Alarming predictions for obesity and non-communicable diseases in the Middle East

The hidden cost of sophistication: economic complexity and obesity

Obesity has become a global health crisis, affecting people of all ages, regions, and socio-economic backgrounds. While individual behaviour and genetic factors contribute to obesity, the role of economic complexity in the evolution of obesity rates has not yet been empirically studied. Using a large panel of 110 countries over the period 1976-2015, this article estimates the linear and non-linear links between obesity and economic complexity. According to baseline results, an improvement in economic complexity will lead to an increase in obesity up to a certain threshold. Beyond this turning point, any further increase in economic complexity will significantly contribute to obesity reduction. The issue of simultaneity is tackled using the two-stage instrumental variable method. Our findings support the Obesity Kuznets Curve (OKC) pattern, which suggests that economic progress and obesity have an inverted U-shaped relationship. Our results suggest that greater embeddedness of knowledge in the products produced and exported by a country increases the likelihood of obesity in society, at least up to a threshold. From these results, some important policy implications are discussed.

Current Perspectives, Practices, and Barriers Faced by Community Pharmacists Regarding Pharmaceutical Care Services for Diabetes Mellitus in the United Arab Emirates

Background

Providing accurate and sufficient information is a crucial requirement for delivering effective diabetes care, making it essential for community pharmacists to possess adequate knowledge of diabetes mellitus (DM) and its management.

Objective

To investigate community pharmacists' level of expertise and engagement in providing counseling and health promotion services for individuals with DM in the United Arab Emirates (UAE).

Methods

A cross-sectional study design was used. The community Pharmacies were chosen via random sampling and researchers then conducted face-to-face interviews with them using the structured questionnaire. The questionnaire included demographic data, 14 questions on the knowledge and 9 questions about the practice concerning pharmaceutical care for Diabetes Mellitus.

Results

The average age ± SD was 31 ± 6.3. Of the total 516 community pharmacists recruited in the study, 37.2% (n=192) were male and 62.8% (n=324) were female. The average knowledge score about DM prevention and management was 9.7 with a 95% confidence interval (CI) [9.5, 9.9] and the average practice score about DM prevention and management was 7.1 with a 95% confidence interval (CI) [6.9, 7.2]. Better knowledge scores were observed in chief pharmacists (OR 1.29; 95% CI 1.08-1.56), pharmacists with 6-10 Years of experience (OR 6.92; 95% CI 3.43-8.86), pharmacist with > 10 years of experience (OR 1.99; 95% CI 1.67-2.36), when the number of patients the pharmacist serve is 5-10 (OR 1.27; 95% CI 1.06-1.53) and being trained on DM prevention and management (OR 2.18; 95% CI 1.92-2.47). Similarly, better practice scores were observed in older participants (OR1.02; 95% CI 1.001-1.03), chain pharmacies (OR 1.42; 95% CI 1.20-1.68), chief pharmacists (OR 1.56; 95% CI 1.18-2.06), when the number of patients the pharmacists serve was 5-10 (OR 12.26; 95% CI 7.26-16.19), when the number of patients the pharmacists serve was 11-20 (OR 4.23; 95% CI 3.54-5.06) and being trained on DM prevention and management (OR 1.33; 95% CI 1.11-1.59). The most commonly reported barriers to providing counseling and health promotion services for diabetes mellitus (DM) in community pharmacies include a lack of coordination with other healthcare professionals (77%) and insufficient knowledge or clinical skills (68.7%).

Conclusion

Our study revealed that community pharmacy staff members displayed a noteworthy level of involvement in providing pharmaceutical care services for patients with diabetes mellitus. Based on these findings, it is recommended to enhance pharmacy education by incorporating more advanced, evidence-based training and curricula focusing on disease management and appropriate therapies, particularly for diabetes.

Social network enhanced behavioral interventions for diabetes and obesity: A 3 arm randomized trial with 2 years follow-up in Jordan

While obesity and diabetes are rising pandemics, few low-cost and effective prevention and management strategies exist, especially in the Middle East. Nearly 20% of adults in Jordan suffer from diabetes, and over 75% are overweight or obese. Social network-based programs have shown promise as a viable public health intervention strategy to address these growing crises. We evaluated the effectiveness of the Microclinic Program (MCP) via a 6-month multi-community randomized trial in Jordan, with follow-up at 2 years. The MCP leverages existing social relationships to propagate positive health behaviors and information. We recruited participants from 3 community health centers in Amman, Jordan. Participants were eligible for the study if they had diabetes, pre-diabetes, or possessed ≥1 metabolic risk factor along with a family history of diabetes. We randomized participants into three trial arms: (A Group) received the Full MCP with curriculum-activated social network interactions; (B Group) received Basic MCP educational sessions with organic social network interactions; or (C Group-Control) received standard care coupled with active monitoring and parallel screenings. Groups of individuals were randomized as units in a 3:1:1 ratio, with resulting group sizes of n = 540, 186, and 188 in arms A, B, and C, respectively. We assessed the overall changes in body weight, fasting glucose, hemoglobin A1c (HbA1c) and mean arterial blood pressure between study arms in multiple evaluations across 2 years (including at 6-months and 2-years follow-up). We investigated the effectiveness of Full and Basic MCP social network interventions using multilevel models for longitudinal data with hierarchical nesting of individuals within MCP classrooms, within community centers, and within temporal cohorts. We observed significant overall 2-year differences between all 3 groups for changes in body weight (P = 0.0003), fasting blood glucose (P = 0.0015), and HbA1c (P = 0.0004), but not in mean arterial blood pressure (P = 0.45). However, significant changes in mean arterial pressure were observed for Full MCP versus controls (P = 0.002). Weight loss in the Full MCP exceeded (-0.97 kg (P<0.001)) the Basic MCP during the intervention. Furthermore, both Full and Basic MCP yielded greater weight loss compared to the control group at 2 years. The Full MCP also sustained a superior fasting glucose change over 2 years (overall P<0.0001) versus the control group. For HbA1c, the Full MCP similarly led to greater 6-month reduction in HbA1c versus the control group (P<0.001), with attenuation at 2 years. For mean arterial blood pressure, the Full MCP yielded a greater drop in blood pressure versus control at 6 months; with attenuation at 2 years. These results suggest that activated social networks of classroom interactions can be harnessed to improve health behaviors related to obesity and diabetes. Future studies should investigate how public health policies and initiatives can further leverage social network programs for greater community propagation. Trial registration. ClinicalTrials.gov Identifier: NCT01818674.

Infant feeding practices and risk of preschool obesity in AlAin, UAE: A cross-sectional study

Early childhood obesity is serious public health problem, and poses a risk of obesity in later life. The study aimed to investigate whether infant feeding affects risk of overweight and obesity in preschool children in the United Arab Emirates (UAE). A cross-sectional study was carried out. Data was collected in a kindergarten in Al Ain, UAE. One hundred and fifty parents and preschool children aged 2 to 6 years participated in the study. Univariate and multivariate linear regression were used to investigate associations. A longer duration of breastfeeding and later introduction of complementary foods were associated with a lower BMI z-score in preschool children. Each month of any breastfeeding was associated with a lower BMI z-score in the unadjusted model (β = -0.03; 95% CI -0.05, -0.01; p = 0.01), and each month increase in the age of introducing complementary foods was associated with a lower BMI z-score in the unadjusted model (β = -0.43; 95% CI: -0.60 to-0.027; p<0.001). These associations remained after adjustment for potential confounding factors (age, sex, maternal BMI, maternal education level, mother's age, social class, father's BMI) for duration of breastfeedinig (β = -0.02; 95% CI: -0.05 to 0.00; p<0.001) and age of complementary feeding (β = -0.39; 95% CI: -0.57 to-0.21; p<0.001). Poor infant feeding practices (shorter duration of breastfeedinig and early introduction of complementary foods) were found to be associated with higher BMI in preschool children. Promoting appropriate proper infant feeding practices in line with recommendations could be one strategy to help prevent childhood obesity in the UAE.

A Scoping Review of the Biological, Socioeconomic and Environmental Determinants of Overweight and Obesity Among Middle Eastern and Northern African Nationalities

Objectives

Globally, and particularly in the Middle East and North Africa (MENA) region, overweight and obesity have become serious public health concerns. This scoping review aimed to identify and summarise the available data on the determinants of overweight and obesity among MENA nationalities.

Methods

An extensive search of electronic databases, including Google Scholar, PubMed and ProQuest, for articles published from 2007 until 2022 was conducted. A total of 10 articles, of the 333 that were found in the original search, met the inclusion criteria. Data extraction and quality assessment were applied to each of the selected studies.

Results

There is an intricate interplay of anthropometric, behavioural, sociodemographic and environmental factors that caused overweight and obesity in this population.

Conclusions

A thorough synthesis of the factors influencing overweight and obesity in MENA nationalities was provided by this scoping review.

Burden of ischemic heart disease in the Middle East and North Africa (MENA) and attributable risk factors: An epidemiological analysis from 1990 to 2019

Introduction

Despite the burden of ischemic heart disease (IHD), there remains a paucity of research on the incidence, mortality, and burden of this condition in the Middle East and North Africa (MENA) regions. This study aimed to evaluate the epidemiology and the risk factors associated with IHD in the MENA region.

