The prevalence and characteristics of overweight and obesity among students in Qatar

Single-Center Experience of Using Liraglutide in Adolescents With Obesity +/- Type 2 Diabetes

Background Childhood obesity is recognized as a chronic illness with limited therapeutic options. Tackling obesity (BMI; the weight in kilograms divided by the square of the height in meters, at the 95th percentile or higher) with lifestyle interventions, especially in adolescents, has proven to be a daunting task, yielding only modest results. Research on the use of liraglutide for weight reduction in pediatric patients has yielded conflicting results. Notably, there is a lack of studies in the Middle East reporting on the outcomes of glucagon-like peptide 1 (GLP-1) receptor agonists in treating obesity in children and adolescents, with or without diabetes. This study, conducted in the Middle East, represents the first investigation into the utilization of liraglutide for weight reduction in this pediatric population. Methods This retrospective study collected data on 22 consecutive participants, aged 12 to 19 years, who were diagnosed with obesity (defined as having a BMI greater than the 95th percentile for their age and sex) and had either type 2 diabetes mellitus (T2DM) or were non-diabetic who attended endocrine clinics in Sidra Medicine, Doha, Qatar, between 2020 and 2022. The study protocol involved a liraglutide treatment period spanning 18 months (72 weeks), with scheduled follow-up appointments at six-month intervals. The primary endpoints were changes in weight and BMI from baseline to the 72-week mark. Secondary endpoints were safety measures and changes in HbA1c.  Results Out of the initial cohort of 22 patients, 12 completed the full 72-week duration of the study, while 10 patients either discontinued treatment or did not adhere to the prescribed medication regimen due to side effects. Among the 12 patients who completed the study, six had a diagnosis of T2DM. At baseline, the weight, standard deviation score (SDS), BMI, and BMI standard deviation (SD) were 113.9 kg, 2.9, 40.9 kg/m2, and 2.6 respectively. At the 18-month follow-up, the weight, SDS, BMI, and BMI SD were 117.8kg, 2.6, 39kg/m2, and 2.5, respectively. Thus, no statistically significant change in the weight parameters was evident at 18 months compared to baseline. Dropout from the study and poor compliance were high (10 out of 22 patients) due to side effects, mainly gastrointestinal (nausea, abdominal pain, diarrhea, and vomiting). No statistically significant differences were observed between obese vs. obese with T2DM. No significant change in HbA1c was found between baseline and treatment follow-up in the diabetes patients. No adverse effects in terms of impairment of liver and kidney function or pancreatitis were observed. Conclusions The administration of liraglutide to adolescents with obesity, regardless of whether they had T2DM or not, in a real-life setting, did not yield statistically significant reductions in BMI/weight parameters, and HbA1c levels at the 72-week mark. Nevertheless, the study findings indicate that liraglutide is deemed safe for utilization within this age group, despite the presence of mild gastrointestinal side effects.

Understanding the Genetics of Early-Onset Obesity in a Cohort of Children From Qatar

CONTEXT

Monogenic obesity is a rare form of obesity due to pathogenic variants in genes implicated in the leptin-melanocortin signaling pathway and accounts for around 5% of severe early-onset obesity. Mutations in the genes encoding the MC4R, leptin, and leptin receptor are commonly reported in various populations to cause monogenic obesity. Determining the genetic cause has important clinical benefits as novel therapeutic interventions are now available for some forms of monogenic obesity.

OBJECTIVE

To unravel the genetic causes of early-onset obesity in the population of Qatar.

METHODS

In total, 243 patients with early-onset obesity (above the 95% percentile) and age of onset below 10 years were screened for monogenic obesity variants using a targeted gene panel, consisting of 52 obesity-related genes.

RESULTS

Thirty rare variants potentially associated with obesity were identified in 36 of 243 (14.8%) probands in 15 candidate genes (LEP, LEPR, POMC, MC3R, MC4R, MRAP2, SH2B1, BDNF, NTRK2, DYRK1B, SIM1, GNAS, ADCY3, RAI1, and BBS2). Twenty-three of the variants identified were novel to this study and the rest, 7 variants, were previously reported in literature. Variants in MC4R were the most common cause of obesity in our cohort (19%) and the c.485C>T p.T162I variant was the most frequent MC4R variant seen in 5 patients.

CONCLUSION

We identified likely pathogenic/pathogenic variants that seem to explain the phenotype of around 14.8% of our cases. Variants in the MC4R gene are the commonest cause of early-onset obesity in our population. Our study represents the largest monogenic obesity cohort in the Middle East and revealed novel obesity variants in this understudied population. Functional studies will be required to elucidate the molecular mechanism of their pathogenicity.

