Prevalence of overweight and obesity among adult females in the United Arab Emirates

Long-term impact of psychological factors and social interactions on obesity of female nationals in the United Arab Emirates

OBJECTIVE

Along with rapid economic growth, the United Arab Emirates (UAE) has undergone enormous sociocultural changes. Consequently, sociocultural and psychological factors, along with malnutrition and physical inactivity, have contributed to the high obesity rate. The objective of this study is to assess the long-term impact of these new emerging factors on obesity among women in the UAE via mathematical modeling.

METHODS

A differential equation model was developed considering psychological/social factors in population dynamics. It predicts the long-term prevalence of obesity among women in the UAE under these factors by 2070. Computer simulations and a sensitivity analysis of the model were conducted to measure the impact of these factors on obesity.

RESULTS

The model predicts the following: 80.07% of female UAE nationals will become overweight or have obesity and 60.19% will have obesity by 2070, and the population with abnormal eating behavior will increase to 15% by 2070. Psychological/social factors aggravate the obesity problems and can cause abnormal eating behavior to develop with little effect on weight reduction.

CONCLUSIONS

The obesity rate of female UAE nationals will continue to rise by 2070. Rising abnormal eating behavior caused by psychological/social factors is an emerging issue and should be recognized as a sign of escalating obesity problems in the UAE.

Psychosocial factors affecting dietary habits of university students: A cross-sectional study

Background

University student transition from living at home to more independent living which might influence their eating habits. This study aims to assess the effect of psychosocial factors on eating habits among university students.

Methods

A cross-sectional study was conducted among 529 students at the University of Sharjah. Participants completed a self-administered questionnaire on dietary habits, social, and psychological factors. The height and weight were also measured.

Results

More than one-third of participants were classified as overweight or obese (37.6%) and 39.1% reported not engaging in regular physical activity. Less than half of the participants consumed breakfast daily (45.4%) and 83.2% consumed less than two liters of water per day. Only 28.7% and 34.0% of participants consumed fruits and vegetables daily, respectively. Almost 80% of participants reported eating when they were bored, 83.7% ate when feeling happy, and 56.5% ate when they were sad. Eating habits score was significantly lower among unmarried participants (p = 0.03), those not living with their family (p < 0.001), smokers (p = 0.001), those not engaging in regular physical activity (p < 0.001), and those who reported eating uncontrollably (p = 0.007).

Conclusions

Psychosocial factors were important indicators of dietary habits among students. Implementing nutrition education campaigns and health-related courses at the university are recommended.

Prevalence of Obesity and Overweight among Adults in the Middle East Countries from 2000 to 2020: A Systematic Review and Meta-Analysis

BACKGROUND

Obesity has become a significant public health issue worldwide, and it is a major risk factor for many noncommunicable diseases. This systematic review aimed to identify the prevalence of obesity and overweight in the Middle East region and different countries in this region.

MATERIALS AND METHODS

PubMed, Google Scholar, and MEDLINE databases were searched from 2000-2020 to identify relevant studies in the Middle East area. The survey was carried out using combinations of Medical Subject Headings (Mesh) keywords like "body mass index", "obesity", "overweight", "prevalence", "Middle-East", and "Countries in the Middle East area". Analysis of the data was done using STATA-14, and a random-effects model was used to estimate the pooled prevalence.

RESULTS

A total of 101 studies with 698905 participants have been identified that met inclusion criteria for this meta-analysis. The pooled estimates of the prevalence of obesity and overweight in the Middle East area were 21.17 (95% CI: 17.05-26.29) and 33.14 (95% CI: 26.87-40.87), respectively. The findings showed that obesity prevalence increased with age so that the highest prevalence of obesity and overweight was observed in people >40 years old. Obesity prevalence in the Middle East area remained steady between 2000-2006 and 2014-2020 (23%). During these time intervals, the prevalence of overweight decreased from 34.83 (95% CI: 32.40-37.45) to 32.85 (95% CI: 31.39-34.38).

CONCLUSIONS

Despite the relative stabilization of the overweight and obesity trend in the Middle East, current interventions to combat the overweight epidemic need to be maintained and strengthened because the prevalence of overweight and obesity in this region is still very high. The prevalence of obesity increases with age so that people over 40 have the highest percentage of obesity and overweight. Therefore, implementing intervention programs to prevent and control obesity and overweight in the Middle East is essential.