Methods

This study was performed based on the GBD study 2019 data. We retrieved the data related to the epidemiology and burden of IHD, including prevalence, incidence, years of life lost due to premature death (YLLs), years lived with disability (YLDs), and mortality at the global level and in MENA countries across years and sexes.

Results

IHD accounted for approximately 2.55 million (95 % UI 2.29-2.83) incident cases in MENA in 2019, with an age-standardized incidence rate of 613.87 (95 % UI 555.84-675.16) per 100 000 people, which has decreased by 9 % between 1990 and 2019. IHD accounted for 11.01 % of DALYs causes in MENA in 2019, an increase of 68 % compared to 1990. The DALYs rate from IHD increased with age in both men and women and was higher in men than in women in all age groups, except 85-89 years age-group, in 2019.

Conclusion

The age-standardized prevalence and incidence of IHD are decreasing in MENA. However, this reduction is lower than the global level, which can be due to a weaker performance of the countries in the region in reducing the prevalence and incidence of the disease compared to the global average.

Changing trends of the diseases burden attributable to high BMI in Asia from 1990 to 2019: results from the global burden of disease study 2019

OBJECTIVE

To analyse the trends of diseases burden attributed to high body mass index (BMI), including overweight and obesity, in Asia from 1990 to 2019.

DESIGN

Observational study.

SETTING

The data of 45 countries and regions in Asia were obtained from the Global Burden of Disease Study 2019 database.

MAIN OUTCOME MEASURES

Numbers, age-standardised rate (ASR) of deaths and disability-adjusted life years (DALYs), and the corresponding estimated annual percentage changes (EAPCs), attributable to high BMI in Asia from 1990 to 2019, were analysed by regions, genders and age. We also analysed changes in the causes of deaths and DALYs that are attributable to high BMI over this period.

RESULTS

In 2019, all causes deaths attributable to high BMI in Asia were 2 329 503, with increases by 265% compared with 1990. Over three decades, DALYs related to high BMI have increased by 268%. The ASRs of deaths and DALYs in Asia both showed continuous upward trends during this period (EAPC 1.39; 95% certainty interval [95% CI] 1.35 to 1.43 for deaths; EAPC 1.8; 95% CI 1.76 to 1.84 for DALYs), while both were declined in high-income areas (EAPC -2.03 and -1.26). By geographical regions, disease burden in Central Asia and West Asia have been fluctuating at high levels, but high-income Asia Pacific showed decreasing trends of ASR of deaths (EAPC -2.03) and DALYs (EAPC -1.26). Over this period, disease burden in Asia was changing from women to men, and tends to ageing. In addition, diabetes were the diseases most affected by high BMI, and cancer burden was high in middle-aged and elderly people.

CONCLUSIONS

The disease burden attributed to high BMI in Asia has experienced great changes. It is necessary to promote the prevention of obesity and chronic diseases in a comprehensive manner, especially in low-income areas, men and elderly.

Burden of knee osteoarthritis in the Middle East and North Africa (MENA): an epidemiological analysis from 1990 to 2019

BACKGROUND

Knee is the most affected joint in osteoarthritis (OA) and accounts for almost four-fifths of the burden of OA globally. We aimed to explore the prevalence, incidence, trends, and burden of knee OA during 1990-2019 in the Middle East and North Africa (MENA) region, using the Global Burden of Disease (GBD) study data.

METHODS

This is an epidemiological study based on the GBD data from 1990 to 2019 on knee OA in MENA countries. The prevalence, incidence, and years lived with disability (YLD) numbers of knee OA were obtained for both genders. Similarly, age-standardized rates of these indexes per 100,000 people and the proportion of total YLD caused by knee OA in each country and for the MENA region were evaluated.

RESULTS

The prevalence of knee osteoarthritis in the MENA region increased 2.88-fold, from 6.16 million cases to 17.75 million, between 1990 and 2019. Furthermore, in 2019, knee osteoarthritis accounted for approximately 1.69 million (95% UI 1.46-1.95) incident cases in MENA. The age-standardized prevalence was higher in women between 1990 (3.94% [95% UI 3.39-4.55] in women and 3.24% [95% UI 2.79-3.72] in men) and 2019 (4.44% [95% UI 3.83-5.10] in women and 3.66% [3.14-4.21] in men). Total YLDs due to knee osteoarthritis increased by more than 2.88-fold, rising from 196.29 thousand [95% UI 97.17-399.29] in 1990 to 564.66 thousand [95% UI 275.06-1,150.68] in 2019. In the year 2019, Kuwait, Turkey, and Oman had the highest age-standardized prevalence (4.42% [95% UI 3.79-5.08]), YLD (132.41 [95% UI 65.79-267.56] per 100 000), and increase (21.17%) in YLD compared with 1990 in MENA region, respectively.

CONCLUSION

The prevalence of and YLDs due to knee OA in MENA has escalated over the last three decades. Considering the expanding burden of knee OA in MENA, policymakers should be more concerned to implement preventive strategies.

Focus on the impact of social factors and lifestyle on the disease burden of low back pain: findings from the global burden of disease study 2019

BACKGROUND

Low back pain (LBP) is one of the leading causes of disability worldwide. Differences in social backgrounds and lifestyles in various regions and countries may contribute to the discrepancies in the disease burden of LBP.

METHODS

Based on the GBD 2019, we collected and analyzed numbers and age-standardized rates (ASR) of LBP disability-adjusted life years (DALYs). Temporal trends in ASR were also analyzed using estimated annual percentage change (EAPC). The Age-period-cohort (APC) model was used to estimate age, period and cohort trends in DALYs of LBP. An autoregressive integrated moving average (ARIMA) model was used to forecast DALYs of LBP trends from 2020 to 2035.

RESULTS

The DALYs due to LBP increased from 1990 to 2019. The APC model showed that the risk of DALYs for global LBP increased with age and year and that the risk of DALYs was lower in the later-born cohort than in the earlier-born cohort. The main risk factors which GBD estimates were available for DALYs of LBP include smoking, occupational ergonomic factors and high BMI. It is expected that DALYs of LBP will continue to rise until 2035.

CONCLUSION

From 1990 to 2019, the global disease burden of LBP remained high. It is necessary to pay attention to the influence of social factors and lifestyle on LBP. Focusing on the impact of social factors as well as lifestyle on the prognosis of LBP and targeting interventions may further reduce the disease burden of LBP.

How Could Different Obesity Scenarios Alter the Burden of Type 2 Diabetes and Liver Disease in Saudi Arabia?

INTRODUCTION

Obesity is a major risk factor for type 2 diabetes (T2DM) and liver disease, and obesity-attributable liver disease is a common indication for liver transplant. Obesity prevalence in Saudi Arabia (SA) has increased in recent decades. SA has committed to the WHO "halt obesity" target to shift prevalence to 2010 levels by 2025. We estimated the future benefits of reducing obesity in SA on incidence and costs of T2DM and liver disease under two policy scenarios: (1) SA meets the "halt obesity" target; (2) population body mass index (BMI) is reduced by 1% annually from 2020 to 2040.

METHODS

We developed a dynamic microsimulation of working-age people (20-59 years) in SA between 2010 and 2040. Model inputs included population demographic, disease and healthcare cost data, and relative risks of diseases associated with obesity. In our two policy scenarios, we manipulated population BMI and compared predicted disease incidence and associated healthcare costs to a baseline "no change" scenario.

RESULTS

Adults <35 years are expected to meet the "halt obesity" target, but those ≥35 years are not. Obesity is set to decline for females, but to increase amongst males 35-59 years. If SA's working-age population achieved either scenario, >1.15 million combined cases of T2DM, liver disease, and liver cancer could be avoided by 2040. Healthcare cost savings for the "halt obesity" and 1% reduction scenarios are 46.7 and 32.8 billion USD, respectively.

CONCLUSION

SA's younger working-age population is set to meet the "halt obesity" target, but those aged 35-59 are off track. Even a modest annual 1% BMI reduction could result in substantial future health and economic benefits. Our findings strongly support universal initiatives to reduce population-level obesity, with targeted initiatives for working-age people ≥35 years of age.

Patterns of Non-Communicable Disease, Multimorbidity, and Population Awareness in Bahir Dar, Northwest Ethiopia: A Cross-Sectional Study

Objective

Ethiopia, like other developing countries, is going through an epidemiological transition, and high rates of non-communicable diseases (NCDs) are having a significant impact on the health system; however, there is limited evidence about community level NCD prevalence, multimorbidity, and population awareness that could inform targeted interventions and policy responses. This study aimed to identify factors associated with NCD prevalence, multimorbidity, and population awareness of NCDs in Bahir Dar, Northwest Ethiopia.

Methods

A community-based cross-sectional survey was conducted with 417 randomly sampled adults. We performed descriptive and logistic regression analyses to evaluate associations between NCD prevalence (cardiovascular diseases, diabetes, cancer, chronic respiratory diseases, chronic kidney disease, and hypertension) multimorbidity (2 or more NCDs) and demographic, socioeconomic, individual risk factors, anthropometrics, knowledge, and attitude.

Results

This study reveals that 24% of participating adults have an NCD, and 8% have multimorbidity. One-third (34.5%) have some NCD knowledge, and 75% consider NCDs more dangerous than communicable diseases. We find low NCD prevalence in participants: younger than 40 years of age (AOR 0.17, 95% CI 0.07 to 0.39); with normal body mass index (AOR 0.27, 0.10 to 0.77) and; with a family history of NCD (AOR 7.7, 4.2 to 14.1). Multimorbidity is lower in young adults (AOR 0.08, 0.03 to 0.26). NCD knowledge is higher in men (AOR 1.76, 1.06 to 2.93) and employed adults (AOR 2.91, 1.52 to 5.57), and NCD attitude in normal-weight adults (AOR 3.23, 1.42 to 7.39).