Sphingolipids in Childhood Asthma and Obesity (SOAP Study): A Protocol of a Cross-Sectional Study

Asthma and obesity are two of the most common chronic conditions in children and adolescents. There is increasing evidence that sphingolipid metabolism is altered in childhood asthma and is linked to airway hyperreactivity. Dysregulated sphingolipid metabolism is also reported in obesity. However, the functional link between sphingolipid metabolism, asthma, and obesity is not completely understood. This paper describes the protocol of an ongoing study on sphingolipids that aims to examine the pathophysiology of sphingolipids in childhood asthma and obesity. In addition, this study aims to explore the novel biomarkers through a comprehensive multi-omics approach including genomics, genome-wide DNA methylation, RNA-Seq, microRNA (miRNA) profiling, lipidomics, metabolomics, and cytokine profiling. This is a cross-sectional study aiming to recruit 440 children from different groups: children with asthma and normal weight (n = 100), asthma with overweight or obesity (n = 100), overweight or obesity (n = 100), normal weight (n = 70), and siblings of asthmatic children with normal weight, overweight, or obesity (n = 70). These participants will be recruited from the pediatric pulmonology, pediatric endocrinology, and general pediatric outpatient clinics at Sidra Medicine, Doha, Qatar. Information will be obtained from self-reported questionnaires on asthma, quality of life, food frequency (FFQ), and a 3-day food diary that are completed by the children and their parents. Clinical measurements will include anthropometry, blood pressure, biochemistry, bioelectrical impedance, and pulmonary function tests. Blood samples will be obtained for sphingolipid analysis, serine palmitoyltransferase (SPT) assay, whole-genome sequencing (WGS), genome-wide DNA methylation study, RNA-Seq, miRNA profiling, metabolomics, lipidomics, and cytokine analysis. Group comparisons of continuous outcome variables will be carried out by a one-way analysis of variance or the Kruskal-Wallis test using an appropriate pairwise multiple comparison test. The chi-squared test or a Fisher's exact test will be used to test the associations between categorical variables. Finally, multivariate analysis will be carried out to integrate the clinical data with multi-omics data. This study will help us to understand the role of dysregulated sphingolipid metabolism in obesity and asthma. In addition, the multi-omics data from the study will help to identify novel genetic and epigenetic signatures, inflammatory markers, and mechanistic pathways that link asthma and obesity in children. Furthermore, the integration of clinical and multi-omics data will help us to uncover the potential interactions between these diseases and to offer a new paradigm for the treatment of pediatric obesity-associated asthma.

Obesity during Adolescence and Feeding Practices during Infancy: Cross-Sectional Study

BACKGROUND

Breastfeeding is proposed to play a role in reducing the risk of obesity throughout life. Kuwait has an extremely high prevalence of childhood obesity (45% of adolescents are overweight/obese) and extremely low breastfeeding indicators, particularly exclusive breastfeeding. In fact, little is known about the association between breastfeeding and obesity from Kuwait and the broader Middle East.

AIMS

To estimate the prevalence of overweight/obesity in female adolescents in Kuwait and assess its association with breastfeeding during infancy.

METHODS

This is a cross-sectional study that included 775 girls randomly selected from public and private high schools in Kuwait. The primary exposure was breastfeeding in the first four months of life, and the outcome was overweight/obesity during adolescence. Multivariable logistic regression was used to assess the association between breastfeeding and overweight/obesity while adjusting for potential confounders.

RESULTS

Approximately 45% of adolescent girls were either overweight/obese. We found no significant association between breastfeeding (exclusive/mixed breastfeeding and formula feeding/no breastfeeding) and overweight/obesity neither in univariable analysis (Crude Prevalence Ratio: 1.14, 95%CI [0.92-1.36] & Crude Prevalence Ratio: 1.29, 95%CI [0.86-1.68]; p = 0.293) for mixed feeding and no breastfeeding respectively, nor in multivariable analysis (Adjusted Prevalence Ratio: 1.14, 95%CI [0.85-1.42] & Adjusted Prevalence Ratio: 1.20, 95%CI [0.68-1.68]; p = 0.589) for mixed feeding and no breastfeeding respectively.

CONCLUSION

Breastfeeding during infancy was not significantly associated with overweight/obesity during adolescence. However, breastfeeding should be encouraged for its indisputable benefits for infants and their mothers alike. Further prospective studies are needed to assess the association.

The COVID-19 Pandemic and the Prevalence of Childhood Obesity in Turkiye

OBJECTIVES

To examine the prevalence of overweight and obesity in school-age children in Isparta Province, Turkiye, during the coronavirus disease 2019 (COVID-19) pandemic, and to compare the results with those of previous studies conducted in Isparta in 2005, 2009, and 2014.

METHODS

The study was carried out in schools in the city center of Isparta in March 2022, during which the weight and height of students were measured using a scale and stadiometer, and the body mass indices (BMI), BMI percentiles, and z scores were calculated.

