: Journal of Diabetes & Metabolic Disorders | Issue 1/2014

Abstract

This review is undertaken to address the possible role of arsenic and pesticides in the prevalence of diabetes in Pakistan and to highlight a resourceful targeted research in this area.

A bibliographic search of scientific databases was conducted with key words of “epidemics of diabetes in Pakistan”, “diabetes in Asia”, “diabetes mellitus and environmental pollutants”, “diabetes mellitus and heavy metals”, “diabetes mellitus and pesticides”, “prevalence of pesticides in Pakistan”, and “heavy metals contamination of drinking water, “vegetables and fruits in Pakistan”. More than 200 articles were examined. Studies reporting the prevalence of diabetes mellitus (DM), pesticides and heavy metal contamination of drinking water, fruits and vegetables were included in the study. According to WHO 2011 report, about 12.9 million people are suffering from DM and the number is constantly increasing. Water pollution is a major public health threat in Pakistan. Most of the people in Pakistan are exposed to arsenic and pesticides either in drinking water or through vegetables, fruits, and other edible items with various concentrations above the WHO/FAO permissible limits. Being an agricultural country, a 1169% increase has been recorded with the use of different types of pesticides since last two decades, and almost similar rise in the burden of diabetes.

There is a growing global concern of arsenic and pesticides exposure with the incidence of DM. Besides other factors, the environmental attributors in the incidence of DM in Pakistan have not been conclusively elucidated yet which in turn deserve a resourceful targeted research.

Available only for authorised users

Maduka H: Water pollution and man’s health. Internet J Gastroenterol 2006, 4(1):1–11.

Briggs D: Environmental pollution and the global burden of disease. Brit Med Bull 2003, 68(1):1–24. 10.1093/bmb/ldg019PubMedCrossRef

Waheed Y, Tahir S, Ahmad T, Qadri I: Sequence comparison and phylogenetic analysis of core gene of hepatitis C virus from Pakistani population. Afr J Biotechnol 2010, 9(29):4561–4567.

Chouhan S, Flora SJ: Arsenic and fluoride: two major ground water pollutants. Indian J Exp Biol 2010, 48(7):666–678.PubMed

Rahman MM, Naidu R, Bhattacharya P: Arsenic contamination in groundwater in the Southeast Asia region. Environ Geochem Health 2009, 31(Suppl 1):9–21. 10.1007/s10653-008-9233-2PubMedCrossRef

Mukherjee A, Sengupta MK, Hossain MA, Ahamed S, Das B, Nayak B, Lodh D, Rahman MM, Chakraborti D: Arsenic contamination in groundwater: a global perspective with emphasis on the Asian scenario. J Health Popul Nutr 2006, 24(2):142–163.PubMed

Uqaili A, Mughal A, Maheshwari B: Arsenic contamination in ground water sources of district Matiari, Sindh. Int J Chem Environ Eng 2012, 3(4):259–266.

Haque IU, Nabi D, Baig M, Hayat W, Trefry M: Groundwater arsenic contamination: A multi-directional emerging threat to water scarce areas of Pakistan. IAHS publication 2008, 324: 24.

Arain MB, Kazi TG, Baig JA, Jamali MK, Afridi HI, Shah AQ, Jalbani N, Sarfraz RA: Determination of arsenic levels in lake water, sediment, and foodstuff from selected area of Sindh, Pakistan: Estimation of daily dietary intake. Food Chem Toxicol 2009, 47(1):242–248. 10.1016/j.fct.2008.11.009PubMedCrossRef

10.

Brahman KD, Kazi TG, Afridi HI, Naseem S, Arain SS, Ullah N: Evaluation of high levels of fluoride, arsenic species and other physicochemical parameters in underground water of two sub districts of Tharparkar, Pakistan: A multivariate study. Water Res 2013, 47(3):1005–1020. 10.1016/j.watres.2012.10.042PubMedCrossRef

11.

Baig JA, Kazi TG, Arain MB, Afridi HI, Kandhro GA, Sarfraz RA, Jamal MK, Shah AQ: Evaluation of arsenic and other physico-chemical parameters of surface and ground water of Jamshoro. Pakistan J Hazard Mater 2009, 166(2–3):662–669. 10.1016/j.jhazmat.2008.11.069PubMedCrossRef

12.