The prevalence of diabetes amongst young Emirati female adults in the United Arab Emirates: A cross-sectional study

AIMS

The prevalence of type 2 diabetes is rapidly increasing in the United Arab Emirates (UAE). The purpose of this study was to investigate the prevalence of prediabetes and diabetes using FPG and HbA1c and to examine their relationships with obesity and other risk factors in young female Emirati college students.

METHODS

In this cross-sectional study we recruited 555 female college students aged 17-25, enrolled at United Arab Emirates University in Al Ain, UAE. Anthropometric analysis, blood pressure, and various biochemical markers were measured using standard methods. Type 2 Diabetes, impaired fasting plasma glucose (FPG), and elevated HbA1c levels were examined in the study population as per the standards of medical care in diabetes, set out by the American Diabetes Association in 2020.

RESULTS

Based on the HbA1c test, the prevalence of pre-diabetes and diabetes were 24% and 8.6%, respectively. Based on the FPG test, the prevalence of pre-diabetes and diabetes were 9.2% and 0.5%, respectively. The kappa statistic of concordance between HbA1c and FPG was 0.287, P < 0.001. Abnormal glycemic status was significantly associated with decreased high-density lipoprotein (HDL) level (< 50 mg/dl) (p = 0.002) and elevated high-sensitivity C-reactive protein (Hs-CRP) level (≥ 2.0 mg/L) (P < 0.001).

CONCLUSIONS

Using FPG to evaluate glycemic control seems to underestimate the burden of undiagnosed diabetes which could have a significant impact on clinical practice. Our data indicates an association between abnormal glycemic status with HDL and Hs-CRP. Further evaluation is needed to assess the impact of using HbA1c as a diagnostic test for diabetes in the UAE.

Sleep quality and Dietary Inflammatory Index among university students: a cross-sectional study

PURPOSE

Evidence indicates that most college students face reduced sleep quality due to unhealthy dietary habits and hectic daily schedules. While the relationship between sleep quality and general health has been the subject of intensive research, little is known about the association between sleep and its relation with the inflammatory potential of the diet until recently. This study aimed to investigate the association between Energy-Adjusted Dietary Inflammatory Index (E-DII^®) scores and sleep quality in a group of students from the University of Sharjah (UOS).

METHODS

A cross-sectional study design was followed, and convenience sampling was used. Participants were assessed for sleep quality using the Pittsburgh Sleep Quality Index (PSQI), E-DII scores were derived from a semi-quantitative food frequency questionnaire (FFQ), and physical activity level was measured using the International Physical Activity Questionnaire (IPAQ). Chi-square tests and two-sample t tests were used to find an association between E-DII scores and sleep quality.

RESULTS

A total of 379 college students were included in the study of whom 64 % were female and 81% were between 18 and 21 years of age. Two-thirds of participants experienced poor sleep quality. Although results were trending in the hypothesized direction, no significant association was found between E-DII scores and sleep quality. Among the individual components of sleep quality, a direct significant association was found between E-DII scores and day dysfunction (P = 0.03).

CONCLUSIONS

These results suggest that a pro-inflammatory diet maybe related to increased day dysfunction among UOS students. Consuming a more anti-inflammatory diet may reduce daytime dysfunction. Further prospective and controlled studies are required to confirm this association, and to explore other attributes and their sequelae on sleep quality.

Incidence and risk factors of type 2 diabetes mellitus in an overweight and obese population: a long-term retrospective cohort study from a Gulf state

OBJECTIVES

A high body mass index (BMI) is associated with risk of type 2 diabetes mellitus (DM). The United Arab Emirates (UAE) is experiencing a marked increase in obesity. Nonetheless, no data are available regarding the incidence of type 2 DM in the high-risk adult UAE population. Therefore, this study aimed to evaluate the incidence rate and risk of developing type 2 DM among individuals with above-normal BMI in the UAE.

DESIGN

A retrospective cohort study.

SETTING

Outpatient clinics at a tertiary care centre in Al Ain, UAE.