RESULTS

Of the 8871 students assessed, 4547 (51.3%) were female and the mean age of the sample was 11.92 ± 3.42 (6-18.93) years. The prevalence of overweight was 12%, the prevalence of obesity was 14.5%, and the prevalence of overweight + obesity was 26.5%. A comparison of the figures since 2005 revealed the prevalence of overweight to be stable, while the prevalence of obesity and the prevalence of overweight + obesity were found to have witnessed a increase (χ 2 : 57.01, P < 0.001). The prevalence of obesity was 13% among girls under 11 years of age and 14.3% among girls over 11 years of age; and 18.2% and 12.8% among boys under and over 11 years of age, respectively (χ 2 : 23.26, P < 0.001). The prevalence of obesity was significantly higher in boys under 11 years of age.

CONCLUSIONS

The prevalence of overweight + obesity was nearly stable in the 3 studies conducted over the 17-year period, but we witnessed an increase in our most recent study conducted during the pandemic. The prevalence of obesity is significantly higher in boys under 11 years of age.

Identifying lifestyle factors associated to co-morbidity of obesity and psychiatric disorders, a pilot study

Obesity and psychiatric disorders are linked through a bidirectional association. Obesity rates have tripled globally in the past decades, and it is predicted that by 2025, one billion people will be affected by obesity, often with a co-morbidity such as depression. While this co-morbidity seems to be a global health issue, lifestyle factors associated to it differ between countries and are often attributed to more than one factor. Prior obesity studies were performed in Western populations; this is the first study that investigates lifestyle factors relating to obesity and mental health of the diverse population in Qatar, a country that has witnessed tremendous lifestyle change in a short time. In this pilot study, we surveyed 379 respondents to assess and compare the lifestyles of Qatar residents to the global population. However due to the high proportion of responses from the United Kingdom (UK) residents, we have made comparisons between Qatar residents and UK residents. We used chi-square analysis, spearman rank correlation and logistic regression to compare the lifestyle factors of individuals suffering from both increased BMI and mental health conditions. The types of food consumed, stress, exercise frequency and duration, alcohol and tobacco consumption, and sleep duration, were explored and results argue that different lifestyle factors can contribute to the same health condition, suggesting different mechanisms involved. We found that both groups reported similar sleep durations (p = 0.800), but that perception of sleep (p = 0.011), consumption of alcohol (p = 0.001), consumption of takeaway food (p = 0.007), and physical activity significantly varied between the groups (p = 0.0001). The study examined the predictors of comorbidity in Qatar as well as UK populations using multivariate logistic regression analysis. The result of the study showed no statistical association between comorbidity and the predictors drinking habit, smoking, physical activity, vegetable consumption, eat outs, and sleep perception for the Qatar population, and for the combined population. This study, however showed a significant association (p = 0.033) between sleep perception and comorbidity for the UK population. We conclude that further analysis is needed to understand the relationship between specific lifestyle factors and multimorbidity in each country.

Assessment of Overweight, Obesity, Central Obesity, and Type 2 Diabetes among Adolescents in Qatar: A Cross-Sectional Study

Qatar has a high obesity and type 2 diabetes mellitus (T2DM) burden. This study aimed to (1) determine the prevalence of overweight, obesity, and T2DM in 13-17-year-old adolescents and (2) evaluate associations with adolescents' lifestyle and breastfeeding history, parental weight, and familial T2DM history. A cross-sectional study (double-stage cluster sampling) was conducted in 2018-2020 using a self-administered parental and adolescent questionnaire. In the results, 23.4% of the adolescents (107/459) were overweight; 19.9% (91/459) were obese; and 37.6% (171/459) had evidence of central obesity. Random blood sugar (RBS) was suggestive of prediabetes (≥140 mg/dL) for 23 (5.0%) adolescents and T2DM (≥200 mg/dL) for none. In multivariable analysis, obesity was significantly associated with no breastfeeding (OR = 3.17, 95% CI: 1.09-9.26) compared to breastfed adolescents for ≥6 months, with first-degree family history of T2DM (OR = 2.27; 95% CI: 1.22-4.27), with maternal obesity (OR = 2.40; 95% CI: 1.01-5.70), and with acanthosis nigricans in adolescents (OR = 19.8; 95% CI: 8.38-46.9). Central obesity was significantly associated with maternal obesity (OR = 2.21; 95% CI: 1.14-4.27) and with acanthosis nigricans (OR = 3.67; 95% CI: 1.88-7.18). Acanthosis nigricans (OR = 4.06; 95% CI: 1.41-11.7) was the only factor associated with elevated RBS. Addressing future disease burden among adults in Qatar will require extensive health and well-being programs, focused on healthy lifestyles and behaviors such as nutritious diets, physical activity, stress management, and self-care.