Conclusion

This study reveals a high prevalence of NCD and overall low NCD awareness in the population. Age above 40 years, family history of NCD, and weight in the obese category are significant predictors of NCD prevalence. These findings can help health professionals, health offices, and concerned stakeholders to plan targeted health interventions to reduce NCDs in the population.

The Association Between Depression and Obesity Among Adults in Jeddah, Saudi Arabia, in 2022

Background Depression has emerged as a significant contributor to the worldwide loss of disability-adjusted life years. Simultaneously, obesity is regarded as a substantial global health issue. The co-existence of depression and obesity can further exacerbate negative health outcomes. Objective The objective of this study was to investigate the relationship between depression and obesity in adult populations in Jeddah, Saudi Arabia. Further, the study aimed to examine the impact of confounding variables and their association with depression and obesity. Methods This analytical cross-sectional study utilized an interviewer-assisted questionnaire to collect data from adult participants aged 18 y/o or older attending primary healthcare centers at the Ministry of Health in Jeddah. The study was conducted at primary healthcare centers in Jeddah city, Saudi Arabia. The questionnaire included information on demographic characteristics, comorbidities, weight and height, and the Patient Health Questionnaire-9 (PHQ-9) tool for assessing the incidence of depression. Results A total of 397 individuals were included in the study with more than 50% of the participants between 26 and 45 years. The majority of the participants were males in the study (56.9%). The self-reported chronic diseases by the participants included diabetes mellites (25.9%), hypertension (23.7%), and dyslipidemia (19.9%). The study found that 12.8% of respondents had depression, 11.1% had anxiety, and 2.5% had obsessive-compulsive disorder. A total of 29.7% of participants had a PHQ-9 score of 10 or more. A significant negative linear correlation was found between the PHQ-9 score of the participants and their body mass index (BMI) results. However, this association did not remain significant when the chi-square test was used. Moreover, diabetes mellites and hypertension among the study sample were significantly associated with moderate to severe depression (p-values = .006 and = .005, respectively). The PHQ-9 score was negatively correlated with the participants' BMI, with a coefficient of -.190 (p-value < .001). Conclusion In the current study, the majority of obese participants displayed symptoms of depression ranging from mild to moderate. However, no significant correlation was established between depression and BMI.

The Role of Pharmacists and Community Pharmacies in the Screening, Knowledge, and Awareness of Diabetes Mellitus Type 2 in Jordanian People Visiting Community Pharmacies

BACKGROUND

According to the International Diabetes Federation (IDF), diabetes is increasing exponentially worldwide and will become more prevalent than ever in the Middle East by 2045, with a 110% increase. This study aims to clarify the role of pharmacists and community pharmacies in the screening, knowledge, and awareness of Type 2 diabetes among Jordanian people who visit community pharmacies in Amman, Jordan.

METHODS

Study design: This was a cross-sectional prospective study that was conducted from September to December 2021 in Amman, Jordan. Data were collected using a standardized questionnaire that was composed of multiple parts. The first part collected information on demographics, residence, educational level, and insurance status; the second part was composed of 14 knowledge assessing questions; the last part was composed of the American Diabetes Association (ADA) diabetes risk score card test. Additionally, after confirming that each participant had returned their completed sheets, participants who scored greater than 5 had their blood sugar levels checked using a finger-prick blood test. The questionnaire was administered in person by a trained researcher. Using Slovin's formula, a 95% confidence interval (CI), and a 0.05 margin of error, the sample size was determined to be 267 participants. The study included 305 participants. Descriptive and regression analyses were performed by using the Statistical Package for Social Science (SPSS) with a significance level of p < 0.05.

RESULTS

A significant relationship was found between specialty (medical education) and the knowledge of risk factors for Type 2 diabetes mellitus (T2DM), (p < 0.012). In terms of knowledge, from a total of 13 correct knowledge points (13 marks for correct answers out of 14), some subjects scored slightly higher than others (n = 175; 57.4% of participants scored above 7, nearly over half of the correct answers, compared to n = 130; 42.6% scoring below 7). We found 132 individuals (44%) with risk scores of five or above (high risk for developing T2DM according to ADA). Smokers comprised n = 138, 45%, and nonsmokers comprised n = 148, 48%. Although 50.5% of the participants (n = 154) held a bachelor's, master's, or doctorate degree, these degrees did not improve the participants' overall general knowledge levels. The association was tested using chi-squared analysis, but no significance was found.

CONCLUSIONS

Random visitors to Jordanian community pharmacies are expected to benefit from awareness and educational campaigns. These test results revealed a lack of knowledge, indicating the need for education to dispel myths and highlight the serious risks associated with T2DM. The study discovered that participants' understanding of diabetes disease prevention through lifestyle and dietary changes was inadequate. A specialist-led educational program may increase knowledge among visitors who participate. In order to prevent the spread of diabetes, more campaigns and health-promoting and prevention educational activities are required.

Projecting the Epidemiological and Economic Impact of Chronic Kidney Disease Using Patient-Level Microsimulation Modelling: Rationale and Methods of Inside CKD

INTRODUCTION

Chronic kidney disease (CKD) is a serious condition associated with significant morbidity and healthcare costs. Despite this, early-stage CKD is often undiagnosed, and globally there is substantial variation in the effectiveness of screening and subsequent management. Microsimulations can estimate future epidemiological costs, providing useful insights for clinicians, policymakers and researchers. Inside CKD is a programme designed to analyse the projected prevalence and burden of CKD for countries across the world, and to simulate hypothetical intervention strategies that can then be assessed for potential impact on health and economic outcomes at a national and a global level.

METHODS

Inside CKD uses a population-based approach that creates virtual individuals for a given country, with this simulated population progressing through a microsimulation in 1-year increments. A series of data inputs derived from national statistics and key literature defined the likelihood of a change in health state for each individual. Input modules allow for the input of nationally specific demographic and CKD status (including prevalence, diagnosis rates, disease stage and likelihood of renal replacement therapy), disease progression, critical comorbidities, and mortality. Health economics are reflected in cost data and a flexible intervention module allows for the testing of hypothetical policies-such as screening strategies-that may alter disease progression and outcomes.

RESULTS

Using input data from the UK as a case study and a 6-year simulation period, Inside CKD estimated a prevalence of 9.2 million individuals (both diagnosed and estimated undiagnosed) with CKD by 2027 and a 5.0% increase in costs for diagnosed CKD and renal replacement therapy. External validation and sensitivity analyses confirmed the observed trends, substantiating the robustness of the microsimulation.

CONCLUSIONS

Using a microsimulation approach, Inside CKD extends the reach of current CKD policy analyses by factoring in multiple inputs that reflect national healthcare systems and enable analysis of the effect of multiple hypothetical screening scenarios on disease progression and costs.

Cannabidiol ameliorates the anxiogenic and compulsive-like behaviors induced by chronic consumption of a high-carbohydrate diet in male mice

The excessive consumption of ultra-processed foods and the development of obesity has been associated with several comorbidities, including psychiatric disorders. Excess fat tissue promotes a low-intensity inflammatory state, mainly in the white tissue, which is essential in developing metabolic alterations and influences brain homeostasis. In this scenario, Cannabidiol (CBD), a compound from Cannabis sativa, has presented anxiolytic and anti-inflammatory effects in murine models. This study verified whether CBD treatment would ameliorate the compulsive-like and anxiety-like behaviors observed after mice's chronic consumption of a high-refined carbohydrate (HC) diet. BALB/c male mice received a control or HC diet for 12 weeks followed by vehicle and CBD (30 mg/Kg, i.p.) administration, and their behavior was evaluated in the Marble Burying test (MB) and Novel Suppressing Feeding test (NSF). The sub-chronic, but not acute, treatment with CBD attenuated the compulsive-like and anxiogenic-like behavior induced by the HC diet. Our data reinforced the harmful effects of the HC diet's chronic consumption on compulsive and anxious behaviors and the potential of CBD as a drug treatment for psychiatric disorders associated with obesity.

The Mediating Role of Physical Activity and Physical Function in the Association between Body Mass Index and Health-Related Quality of Life: A Population-Based Study with Older Adults

This study aimed (1) to investigate the association between body mass index (BMI), physical activity (PA), and physical function (PF) with health-related quality of life (HRQoL), and (2) to examine in-depth whether PA and PF mediate the relationship between BMI and HRQoL in older adults. We investigated 802 individuals (mean age 69.8 ± 5.6 years), residents of the Autonomous Region of Madeira, Portugal. Harmol and PA were assessed using the SF-36 and Baecke questionnaires, respectively, and PF by the Senior Fitness Test. The prevalence of overweight was 71.3%, 26.5% for normal weight, and 2.1% for underweight. We verified a small correlation between age and sex with BMI, PA, PF, and medium borderline with HRQoL. After adjusting for covariates (i.e., sex, age, comorbidities), the multivariate regression analysis indicated a 93.1% chance of improvement in HRQoL for low BMI, while PA and PF revealed a chance of increasing HRQoL by 91.8% and 60.0%, respectively. According to the serial mediation pathway, PA and PF partially mediated the association between BMI and HRQoL by 32.3% and 81.5%, respectively. The total variance of the model was 90%. It was concluded that BMI can negatively affect HRQoL. On the other hand, PA and PF are able to increase HRQoL levels during the aging process.