PARTICIPANTS

Three hundred and sixty-two overweight or obese adult UAE nationals who visited outpatient clinics between April 2008 and December 2008.

PRIMARY OUTCOME MEASURE

Patients with type 2 DM were identified based on diagnosis established by a physician or through glycated haemoglobin (HbA1c) levels ≥6.5% during the follow-up period (until April 2018).

RESULTS

The overall incidence rate of type 2 DM during the median follow-up time of 8.7 years was 16.3 (95% CI 12.1 to 21.4) cases per 1000 person-years. Incidence rates in men and women were 17.7 (95% CI 11.6 to 25.9) and 15.0 (95% CI 9.8 to 22.2) cases per 1000 person-years, respectively. Multivariable Cox proportional hazard analysis determined older age and obesity in women and pre-diabetes in men to be independent risk factors for developing type 2 DM.

CONCLUSIONS

The incidence rate of type 2 DM in overweight and obese UAE nationals is high. In addition to screening, current strategies should strongly emphasise lifestyle modifications to decrease HbA1c and BMI levels in this high-risk population.

Treatment destinations and visit frequencies for patients seeking medical treatment overseas from the United Arab Emirates: results from Dubai Health Authority reporting during 2009-2016

BACKGROUND

Each year, the Dubai Health Authority (DHA) spends millions of dollars to cover the costs of United Arab Emirates (UAE) nationals seeking healthcare overseas. Patients may travel overseas to seek an array of treatments. It is important to analyze the number of trips and treatment destinations for patients travelling overseas to provide baseline information for the DHA to improve polices and strategies related to overseas treatment for UAE nationals.

METHODS

Administrative data were obtained from the DHA for UAE nationals who sought medical treatment overseas during 2009-2016. We examined the number of trips and treatment destinations by medical specialty, age, gender, years of travel and travel seasons. Multinomial logistic and negative binomial regression models were used to assess the relationships of the treatment destinations and number of trips, respectively, with the key variables of interest.

RESULTS

The study included data from 6557 UAE nationals. The top three treatment destinations were Germany (46%), the UK (19%) and Thailand (14%). The most common medical specialties were orthopedic surgery (13%), oncology (13%) and neurosurgery (10%). Oncology had the highest expected number of trips adjusted for a number of covariates (IRR 1.34, 95% CI: 1.24-1.44). Regarding destination variation, patients had a lower relative risk ratio of seeking healthcare in Germany in the winter (RRR 0.68, 95% CI: 0.57-0.80). Endocrinology was the most common medical specialty sought in the UK (RRR 3.36, 95% CI: 2.01-5.60).

CONCLUSIONS

This is the first study to systematically examine the current practice of medical treatment overseas among UAE nationals. The results demonstrate that treatment destinations, medical specialties for which treatment was sought, age, gender and travel season are significant factors in understanding overseas travel for medical care. The study can guide the DHA in collecting more data for further research that may lead to policy-relevant information about sending patients to the best-quality treatment choices at an optimal cost.

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

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.

The Epidemiology and Economic Burden of Obesity and Related Cardiometabolic Disorders in the United Arab Emirates: A Systematic Review and Qualitative Synthesis

BACKGROUND

Noncommunicable diseases (NCDs) are considered as a global health problem and considered as a public health priority with the more considerable increasing trend of obesity and cardiometabolic disorders rates in the Middle Eastern countries. This systematic review aims at assessing the prevalence, incidence rates, and trends, as well as the cost of obesity and related cardiometabolic disorders in the United Arab Emirates (UAE).

METHODS

A highly sensitive strategy was used to retrieve original observational studies, addressing the epidemiology and cost of obesity and related cardiometabolic disorders in the UAE, irrespective of nationality (nationals and expatriates). The search was conducted on April 4, 2017, within numerous electronic databases and the grey literature. Standardized and validated methods were used for data extraction and analysis as well as quality assessment.

RESULTS

6789 records were retrieved, of which 36 were deemed eligible. High prevalence rates were reported for obesity, diabetes, hypertension, and metabolic syndrome in all studies. However, the definitions and methods employed by the studies were highly variable. The risk of bias in the epidemiological studies ranged between low and medium. Only one study reported the cost of illness for diabetes. In this study, the estimated cost per patient was $2,015 (adjusted to the year 2015), and it became twofold and sixfold higher in patients with microvascular and macrovascular complications, respectively.

CONCLUSIONS

Obesity and related cardiometabolic disorders are highly prevalent in the UAE, but quoting a precise prevalence for them is difficult given the methodological heterogeneity of the epidemiological studies addressing them. Nonetheless, we detected a 2-3-fold increase in the prevalence of overweight and obesity in the UAE between 1989 and 2017. It is hopeful that this systematic review will provide an insight into direct future studies, especially longitudinal studies exploring obesity and cardiometabolic risks and their costs.

Quantity and quality of obesity-related research in Arab countries: assessment and comparative analysis

BACKGROUND

Obesity is a serious worldwide medical condition, considered by some researchers as one of the most serious public health problems of the 21st century. The main objective of this study was to assess the quantity and quality of obesity-related research from Arab countries and compare it with that from non-Arab Middle Eastern countries.

METHODS

Original scientific articles or reviews published by Arab countries about obesity up until 2011 were screened using the ISI Web of Science database. Research activity was assessed by analyzing the annual research productivity, journals names, citations, top 10 active institutions, and the contribution of each Arab country to obesity research.

RESULTS

The total number of original and review research articles published globally about obesity was 110,167. The leading country in obesity research was United States of America (42.47%). Turkey, Israel, and Iran were in the top 30 countries while Kingdom of Saudi Arabia (KSA), Egypt, and Kuwait ranked 39th, 43rd, and 47th, respectively. A total of 1,121 documents about "obesity" were published by Arab countries, representing 1.0% of the global research output, with 13,343 citations (average citation of 11.9 per document) and an h-index of 44. The Arab countries' research output was very low until the mid-1990s and then increased steadily. Of the 1,121 documents, 107 (9.55%) were published in the Saudi Medical Journal. KSA, with a total of 318 publications ranked first among Arab countries in research quantity while Kuwait ranked first after adjustment based on population size. King Saud University in KSA was the most productive institution with a total of 140 documents. Compared with other non-Arab Middle Eastern countries, the research productivity from Arab countries was lower than that from Turkey, higher than that from Iran, and close to that from Israel. However, the h-index of documents about obesity published from Arab countries was lower than that of Turkey and Israel, but slightly higher than that from Iran.

CONCLUSIONS

The present data reveals a good contribution by some Arab countries, particularly Arab gulf countries, to obesity research. More efforts are needed by other Arab countries to bridge the gap in this topic and to improve the quality of obesity-related research originating from Arab countries.

Obesity hypoventilation syndrome in obstructive sleep apnea patients in the United Arab Emirates: a retrospective cross-sectional study

Objectives

To estimate the frequency of symptoms of obesity hypoventilation syndrome (OHS) in patients with obstructive sleep apnoea (OSA) and to evaluate comorbidities associated with OHS.

Design

Retrospective study based on patients' medical records and on further sleep tests performed in the study centre during the inclusion visit.

Setting

Respiratory Care Unit and Sleep Disorder Centre of the Zayed Military Hospital United Arab Emirates.

Participants

All patients referred to the study centre for a suspicion of sleep-disordered breathing.

Main outcome measures

Prevalence of OSA and OSA + OHS and comorbidities in patients with OSA and OHS.

Results

A total of 212 adult patients participated in the study. Of these, 107 patients (50.5% [43.8–57.1% CI 95%]) fulfilled diagnostic criteria for OSA, and the majority were men (79.4%). Among patients with OSA, 18 patients (16.8% [10.8–25.1% CI 95%]) fulfilled diagnostic criteria for OHS. In this group, women were more frequently affected than men (31.8% [7/22] vs. 12.9% [11/85], respectively; p = 0.03) and tended to be older than affected men, with a mean age of 55 ± 10.6 years versus 46 ± 13 for men. After adjustment for gender, OHS was significantly associated with hypertension (OR = 3.5; p = 0.03), diabetes mellitus (OR = 4.6; p = 0.02), ischaemic heart disease (OR = 5.1; p = 0.04) and pulmonary hypertension (OR = 16.1; p = 0.001).