Ahmad T, Kahlown M, Tahir A, Rashid H. Arsenic an emerging issue: Experiences from Pakistan. Paper presented at: 30th WEDC international conference, Vientiane, Lao 2004. Water, Engineering and Developing Center, Loughborough University Leicestershire LE11 3TU UK: http://wedc.lboro.ac.uk/resources/conference/30/Ahmad.pdf., Ahmad T, Kahlown M, Tahir A, Rashid H. Arsenic an emerging issue: Experiences from Pakistan. Paper presented at: 30th WEDC international conference, Vientiane, Lao 2004. Water, Engineering and Developing Center, Loughborough University Leicestershire LE11 3TU UK: . http://wedc.lboro.ac.uk/resources/conference/30/Ahmad.pdf

13.

Soomro M, Khokhar M, Hussain W, Hussain M: Drinking water Quality challenges in Pakistan. Council of Research in Water Resources, Pakistan; 2011.

14.

PCRWR. National Water Quality Monitoring programme 5th Monitoring report 2005-2006: Pakistan Council for Research in Water Resources,Islamabad Pakistan. http://www.pcrwr.gov.pk/publication%20pcrwr.aspx., PCRWR. National Water Quality Monitoring programme 5^th Monitoring report 2005–2006: Pakistan Council for Research in Water Resources,Islamabad Pakistan. . http://www.pcrwr.gov.pk/publication%20pcrwr.aspx

15.

Ahmad SA, Gulzar A, Rehman HU, Soomro Z, Hussain M, Rehman M, Qadir M: Study of Arsenic in drinking water of distric Kasur Pakistan. World Appl Sci J 2013, 24(5):634–640.

16.

Tahir MA, Rasheed MH, Imran MS: Water Quality status in rural areas of Pakistan.Pakistan Council of Research in Water Resources 2010, (143):1-66. www.pcrwr.gov.pk/Btl_wr…/Rural%20Areas%20Report/WQSReport.pdf., Tahir MA, Rasheed MH, Imran MS: Water Quality status in rural areas of Pakistan. Pakistan Council of Research in Water Resources 2010, (143):1–66. . www.pcrwr.gov.pk/Btl_wr…/Rural%20Areas%20Report/WQSReport.pdf

17.

Al-Othman ZA, Ali R, Al-Othman AM, Ali J A. Habila: Assessment of toxic metals in wheat crops grown on selected soils of Khyber Pukhtoon Khaw, Pakistan, irrigated by different water sources. Arab J Chem 2012. doi.org/10.1016/j.arabjc.2012.04.006

18.

Farooqi A, Masuda H, Siddiqui R, Naseem M: Sources of arsenic and fluoride in highly contaminated soils causing groundwater contamination in Punjab, Pakistan. Arch Environ Contam Toxicol 2009, 56(4):693–706. 10.1007/s00244-008-9239-xPubMedCrossRef

19.

Van der Werf HMG: Assessing the impact of pesticides on the environment. Agricult Ecosys Environ 1996, 60(2–3):81–96. 10.1016/S0167-8809(96)01096-1CrossRef

20.

Pimentel D: Amounts of pesticides reaching target pests: environmental impacts and ethics. J Agricult Environ Ethics 1995, 8(1):17–29. 10.1007/BF02286399CrossRef

21.

Caughey, M. E: Pesticides in surface waters: Distribution, trends, and governing factors. Environmen Progress 1999, (18(1): S8-S9 doi:10.1002/ep.670180107

22.

Azizullah A, Khattak MNK, Richter P, Häder DP: Water pollution in Pakistan and its impact on public health A review. Environ Int 2011, 37(2):479–497. 10.1016/j.envint.2010.10.007PubMedCrossRef

23.

Tariq MI, Afzal S, Hussain I, Sultana N: Pesticides exposure in Pakistan: a review. Environ Int 2007, 33(8):1107–1122. 10.1016/j.envint.2007.07.012PubMedCrossRef

24.

Tariq MI, Afzal S, Hussain I: Pesticides in shallow groundwater of Bahawalnagar, Muzafargarh, D.G. Khan and Rajan Pur districts of Punjab, Pakistan. Environ Int 2004, 30(4):471–479. 10.1016/j.envint.2003.09.008PubMedCrossRef

25.

Khan MJ, Zia MS, Qasim M: Use of pesticides and their role in environmental pollution. World Acad Sci Eng Technol 2010, 72: 122–128.

26.

Hussain S, Masud T, Ahad K: Determination of pesticides residues in selected varieties of mango. Pakistan J Nutr 2002, 1(1):41–42. 10.3923/pjn.2002.41.42

27.

Anwar T, Ahmad I, Tahir S: Determination of pesticide residues in fruits of Nawabshah district, Sindh, Pakistan. Pak J Bot 2011, 43(2):1133–1139.

28.

Latif Y, Sherazi STH, Bhanger MI: Assessment of pesticide residues in commonly used vegetables in Hyderabad, Pakistan. Ecotoxicol Environ Safety 2011, 74(8):2299–2303. 10.1016/j.ecoenv.2011.07.030PubMedCrossRef

29.