Differences in Health-Related Physical Fitness and Academic School Performance in Male Middle-School Students in Qatar: A Preliminary Study

This study examined the differences in the level of physical fitness and academic performance among male middle-school children based on different body status categories. A total of 69 male children [age: 12.4 ± 0.7 years; body mass: 58.5 ± 7.2 kg; height: 1.62 ± 0.09 m; and body mass index (BMI): 22.4 ± 3.3 kg/m²] participated and were divided into BMI age-adjusted groups (i.e., lowest, middle, and highest BMI). Height, mass, BMI, stork test of static balance, 10 and 15 m sprint as an indicator for speed, hand-grip strength test, agility T-half test, medicine ball throw (MBT), and the Yo-Yo Intermittent Recovery Test level 1 (Yo-Yo IR1) were assessed. School records were retrieved for grade point averages (GPA) of mathematics, science, and Arabic. We found significant group differences regarding anthropometric (height: ηp2 = 0.24, mass: ηp2 = 0.33, and BMI: ηp2 = 0.66), physical (sprint 10 m: ηp2 = 0.26), and academic (mathematics: ηp2 = 0.19 and science: ηp2 = 0.15) performance parameters. The largest difference (p < 0.001) was observed between the lowest and highest group for the 10 m sprint. All pairwise differences were between the lowest and highest BMI group or the lowest and middle BMI group. No relevant (r > 0.5) correlation between parameters of different dimensions (e.g., anthropometric vs. physical performance parameters) was found. In conclusion, the highest BMI group exhibited similar physical and academic performances than the lowest group. Thus, these data emphasize the importance and appropriateness to engage young Qatari schoolchildren in physical activity as it associates with superior academic performance.

Obesity among children and adolescents in Qatar: protocol for a scoping review

INTRODUCTION

Approximately half of the school-aged children are overweight or obese in Qatar. Childhood obesity is associated with health conditions in adulthood, such as hypertension, diabetes, metabolic defects, cardiovascular risks and psychological challenges. Existing obesity studies have limitations; thus, there is a need for further research with improved quality, wider representation of population including children and adolescents and methodological diversity. As Qatar moves towards a preventive evidence-based approach in tackling obesity, this scoping review aims to support the efforts of obesity prevention among children and adolescents in Qatar by providing an up-to-date research map that systematically highlights existing knowledge, research gaps and methodological range. In addition, this will be the first scoping review that analyses how obesity research has evolved in Qatar since 2000.

METHODS AND ANALYSIS

This scoping review follows the guidelines of Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews for both developing the protocol and reporting the findings. It will use the System for the Unified Management, Assessment and Review of Information-JBI software for synthesis. The review will include any study in Arabic or English published between 1 January 2000 and 31 December 2021 on obesity/overweight among children and/or adolescents in Qatar. Studies without specific data on the concept of obesity, the population of children and adolescents or the context of Qatar will be excluded. The following databases will be searched: PubMed, Embase, Web of Science, IBSS, Scopus, J-STOR, APA PsycNET and Google Scholar. In addition, Arabic literature via Dar Almanthomah, Dar Almanhal and E-Marefah will be searched. A search strategy to identify grey literature will be adopted for a wider reach. The screening process will be conducted by two independent reviewers. Extracted data will be analysed descriptively and analytically using simple frequency counts and qualitative content analysis. The results will be presented using maps, tables and diagrams.

ETHICS AND DISSEMINATION

Ethics approval is not required as data will be collected from publicly available published research. The results of this review will be disseminated via a peer-reviewed publication, national and international conferences, workshops and knowledge mobilisation activities among key stakeholders.

Association between waterpipe smoking and obesity: Population-based study in Qatar

INTRODUCTION

Over the past decade obesity prevalence has been increasing rapidly in the Gulf region (GR) including Qatar, becoming one of the major health issues in the region. Concomitantly, waterpipe (WP) smoking is increasing worldwide especially in the GR, and although the effect of cigarette smoking on body weight is well-established, studies indicating an association between WP smoking and obesity are scarce. Thus, we explored the association between WP smoking and obesity in comparison with cigarette smokers and healthy population in Qatar.

METHODS

We performed a cross-sectional study using data from Qatar Biobank and analyzed anthropometric measurements among 879 adults (aged 18-65 years) that included WP smokers, cigarette smokers, dual smokers and never smokers. Body composition was measured using bioelectrical impedance analysis and reported as lean mass, fat mass, and body fat percentage.

RESULTS

Overall, 12% (n=108) were WP smokers, 22% (n=196) were cigarette smokers, 9% (n=77) smoked both WP and cigarettes and 57% (n=498) were never smokers. Age, sex, history of diabetes, and hypertension, in addition to nationality were considered as confounding factors. Our analysis revealed that WP smokers had a significantly higher BMI (kg/m2) and fat mass when compared with cigarette smokers (p<0.05). Moreover, compared to cigarette smoking, WP smoking had a higher significant effect on BMI (β=3.8, SE=0.38; and β=5.5, SE=0.46; respectively), and fat mass (β=5.1, SE=0.79; and β=9.0, SE=0.97; respectively). However, WP users were similar to never-smokers in terms of body fat percent.

