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Clinical correlations and genetic associations of metabolic syndrome in the United Arab Emirates. Gene 2020; 738:144476. [PMID: 32061761 DOI: 10.1016/j.gene.2020.144476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/22/2020] [Accepted: 02/11/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Metabolic syndrome (MetS) contributes to increased risk of morbidity and mortality. The United Arab Emirates (UAE) has a high prevalence of MetS which may be linked to modifiable and genetic risk factors in the local population. The association between MetS as a phenotype and key genetic variants in the UAE has not been investigated. This study reports on the clinical, biochemical and genetic associations of MetS and its risk factors to improve individualized medicine outcomes. METHODS There were 471 subjects included in this cross-sectional study, 367 with MetS and 104 without MetS. Along with clinical and laboratory parameters, multiple risk genetic variants were tested for their association with MetS, which include 49 variants that have previously been shown to be linked with MetS development as a phenotype, 116 variants for association with waist-hip ratio (WHR), 398 variants with body-mass index (BMI), 213 variants with T2DM and insulin resistance, 307 variants with different lipid traits, 308 variants with blood pressure traits, and 64 variants with coronary and cerebrovascular accidents. RESULTS Patients with MetS had higher rates of type 2 diabetes mellitus (T2DM), hypertension and dyslipidemia (p < 0.0001). Waist circumference and T2DM were identified as the key risk factors for MetS development. Individuals with MetS were also found to have a higher rate of clinical complications than those without MetS (76% vs. 52%). Several gene variants including those of the FTO gene were found to be associated with a predisposition to developing MetS or some of its components (PFTO ~0.005-0.009). CONCLUSIONS This study showed associations between MetS as well as clinical factors contributing to MetS and specific genetic and metabolic risk factors, providing an insight into the metabolic and genetic links to disease development. Knowledge with respect to population specific risk markers including at risk genotypes will help in early identification of individuals with increased susceptibility to MetS in the UAE and provide the opportunity for timely intervention to prevent or delay the onset of MetS.
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Hachim MY, Aljaibeji H, Hamoudi RA, Hachim IY, Elemam NM, Mohammed AK, Salehi A, Taneera J, Sulaiman N. An Integrative Phenotype-Genotype Approach Using Phenotypic Characteristics from the UAE National Diabetes Study Identifies HSD17B12 as a Candidate Gene for Obesity and Type 2 Diabetes. Genes (Basel) 2020; 11:genes11040461. [PMID: 32340285 PMCID: PMC7230604 DOI: 10.3390/genes11040461] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 12/14/2022] Open
Abstract
The United Arab Emirates National Diabetes and Lifestyle Study (UAEDIAB) has identified obesity, hypertension, obstructive sleep apnea, and dyslipidemia as common phenotypic characteristics correlated with diabetes mellitus status. As these phenotypes are usually linked with genetic variants, we hypothesized that these phenotypes share single nucleotide polymorphism (SNP)-clusters that can be used to identify causal genes for diabetes. We explored the National Human Genome Research Institute-European Bioinformatics Institute Catalog of Published Genome-Wide Association Studies (NHGRI-EBI GWAS) to list SNPs with documented association with the UAEDIAB-phenotypes as well as diabetes. The shared chromosomal regions affected by SNPs were identified, intersected, and searched for Enriched Ontology Clustering. The potential SNP-clusters were validated using targeted DNA next-generation sequencing (NGS) in two Emirati diabetic patients. RNA sequencing from human pancreatic islets was used to study the expression of identified genes in diabetic and non-diabetic donors. Eight chromosomal regions containing 46 SNPs were identified in at least four out of the five UAEDIAB-phenotypes. A list of 34 genes was shown to be affected by those SNPs. Targeted NGS from two Emirati patients confirmed that the identified genes have similar SNP-clusters. ASAH1, LRP4, FES, and HSD17B12 genes showed the highest SNPs rate among the identified genes. RNA-seq analysis revealed high expression levels of HSD17B12 in human islets and to be upregulated in type 2 diabetes (T2D) donors. Our integrative phenotype-genotype approach is a novel, simple, and powerful tool to identify clinically relevant potential biomarkers in diabetes. HSD17B12 is a novel candidate gene for pancreatic β-cell function.