Tahir S, Anwar T, Ahmad I, Aziz S, Mohammad A, Ahad K: Determination of pesticide residues in fruits and vegetables in Islamabad market. J Environ Biol /Acad Environ Biol India 2001, 22(1):71–74.

30.

Ahad K, Anwar T, Ahmad I, Mohammad A, Tahir S, Aziz S, Baloch U: Determination of insecticide residues in groundwater of Mardan Division, NWFP, Pakistan: A case study. Water SA 2000, 26(3):409–412.

31.

Ahad K, Mohammad A, Khan H, Ahmad I, Hayat Y: Monitoring results for organochlorine pesticides in soil and water from selected obsolete pesticide stores in Pakistan. Environ Monit Assess 2010, 166(1–4):191–199. 10.1007/s10661-009-0995-5PubMedCrossRef

32.

Masud SZ, Hasan N: Pesticide Residues in Foodstuffs in Pakistan: Organochlorine, Organophosphorus and pyrethroid insecticides in Fruits and Vegetables. In Environ Toxicol Assess. Edited by: Richardson M. Taylor and Francis Ltd, London; 2004:270–280.

33.

Huang CF, Chen YW, Yang CY, Tsai KS, Yang RS, Liu SH: Arsenic and diabetes: current perspectives: Kaohsiung. J Med Sci 2011, 27(9):402–410.

34.

Smith AH: Arsenic and diabetes. Environ Health Perspect 2013, 121(3):A70-A71. 10.1289/ehp.1206100PubMedPubMedCentralCrossRef

35.

Rahman M, Tondel M, Ahmad SA, Axelson O: Diabetes mellitus associated with arsenic exposure in Bangladesh. Am J Epidemiol 1998, 148(2):198–203. 10.1093/oxfordjournals.aje.a009624PubMedCrossRef

36.

Yen CC, Lu FJ, Huang CF, Chen WK, Liu SH, Lin-Shiau SY: The diabetogenic effects of the combination of humic acid and arsenic: in vitro and in vivo studies. Toxicol Lett 2007, 172(3):91–105. 10.1016/j.toxlet.2007.05.008PubMedCrossRef

37.

Navas-Acien A, Silbergeld EK, Pastor-Barriuso R, Guallar E: Arsenic exposure and prevalence of type 2 diabetes in US adults. JAMA J Am Med Asso 2008, 300(7):814–822. 10.1001/jama.300.7.814CrossRef

38.

Coronado-González JA, Del Razo LM, García-Vargas G, Sanmiguel-Salazar F: Escobedo-de la Peña J: Inorganic arsenic exposure and type 2 diabetes mellitus in Mexico. Environ Res 2007, 104(3):383–389. 10.1016/j.envres.2007.03.004PubMedCrossRef

39.

Wang SL, Chang FH, Liou SH, Wang HJ, Li WF, Hsieh DP: Inorganic arsenic exposure and its relation to metabolic syndrome in an industrial area of Taiwan. Environ Int 2007, 33(6):805–811. 10.1016/j.envint.2007.03.004PubMedCrossRef

40.

Pan WC, Seow WJ, Kile ML, Hoffman EB, Quamruzzaman Q, Rahman M, Mahiuddin G, Mostofa G, Lu Q, Christiani DC: Association of low to moderate levels of arsenic exposure with risk of type 2 diabetes in Bangladesh. Am J Epidemiol 2013, 178(10):1563–1570. 10.1093/aje/kwt195PubMedPubMedCentralCrossRef

41.

Rhee SY, Hwang YC, Woo JT, Chin SO, Chon S, Kim YS: Arsenic exposure and prevalence of diabetes mellitus in Korean adults. J Korean Med Sci 2013, 28(6):861–868. 10.3346/jkms.2013.28.6.861PubMedPubMedCentralCrossRef

42.

Makris KC, Christophi CA, Paisi M, Ettinger AS: A preliminary assessment of low level arsenic exposure and diabetes mellitus in Cyprus. BMC Public Health 2012, 12(1):334. 10.1186/1471-2458-12-334PubMedPubMedCentralCrossRef

43.

Wang W, Xie Z, Lin Y, Zhang D: Association of inorganic arsenic exposure with type 2 diabetes mellitus: a meta-analysis. J Epidemiol Commu Health 2014, 68(2):176–184. 10.1136/jech-2013-203114CrossRef

44.

Mahram M, Shahsavari D, Oveisi S, Jalilolghadr S: Comparison of hypertension and diabetes mellitus prevalence in areas with and without water arsenic contamination. J Res Med Sci 2013, 18(5):408–412.PubMedPubMedCentral

45.