CONCLUSIONS

Our data indicate that compared to never smokers, daily WP users have higher BMI and fat mass, and are likely to be obese.

Epidemiological health assessment in primary healthcare in the State of Qatar- 2019

BACKGROUND

In the public sector in Qatar, the Primary Health Care Corporation (PHCC) is the major provider of primary healthcare services to families. Therefore, the PHCC conducted the first epidemiological health assessment to understand the burden of diseases and their subsequent risk factors impacting its registered population, to design better services, implement it and allocate resources to respond to the population health needs.

METHODS

A cross-sectional study design was adopted among all PHCC registered populations between September 1, 2018, and August 31, 2019. The study target population was all persons residing in Qatar aged 0+ years and registered at the 27 health centers affiliated with the PHCC; excluding patients with an expired residence permit on August 31, 2019, and craft male workers were provided their primary healthcare services at the Qatar Red Crescent health facilities. The data were extracted from patients' electronic medical records (EMR).

RESULTS

The burden of type 2 diabetes, hypertension, and dyslipidemia were the highest among the population of the central region at 13.9%, 15.7%, and 11.1%, respectively. Tobacco consumption among males was higher than females and ranged from 25.4% to 27.8%, with the highest rate in the northern region. Obesity rates ranged between 34.7% and 37.0% among the total population registered with the lowest rate in the central region, while 39.9% of females in the northern region had a body mass index above 30 kg/m². Exclusive breastfeeding at 6 months was significantly lower than that at 4 months across all regions. Children in the northern region had the highest rate of overweight/obesity based on Z-scores. The western region population had the highest number of communicable diseases notifications.

CONCLUSION

Understanding the patterns of disease in the local population will enable the PHCC to plan a clear set of services that meet the population's health needs, which include tailored health education and promotion components.

Serum vitamin E concentration is negatively associated with body mass index change in girls not boys during adolescence

BACKGROUND

Vitamin E is the most abundant lipid-soluble antioxidants present in plasma; however, the relationship between serum vitamin E and change in body mass index (BMI)-for-age Z scores in adolescents has not been well described.

METHODS

This study is a cross-sectional study. Data were analyzed from 4014 adolescents who participated in the National Health and Nutrition Examination Survey. The nutritional status was calculated by BMI Z scores and was classified into normal weight, overweight, and obese. Multivariable-adjusted logistic regression was used to examine the association between serum vitamin E levels with overweight/obesity. Besides, the interaction effects between potential confounders and vitamin E on obesity were further evaluated.

RESULTS

After adjusting potential confounders, serum vitamin E levels were negatively associated with overweight/obesity in girls but not in boys. Per standard deviation increment in vitamin E concentrations was associated with a 92% decreased risk of obesity in females. Besides, lower quartiles of serum vitamin E were associated with a higher risk of overweight/obesity in girls. Moreover, the inverse association between serum vitamin E levels and obesity was also found in most subgroups through subgroup analysis.

CONCLUSIONS

Our study supports the negative association between serum vitamin E levels and overweight/obesity in adolescents. A higher serum vitamin E level may be associated with a reduced probability of obesity in girls, but not in boys.

The Prevalence of the Different Components of the Metabolic Syndrome (MetS) in Obese Nondiabetic Children and Young Adolescents and their Anthropometric Data in Relation to Parents

In Qatar, the prevalence of metabolic syndrome (MetS) in children and adolescents is increasing in parallel with the increasing trends in obesity rates. In Qatar, the prevalence of obesity is relatively high.

AIM

To assess the prevalence of the different components of MetS and plasma atherogenic indexes (AIP) in obese children and adolescents and to compare their anthropometric data with their parents (genetic background).

METHODOLOGY

We analysed the anthropometric and biochemical profile of 91 randomly selected obese children and young adolescents (age: 10.5 ± 2.7 years) who attended to the Paediatric Clinic of Hamad Medical Center (HGH) in Doha (Qatar) form January 2017 to December 2019.  Data recorded included: age, gender, weight and height, body mass index (BMI), systolic and diastolic blood pressures. Biochemical data including lipid profile, glycated hemoglobin (A1C), and alanine transferase level (ALT) were recorded and compared with normal lab data for the same age group.

RESULTS

Obese children had a high prevalence of dyslipidaemia, dysglycemia and non-alcoholic fatty liver disease (NAFLD). Using the modified adult MetS criteria, MetS was present in 30.2% of this obese cohort. AIP was high in 76.7% of the patients. Standing height standard deviation score (Ht-SDS) of obese children was significantly higher compared to Ht-SDS of their parents as well as to mid-parental height SDS (MPHt-SDS) (-0.37± 0.79). The BMI and BMI-SDS did not differ between obese children and their parents.

CONCLUSION

The occurrence of MetS in 30% of our obese non-diabetic children and young adolescents pointed out to the necessity to impose early detection and preventive measures on a national scale.