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Affiliation(s)
- Mahmood Y. Hachim
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27273, UAE; (M.Y.H.); (H.A.); (R.A.H.); (N.M.E.); (A.K.M.)
| | - Hayat Aljaibeji
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27273, UAE; (M.Y.H.); (H.A.); (R.A.H.); (N.M.E.); (A.K.M.)
| | - Rifat A. Hamoudi
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27273, UAE; (M.Y.H.); (H.A.); (R.A.H.); (N.M.E.); (A.K.M.)
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, UAE;
| | - Ibrahim Y. Hachim
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, UAE;
| | - Noha M. Elemam
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27273, UAE; (M.Y.H.); (H.A.); (R.A.H.); (N.M.E.); (A.K.M.)
| | - Abdul Khader Mohammed
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27273, UAE; (M.Y.H.); (H.A.); (R.A.H.); (N.M.E.); (A.K.M.)
| | - Albert Salehi
- Department of Clinical Sciences, Division of Islets Cell Pathology, Lund University, SE-205 02 Malmö, Sweden;
| | - Jalal Taneera
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27273, UAE; (M.Y.H.); (H.A.); (R.A.H.); (N.M.E.); (A.K.M.)
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, UAE
- Correspondence: (J.T.); (N.S.)
| | - Nabil Sulaiman
- Department of Family and Community Medicine and Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah 27272, UAE
- Baker Heart and Diabetes Institute, Melbourne 3004, Australia
- Correspondence: (J.T.); (N.S.)
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Role of Functional Biomarkers to Identify Early Vitamin B12 Deficiency in Patients with Sleeve Gastrectomy: A Cross-Sectional Study. ACTA ACUST UNITED AC 2020; 56:medicina56030142. [PMID: 32245061 PMCID: PMC7143905 DOI: 10.3390/medicina56030142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 12/19/2022]
Abstract
Background and objectives: Although laparoscopic sleeve gastrectomy (LSG) is effective for obesity management, postoperative vitamin B12 (B12) deficiency is of major concern. In this cross-sectional study, we assessed the levels of B12 and its related functional biomarkers, namely, total homocysteine (tHcy), methylmalonic acid (MMA), folate, methylcitric acid (MCA), and hemoglobin (Hb), in one-year postoperative LSG patients and matched controls. Materials and Methods: Plasma B12, tHcy, MMA, folate, and MCA were measured in matched controls (n = 66) and patients (n = 71) using validated liquid chromatography-tandem mass spectrometry techniques and protocols in the United Arab Emirates (UAE). Results: The median B12 concentration in patients (177 pmol/L) was significantly lower (p < 0.001) than in the controls (334.7 pmol/L). The tHcy and MMA levels were significantly increased (p < 0.001 and p = 0.011, respectively) and folate levels were significantly decreased (p = 0.001) in the LSG patients compared to the controls. Interestingly, no significant difference in MCA levels were observed between the two groups. The levels of tHcy and MMA were concomitantly increased with the decreased folate levels in postoperative LSG patients when compared with the controls. The Hb levels were significantly lower in males and females in the patient group compared with those in the control group, respectively (p = 0.005 and p = 0.043). Conclusions: This is the first report of serum levels of B12 and its functional biomarkers in postoperative LSG patients among a local population from the UAE. Our findings revealed significant alterations of the B12 biomarkers, total B12, MMA, and tHcy in one-year postoperative LSG patients.