Shedding Light on the Causes and Characteristics of Stroke in Lebanon: A Systematic Review of Literature

BACKGROUND

The prevalence and severity of stroke in Lebanon has increased over the past decade and stroke is currently the second leading cause of death in the country.

METHODS

We systematically reviewed existing research on stroke prevalence, risk factors, mortality and morbidity of stroke, stroke treatment, and stroke education to assess the epidemiology of stroke in Lebanon. A literature search was conducted on the PubMed database for articles presenting data in any of these 5 categories in Lebanon, as well as articles discussing the Middle East and North Africa region generally.

RESULTS

A high prevalence of modifiable risk factors (cigarette and waterpipe smoking) and risk factors that could be mitigated by lifestyle changes (obesity and hypertension) were found in Lebanon. Stroke mortality rates and risk factors of mortality were consistent with global trends, though the cost of treatment in Lebanon was significantly higher than in other developing nations.

CONCLUSION

Urgent public health initiatives are needed to educate the public about the dangers of modifiable stroke risk factors and to reduce the burden of stroke in Lebanon.

Increasing burden of hip osteoarthritis in the Middle East and North Africa (MENA): an epidemiological analysis from 1990 to 2019

INTRODUCTION

The hip is the second most affected joint in osteoarthritis (OA), diagnosed annually worldwide. This is the first study presenting the epidemiology of hip OA in the Middle Eastern and North African countries from 1990 to 2019.

MATERIALS AND METHODS

This study was performed based on the analysis of global burden of disease (GBD) study data. Epidemiological indices including prevalence, incidence, and years lived with disability (YLD) were compared in all 21 countries located in Middle East and North Africa (MENA) region during 1990 to 2019.

RESULTS

The prevalence of patients with hip OA in MENA increased 3.1-fold, from 0.40 to 1.28 million during the study period. Hip OA accounted for about 74.46 thousand (95% UI 56.64-94.92) incident cases in MENA at 2019. It was found that Qatar had the highest age-standardized prevalence in both 1990 (0.33% [0.25-42]), and 2019 (0.40% [0.30-0.50]) in MENA. Oman showed the greatest relative increase (around 50.10%) in age-standardized prevalence of hip OA, whereas Iraq showed the lowest relative increase (around 9.94%) compared with other MENA countries.

CONCLUSIONS

Hip OA prevalence and YLD have both increased in MENA over the last three decades. The region's rapidly increasing burden of hip OA emphasizes the need to focus on OA prevention strategies especially in Qatar, Kuwait, Saudi Arabia, and UAE.

Burden of stroke in North Africa and Middle East, 1990 to 2019: a systematic analysis for the global burden of disease study 2019

BACKGROUND

While several studies investigated the epidemiology and burden of stroke in the North Africa and Middle East region, no study has comprehensively evaluated the age-standardized attributable burden to all stroke subtypes and their risk factors yet.

OBJECTIVE

The aim of the present study is to explore the regional distribution of the burden of stroke, including ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage, and the attributable burden to its risk factors in 2019 among the 21 countries of North Africa and Middle East super-region.

METHODS

The data of the Global Burden of Disease Study (GBD) 2019 on stroke incidence, prevalence, death, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs) rates, and attributed deaths, DALYs, YLLs, and YLDs to stroke risk factors were used for the present study.

RESULTS

The age-standardized deaths, DALYs, and YLLs rates were diminished statistically significant by 27.8, 32.0, and 35.1% from 1990 to 2019, respectively. Attributed deaths, DALYs, and YLLs to stroke risk factors, including high systolic blood pressure, high body-mass index, and high fasting plasma glucose shrank statistically significant by 24.9, 25.8, and 28.8%, respectively.

CONCLUSION

While the age-standardized stroke burden has reduced during these 30 years, it is still a concerning issue due to its increased burden in all-age numbers. Well-developed primary prevention, timely diagnosis and management of the stroke and its risk factors might be appreciated for further decreasing the burden of stroke and its risk factors and reaching Sustainable Development Goal 3.4 target for reducing premature mortality from non-communicable diseases.

The future health and economic burden of obesity-attributable type 2 diabetes and liver disease among the working-age population in Saudi Arabia

Background

Obesity and type 2 diabetes (T2DM) are increasing in Saudi Arabia (SA). Among other conditions, these risk factors increase the likelihood of non-alcoholic fatty liver disease (NAFLD), which in turn increases risks for advanced liver diseases, such as non-alcoholic steatohepatitis (NASH), cirrhosis and cancer. The goal of this study was to quantify the health and economic burden of obesity-attributable T2DM and liver disease in SA.

Methods

We developed a microsimulation of the SA population to quantify the future incidence and direct health care costs of obesity-attributable T2DM and liver disease, including liver cancer. Model inputs included population demographics, body mass index, incidence, mortality and direct health care costs of T2DM and liver disease and relative risks of each condition as a function of BMI category. Model outputs included age- and sex-disaggregated incidence of obesity-attributable T2DM and liver disease and their direct health care costs for SA’s working-age population (20–59 years) between 2020 and 2040.

Results

Between 2020 and 2040, the available data predicts 1,976,593 [± 1834] new cases of T2DM, 285,346 [±874] new cases of chronic liver diseases, and 2,101 [± 150] new cases of liver cancer attributable to obesity, amongst working-age people. By 2040, the direct health care costs of these obesity-attributable diseases are predicted to be 127,956,508,540 [± 51,882,446] USD.

Conclusions

The increase in obesity-associated T2DM and liver disease emphasises the urgent need for obesity interventions and strategies to meaningfully reduce the future health and economic burden of T2DM, chronic liver diseases and liver cancer in SA.

Non-communicable diseases (NCDs) and vulnerability to COVID-19: The case of adult patients with hypertension or diabetes mellitus in Gamo, Gofa, and South Omo zones in Southern Ethiopia

BACKGROUND

A growing body of evidence demonstrating that individuals with Non-Communicable Disease (NCD) are more likely to have severe forms of COVID-19 and subsequent mortality. Hence, our study aimed to assess the knowledge of vulnerability and preventive practices towards COVID-19 among patients with hypertension or diabetes in Southern Ethiopia.

OBJECTIVE

To assess the knowledge and preventive practices towards COVID-19 among patients with hypertension or diabetes mellitus in three zones of Southern Ethiopia, 2020.

METHODS

A community-based cross-sectional study design was used with a multi-stage random sampling technique to select 682 patients with hypertension or diabetes mellitus from 10th -17th July 2020 at the three zones of Southern Ethiopia. Logistic regression analysis with a 95% confidence interval was fitted to identify independent predictors of knowledge and preventive practices towards COVID-19. The adjusted odds ratio (AOR) was used to determine the magnitude of the association between the outcome and independent variables. P-value <0.05 is considered statistically significant.

RESULTS

The Multi-dimensional knowledge (MDK) analysis of COVID-19 revealed that 63% of study subjects had good knowledge about COVID-19. The overall preventive practice towards COVID -19 was 26.4%. Monthly income (AOR = 1.42; 95% CI: 1.04, 1.94) significantly predicted knowledge towards COVID-19. Ninety-five percent of the study subjects knew that the COVID-19 virus spreads via respiratory droplets of infected individuals. One hundred and ten (16.2%) of study subjects correctly responded to the questions that state whether people with the COVID-19 virus who do not have a fever can infect the other. Knowledge about COVID-19 (AOR = 1.47; 95% CI: 1.03, 2.1) became the independent predictor of preventive practice.

CONCLUSIONS

In this study, the knowledge of the respondents towards the COVID-19 pandemic was good. But the preventive practice was very low. There was a significant gap between knowledge and preventive practices towards the COVID-19 pandemic among the study subjects. Monthly income was significantly associated with knowledge of COVID-19. Knowledge of COVID-19 was found to be an independent predictor of preventive practice towards COVID-19. Community mobilization and improving COVID-19- related knowledge and practice are urgently recommended for those patients with hypertension or diabetes mellitus.

Timing and types of fluids and foods first introduced in a representative sample of toddlers attending day care programs across Lebanon: Are parents following international recommendations?

BACKGROUND

Current WHO's recommendation for optimal infant feeding advises exclusive breastfeeding for 6 months. After this initial period, infants should receive nutritionally adequate and safe complementary food starting from the age of 6 months with continued breastfeeding up to 2 years of age or beyond.

PURPOSE

This study examined the timing and types of fluids and foods first introduced in a representative sample of toddlers (n = 1051) from 79 daycares across Lebanon. Questionnaires were self-administered to parents of toddlers (12-36 months) with a participation rate of 67%.

RESULTS

Results showed that more than half of toddlers (55.7%) were introduced to infant formula within their first month of life. Around two-thirds received water as the first type of additional fluid (62.5%) with a mean age of 3.86 ± 2.15 months and fruits or cooked vegetables (69.7%) as the first types of food introduced with a mean age of 5.73 ± 1.56 months. Unfortunately, two-third (67.3%) were not breastfed after solid food introduction.

PRACTICE IMPLICATIONS

Our data on current suboptimal feeding practices in Lebanon shows the need to reinforce BF and CF practices recommendations and guidelines at the community, social and health system levels.