Kuo C-C, Moon K, Thayer KA, Navas-Acien A: Environmental chemicals and type 2 diabetes: an updated systematic review of the epidemiologic evidence. Curr Diab Rep 2013, 13(6):831–849. 10.1007/s11892-013-0432-6PubMedPubMedCentralCrossRef

46.

Díaz-Villaseñor A, Burns AL, Hiriart M, Cebrián ME, Ostrosky-Wegman P: Arsenic-induced alteration in the expression of genes related to type 2 diabetes mellitus. Toxicol Appl Pharmacol 2007, 225(2):123–133. 10.1016/j.taap.2007.08.019PubMedCrossRef

47.

Tseng CH: The potential biological mechanisms of arsenic-induced diabetes mellitus. Toxicol Appl Pharmacol 2004, 197(2):67–83. 10.1016/j.taap.2004.02.009PubMedCrossRef

48.

Macfarlane WM, McKinnon CM, Felton-Edkins ZA, Cragg H, James RF, Docherty K: Glucose stimulates translocation of the homeodomain transcription factor PDX1 from the cytoplasm to the nucleus in pancreatic beta-cells. J Biol Chem 1999, 274(2):1011–1016. 10.1074/jbc.274.2.1011PubMedCrossRef

49.

Pal S, Chatterjee AK: Prospective protective role of melatonin against arsenic-induced metabolic toxicity in Wistar rats. Toxicology 2005, 208(1):25–33. 10.1016/j.tox.2004.11.005PubMedCrossRef

50.

Díaz-Villaseñor A, Burns AL, Salazar AM, Sordo M, Hiriart M, Cebrián ME, Ostrosky-Wegman P: Arsenite reduces insulin secretion in rat pancreatic β-cells by decreasing the calcium-dependent calpain-10 proteolysis of SNAP-25. Toxicol Appl Pharmacol 2008, 231(3):291–299. 10.1016/j.taap.2008.05.018PubMedCrossRef

51.

Lai MS, Hsueh YM, Chen CJ, Shyu MP, Chen SY, Kuo TL, Wu MM, Tai TY: Ingested inorganic arsenic and prevalence of diabetes mellitus. Am J Epidemiol 1994, 139(5):484–492.PubMedCrossRef

52.

Jovanovic D, Rasic-Milutinovic Z, Paunovic K, Jakovljevic B, Plavsic S, Milosevic J: Low levels of arsenic in drinking water and type 2 diabetes in Middle Banat region, Serbia. Int J Hyg Environ Health 2013, 216(1):50–55. 10.1016/j.ijheh.2012.01.001PubMedCrossRef

53.

Abdollahi M, Donyavi M, Pournourmohammadi S, Saadat M: Hyperglycemia associated with increased hepatic glycogen phosphorylase and phosphoenolpyruvate carboxykinase in rats following subchronic exposure to malathion. Comp Biochem Physiol C Toxicol Pharmacol 2004, 137(4):343–347. 10.1016/j.cca.2004.03.009PubMedCrossRef

54.

Mostafalou S, Eghbal MA, Nili-Ahmadabadi A, Baeeri M, Abdollahi M: Biochemical evidence on the potential role of organophosphates in hepatic glucose metabolism toward insulin resistance through inflammatory signaling and free radical pathways. Toxicol Indust Health 2012, 28(9):840–851. 10.1177/0748233711425073CrossRef

55.

Lee D-H, Lind PM, Jacobs DR, Salihovic S, van Bavel B, Lind L: Polychlorinated Biphenyls and Organochlorine Pesticides in Plasma Predict Development of Type 2 Diabetes in the Elderly The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Diab Care 2011, 34(8):1778–1784. 10.2337/dc10-2116CrossRef

56.

Montgomery M, Kamel F, Saldana T, Alavanja M, Sandler D: Incident diabetes and pesticide exposure among licensed pesticide applicators: Agricultural health study, 1993–2003. Am J Epidemiol 2008, 167(10):1235–1246. 10.1093/aje/kwn028PubMedCrossRef

57.

Raafat N, Abass MA, Salem HM: Malathion exposure and insulin resistance among a group of farmers in Al-Sharkia governorate. Clin Biochem 2012, 45(18):1591–1595. 10.1016/j.clinbiochem.2012.07.108PubMedCrossRef

58.

Saldana TM, Basso O, Hoppin JA, Baird DD, Knott C, Blair A, Alavanja MC: Sandler D P: Pesticide exposure and self-reported gestational diabetes mellitus in the Agricultural Health Study. Diab Care 2007, 30(3):529–534. 10.2337/dc06-1832CrossRef

59.