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El Hajj Chehadeh S, Osman W, Nazar S, Jerman L, Alghafri A, Sajwani A, Alawlaqi M, AlObeidli M, Jelinek HF, AlAnouti F, Khalaf K, Alsafar H. Implication of genetic variants in overweight and obesity susceptibility among the young Arab population of the United Arab Emirates. Gene 2020; 739:144509. [PMID: 32109558 DOI: 10.1016/j.gene.2020.144509] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Overweight and obesity are major risk factors for Type 2 Diabetes Mellitus (T2DM), cardiovascular disease (CVD) and cancer. Genetic predisposition has been shown to play a key role in obesity, and genome-wide association studies (GWAS) have identified multiple loci linked with obesity in various ethnic groups. The aim of this study was to validate the reported genetic variants associated with obesity and overweight in a young UAE Arab population. METHODS Twenty-two associated single nucleotide polymorphisms (SNPs) at 11 loci (FTO, MC4R, TMEM18, KCTD15, MTCH2, SH2B1, TFAP2B, GNPDA2, NEGR1, PCSK1 and BDNF) were studied in 392 controls and 318 overweight/obese young Emiratis (aged 18-35 years). RESULTS After adjusting for age and smoking, rs3751812 of the FTO gene was associated with overweight/obesity in male participants (p-value < 0.016), while SNPs rs17782313, rs571312 of the MC4R gene and rs12463617 of the TMEM18 gene were significantly associated with overweight/obesity in female participants (p-value = 0.001, 0.028, 0.044, respectively). Follow-up association tests and logistic regression revealed the contribution of the FTO rs3751812 and MC4R rs571213 SNPs to the risk of overweight/obesity after adjusting for age, sex and smoking (p-value = 0.044, 0.049, respectively). In addition, the FTO rs3751812 was associated with the risk of overweight/obesity after adjusting for the effect of other markers (rs17782313, rs571312, rs2867125, rs6548238 and rs12463617) (p-value = 0.035). A significant gene-gene interaction was seen between FTO, MCR4 and TMEM18 (p-value = 0.013). CONCLUSIONS Our data demonstrates that rs3751812 of the FTO gene is the key SNP associated with risk of overweight/obesity among the young UAE Arab population, in alignment with previous findings. Our results also indicate that the identified genes stratify with sex and risk of overweight/obesity. In addition to their direct association with overweight/obesity, rs17782313 and rs571312, as well as rs2867125 and rs6548238, may have a modifying effect on the risk of overweight/obesity caused by the rs3751812. Population-specific, sex-specific genetic profiling is important in understanding the heritability of obesity.
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Affiliation(s)
| | - Wael Osman
- Center for Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates; College of Arts and Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Suna Nazar
- Center for Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Laila Jerman
- Center for Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Ameera Alghafri
- College of Medicine, Mohammad Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Ali Sajwani
- College of Medicine, Mohammad Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Mohamed Alawlaqi
- School of Medicine, The Royal College of Surgeons, Dublin, Ireland
| | - Mohamed AlObeidli
- College of Medicine and Health Sciences, United Arab Emirates University, AlAin, United Arab Emirates
| | - Herbert F Jelinek
- School of Community Health, Charles Sturt University, Albury, Australia; Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Fatme AlAnouti
- College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates
| | - Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Habiba Alsafar
- Center for Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates; Department of Genetics and Molecular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.
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Hamoudi R, Saheb Sharif-Askari N, Saheb Sharif-Askari F, Abusnana S, Aljaibeji H, Taneera J, Sulaiman N. Prediabetes and diabetes prevalence and risk factors comparison between ethnic groups in the United Arab Emirates. Sci Rep 2019; 9:17437. [PMID: 31767874 PMCID: PMC6877520 DOI: 10.1038/s41598-019-53505-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 10/29/2019] [Indexed: 01/14/2023] Open
Abstract
The economic growth has paralleled the rise of diabetes and its complications in multiethnic population of United Arab Emirates (UAE). Previous studies have shown that characteristics of diabetes is variable across different ethnicities. The objective of this study was to compare diabetes prevalence and risk factors between UAE nationals and different expatriate’s ethnic groups in UAE using data from UAE National Diabetes and Lifestyle Study (UAEDIAB). The UAE nationals made one-fourth (n = 797, 25%) of total cohort and the remaining 75% belonged to immigrants. Across different ethnicities, adjusted prevalence of prediabetes ranged from 8% to 17%, while adjusted prevalence of newly diagnosed diabetes ranged from 3% to 13%. UAE nationals, Arabs non-nationals and Asians had the highest number of pre-diabetic as well as newly diagnosed diabetic patients. Adjusted prevalence of diabetes was highest in UAE nationals (male 21% and female 23%) as well as Asian non-Arabs (male 23% and female 20%), where 40% of both groups fell under the range of either prediabetes or diabetes conditions. Multivariate factors of diabetes versus non-diabetes included older age, ethnicities of Asian non-Arabs and local UAE nationals, family history of diabetes, obesity, snoring, decreased level of high density lipoprotein, elevated levels of triglycerides and blood pressure. In conclusion, diabetes prevalence and risk factors vary across the different ethnic groups in UAE, and hence interventions towards identification and prevention of diabetes should not treat all patients alike.
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Affiliation(s)
- Rifat Hamoudi
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Narjes Saheb Sharif-Askari
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Fatemeh Saheb Sharif-Askari
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Salah Abusnana
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Hayat Aljaibeji
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Jalal Taneera
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Nabil Sulaiman
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates. .,Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004, Australia.
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Alzubaidi HT, Chandir S, Hasan S, McNamara K, Cox R, Krass I. Diabetes and cardiovascular disease risk screening model in community pharmacies in a developing primary healthcare system: a feasibility study. BMJ Open 2019; 9:e031246. [PMID: 31712336 PMCID: PMC6858145 DOI: 10.1136/bmjopen-2019-031246] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study aimed to develop an evidence-based community pharmacist-delivered screening model for diabetes and cardiovascular disease (CVD), and assess its feasibility to identify and refer patients with elevated risk. DESIGN A feasibility study. SETTING A purposive sample of 12 community pharmacies in three cities in the United Arab Emirates (UAE). PARTICIPANTS Adults 40 years of age and above who have not been previously diagnosed with either diabetes or CVD. INTERVENTION Pharmacist screening of adults visiting pharmacies involved history, demographics, anthropometric measurements, blood pressure and point-of-care testing including glycated haemoglobin (HbA1c) levels and lipid panel. Participants with a 10-year CVD risk ≥7.5%, HbA1c level ≥5.7% or American Diabetes Association (ADA) risk score ≥5 points were advised to visit their physician. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were (1) development of UAE pharmacist-delivered screening model, (2) the proportion of screened participants identified as having high CVD risk (atherosclerotic CVD 10-year risk defined as ≥7.5%) and (3) the proportion of participants identified as having elevated blood glucose (high HbA1c level ≥5.7% (38.8 mmol/mol)) or high self-reported diabetes risk (ADA risk score ≥5 points). Secondary outcome is participants' satisfaction with the screening. RESULTS The first UAE pharmacist-delivered screening model was developed and implemented. A total of 115 participants were screened, and 92.3% of the entire screening process was completed during a single visit to pharmacy. The mean duration of the complete screening process was 27 min. At-risk individuals (57.4%) were referred to their physicians for further testing, while 94.5% of participants were at least satisfied with their screening experience. CONCLUSIONS The community pharmacist-delivered screening of diabetes and CVD risk is feasible in the UAE. The model offers a platform to increase screening capacity within primary care and provides an opportunity for early detection and treatment. However, pathways for the integration of the pharmacist-delivered screening service with physicians in primary care are yet to be explored.