CONCLUSIONS

In the absence of specific recommendations and with the poor involvement of the various stakeholders, it was noted that more than half of the parents were not following the WHO recommendation concerning unnecessary fluid supplementation of infants and were introducing food before the recommended age of 6 months; moreover, only a minority of mothers continued breastfeeding after introducing food to their infants.

Projections for obesity, smoking and hypertension based on multiple imputation

AIMS

Information on the future development of prevalences of risk factors and health indicators is needed to prepare for the forthcoming burden of disease in the population and to allocate resources properly for prevention. We aim to present how multiple imputation can be used flexibly to project future prevalences.

METHODS

The proposed approach uses data on repeated cross-sectional surveys from different years. We create future samples with age and sex distributions corresponding to the official national population forecasts. Then, the risk factors are simulated using multiple imputation by chained equations. Finally, the imputations are pooled to obtain the prevalences of interest. Covariates, such as sociodemographic variables as well as their possible interactions and non-linear terms, can be included in the modelling. The future development of these covariates is also projected simultaneously. We apply the procedure to data from five Finnish health examination surveys conducted between 1997 and 2017, and project the prevalences of obesity, smoking and hypertension to 2020 and 2025.

RESULTS

The prevalence of obesity is projected to increase to 24% for both men and women in 2025. The prevalences of hypertension and smoking are expected to continue decreasing, and the differences between men and women are projected to remain so that men will have higher prevalences.

CONCLUSIONS

Simulation of future observations by multiple imputation can be used as a flexible yet relatively easy-to-use projection method.

Economic impacts of overweight and obesity: current and future estimates for eight countries

BACKGROUND

Obesity is a growing public health challenge worldwide with significant health and economic impacts. However, much of what is known about the economic impacts of obesity comes from high-income countries and studies are not readily comparable due to methodological differences. Our objective is to demonstrate a method for estimating current and future national economic impacts of obesity and apply it across a sample of heterogeneous contexts globally.

METHODS

We estimated economic impacts of overweight and obesity for eight countries using a cost-of-illness approach. Direct and indirect costs of obesity from 2019 to 2060 were estimated from a societal perspective as well as the effect of two hypothetical scenarios of obesity prevalence projections. Country-specific data were sourced from published studies and global databases.

RESULTS

In per capita terms, costs of obesity in 2019 ranged from US$17 in India to US$940 in Australia. These economic costs are comparable to 1.8% of gross domestic product (GDP) on average across the eight countries, ranging from 0.8% of GDP in India to 2.4% in Saudi Arabia. By 2060, with no significant changes to the status quo, the economic impacts from obesity are projected to grow to 3.6% of GDP on average ranging from 2.4% of GDP in Spain to 4.9% of GDP in Thailand. Reducing obesity prevalence by 5% from projected levels or keeping it at 2019 levels will translate into an average annual reduction of 5.2% and 13.2% in economic costs, respectively, between 2020 and 2060 across the eight countries.

CONCLUSION

Our findings demonstrate that the economic impacts of obesity are substantial across countries, irrespective of economic or geographical context and will increase over time if current trends continue. These findings strongly point to the need for advocacy to increase awareness of the societal impacts of obesity, and for policy actions to address the systemic roots of obesity.

Assessment of eating habits and lifestyle during the coronavirus 2019 pandemic in the Middle East and North Africa region: a cross-sectional study

Coronavirus disease 2019 (COVID-19) has rapidly spread globally, forcing countries to apply lockdowns and strict social distancing measures. The aim of this study was to assess eating habits and lifestyle behaviours among residents of the Middle East and North Africa (MENA) region during the lockdown. A cross-sectional study among adult residents of the MENA region was conducted using an online questionnaire designed on Google Forms during April 2020. A total of 2970 participants from eighteen countries participated in the present study. During the pandemic, over 30 % reported weight gain, 6·2 % consumed five or more meals per d compared with 2·2 % before the pandemic (P < 0·001) and 48·8 % did not consume fruits on a daily basis. Moreover, 39·1 % did not engage in physical activity, and over 35 % spent more than 5 h/d on screens. A significant association between the frequency of training during the pandemic and the reported change in weight was found (P < 0·001). A significantly higher percentage of participants reported physical and emotional exhaustion, irritability and tension either all the time or a large part of the time during the pandemic (P < 0·001). Although a high percentage of participants reported sleeping more hours per night during the pandemic, 63 % had sleep disturbances. The study highlights that the lockdown due to the COVID-19 pandemic caused a variety of lifestyle changes, physical inactivity and psychological problems among adults in the MENA region.

A hypertension risk score for adults: a population-based cross-sectional study from Dubai Household Survey 2019

OBJECTIVES

The aim of this study was to develop a risk score model for predicting hypertension specific to the population of Dubai in the United Arab Emirates (UAE) to facilitate prevention and early intervention.

METHODS

A retrospective analysis of data from the Dubai Household Health Survey 2019 was conducted. Demographic and physical parameters, as well as blood glucose levels, were included in the data. The risk factors for hypertension were identified using bivariate analysis. A risk score model was developed using the enter method, where all significant predictors of hypertension in bivariate analyses were entered in a single step with the primary outcome of hypertension status (yes/no). The model was validated internally by splitting the data into Emirati and non-Emirati populations.

RESULTS

A total of 2,533 subjects were studied. The significant risk factors for hypertension identified were male sex, older age (≥40 years), education level, body mass index, diabetes mellitus, and dyslipidaemia. The model showed a high discrimination ability between individuals with and without hypertension, with an area under the curve of 0.77 (95% confidence interval [CI], 0.75 to 0.79), excellent sensitivity (81.0%; 95% CI, 71.9 to 88.2) and moderate specificity (56.0%; 95% CI, 45.7 to 65.9).

CONCLUSIONS

The model developed by this study is simple, convenient, and based on readily available demographic and medical characteristics. This risk score model could support initial hypertension screening and provide an effective tool for targeted lifestyle counselling and prevention programs.

The role of the school food environment in improving the healthiness of school canteens and the readiness to reopen post COVID-19 pandemic: A study conducted in Indonesia

BACKGROUND

Indonesian school children spend one-third of their time in school, where they are exposed to a variety of foods at school canteens. However, the healthiness of school canteens is not yet well understood. This study was conducted to characterize the healthiness and quality of management of school canteens, and measure readiness of school canteens to reopen following COVID-19 closures.

DESIGN AND METHODS

Mixed-methods were used to conduct a cross-sectional study. Data were collected from schools located in the Bantul District of Indonesia. Primary schools (n=152) were randomly selected, with a final sample size of 147. Data were collected using Google Forms, delivered via WhatsApp or email. School canteens were classified as healthy if they had a Healthy Canteen Score (HCS) >= 10, or unhealthy if they had a HCS < 10.

RESULTS

Less than half (43.5%) of school canteens were deemed to be healthy. School canteens were more likely to be healthy if the canteen manager had a formal decision letter (OR=15.2; 95% CI=3.7-62.5); used print material messaging (OR= 3.2 to 4.6 times); or received inspection by external officers periodically (OR=2.8; 95% CI= 1.04-7.5). Readiness to reopen was 4.5 (OR=4.5; 95%CI: 1.1-17.9) times higher among schools that had their own canteen, and 4 (OR=3.9; 95% CI =1.1-13.8) times higher among schools located in rural areas, adjusting for the remaining variables.

CONCLUSIONS

School canteen healthiness can be improved by implementing national food policy and healthy school canteen standards accompanied by the existence of good management practices within schools, particularly following the COVID-19 pandemic.

A systematic literature review on obesity: Understanding the causes & consequences of obesity and reviewing various machine learning approaches used to predict obesity

Obesity is considered a principal public health concern and ranked as the fifth foremost reason for death globally. Overweight and obesity are one of the main lifestyle illnesses that leads to further health concerns and contributes to numerous chronic diseases, including cancers, diabetes, metabolic syndrome, and cardiovascular diseases. The World Health Organization also predicted that 30% of death in the world will be initiated with lifestyle diseases in 2030 and can be stopped through the suitable identification and addressing of associated risk factors and behavioral involvement policies. Thus, detecting and diagnosing obesity as early as possible is crucial. Therefore, the machine learning approach is a promising solution to early predictions of obesity and the risk of overweight because it can offer quick, immediate, and accurate identification of risk factors and condition likelihoods. The present study conducted a systematic literature review to examine obesity research and machine learning techniques for the prevention and treatment of obesity from 2010 to 2020. Accordingly, 93 papers are identified from the review articles as primary studies from an initial pool of over 700 papers addressing obesity. Consequently, this study initially recognized the significant potential factors that influence and cause adult obesity. Next, the main diseases and health consequences of obesity and overweight are investigated. Ultimately, this study recognized the machine learning methods that can be used for the prediction of obesity. Finally, this study seeks to support decision-makers looking to understand the impact of obesity on health in the general population and identify outcomes that can be used to guide health authorities and public health to further mitigate threats and effectively guide obese people globally.

Future trends in social inequalities in obesity in England, Wales and Scotland

BACKGROUND

Previous studies have shown persistent or increasing socioeconomic inequalities in obesity in many European countries. The aim of this study was to project trends in social inequalities in obesity to 2035 in male and female adults (aged 16+) in the UK to ascertain if the gap is widening or narrowing.