Obesity, a major risk factor for immunity and severe outcomes of COVID-19

An influenza-like virus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for COVID-19 disease and spread worldwide within a short time. COVID-19 has now become a significant concern for public health. Obesity is highly prevalent worldwide and is considered a risk factor for impairing the adaptive immune system. Although diabetes, hypertension, cardiovascular disease (CVD), and renal failure are considered the risk factors for COVID-19, obesity is not yet well-considered. The present study approaches establishing a systemic association between the prevalence of obesity and its impact on immunity concerning the severe outcomes of COVID-19 utilizing existing knowledge. Overall study outcomes documented the worldwide prevalence of obesity, its effects on immunity, and a possible underlying mechanism covering obesity-related risk pathways for the severe outcomes of COVID-19. Overall understanding from the present study is that being an immune system impairing factor, the role of obesity in the severe outcomes of COVID-19 is worthy.

Exploring the Role of Community Pharmacists in Obesity and Weight Management in Qatar: A Mixed-Methods Study

Introduction

Obesity is a major public health burden in Qatar. Pharmacists can play an important role in providing weight management services (WMSs). This study aimed to explore their attitudes, practice, perceived competence, and role in WMSs in Qatar.

Methods

A mixed-method explanatory sequential design was applied in the study. A validated online questionnaire was administered followed by qualitative individual and focus group interviews.

Results

Two-hundred seventy community pharmacists completed the survey (response rate 45%). More than half of them indicated that they often or always explain to patients the risks associated with overweight and obesity (56.2%), recommend weight loss medications, herbs or dietary supplements (52.4%), and counsel about their proper use and/or side effects (56.9%). Conversely, the majority of the pharmacists rarely or never measure patients’ waist circumference (83.8%) or calculate their body mass index (72.1%). Over 80% had very positive attitudes towards their role in weight management. Around three-quarters of the participants agreed or strongly agreed that difficulty in following-up with patients (80.7%), lack of private consultation area (75.7%), and lack of pharmacist’s time (75.2%) are barriers for implementing WMSs. More than 60% stated that they are fully competent in 7 out of 24 WMSs listed. Some themes generated include pharmacist’s role and impact in weight management, need for training about weight management, and impact of social media on patients’ perceptions.

Conclusion

Qatar community pharmacists reported positive attitudes towards the provision of WMSs. However, they identified several barriers against provision of WMSs. Several strategies are proposed to overcome barriers and to improve the provision of WMSs in community pharmacies in Qatar.

Testing a multicomponent lifestyle intervention for combatting childhood obesity

BACKGROUND

Childhood obesity is a major global health concern. Weight-management camps involving delivery of a program of physical activity, health education, and healthy eating are an effective treatment, although post-intervention weight-management is less well understood. Our objective was to assess the effectiveness of a weight-management camp followed by a community intervention in supporting weight-management for overweight children and children with obesity.

METHODS

Participants were overweight Qatari schoolchildren or schoolchildren with obesity, ages 8-14 years, (n = 300) recruited over a three-year period across 14 randomly selected schools in the Doha area. They attended a two-week weight management camp, then a 10-week program of weekly lifestyle education and physical activity sessions, which also included behavior change techniques. The programme was cognitive behavioural therapy (CBT)-focused with a strong element of behavioural economics blended in.

RESULTS

Participants saw a significant BMI SDS reduction as a result of the entire intervention (camp + education and activity sessions) both at the individual (p < 0.0001) and cluster/school (p = 0.0002) levels, and weight loss occurred during each intervention stage separately for the camp (p < 0.0001 for both the individual and cluster/school levels) and the lifestyle education and activity phase (p < 0.0001 and p = 0.0220 at the individual and cluster/school levels, respectively).

CONCLUSIONS

Weekly lifestyle education and activity sessions which include behavior change techniques may be useful in promoting continued weight management in the period following intensive, immersive childhood obesity interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02972164 , November 23, 2016.

Whole genome sequencing in the Middle Eastern Qatari population identifies genetic associations with 45 clinically relevant traits

Clinical laboratory tests play a pivotal role in medical decision making, but little is known about their genetic variability between populations. We report a genome-wide association study with 45 clinically relevant traits from the population of Qatar using a whole genome sequencing approach in a discovery set of 6218 individuals and replication in 7768 subjects. Trait heritability is more similar between Qatari and European populations (r = 0.81) than with Africans (r = 0.44). We identify 281 distinct variant-trait-associations at genome wide significance that replicate known associations. Allele frequencies for replicated loci show higher correlations with European (r = 0.94) than with African (r = 0.85) or Japanese (r = 0.80) populations. We find differences in linkage disequilibrium patterns and in effect sizes of the replicated loci compared to previous reports. We also report 17 novel and Qatari-predominate signals providing insights into the biological pathways regulating these traits. We observe that European-derived polygenic scores (PGS) have reduced predictive performance in the Qatari population which could have implications for the translation of PGS between populations and their future application in precision medicine.