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Affiliation(s)
- Hamzah Tareq Alzubaidi
- Pharmacy Practice & Pharmacotherapy, University of Sharjah, College of Pharmacy, Sharjah, United Arab Emirates
| | - Subhash Chandir
- Center for Global Health Delivery-Dubai, Harvard Medical School, Dubai, United Arab Emirates
| | - Sanah Hasan
- Ajman University of Science and Technology College of Pharmacy and Health Science, Ajman, United Arab Emirates
| | - Kevin McNamara
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Institute for Healthcare Transformation, Deakin University, Geelong, Victoria, Australia
| | - Rachele Cox
- Center for Global Health Delivery-Dubai, Harvard Medical School, Dubai, United Arab Emirates
| | - Ines Krass
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
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Alzaabi A, Al‐Kaabi J, Al‐Maskari F, Farhood AF, Ahmed LA. Prevalence of diabetes and cardio-metabolic risk factors in young men in the United Arab Emirates: A cross-sectional national survey. Endocrinol Diabetes Metab 2019; 2:e00081. [PMID: 31592445 PMCID: PMC6775448 DOI: 10.1002/edm2.81] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/22/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The aim of the study was to determine the prevalence of cardio-metabolic risk factors in men under 30 in the United Arab Emirates. METHODS This cross-sectional observational study included 33 327 Emirati men aged 18-29 attending an obligatory standardized medical examination between May 2015 and February 2017. Body mass index, fasting blood glucose, total cholesterol, triglycerides and blood pressure were assessed. RESULTS Overall, 7720 subjects (24.4%) were overweight and 8835 (28.0%) obese. The age-adjusted prevalence was 4.7% [95% CI: 4.4-5.0] for diabetes, 41.3% [40.6-41.9] for impaired fasting glucose, 5.5% [5.2-5.8] for hypercholesterolaemia (total cholesterol ≥ 240 mg/dL), 11.5% [11.1%-12.0%] for hypertriglyceridaemia (≥150 mg/dL) and 10.4% [10.0%-10.8%] for hypertension (diastolic or systolic blood pressure-or both-above upper limit of normal). These conditions were already present in the youngest age groups and rise progressively and rapidly with age. Of the 26 648 subjects with valid data for all cardio-metabolic risk factors, 16 563 subjects (62.2%) presented ≥ 1 factor, 6392 subjects presented ≥2 factors (24.0%) and 63 (0.2%) presented all five. Patients who were obese were more likely to present multiple cardio-metabolic risk factors and to have hypertension (P < 0.0001). All cardio-metabolic risk factors were highly correlated with each other. CONCLUSIONS This national cohort study in the UAE revealed that obesity, diabetes, impaired fasting glucose, hypercholesterolaemia, triglyceridaemia and hypertension are already highly prevalent in young adulthood. Public health initiatives are required to address these and to anticipate the future burden of diabetes and major cardiovascular disease for which these men are at high risk.
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Affiliation(s)
- Ashraf Alzaabi
- Respiratory Medicine DivisionZayed Military HospitalAbu DhabiUAE
| | - Juma Al‐Kaabi
- Department of Internal Medicine, College of Medicine and Health SciencesUnited Arab Emirates UniversityAl‐AinUAE
| | - Fatma Al‐Maskari
- Institute of Public Health, College of Medicine and Health SciencesUnited Arab Emirates UniversityAl‐AinUAE
- Zayed Center for Health SciencesUAE UniversityAl‐AinUAE
| | | | - Luai A. Ahmed
- Institute of Public Health, College of Medicine and Health SciencesUnited Arab Emirates UniversityAl‐AinUAE
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Al Busaidi N, Shanmugam P, Manoharan D. Diabetes in the Middle East: Government Health Care Policies and Strategies that Address the Growing Diabetes Prevalence in the Middle East. Curr Diab Rep 2019; 19:8. [PMID: 30715611 DOI: 10.1007/s11892-019-1125-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Noor Al Busaidi
- National Diabetes and Endocrine Centre, Royal Hospital, Muscat, Sultanate of Oman.
| | - Prakash Shanmugam
- National Diabetes and Endocrine Centre, Royal Hospital, Muscat, Sultanate of Oman
| | - Deepa Manoharan
- National Diabetes and Endocrine Centre, Royal Hospital, Muscat, Sultanate of Oman
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Pepper I, Vinik A, Lattanzio F, McPheat W, Dobrian A. Countering the Modern Metabolic Disease Rampage With Ancestral Endocannabinoid System Alignment. Front Endocrinol (Lausanne) 2019; 10:311. [PMID: 31156558 PMCID: PMC6533883 DOI: 10.3389/fendo.2019.00311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
When primitive vertebrates evolved from ancestral members of the animal kingdom and acquired complex locomotive and neurological toolsets, a constant supply of energy became necessary for their continued survival. To help fulfill this need, the endocannabinoid (eCB) system transformed drastically with the addition of the cannabinoid-1 receptor (CB1R) to its gene repertoire. This established an eCB/CB1R signaling mechanism responsible for governing the whole organism's energy balance, with its activation triggering a shift toward energy intake and storage in the brain and the peripheral organs (i.e., liver and adipose). Although this function was of primal importance for humans during their pre-historic existence as hunter-gatherers, it became expendable following the successive lifestyle shifts of the Agricultural and Industrial Revolutions. Modernization of the world has further increased food availability and decreased energy expenditure, thus shifting the eCB/CB1R system into a state of hyperactive deregulated signaling that contributes to the 21st century metabolic disease pandemic. Studies from the literature supporting this perspective come from a variety of disciplines, including biochemistry, human medicine, evolutionary/comparative biology, anthropology, and developmental biology. Consideration of both biological and cultural evolution justifies the design of improved pharmacological treatments for obesity and Type 2 diabetes (T2D) that focus on peripheral CB1R antagonism. Blockade of peripheral CB1Rs, which universally promote energy conservation across the vertebrate lineage, represents an evolutionary medicine strategy for clinical management of present-day metabolic disorders.
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Affiliation(s)
- Ian Pepper
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA, United States
- *Correspondence: Ian Pepper
| | - Aaron Vinik
- Strelitz Diabetes Center, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Frank Lattanzio
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA, United States
| | - William McPheat
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Anca Dobrian
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA, United States
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Alnageeb H, Abdelgadir E, Khalifa A, Suliman M, Gautam SC, Layani L, Subramaniam S, Bashier A. Efficacy of bariatric surgery in improving metabolic outcomes in patients with diabetes. A 24-month follow-up study from a single center in the UAE. Diabetes Metab Syndr Obes 2018; 11:459-467. [PMID: 30214265 PMCID: PMC6126480 DOI: 10.2147/dmso.s176761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Owing to its impact on weight loss, remission of diabetes mellitus and metabolic syndrome, bariatric surgery has offered hope for grossly obese individuals. In recent years, obesity has increased in the UAE and the use of bariatric surgery has increased in-line with this trend. However, data regarding bariatric surgery outcomes in diabetic Emirati people is scarce. OBJECTIVE To evaluate the effect of bariatric surgery in patients with diabetes mellitus. METHODS This is a retrospective analysis of diabetic patients treated with bariatric surgery with a minimal follow-up of 1 year and extended for some patients (21) to 2 years follow up. A total of 80 patients underwent bariatric surgery. Two surgical procedures were used; laparoscopic sleeve gastrectomy (n=53) or mini-gastric bypass between January 1, 2015, and July 20, 2017. RESULTS Mean baseline weight was 119.2±31.2 kg, this has significantly dropped to 100.1±23.1, 91.2±22.3, 82.3±17.5, and 81.3±15.3 kg at 3, 6, 12, and 24 months respectively, and this change was statistically significant P<0.001 at each time point. Mean baseline HbA1c was 8.6% ± 2.3% and this dropped significantly to 6.5±1.7, 5.9±1.2, 5.6±0.8, and 5.4±0.7 at 3, 6, 12, and 24 months respectively (P<0.000). In 49 (61.3%) we considered fatty liver based on ultrasound features either with or without elevation in alanine aminotransferase (ALT). We noticed a significant decrease in ALT at 3, 6, and 12 months after surgery. Furthermore, 11 patients (22.4%) showed sonographic features of improvement in fatty liver in addition to normalization of ALT. CONCLUSIONS Bariatric surgery was effective over a follow-up period of 2 years in achieving significant weight loss as well as resulting in improvements in glycemic control, blood pressure, and fatty liver.