METHODOLOGY

BMI data for the UK were extracted from the Health Survey for England (2004-14), Scottish Health Survey (2008-14) and the Welsh Health Survey (2004-14), respectively. A non-linear multivariate regression model was fitted to cross-sectional risk factor data to create longitudinal projections to 2035 stratified by sex, and occupational status or education level.

RESULTS

Individuals in routine and manual jobs are projected to have the highest prevalence of obesity by 2035 and to experience the highest increases in obesity prevalence to 2035. Social inequalities based on occupation are projected to widen (except in English females). Social inequalities based on education are projected to decrease (except in Welsh females).

DISCUSSION

A population strategy of prevention focused on the structural determinants of obesity is needed to change the trajectory of obesity prevalence trends and to tackle health inequalities.

Population pharmacokinetics and dosing simulations of amoxicillin in obese adults receiving co-amoxiclav

BACKGROUND

Pneumonia, skin and soft tissue infections are more frequent in obese patients and are most often treated by co-amoxiclav, using similar dosing regimens to those used for non-obese subjects. No data are available on amoxicillin pharmacokinetics among obese subjects receiving co-amoxiclav.

MATERIALS AND METHODS

Prospective, single-centre, open-label, non-randomized, crossover pharmacokinetic trial having enrolled obese otherwise healthy adult subjects. A first dose of co-amoxiclav (amoxicillin/clavulanate 1000/200 mg) was infused IV over 30 min, followed by a second dose (1000/125 mg) administered orally, separated by a washout period of ≥24 h. We assayed concentrations of amoxicillin by a validated ultra HPLC-tandem MS technique. We estimated population pharmacokinetic parameters of amoxicillin by non-linear mixed-effect modelling using the SAEM algorithm developed by Monolix.

RESULTS

Twenty-seven subjects were included in the IV study, with 24 included in the oral part of the study. Median body weight and BMI were 109.3 kg and 40.6 kg/m2, respectively. Amoxicillin pharmacokinetics were best described by a two-compartment model with first-order elimination. Mean values for clearance, central volume, intercompartmental clearance and peripheral volume were, respectively, 14.6 L/h, 9.0 L, 4.2 L/h and 6.4 L for amoxicillin. Oral bioavailability of amoxicillin was 79.7%. Amoxicillin Cmax after oral administration significantly reduced with weight (P = 0.013). Dosing simulations for amoxicillin predicted that most of the population will achieve the pharmacodynamic target of fT>MIC ≥40% with the regimen of co-amoxiclav 1000/200 mg (IV) or 1000/125 mg (oral) q8h for MICs titrated up to 0.5 mg/L (IV) and 1 mg/L (oral).

CONCLUSIONS

Pharmacokinetic/pharmacodynamic goals for amoxicillin can be obtained in obese subjects.

Descriptive Regional Subanalysis of a Real-World Study in Patients with Type 2 Diabetes Treated with Gliclazide MR During Fasting: DIA-RAMADAN

INTRODUCTION

To analyse the safety and effectiveness of gliclazide modified release (MR) in adults with type 2 diabetes mellitus participating in Ramadan from three geographically and culturally different regions of the world included in the DIA-RAMADAN study.

METHODS

DIA-RAMADAN was a real-world, observational, international, non-comparative study. The global study population was divided into three regional subgroups, with data gathered at inclusion 6-8 weeks prior to Ramadan (V0), during Ramadan (4.5 weeks) and 4-6 weeks after Ramadan (V1). Primary endpoint was the proportion of patients reporting ≥ 1 symptomatic hypoglycaemic events (HE), which were collected using a patient diary along with other adverse events.

RESULTS

Patient numbers from the three regions were n = 564 (46.5%; Indian sub-continent), n = 354 (29.1%; Middle East) and n = 296 (24.4%; South-East Asia). Patient baseline characteristics, demographics, fasting habits and antidiabetic treatments varied between regions. There were similar proportions of symptomatic HE between regions, with no severe HE. Significant weight reductions were observed in all regions following Ramadan, along with reductions in HbA_1c and fasting plasma glucose.

CONCLUSION

These real-world study data indicate that gliclazide MR is safe and effective for management of type 2 diabetes during Ramadan in all three regions studied as part of DIA-RAMADAN.

TRIAL REGISTRATION

Clinicaltrials.gov identifier NCT04132934. INFOGRAPHIC.

A systematic review of randomized controlled trials of dietary interventions for weight loss in adults in the Middle East and north Africa region

The prevalence and incidence of obesity, and associated complications, such as type 2 diabetes, in the Middle East and north Africa (MENA) region rank among the highest in the world. Little is known about the effectiveness of dietary weight loss interventions conducted in the MENA region. We conducted a systematic review of randomized clinical trials aiming to assess the effectiveness of dietary interventions for weight loss in the adult population originating from and residing in the MENA region. In accordance with PRISMA guidelines, PubMed, CINAHL, Cochrane, and EMBASE were systematically searched for randomized controlled trials (RCT) using dietary interventions for weight loss conducted in the MENA region. RCTs examining weight loss as an outcome in adults (≥ 18 years old) were included. The Cochrane Collaboration tool for assessing risk of bias was used to ascertain the quality of the eligible RCTs and the Template for Intervention Description and Replication for population health and policy interventions (TIDieR-PHP) checklist was used to evaluate the reporting of the interventions. Twenty-nine RCTs including 2792 adults from five countries in the MENA region met the search criteria. Study participants were predominantly middle-aged females. Duration of follow up was mostly 3 months or less. Weight loss ranged from -0.7 to 16 kg across all intervention groups and the average weight loss was 4.8 kg. There was paucity of description of the weight loss interventions and variations amongst studies did not allow a meta-analysis of findings. It was not possible to draw firm conclusions on the effectiveness of dietary weight loss interventions in the region. High quality studies using more structured interventions of longer duration with standardized outcome measures are needed in the MENA region to support clinical practice with evidence-based interventions for obesity.

Gender-Dependent Association of Vitamin D Deficiency with Obesity and Hypercholesterolemia (LDLC) in Adults

BACKGROUND

Obesity, dyslipidemia and vitamin D deficiency are growing health problems in the Arabian Gulf region. Their association with each other is yet to be clarified.

METHODS

Three-hundred and fourteen Bahraini adults, 164 males and 150 females comparable in median age (34.5 vs. 31.0 yrs), body mass index (BMI), and ethnicity were recruited. The plasma level of 25-hydroxyvitamin D3 (25OHD3) was measured by chemiluminescent immunoassay and lipid profile parameters were measured by an automated clinical chemistry analyzer. Based on BMI, study subjects were grouped into underweight, normal, overweight, moderate obesity, and severe obesity subjects.

RESULTS

The results revealed an extremely high prevalence of vitamin D deficiency (79.9%) and insufficiency (18.8%). The predictors of low 25OHD3 levels were female gender, small age, conservative dressing, least exposure to sunlight, and less fish intake. In all subjects, the lowest 25OHD3 level was seen in underweight and severe obesity groups. Furthermore, the 25OHD3 level was significantly higher in males as compared to females and it was positively correlated with the age. However, detailed analysis showed that overweight males unlike females had the highest 25OHD3 levels which were significantly higher than in the severely obese males. While the lipid profile parameters were positively correlated with BMI, the total and LDL cholesterols were negatively correlated with the levels of 25OHD3 in males.

CONCLUSION

Vitamin D deficiency was associated with both severely obese and underweight subjects, in the former it was likely to be institutional while in the latter it was likely to be nutritional. Furthermore, hypercholesterolemia (LDL-C) was associated with 25OHD3 sub-normality. Further analysis revealed that the significant associations were gender-dependent.

The Influence of Gender and Menopausal Status on Hba1c Variation in a Big Data Study of a Saudi Population

BACKGROUND

Glycated haemoglobin (HbA1c) is the gold standard measurement in the screening, diagnosis and monitoring of diabetes mellitus. Saudi Arabia has a high prevalence of diabetes mellitus that is expected to rise, and the HbA1c test is commonly used in the screening, diagnosis and monitoring of diabetes.

OBJECTIVE

This study aims to assess the impact of age and gender on HbA1c levels, and the influence of menopausal status on HbA1c variation in a large group of Saudis.

METHODS

Age, gender, and HbA1c results of 168,614 Saudi adult individuals were obtained from their medical records. Patients' records were extracted irrespective of their status regarding the presence of diabetes and the status of glycaemic control. Linear regression models were used for predicting HbA1c from age and gender, and their interaction term. HbA1c levels were compared between genders in different age groups and different HbA1c categories.

RESULTS

There was a statistically significant positive correlation between age and HbA1c levels, where for each ten years increase in age, HbA1c increased by 0.35%. Although the overall mean HbA1c in women was significantly lower than in men (P < 0.001), women showed a significant increase in HbA1c with older age compared to men (B = 0.014, P < 0.001). Furthermore, the mean HbA1c levels in the age group > 50 years was significantly higher than before that age (P < 0.001). Thus, HbA1c increased by 1.118% in age > 50 years group compared to age ≤ 50 years, and this increase in HbA1c was significantly higher in women compared to men (B = 0.495, P < 0.001).

CONCLUSION

HbA1c levels are lower in women before the estimated menopausal age, which should be taken into consideration when using HbA1c for screening, diagnosis, and monitoring of diabetes in Saudi adult women. The short lifespan of red blood cells, due to loss of blood through menstruation, in women before menopause age, is a possible reason for these variations.