Everett CJ, Matheson EM: Biomarkers of pesticide exposure and diabetes in the 1999–2004 National Health and Nutrition Examination Survey. Environ Int 2010, 36(4):398–401. 10.1016/j.envint.2010.02.010PubMedCrossRef

60.

Rahimi R, Abdollahi M: A review on the mechanisms involved in hyperglycemia induced by organophosphorus pesticides. Pest Biochem Physiol 2007, 88(2):115–121. 10.1016/j.pestbp.2006.10.003CrossRef

61.

Mostafalou S, Abdollahi M: Pesticides and human chronic diseases: evidences, mechanisms, and perspectives. Toxicol Appl Pharmacol 2013, 268(2):157–177. 10.1016/j.taap.2013.01.025PubMedCrossRef

62.

Saeidnia S, Abdollahi M: Toxicological and pharmacological concerns on oxidative stress and related diseases. Toxicol Appl Pharmacol 2013, 273(3):442–455. 10.1016/j.taap.2013.09.031PubMedCrossRef

63.

Shera AS, Jawad F, Maqsood A: Prevalence of diabetes in Pakistan. Diab Res Clin Practice 2007, 76(2):219–222. 10.1016/j.diabres.2006.08.011CrossRef

64.

Akhter J: The burden of diabetes in Pakistan: the national diabetes survey. J Pak Med Asso 1999, 49(9):205–205.

65.

Zahid N, Claussen B, Hussain A: Diabetes and impaired glucose tolerance in a rural area in Pakistan and associated risk factors. Diabetes Metab Synd. Clin Res Reviews 2008, 2(2):125–130.

66.

Shera A, Rafique G, Ahmed K, Baqai S, Khan I, King H: Pakistan national diabetes survey prevalence of glucose intolerance and associated factors in North West Frontier Province (NWFP) of Pakistan. J Pak Med Asso 1999, 49(9):206–210.

67.

Shera AS, Basit A, Fawwad A, Hakeem R, Ahmedani MY, Hydrie MZI, Khwaja IA: Pakistan National Diabetes Survey: Prevalence of glucose intolerance and associated factors in the Punjab Province of Pakistan. Prim Care Diab 2010, 4(2):79–83. 10.1016/j.pcd.2010.01.003CrossRef

68.

Shera A, Rafique G, Khwaja I, Ara J, Baqai S, King H: Pakistan national diabetes survey: prevalence of glucose intolerance and associated factors in Shikarpur. Sindh Province. Diab Med 1995, 12(12):1116–1121. 10.1111/j.1464-5491.1995.tb00430.xCrossRef

69.

Shaw J, Sicree R, Zimmet P: Global estimates of the prevalence of diabetes for 2010 and 2030. Diab Res Clin Practice 2010, 87(1):4–14. 10.1016/j.diabres.2009.10.007CrossRef

70.

Nordstrom DK: Worldwide occurrences of arsenic in ground water. Science 2002, 296: 2143–2145. 10.1126/science.1072375PubMedCrossRef

71.

Mandal BK, Suzuki KT: Arsenic round the world: a review. Talanta 2002, 58(1):201–235. 10.1016/S0039-9140(02)00268-0PubMedCrossRef

72.

Chowdhury UK, Biswas BK, Chowdhury TR, Samanta G, Mandal BK, Basu GC, Chanda CR, Lodh D, Saha KC, Mukherjee SK: Groundwater arsenic contamination in Bangladesh and West Bengal, India. Environ Health Perspect 2000, 108(5):393. 10.1289/ehp.00108393PubMedPubMedCentralCrossRef

Title: Growing burden of diabetes in Pakistan and the possible role of arsenic and pesticides
Authors: Haji Bahadar
Sara Mostafalou
Mohammad Abdollahi
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Journal of Diabetes & Metabolic Disorders / Issue 1/2014
Electronic ISSN: 2251-6581
DOI: https://doi.org/10.1186/s40200-014-0117-y

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2014

Predictive factors of diabetic complications: a possible link between family history of diabetes and diabetic retinopathy

Effect of Boswellia serrata supplementation on blood lipid, hepatic enzymes and fructosamine levels in type2 diabetic patients

Association between dietary intake and seasonal variations in postmenopausal women

Effects of educational intervention based on PRECEDE model on self care behaviors and control in patients with type 2 diabetes in 2012

Validating a Web-based Diabetes Education Program in continuing nursing education: knowledge and competency change and user perceptions on usability and quality

Carbimazole inhibits TNF-α expression in Fat-induced hypothyroidism

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage