Kuwait National Programme for Healthy Living: first 5-year plan (2013-2017)

Temporal trends of carbonated soft-drink consumption among adolescents aged 12-15 years from eighteen countries in Africa, Asia and the Americas

Carbonated soft-drink consumption is detrimental to multiple facets of adolescent health. However, little is known about temporal trends in carbonated soft-drink consumption among adolescents, particularly in non-Western countries. Therefore, we aimed to examine this trend in representative samples of school-going adolescents from eighteen countries in Africa, Asia and the Americas. Cross-sectional data from the Global School-based Student Health Survey 2009-2017 were analysed. Carbonated soft-drink consumption referred to drinking carbonated soft-drinks at least once per day in the past 30 d. The prevalence of carbonated soft-drink consumption was calculated for each survey, and crude linear trends were assessed by linear regression models. Data on 74 055 students aged 12-15 years were analysed (mean age 13·9 (sd 1·0) years; 49·2 % boys). The overall mean prevalence of carbonated soft-drink consumption was 42·1 %. Of the eighteen countries included in the study, significant decreasing, increasing and stable trends of carbonated soft-drink consumption were observed in seven, two and nine countries, respectively. The most drastic decrease was observed in Kuwait between 2011 (74·4 %) and 2015 (51·7 %). Even in countries with significant decreasing trends, the decrease was rather modest, while some countries with stable trends had very high prevalence across time (e.g. Suriname 80·5 % in 2009 and 79·4 % in 2016). The prevalence of carbonated soft-drink consumption was high in all countries included in the present analysis, despite decreasing trends being observed in some. Public health initiatives to reduce the consumption of carbonated soft-drink consumption among adolescents are urgently required.

School-Based Nutrition Programs in the Eastern Mediterranean Region: A Systematic Review

This systematic review aims at documenting government-led school nutrition programs/interventions in countries of the Eastern Mediterranean Region (EMR). A systematic review of the available literature on this topic was conducted between 25 October 2022 and 15 November 2022 using 15 electronic databases as well as grey literature. The search was limited to materials published post 2000 in English, Arabic, or French. Articles/Reports were included in the review if they provided information on school-based nutrition programs/interventions developed, adopted or implemented by a governmental entity in the EMR countries, irrespective of study design. In total, 158 documents were retained until 16 May 2023. School-based programs/interventions were categorized into 13 types. In total, 298 school-based nutrition programs/interventions were identified. The most common were school meals and school feeding programs (all EMR countries) followed by nutrition education within the curriculum (77% of countries), extracurricular nutrition education (64%), standards for school canteens or foods/beverages available in schools (64%), and training of school staff (59%). Approximately half reported the inclusion of fruit and vegetable schemes (54%) or the establishment of hygienic cooking facilities (50%), while less than half reported standards for the marketing of food/beverages (45%), bans/standards for vending machines, milk feeding schemes, or micronutrient supplementation programs (41%). The least common interventions were school gardens (32%) and take-home rations (14%). Countries with the lowest gross domestic product and lowest government effectiveness score had the lowest number of programs/interventions. Many of the programs have tackled both school-aged children as well as preschoolers. We were able to identify monitoring and process evaluation for 21 programs in 14 countries. Few programs have undergone impact assessment.

Unhealthy weight among young children in the Middle East and North African region

OBJECTIVE

To understand early-life growth in the Middle East and North Africa (MENA) region, and how it has changed over time, we estimated the prevalence of wasting and overweight at ages under 5 years.

DESIGN

Cross-sectional data from twenty-nine Demographic and Health Surveys with direct anthropometric data and parent-reported demographic information were examined. The study utilised the WHO Child Growth Standards to classify overweight (weight-for-height z-score ≥ 2 sd above the median), wasting (weight-for-height z-score ≤ 2 sd below the median) and unhealthy weight defined as either wasting or overweight.

SETTING

Nationally representative for nine of the MENA countries (Armenia, Azerbaijan, Egypt, Jordan, Mauritania, Morocco, Tunisia, Turkey and Yemen).

PARTICIPANTS

Children under age 5 from nine MENA countries between 1987 and 2016 (n 155 961).

RESULTS

Across the region, at the most recent time point, between 7·3 and 23·6 % of children experienced unhealthy weight (Jordan - 7·3 %, Egypt -23·6 %); 1·7 and 16·6 % had wasting (Turkey, Yemen) and 2·0 and 15·0 % had overweight (Yemen, Egypt). Overweight was more common than wasting in all countries except Yemen and Mauritania. Between 1987 and 2016, the prevalence of unhealthy weight in the region increased (10·0-18·4 %) due to increases in both wasting and overweight. Boys had a higher prevalence of unhealthy weight than girls.

CONCLUSION

Undernutrition continues to be a problem in some countries in the MENA region, and overnutrition is emerging as a health concern in many countries in the region. Countries in the region must advance programmes that reduce undernutrition while not overlooking or inadvertently promoting overnutrition.

#Arabhealth on Instagram: Examining Public Health Messages to Arabian Gulf State Audiences

Instagram is a social media platform used for communicating health information to audiences in the member states of the Gulf Cooperation Council (GCC), but little is known about the specific use of the platform for this purpose. This study, focused on 1,000 Instagram posts by the GCC Ministries of Health, analyzed how public health information is discussed differently across the GCC on Instagram, as well as the extent to which Health Belief Model (HBM) variables - a frequently used health behavior theory focused on understanding individual adoption of certain health behaviors - are present in these posts. Results showed that a majority of messages did not include HBM constructs other that perceived benefits and calls to action, limiting their potential for effective public health communication. Results also showed a minority of posts deal with mental health. Recommendations for future best practices are discussed.

Physical activity and sedentary behaviors among active college students in Kuwait relative to gender status

Objectives

To determine the prevalence of physical activity (PA), sedentary behaviors (SB) and sleep duration and the associations between those variables among Kuwaiti Physical Education (PE) College students.

Methods

A total of 418 participants (220 females) were randomly selected from the Basic Education College in the Public Authority for Applied Education and Training in Kuwait. Body weight and height were measured, and body mass index (BMI) was calculated. A validated questionnaire was used to assess lifestyle behaviors.

Results

Based on BMI classification, the prevalence of overweight or obesity among males (34.9%) was significantly higher than that of females (16.7%). However, the mean (SD) of body fat percentage using bioelectrical impedance analysis was 21.3 (9.0) for males and 32.3 (7.7) for females. The proportions of highly active (> 1,200 METs-min/week) males (85.9%) and females (64.3%) were significantly (p < 0.005) different. The participants exceeding 3 hours of screen viewing time/day and insufficient sleep duration (< 7 hours/night) were 76.8% and 65.1%, respectively, with no gender differences. Logistic regression, adjusted for confounders, showed that highly active PE students had a higher proportion of SB. However, neither sleep duration nor body fat percentage exhibited any significant difference relative to PA.

Conclusions

Despite having high PA, Kuwaiti PE College students had a high prevalence of SB and insufficient sleep. Gender differences were found in PA but not in screen time or sleep duration. Efforts toward reducing SB and insufficient sleep among Kuwaiti PE College students are needed to reduce unhealthy lifestyle behaviors and promote health and well-being.

A critical review of national diabetes prevention and control programs in 12 countries in Middle East

BACKGROUND

Diabetes mellitus has been known as one of the most significant systemic diseases with severe consequences and challenges to human health.

AIM

The primary aim of the current paper was to review the diabetes prevention programs in the Middle East countries, and secondary compare their goals and success rate and conclude possible upcoming strategies.

METHODS

All reports and documents regarding to diabetes prevention and control programs in the region were collected by searching Web of Science, PubMed, MEDLINE, Google Scholar, Scopus and EMBASE for articles up to 2020. The health policy triangle framework was used to analyze diabetes policies and programs. In the Middle East, a shift from rural to urban life, socioeconomic development, sedentary lifestyles, and high fat and sugary foods consumption led to increasing in obesity and diabetes rate, which have become a real challenge.

RESULTS

To decrease the burden of diabetes, preventive strategies with proper local socio-cultural context are needed. Evaluation of current policies and identifying stakeholders' views can help to improve the current strategies for the prevalence of diabetes and its complications.

CONCLUSIONS

It can provide local and global insight to evidence-informed decision-making for future policy reforms to enhance effectiveness of the program.

Health Promotion Programs to Reduce Noncommunicable Diseases: A Call for Action in Kuwait

Most public health issues in Kuwait are related to unhealthy behaviours. Research shows that behaviours are the result not only exclusively of personal choices but also of myriads of other social and environmental factors. Kuwait is one of the leading countries in obesity and tobacco use in the world. Cardiovascular diseases stemming from complications related to these and other risk factors are important health issues based on their morbidity and mortality implications. These risks are spread across society and affect the old as well as young boys. The serious gaps between Kuwait's health-related needs and the existing policies to reduce public health risks in Kuwait create a significant obstacle to healthy behaviour change. Kuwait requires adequate laws, policies, regulations, activities, and programs to promote people's health. The Socio-Ecological Model (SEM) has been used successfully in health promotion in various behavioural settings, including obesity, physical inactivity, and smoking. We propose the use of SEM as a planning framework in building sustainable health promotion programs in Kuwait while paying attention to other concepts such as systems thinking, authentic community participation, community capacity, policy development, public health infrastructure enhancement, health coaching, and equity.

Understanding health information management practices in public hospitals in Kuwait

BACKGROUND

Health information technology (IT) solutions can aid healthcare reform efforts, but without proper information management, these efforts are futile. In this study, we used Kuwait as an example of a high per-capita gross domestic product country that faces information management challenges to draw insights that can be generalised to other developed countries.

OBJECTIVE

(i) to uncover the status quo of information management practices in public hospitals and (ii) to offer recommendations to improve them.

METHOD

This study analysed qualitative and quantitative accreditation-related data pertaining to the compliance with the information management standard at all secondary care public hospitals over two accreditation cycles.

RESULTS

Overall, public hospitals had made positive progress in their compliance with the information management standard. However, issues still existed with (i) developing and implementing an information management plan, (ii) involving the appropriate stakeholders in selecting health IT solutions and (iii) access to the Internet by staff and patients.

CONCLUSION

Evidence underscored the importance of proper information management driven by clear centralised strategic plans.

IMPLICATIONS

With the rapid adoption of digital health systems, the role of health information management leaders should not be undervalued. Embracing health IT solutions with strong information management practices can aid healthcare reform efforts.

Diabetes in the Middle East: Government Health Care Policies and Strategies that Address the Growing Diabetes Prevalence in the Middle East

PURPOSE OF REVIEW

Diabetes is a primary public health concern and a challenge for health decision makers in this century. Though the number of people with diabetes is increasing all over the globe, the very high prevalence of diabetes in many Middle East countries has made this region one of the global diabetes hot spots. Due to rapid socioeconomic growth, lifestyle changes and increasing obesity prevalence, the number of people with diabetes is expected to double by 2045 in this region. This high prevalence of diabetes imposes a substantial socioeconomic impact on the individual and governments in this region. The governments in the Middle East have devised many policies, programs, and strategies to address the growing prevalence of diabetes. In this article, we aim to review such policies, programs, and the magnitude of diabetes in this part of the world.

RECENT FINDINGS

Faced with a challenge on a high scale, most governments in the Middle East are making progress in responding to diabetes. Diabetes is a chronic and costly disease; however, it can be prevented. The alarm of the rising tide of diabetes has not yet been successfully translated into action in the Middle East. The governments in the region need to devise more intense, broader policies and preventive measure programs based on local sociocultural practices to effectively combat the situation. Further improvements of the primary health care system and cross-governmental approaches are needed in the region to keep the growing epidemic of diabetes under control.

Population aging and long-term care policies in the Gulf region: a case study of Oman

Population aging is a phenomenon occurring across the globe including in countries traditionally exhibiting population dividends and "youth bulges." The Gulf Corporation Council countries are no exception as they currently experience a process of population aging, albeit at a different stage from many developed countries. However, due to historically high fertility rates and fast-paced epidemiological transition, some of these countries will experience population aging at a higher pace than what has been observed in Europe and the United States. This article reviews recent developments in long-term care policies in the Gulf region with a focus on Oman as an example of a high-income Arab country that is experiencing population aging while still being governed by traditional family aged-care norms. Utilizing existing data and published research complemented by policy analysis and field visits, we analyze the process of population aging in Oman and neighboring countries and its policy implications.

Age-Period-Cohort Modeling of Multiple Sclerosis Incidence Rates in Kuwait: 1980-2014

BACKGROUND

Multiple sclerosis (MS) is a complex immune-mediated disorder of the central nervous system with undefined etiology. Genetic predisposition and environmental factors play an imperative role in MS causation and its sustained increasing burden worldwide. This study examined the age, period, and cohort effects on MS incidence rates in Kuwait.

METHODS

In this retrospective cohort study, data on MS cases diagnosed between January 1, 1980 and December 31, 2014 and registered in National MS Registry and reference population were obtained. Age-period-cohort (APC) analysis was conducted using a loglinear Poisson regression model to supplement the descriptive and graphical presentation. Descriptive statistics were complemented with APC parameters' estimates including net drift, local drift, age at onset curve, and longitudinal age trend. Age effect was presented as incidence rates (per 105 person-years), whereas period and cohort effects were presented as adjusted relative rates.

RESULTS

A total of 1,131 cases were diagnosed in 1,385,923 person-years. Overall age-standardized MS incidence rate was 64.5 (95% CI 52.4-79.8). An estimated annual percentage change revealed 7.4% annual increase in MS incidence rate during the study period (Net drift = 7.4%; 95% CI 4.1-10.8%). APC "fitted" age-at-onset curve showed a bimodal pattern with peaked incidence rates at 20-24 years and 45-49 years of age. Compared with the referent period (1980-1984) and cohort (1970-1974), MS incidence rates progressively and significantly (p < 0.001) increased during subsequent time periods and in successive cohorts. Results of APC analysis are descriptive in nature and specific etiological hypotheses were not evaluated. However, the findings of this study substantiated the notion of multiplicity of genetic and/or environmental risk factors' contributions.

CONCLUSION

A substantial increase in MS incidence rates was recorded, which significantly varied in all 3 temporal dimensions during the study period. Future studies may contemplate biological basis for recorded temporal increase in MS risk.

Supplementation of Syzygium cumini seed powder prevented obesity, glucose intolerance, hyperlipidemia and oxidative stress in high carbohydrate high fat diet induced obese rats

Background

Obesity and related complications have now became epidemic both in developed and developing countries. Cafeteria type diet mainly composed of high fat high carbohydrate components which plays a significant role in the development of obesity and metabolic syndrome.

This study investigated the effect of Syzygium cumini seed powder on fat accumulation and dyslipidemia in high carbohydrate high fat diet (HCHF) induced obese rats.

Method

Male Wistar rats were fed with HCHF diet ad libitum, and the rats on HCHF diet were supplemented with Syzygium cumini seed powder for 56 days (2.5% w/w of diet). Oral glucose tolerance test, lipid parameters, liver marker enzymes (AST, ALT and ALP) and lipid peroxidation products were analyzed at the end of 56 days. Moreover, antioxidant enzyme activities were also measured in all groups of rats.

Results

Supplementation with Syzygium cumini seed powder significantly reduced body weight gain, white adipose tissue (WAT) weights, blood glucose, serum insulin, and plasma lipids such as total cholesterol, triglyceride, LDL and HDL concentration. Syzygium cumini seed powder supplementation in HCHF rats improved serum aspartate amino transferase (AST), alanine amino transferase (ALT), and alkaline phosphatase (ALP) activities. Syzygium cumini seed powder supplementation also reduced the hepatic thiobarbituric acid reactive substances (TBARS) and elevated the antioxidant enzyme superoxide dismutase (SOD) and catalase (CAT) activities as well as increased glutathione (GSH) concentration. In addition, histological assessment showed that Syzygium cumini seed powder supplementation prevented inflammatory cell infiltration; fatty droplet deposition and fibrosis in liver of HCHFD fed rats.

Conclusion

Our investigation suggests that Syzygium cumini seed powder supplementation prevents oxidative stress and showed anti-inflammatory and antifibrotic activity in liver of HCHF diet fed rats. In addition, Syzygium cumini seed powder may be beneficial in ameliorating insulin resistance and dyslipidemia probably by increasing lipid metabolism in liver of HCHF diet fed rats.

Discordance between Lifestyle-Related Health Practices and Beliefs of People Living in Kuwait: A Community-Based Study

OBJECTIVE

To examine the concordance between lifestyle practices and beliefs of people living in Kuwait, and between their lifestyle practices and established evidence-informed recommendations for health.

SUBJECTS AND METHODS

A cross-sectional interview questionnaire study was conducted using a convenience sample of 100 adults living in Kuwait (age range 19-75 years). The interview included sections on demographics, and lifestyle-related practices and beliefs related to smoking, diet/nutrition, physical activity/exercise, sleep, and stress. Diet/nutrition and physical activity/exercise benchmarks were based on international standards. Analyses included descriptive statistics and the χ2 test.

RESULTS

Beliefs about the importance of nutrition in lifestyle-related conditions were limited, and this was apparent in participants' dietary habits, e.g., low consumption of fruit/vegetables and multigrains: 16 (16%) and 9 (9%) met the recommended guidelines, respectively. Ninety-nine (99%) believed physical activity/exercise affects health overall, and 44 (44%) exercised regularly. Of the sample of 100, 20 (20%) exercised in accordance with evidence-based recommendations for maximal health. Compared with beliefs about other lifestyle-related behaviors/attributes, respondents believed nutrition contributed more than stress to heart disease, cancer, and stroke, and stress contributed more than nutrition to hypertension and diabetes.

CONCLUSION

In this study, our findings showed a discrepancy between lifestyle-related practices and beliefs, and between each of these and evidence-based recommendations for maximal health, i.e., not smoking, several servings of fruit and vegetables and whole-grain foods daily, healthy weight, restorative sleep, and low-to-moderate stress levels.

Knowledge of the Relationships between Oral Health, Diabetes, Body Mass Index and Lifestyle among Students at the Kuwait University Health Sciences Center, Kuwait

OBJECTIVES

To evaluate the level of knowledge regarding the relationships between oral health, diabetes, body mass index (BMI; obesity) and lifestyle among students of the Health Sciences Center (HSC), Kuwait, and to explore any possible correlation between students' oral health knowledge, BMI and lifestyle choices.

SUBJECTS AND METHODS

A stratified random sample was proportionally selected according to the size of each faculty from the 1,799 students. The questionnaire was divided into 3 sections (i.e. demographics, evaluation of oral health knowledge in relation to diabetes, and evaluation of diabetes knowledge in relation to lifestyle) and distributed to 532 students. Oral health knowledge was categorized as limited, reasonable or knowledgeable. Lifestyle was classified as healthy or nonhealthy. The BMI was calculated as weight (kg) divided by the square of the height (m). ANOVA and χ2 tests were used to test for differences between independent variables. A Pearson correlation coefficient test was used to assess correlations. p < 0.05 was considered statistically significant.

RESULTS

Of the 532 questionnaires, 498 (93.6%) were completed. The mean knowledge score was 47.7 ± 25.2; of the 498 students, 235 (47.3%) had a BMI within the normal range, 184 (37.0%) were pre-obese and 67 (13.5%) were obese. Of the 498 students, 244 (49%) had a healthy lifestyle. There was no correlation between oral health knowledge and the other variables; however, there was a correlation between lifestyle and obesity.

CONCLUSION

In this study, the majority of the students had limited knowledge of oral health in association with diabetes and lifestyle. More than half of the students fell in the pre-obese/obese range.

Role of metabolic phenotyping in understanding obesity and related conditions in Gulf Co-operation Council countries

Obesity is a major health concern in the Middle East and the incidence is rising in all sections of the population. Efforts to control obesity through diet and lifestyle interventions, and by surgical means, have had limited effect, and the gene-environment interactions underpinning the development of obesity and related pathologies such as metabolic syndrome, cardiovascular disease and certain cancers are poorly defined. Lifestyle, genetics, inflammation and the interaction between the intestinal bacteria and host metabolism have all been implicated in creating an obesogenic environment. We summarize the role of metabolic and microbial phenotyping in understanding the aetiopathogenesis of obesity and in characterizing the metabolic responses to surgical and non-surgical interventions, and explore the potential for clinical translation of this approach.

School-Based Interventions to Reduce Obesity Risk in Children in High- and Middle-Income Countries

School-based interventions are relatively new and were first introduced in the United States in the 1990s. Early programs were mainly education based with many of the findings now embedded in school policy in the form of a healthy eating curriculum. More recent school programs have taken education outside the classroom and attempted to engage parents as well as teachers. Environmental changes such as improving the quality of foods available at lunchtime and at other times during the school day are now common. Reviews of evaluations of school-based programs have demonstrated that they are effective and successfully improve dietary quality such as increasing fruit and vegetable intake and decreasing sweet and savory snacks and sweetened drinks; not just in school but over the whole day and particularly in younger school children. School-based interventions are also effective at reducing obesity if components to increase physical activity and reduce sedentary behaviors are also targeted but not if only dietary behaviors are tackled. Most of the high-quality evaluation studies using randomized controlled trials have been carried out in high-income countries as they are costly to run. However, middle-income countries have benefitted from the information available from these evaluation studies and many are now starting to fund and evaluate school-based programs themselves, resulting in unique problems such as concomitant under- and overnutrition being addressed. Action for the future demands more focus on populations most at risk of poor dietary quality and obesity in order to reduce inequalities in health and on adolescents who have not benefited as much as younger children from school-based interventions. This will involve innovative solutions within schools as well as targeting the food environment outside schools such as reducing the density of fast-food outlets and marketing of sweet and savory snacks and drinks.

How effective are antioxidant supplements in obesity and diabetes?

Obesity is a central health issue due to its epidemic prevalence and its association with type 2 diabetes and other comorbidities. Obesity is not just being overweight. It is a metabolic disorder due to the accumulation of excess dietary calories into visceral fat and the release of high concentrations of free fatty acids into various organs. It represents a state of chronic oxidative stress and low-grade inflammation whose intermediary molecules may include leptin, adiponectin and cytokines. It may progress to hyperglycemia, leading to type 2 diabetes. Whether or not dietary antioxidant supplements are useful in the management of obesity and type 2 diabetes is discussed in this review. Only the benefits for obesity and diabetes are examined here. Other health benefits of antioxidants are not considered. There are difficulties in comparing studies in this field because they differ in the time frame, participants' ethnicity, administration of antioxidant supplements, and even in how obesity was measured. However, the literature presents reasonable evidence for marginal benefits of supplementation with zinc, lipoic acid, carnitine, cinnamon, green tea, and possibly vitamin C plus E, although the evidence is much weaker for omega-3 polyunsaturated fatty acids, coenzyme Q10, green coffee, resveratrol, or lycopene. Overall, antioxidant supplements are not a panacea to compensate for a fast-food and video-game way of living, but antioxidant-rich foods are recommended as part of the lifestyle. Such antioxidant foods are commonly available.