XGBoost-Based Framework for Smoking-Induced Noncommunicable Disease Prediction

Smoking-induced noncommunicable diseases (SiNCDs) have become a significant threat to public health and cause of death globally. In the last decade, numerous studies have been proposed using artificial intelligence techniques to predict the risk of developing SiNCDs. However, determining the most significant features and developing interpretable models are rather challenging in such systems. In this study, we propose an efficient extreme gradient boosting (XGBoost) based framework incorporated with the hybrid feature selection (HFS) method for SiNCDs prediction among the general population in South Korea and the United States. Initially, HFS is performed in three stages: (I) significant features are selected by t-test and chi-square test; (II) multicollinearity analysis serves to obtain dissimilar features; (III) final selection of best representative features is done based on least absolute shrinkage and selection operator (LASSO). Then, selected features are fed into the XGBoost predictive model. The experimental results show that our proposed model outperforms several existing baseline models. In addition, the proposed model also provides important features in order to enhance the interpretability of the SiNCDs prediction model. Consequently, the XGBoost based framework is expected to contribute for early diagnosis and prevention of the SiNCDs in public health concerns.

Interventions promoting physical activity among adults and children in the six Gulf Cooperation Council countries: protocol for a systematic review

INTRODUCTION

Prevalence of overweight, obesity and diabetes are high and rising across the Gulf Cooperation Council (GCC) countries (Oman, Bahrain, Kuwait, Qatar, Saudi Arabia and the United Arab Emirates). In parallel, physical activity (PA) levels are low relative to international standards. PA aids weight control and reduces risk of non-communicable diseases including diabetes and cardiovascular disease. It is likely interventions developed elsewhere will not translate to GCC countries due to unique environmental, social and cultural factors. This protocol is for a systematic review assessing the efficacy of interventions promoting PA within GCC countries among generally healthy adults and children. The primary outcome of interest is change in objectively measured or self-reported PA levels, the secondary outcomes of interest are changes in anthropometry or chronic disease risk factors (eg, blood pressure). Interventions will be compared with no intervention or those of differing PA intensity or duration. The relationships between PA change and the following will be assessed: intervention intensity or duration, season in which intervention occurs, sex, age, nationality and sustainability over time.

METHODS AND ANALYSIS

A systematic search strategy will identify indexed publications on the efficacy of interventions promoting PA. Randomised controlled trials and quasi-experimental studies recruiting predominantly healthy children and adults will be included. Studies of exercise rehabilitation will be excluded. Medline, Embase, Cinahl, Cochrane Library, SportDiscus, Web of Science, Index Medicus for the Eastern Mediterranean Region and Qscience will be searched. Clinical trial registries including the International Clinical Trials Registry Platform, the Iranian Registry of Clinical Trials and ClinicalTrials.gov will be searched for ongoing and unpublished studies. Searches will be ran from database inception until 1 May 2020 and be supplemented by checking references of key articles. Two reviewers will independently screen identified citations then full texts using prespecified inclusion and exclusion criteria. Piloted data extraction forms will be used in duplicate. Inconsistencies in screening or data extraction will be resolved by a third investigator or study author contact. Risk of bias will be independently assessed by two reviewers using validated tools. A narrative summary of findings will be produced supplemented with meta-analyses and exploration of heterogeneity as appropriate.

ETHICS AND DISSEMINATION

The review aims to strengthen the findings of the primary studies it incorporates and explore the impact of setting. It will synthesise existing published aggregate patient data. If publications or data with ethical concerns are identified, they will be excluded from the review. Results of the systematic review will be published in full and authors will engage directly with research audiences and key stakeholders to share findings.

PROSPERO REGISTRATION NUMBER

131817.

Diabetes mellitus risk among Jordanians in a dental setting: a cross-sectional study

BACKGROUND

Dental offices can be useful to screen and identify patients at risk of developing diabetes mellitus (DM) using risk prediction tools. The Finnish Diabetes Risk Score (FINDRISC) is a validated, questionnaire-based tool used to predict the 10-year risk of developing type II DM.

OBJECTIVES

To determine the 10-year DM risk among Jordanians using the FINDRISC questionnaire in a dental setting.

MATERIALS AND METHODS

Participants attending two university dental teaching centres between March 2017 and February 2018 were interviewed using an Arabic translated version of the FINDRISC questionnaire. Anthropometrics including weight, height, waist circumference (WC) and body mass index (BMI) were recorded. Random capillary blood glucose level was measured for each participant. Statistical analysis was done using Chi-square and independent t-tests.

RESULTS

A total of 1,247 (436 males and 811 females) participants were included. As defined by BMI, 1,012 (81.2%) participants were either overweight or obese. Abdominal adiposity as determined by WC was seen in 738 (59.2%) participants. The mean (± SD) FINDRISC score for females (11.3 ± 4.3) was significantly higher (P = 0.001) than males (10.4 ± 4.9). After age adjustment, more females were in the high-risk categories (FINDRISC ≥ 15) compared with males. This trend was seen among all age groups, but was statistically significant in the older age groups; 55-64 years (P = 0.037) and ≥ 65 years (P = 0.004).

CONCLUSION

In a developing Middle Eastern country such as Jordan, almost half of Jordanians attending university dental clinics are at a moderate to high risk of developing type II DM in 10 years. The risk of DM should be considered in dental patients, particularly older females.

Association between adherence to MIND diet and general and abdominal obesity: a cross-sectional study

BACKGROUND

Recently, a new eating pattern called as "Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND)" has been coined. Emerging studies are examining this dietary pattern with chronic conditions. We aimed to investigate the association between the MIND diet score and general and central obesity among adults.

METHODS

This cross-sectional study was conducted in a framework of the Study on the Epidemiology of Psychological Alimentary Health and Nutrition (SEPAHAN). Dietary information was collected using a validated self-administered 106-item Willett-format dish-based semi-quantitative food frequency questionnaire (DS-FFQ) in 6724 adults. Adherence to the MIND diet was examined based on components suggested in this eating pattern. Anthropometrics data were collected using a validated self-reported questionnaire. General obesity was defined as body mass index ≥30 kg/m2, and abdominal obesity as waist circumference > 102 cm for men and > 88 cm for women.

RESULTS

Mean age, BMI and WC in the study population was 36.8 ± 8.08 y, 24.9 ± 3.8 kg/m2 and 83.7 ± 16.02 cm, respectively. Overall, 9.5% of subjects were generally obese and 24.4 were abdominally obese. Examining the whole study population, we found no significant association between the MIND diet score and odds of general obesity, either before (ORs for comparing T3 vs. T1: 1.03; 95% CI: 0.83, 1.27; P-trend = 0.74) or after controlling for potential confounders (ORs for T3 vs. T1: 0.91; 95% CI: 0.67, 1.25; P-trend = 0.58). This was also the case for men and women when analyzed separately. We also failed to find any significant association between the MIND diet score and odds of abdominal obesity after controlling for potential confounders in the whole study population (ORs for T3 vs. T1: 1.00, 95% CI: 0.79, 1.27; P-trend = 0.87). However, women with the greatest adherence to the MIND diet were 19% less likely to be abdominally obese than those with the lowest adherence in crude model (OR = 0.81; 95% CIs: 0.67, 0.98; P-trend = 0.03). This association disappeared after controlling for potential confounders (OR = 0.87; 95% CIs: 0.66, 1.14; P-trend = 0.55).

CONCLUSION

No significant association was observed between adherence to the MIND diet and odds of general and central obesity.

Women Are at a Higher Risk of Chronic Metabolic Diseases Compared to Men With Increasing Body Mass Index in China

Background: Chronic non-communicable diseases are the major causes of mortality in the world. However, few studies have investigated the association between multi-categories BMI and chronic diseases from perspective of sex stratification. This study aimed to investigate the risk of chronic diseases at different BMI levels, and to further explore whether BMI-health risk associations differ by sex. Methods: In total, 21,134 participants aged 19-65 years (60.4% men) from the Tianjin People's Hospital, Tianjin Union Medical Center-Health Management Center were recruited for this cross-sectional study. Sex-specific percentiles of BMI were calculated and divided into 11 categories according to the 2000 CDC growth charts. Health-related indicators, such as hyperglycemia, hypertension, non-alcoholic fatty liver diseases (NAFLD), hyperuricemia, etc., were used as dependent variables in this study. Statistical differences were tested by unpaired Mann-Whitney U-test and chi-squared test. Logistic regression models were used to examine the associations between BMI and health-related indicators. Results: The risk of hyperglycemia (OR: 1.67, 95%CI: 1.23-2.29), NAFLD (OR: 2.22, 95%CI: 1.74-2.85), hypertriglyceridemia (OR: 1.65, 95%CI: 1.28-2.12), and hyperuricemia (OR: 1.39, 95%CI: 1.12-1.72) in men began to increase significantly when BMI was in the range of 22.59-23.89 kg/m². However, in women, the risk of hyperglycemia (OR: 3.02, 95%CI: 1.25-8.98) and hyperuricemia (OR: 1.94, 95%CI: 1.26-3.05) began to increase significantly when BMI was in the range of 22.76-23.62 kg/m², and the risk of NAFLD (OR: 5.48, 95%CI: 2.49-14.47) began to increase significantly when BMI was in the range of 21.08-21.97 kg/m². Besides, at the same BMI level, the risk of diseases in women were significantly higher than that in men, especially when BMI > 25 kg/m². Conclusion: In the Chinese population, the risk of chronic diseases in women were significantly higher than that in men at the same BMI level, especially when BMI was >25 kg/m². In addition, the risk of chronic diseases began to increase significantly when BMI was >21.97 kg/m² in women and 23.89 kg/m² in men. The results indicated that women should be more alert to the risk of chronic diseases caused by the increase of BMI than men.

Prevalence of overweight and obesity and associated risk factors among adult residents of northwest China: a cross-sectional study

OBJECTIVE

Overweight and obesity have been shown to be related to multiple chronic conditions, leading to a heavy economic burden on society throughout the world. This study aims to estimate the prevalence of overweight and obesity and determine potential influencing factors among adults in Xinjiang, northwest China.

DESIGN

A community-based observational study.

SETTING

The First Affiliated Hospital of Xinjiang Medical University.

METHODS

In total, 14 618 adult participants (7799 males; 6819 females) aged over 35 years were recruited from the Cardiovascular Risk Survey conducted in 2010. Data were obtained from face-to-face interviews and physical examinations. The sample was used to estimate the prevalence of overweight (body mass index (BMI) 24-28 kg/m²) and obesity (BMI ≥28 kg/m²) in Xinjiang Province. Influencing factors were analysed based on statistical methods.

RESULTS

In Xinjiang Province, the overall prevalence of overweight was 36.5% (male 40.1%; female 33.4%), and the prevalence of obesity was 26.5% (male 27.2%; female 25.8%). The prevalence of both overweight and obesity were higher in women than in men (p<0.001). The main influencing factors for overweight and obesity were sex, age, race, marital status, education level, occupation, smoking, drinking, hypertension, diabetes and dyslipidaemia (p<0.05).

CONCLUSIONS

This study estimated that the prevalence of overweight and obesity among adult residents of Xinjiang Province, northwest China, was high. These data suggest that efforts related to the prevention and control of overweight and obesity should be a public health priority in northwest China.

Life-Cycle Approach for Prevention of Non Communicable Disease

Non communicable diseases (NCDs) become symptomatic in adulthood, but they mainly origin from early life. As NCDs are the major cause of mortality both in developed and developing countries, global actions are necessary for their life course prevention and control. The main preventable risk factors of NCDs include tobacco use, unhealthy diet, and physical inactivity. These risk factors track from childhood to adulthood; it is well documented that healthy lifestyles play an important role for primordial and primary prevention of NCDs. Sedentary lifestyle, especially prolonged screen time, is a main underlying factor for NCDs. Regarding dietary intake, lower consumption of fruits, vegetables and fibers, as well as higher consumption of fatty and salty foods (fast foods, junk food), and carbonated soft drinks are of most usual habits correlated with increased risk of NCDs.Strategic action areas for the prevention and control of NCDs are health promotion, risk reduction, health systems strengthening for early detection and management of NCD risk factors. Low-cost solutions for reduction the common modifiable risk factors including unhealthy life-cycle are important for guiding policy and priorities of governments and for decreasing the prevalence of NCDs.

Quality of Life before and after Sleeve Gastrectomy in Lebanese Population

Introduction

Obesity is increasing worldwide and in Lebanon with a negative impact on the quality of life. The primary objective of this study is to measure the quality of life in obese subjects before and after bariatric surgery, depending on age, sex, and degree of weight loss. A secondary objective is to determine the impact of bariatric surgery on comorbidities associated with obesity.

Materials and methods

Patients undergoing laparoscopic sleeve gastrectomy for BMI ≥ 30 kg/m2 between August 2016 and April 2017 were included. Participants completed the Moorehead-Ardelt Quality of Life Questionnaire II (MA II) prior to operation and one year after. Statistical analysis was carried out using SPSS statistics version 20.0.

Results

75 patients participated in the study. The majority were women (75%), and the mean age was 36.3 years. The mean weight loss was 36.57 kg (16-76). Initially, the total MA II score was -0.33 ± 0.93. Postoperatively, it increased to 1.68 ± 0.62 (p ≤ 0.001). All MA II parameters improved after surgery (p ≤ 0.001), but this improvement was independent of age and sex. Improvement in self-esteem, physical activity, work performance, and sexual pleasure was influenced by the degree of weight loss (p ≤ 0.001). All comorbidities associated with obesity regressed significantly after sleeve gastrectomy (p < 0.05) with the exception of gastroesophageal reflux and varicose veins of the lower limbs.

Conclusion

Sleeve gastrectomy improves quality of life and allows reduction of comorbidities.

General and abdominal obesity is related to socioeconomic status and food choices: a cross-sectional study

Purpose

This paper aims to evaluate the prevalence of general obesity (GO) and abdominal obesity (AO) in the north-west of Iran and investigate the association with food choices and socioeconomic status (SES).

Design/methodology/approach

In this cross-sectional study, 500 subjects aged ≥ 18 years were studied. Data on their basic characteristics, anthropometric measurements, dietary habits and physical activity were collected. The authors examined the association between GO and AO with SES and food choices using multiple logistic regression analysis.

Findings

The prevalence of GO and AO was 26.6 and 43.4%, respectively. A positive association was observed between age and GO (p for trend <0.001) and AO (p for trend 0.005) in both sexes. However, a negative correlation was detected between education and income with GO and AO (p for trend <0.001). Two or more servings of fruit consumption a day were associated with lower odds of obesity. It was observed that the odds of GO and AO decreased by three or more servings of daily fruit. The consumption of dairy products in two or more servings a day led to a reduction in odds of GO and AO. The consumption of five or more servings of legumes, beans and nuts a week was associated with lower odds of GO and AO.

Originality/value

Educational attainment, greater income and a higher intake of some specific food groups were associated with lower odds of obesity in the area. More population-based investigations are required to develop effective preventive strategies to control the status of being overweight and obesity in different regions.

Association between dietary insulin index and load with obesity in adults

PURPOSE

Hyperinsulinemia is linked to the development of various chronic diseases, especially obesity given to the role of insulin responses in body fat accumulation; hence, the current study aimed to examine the association of insulinemic potential of the diet with general and abdominal obesity among a large population of Iranian adults.

METHODS

This cross-sectional study was carried out among 8691 adult participants aged 18-55 years. Dietary data were collected using a validated dish-based 106-item semi-quantitative food frequency questionnaire. Dietary insulin index (DII) was computed through considering food insulin index values published earlier. Dietary insulin load (DIL) was also calculated using a standard formula. Assessment of anthropometric measures was conducted through a self-administered questionnaire. General obesity was defined as body mass index ≥ 25 kg/m², and abdominal obesity as waist circumference ≥ 94 cm for men and ≥ 80 cm for women.

RESULTS

Mean age of study participants was 36.8 ± 8.1 years; 60.3% were women. Compared with the lowest quintile, women in the highest quintile of DIL were less likely to be abdominally obese (OR 0.73; 95% CI 0.57-0.92). Such significant association was not seen after controlling for potential confounders (OR 0.86; 95% CI 0.44-1.67). Neither in crude nor in adjusted models, we observed a significant association between DIL and general obesity among men and women. In terms of dietary insulin index, men in the top quintile of DII were more likely to be generally overweight or obese compared with those in the bottom quintile (OR 1.27; 95% CI 1.00-1.62). This association became non-significant after controlling for demographic characteristics (OR 1.14; 95% CI 0.84-1.56). Furthermore, in thefully adjusted model, women in the top quintile of DII were more likely to have general obesity compared with those in the bottom quintile (OR 1.40; 95% CI 1.07-1.84).

CONCLUSIONS

We found that adherence to a diet with a high DII was associated with greater odds of general obesity among women, but not in men. Although such information might help to draw conclusions on the practical relevance of the shown findings, further studies, specifically of prospective design, are warranted.

Plasma metabolomic profiling of amino acids and polar lipids in Iranian obese adults

Background

Obesity, widely recognized as a serious health concern, is characterized by profoundly altered metabolism. However, the intermediate metabolites involved in this change remain largely unknown.

Objective: We conducted targeted metabolomics profiling to identify moieties associated with adult obesity.

Methods

In this case-control study of Iranian adults, 200 obese patients were compared with 100 controls based on 104 metabolites profiled by a targeted metabolomic approach using liquid chromatography coupled to triple quadrupole mass spectrometry (LC-MS/MS). The analysis comprised acylcarnitines, diacyl-phosphatidylcholines (PCaa), acyl-alkyl-phosphatidylcholines (PCae), sphingomyelins (SM), lyso-phospholipids (LPC) and amino acids. We performed multivariable linear regression to identify metabolites associated with obesity, adjusting for age, sex, total energy intake, total physical activity, smoking, and alcohol consumption. The Bonferroni correction was used to adjust for multiple testing.

Results

A pattern of 19 metabolites was significantly associated with obesity. Branched chain amino acids, alanine, glutamic acid, proline, tyrosine LPCa C16:1, PCaa C32:1, PCaa C32:2 and PCaa C38:3 were positively, while serine, asparagine, LPCa C18:1, LPCa C18:2, LPCe C18:0, PCae C34:3, PCae C38:4 and PCae C40:6 were negatively associated with obesity (all p < 0.00048).

Conclusions

A metabolomic profile containing 9 amino acids and 10 polar lipids may serve as a potential biomarker of adult obesity. Further studies are warranted to replicate these findings as well as investigate potential changes in this profile after weight reduction.