The genetic basis for traits can vary between populations. Here the authors report a genome wide association study with 45 clinically-relevant traits in individuals from Qatar, replicating many known loci and identifying new Qatari-predominant signals.

The Associations Between Physical Performance and Anthropometric Characteristics in Obese and Non-obese Schoolchild Handball Players

This study investigated the relationship of body fat and fitness measures in schoolchild handball players. Twenty-eight young male handball players from handball first youth league volunteered for the present investigation (age: 10.9 ± 0.72 years; body mass: 54.8 ± 22.9 kg; height: 1.48 ± 0.10 m; body fat: 27.6 ± 9.23%). Measures included the Yo-Yo Intermittent Recovery Test level 1 (Yo-Yo IR1), jumping ability [squat and counter-movement jumps (SJ, CMJ)], and sprint tests (10 m, 15 m). Anthropometry was assessed by body mass, body mass index (BMI), and fat percentage (%BF). The power of the upper limb was measured as the total distance thrown overhead using a 2 kg medicine ball. Intrarater reliability for all parameters showed a coefficient of variation (CV) below 10% and an intraclass correlation coefficient (ICC) above 0.75. All ICC were excellent (ICC ≥ 0.96). Reliability as shown by the CV differed between 1.0 (sprint 15 m) and 5.6 (sprint 10 m). With the exception of medicine ball throw, we found significant differences between non-obese and obese in all performance parameters. The differences ranged from η _p ² = 0.47 (sprint 10 m) to η _p ² = 0.09 (medicine ball throw). The two-step-linear regression analysis using the predictors body height and body weight (step 1) and body fat (step 2) showed a marked increase of explained variance by adding body fat. The largest r² changes were calculated for sprint 10 m (0.54), CMJ (0.49), and sprint 15 m (0.42). The lowest influence of the predictors was observed for medicine ball throw (step 1: r ² = 0.03, step 2: r ² = 0.07). With the exception of sprint parameters (β-coefficient sprint 10 m: -0.74; β-coefficient sprint 20: -0.66), a decrease of %BF leads to a higher performance in all parameters. %BF in youth handball players should be an important concern for practitioners working in this team sport in contrast to the frequently used BMI. It seems sensible and appropriate to engage very young children in physical activities such as team handball in order to improve their physical fitness. Decrease in% body fat could be considered both as a training and nutritional target to enhance and optimize sport performance-related outcomes.

Association between tracking of extracurricular sports practice and weight status during childhood: a prospective cohort study

BACKGROUND

Overweight and obesity have reached epidemic prevalences. Obesity control involves many factors and needs to begin early in childhood.

OBJECTIVES

To ascertain the association between tracked extracurricular sports practice and weight status; and to analyze tracking of overweight and obesity among school-aged children.

DESIGN AND SETTING

Prospective cohort study conducted in 13 public schools in Cianorte, Paraná, in 2012-2016.

METHODS

The sample comprised 2459 schoolchildren in Cianorte, of mean age 6.3 years at baseline and 9.4 years at follow-up. Body mass index was calculated from body mass and height measurements. The children were grouped as normal weight, overweight or obese. Information on extracurricular sports practice was collected through the dichotomous question "Do you participate in any extracurricular sports?" ("yes" or "no").

RESULTS

Tracking of weight status showed that 75.5% maintained this, with kappa of 0.530. Tracking of extracurricular sports practice showed that 80.9% maintained this, with low concordance (kappa of 0.054). Weight status correlation between baseline and follow-up showed that overweight or obese individuals were 4.65 times (CI: 4.05-5.34) more likely to maintain the same classification or move from overweight to obese at follow-up. Correlation of extracurricular sports practice with overweight or obesity at follow-up was not significant.

CONCLUSIONS

These results demonstrated that overweight or obese children were at higher risk of gaining weight than were normal-weight children. In addition, the proportion of these children who maintained extracurricular sports practices over the years was low. Maintenance of this variable was not associated with weight status.

Body Fat Is a Predictor of Physical Fitness in Obese Adolescent Handball Athletes

We examined the relationships between body fat (BF) and field measures of physical fitness in adolescent handball players. Twenty nine players (age: 16.6 ± 1.72 years; body mass: 79.8 ± 17.0 kg; height: 1.70 ± 0.12 m; body fat: 27.7 ± 8.67%) from Qatar handball first league performed a series of anthropometric and fitness tests related to their performance in sprinting (i.e., 15 m and 30 m sprint), jumping (i.e., countermovement and squat jumps), throwing (i.e., 3 kg medicine ball seated front throw) and running (i.e., agility T-Half and Yo-Yo intermittent recovery level 1 tests). Significant differences between obese and non-obese groups, classified based on age-stratified %BF norms, were found, with the largest difference being attributed to aerobic performance on the Yo-Yo test. Results indicated no significant relationships between anthropometric variables and sprinting or jumping abilities. %BF predicted a significant 8–15% portion in running performances of agility and aerobic capacity, while the latter were mainly explained by body height and mass. %BF was the only and strongest predictor of throwing performance, being an important determinant of performance in handball. Optimizing %BF should be considered as a training and nutrition goal in order to improve sport performance.

Disease Burden, Mechanism and Management of Obesity – Where Do We Stand?

The role of increased body mass index in general morbidity and mortality is well documented. This global public health issue continues to represent a major burden and threat to health systems and the population’s wellbeing. Global statistics show that the prevalence of obesity has increased about three times since the mid-1970s, and an upward trend is still observed, not only in developed but also in developing countries. We used several databases, including PubMed, ProQuest, and Google Scholar, to perform a literature search and review on obesity. Keywords such as “obesity”, “overweight”, and “BMI” were used in combination with multiple keywords such as “mechanism”, “factors”, “socio-economic”, “environmental”, “social determinants”, “management”, “treatment”, “non-traditional treatment”, “alternative therapies”, “non-pharmaceutical treatment” etc. and related phrases. According to the literature, the management of obesity is difficult due to the complex nature of this problem in terms of its course, complications, risks, and etiological factors. The role of alternative therapies in obesity management is still unclear, and further research is needed in this area. Recently introduced weight-loss and -management devices can also help in losing excess bodyweight. The present article summarizes relevant information related to obesity, collected from different regions of the world, and discusses diverse interventional approaches to treat obesity.

Knowledge and Perception of Diabetes and Available Services among Diabetic Patients in the State of Qatar

Introduction

Diabetes is a major public health concern in Qatar. This study examined diabetes knowledge and perception of available services for diabetes control among diabetic patients in Qatar.

Methods

Data from 300 diabetic patients were collected through face-to-face interviews using a semi-structured questionnaire between February and May 2015 at Hamad Medical Corporation healthcare facilities in Qatar. Survey responses were represented as frequencies, and Chi-square tests were used to compare proportions across gender. A p-value of 0.05 was considered statistically significant.

Results

31% of patients had Type 1 Diabetes (T1D) (females 36.6%, males 26.5%) and 54% had Type 2 Diabetes (T2D) (males 56.6%, females 50%). Knowledge about diabetes types did not differ by sex (P=0.16). 32.3% of patients were treated for diabetes-related complications including: high cholesterol (39.2%), vision problems (33.1%), hypertension (30.0%), and foot problems (25.1 %). Most patients were diagnosed at primary care clinics (41.7%). During visits, 78.3% of patients reported that they were fully advised about different diabetes tests. 57.0% of patients had ≥4 visits for diabetes checkups in the past 12 months. 66.7% of patients reported that they were confident or very confident in managing their diabetes as a result of their healthcare visits in the past year. The majority of patients reported receiving diabetes-related guidance from physicians (89.7%).

Conclusions

Study participants had variable knowledge of diabetes, its complications and risk factors, and services available to diabetics. More comprehensive education and awareness about diabetes is recommended for both patients and family members. At the provider level, further improvement in patient counseling and promotion of available services can be beneficial.

Public Awareness and Perceptions about Diabetes in the State of Qatar

Introduction Diabetes is a well-known global public health challenge affecting millions globally. The aims of this study are to examine the community diabetes knowledge, perceptions, and awareness among the public in Qatar regarding (1) disease symptoms, risk factors, complications, prevention, and associated behaviors, and (2) local diabetes campaigns and available services or resources. Methods This study involved a total of 501 respondents selected through purposive sampling from major public malls and public places in Doha, Qatar between February and May 2015. Data were gathered by face-to-face interview utilizing a semi-structured questionnaire. Results were analyzed using count, percentage, median, chi-square test, z-test on proportion and logistic regression. The analysis was carried out at 5% level of significance using SPSS version 22 (IBM Corporation, Chicago, IL, USA). Results About 92% of participants knew at least one type of diabetes. Over 43.9% were physically active for 1-3 days per week. Highest proportion of the population perceived blindness (86%) as the top complication; frequent urination (58%) and excessive thirst (41%) as primary symptoms; hereditary factors (74%) and obesity (74%) as the top risk factors; and exercise (77%) and diet (72%) as among the preventive measures. Demographic overview of diabetes and lifestyle factors showed that the odds of obtaining screening tests were higher among females (OR=1.7, P=0.003), age 35-45 (OR=2.2, P=0.003), age ≥55 (OR=4.1, P<0.001) and married (OR=3.0, CI=2.0-4.6, P<0.001) compared with their respective counterpart groups. Conclusions The general population in Qatar require more awareness and education about diabetes prevention and associated risk factors. This could be achieved by implementation of more public health campaigns to encourage healthier lifestyles.