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Affiliation(s)
| | - Elamin Abdelgadir
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, UAE,
| | - Azza Khalifa
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, UAE,
| | - Mohamed Suliman
- Endocrinology, Imperial College London Diabetes Centre, Al Ain, UAE
| | | | | | | | - Alaaeldin Bashier
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, UAE,
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Alswat K, Aljumah AA, Sanai FM, Abaalkhail F, Alghamdi M, Al Hamoudi WK, Al Khathlan A, Al Quraishi H, Al Rifai A, Al Zaabi M, Babatin MA, Estes C, Hashim A, Razavi H. Nonalcoholic fatty liver disease burden - Saudi Arabia and United Arab Emirates, 2017-2030. Saudi J Gastroenterol 2018; 24:211-219. [PMID: 29956688 PMCID: PMC6080149 DOI: 10.4103/sjg.sjg_122_18] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIM Due to epidemic levels of obesity and type 2 diabetes mellitus (DM), nonalcoholic fatty liver disease (NAFLD) and resulting nonalcoholic steatohepatitis (NASH) will be driving factors in liver disease burden in the coming years in Saudi Arabia and United Arab Emirates (UAE). MATERIALS AND METHODS Models were used to estimate NAFLD and NASH disease progression, primarily based on changes in adult prevalence rates of adult obesity and DM. The published estimates and expert interviews were used to build and validate the model projections. RESULTS In both countries, the prevalence of NAFLD increased through 2030 parallel to projected increases in the prevalence of obesity and DM. By 2030, there were an estimated 12,534,000 NAFLD cases in Saudi Arabia and 372,000 cases in UAE. Increases in NASH cases were relatively greater than the NAFLD cases due to aging of the population and disease progression. Likewise, prevalent cases of compensated cirrhosis and advanced liver disease are projected to at least double by 2030, while annual incident liver deaths increase in both countries to 4800 deaths in Saudi Arabia and 140 deaths in UAE. CONCLUSIONS Continued high rates of adult obesity and DM, in combination with aging populations, suggest that advanced liver disease and mortality attributable to NAFLD/NASH will increase across both countries. Reducing the growth of the NAFLD population, along with potential therapeutic options, will be needed to reduce liver disease burden.
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Affiliation(s)
- Khalid Alswat
- Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman A Aljumah
- Hepatology Division, Department of Hepatobiliary Sciences and Organ Transplant Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia,King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Faisal M Sanai
- Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Faisal Abaalkhail
- Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, Division of Organ Transplant Center, King Faisal Specialist Hospital and Research Center-Riyadh, Alfaisal University, Riyadh, Saudi Arabia,Department of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohamed Alghamdi
- Department of Medicine, Gastroenterology Unit, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Waleed K Al Hamoudi
- Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, Division of Organ Transplant Center, King Faisal Specialist Hospital and Research Center-Riyadh, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah Al Khathlan
- Gastroenterology Section, Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Huda Al Quraishi
- Gastroenterology Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Ahmed Al Rifai
- Gastroenterology Division, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Mohamed Al Zaabi
- Department of Gastroenterology, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Mohamed A Babatin
- Department of Medicine, Gastroenterology Unit, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Chris Estes
- Center for Disease Analysis, Lafayette, Colorado, USA
| | - Almoutaz Hashim
- Department of Internal Medicine, Jeddah University, Jeddah, Saudi Arabia
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, Colorado, USA,Address for correspondence: Dr. Homie Razavi, Center for Disease Analysis, 1120 W. South Boulder Rd., Ste. 102, Lafayette, Colorado, USA. E-mail:
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