Conclusion

OHS is a common condition in obese patients in the UAE and is associated with an increased risk of cardiovascular comorbidities and diabetes.

Nutrition transition in the United Arab Emirates

BACKGROUND/OBJECTIVES

The United Arab Emirates has undergone remarkable economic and social transformations over the past few decades. We present findings on the prevalence of overweight and obesity, dietary and activity patterns among Emiratis in 2009/10, and explore associated urbanization and wealth factors.

SUBJECTS/METHODS

A cross-sectional study was conducted in 628 randomly selected households in all seven emirates. Sociodemographics, 24-h dietary recalls, physical activity and anthropometric data were collected from adult females (≥ 19 years), adolescents (11-18 years) and children (6-10 years) in each family via in-person interviews using validated questionnaires.

RESULTS

In 2009/10, 65% of adult women, 28% of male adolescents and 40% of female adolescents, 25% of male children and 41% of female children were overweight or obese. 43% of girls and 38% of boys (6-10 years) consumed more calories than their estimated energy requirements. Snacking represents a major source of Emirati caloric intake (>20%) of total calories. In addition, caloric beverages account for 8-14% of total calories. Meanwhile, physical activity levels are low, especially among females Emiratis and those living in urban areas.

CONCLUSIONS

These trends represent the potential risk for severe cardiometabolic problems in the United Arab Emirates. The significant gender differentials among children and adolescents are driven by diet and activity differences. More attention should be paid to educate the public on nutrition (for example, limit the consumption of sugared sodas, fruit drinks and whole milk, promote water and low-fat/skim milk consumption instead) and encourage physical activity from a young age, especially among females. Built environments and social support for improved lifestyle choices by individuals are needed.

Prevalences of overweight, obesity, hyperglycaemia, hypertension and dyslipidaemia in the Gulf: systematic review

OBJECTIVES

To examine the prevalence of risk factors for diabetes and its complications in the Co-operation Council of the Arab States of the Gulf (GCC) region.

DESIGN

Systematic review.

SETTING

Co-operation Council of the Arab States of the Gulf (GCC) states (United Arab Emirates, Bahrain, Saudi Arabia, Oman, Qatar, Kuwait).

PARTICIPANTS

Residents of the GCC states participating in studies on the prevalence of overweight and obesity, hyperglycaemia, hypertension and dyslipidaemia.

MAIN OUTCOME MEASURES

Prevalences of overweight, obesity and hyperglycaemia, hypertension and hyperlipidaemia.

RESULTS

Forty-five studies were included in the review. Reported prevalences of overweight and obesity in adults were 25-50% and 13-50%, respectively. Prevalence appeared higher in women and to hold a non-linear association with age. Current prevalence of impaired glucose tolerance was estimated to be 10-20%. Prevalence appears to have been increasing in recent years. Estimated prevalences of hypertension and dyslipidaemia were few and used varied definitions of abnormality, making review difficult, but these also appeared to be high and increasing,

CONCLUSIONS

There are high prevalences of risk factors for diabetes and diabetic complications in the GCC region, indicative that their current management is suboptimal. Enhanced management will be critical if escalation of diabetes-related problems is to be averted as industrialization, urbanization and changing population demographics continue.

UAE population reference standard charts for body mass index and skinfold thickness, at ages 0-18 years

AIMS

To determine a range of anthropometric measurements including skinfold thickness measurements in four different areas of the body, to construct population growth charts for body mass index (BMI), skinfolds, and to compare these with growth charts from other countries. One aim was also to validate body fat charts derived from skinfold thickness.

METHODS

A national cross-sectional growth survey of children, 0-18 years old, was conducted using multistage stratified random sampling. The sample size included at least 200 children in each age-sex group. Height, weight, biceps skinfold, triceps skinfold, subscapular skinfold, suprailiac skinfold, and mid-upper-arm circumference were measured in each child. We describe correlation, standard deviation scores relative to the other standards, and calculation of body density in the United Arab Emirates population. We determined whether any of the above is a good indicator of fatness in children.

RESULTS

BMI, upper-arm circumference, sum of four skinfolds, and percentage body fat charts were constructed using the LMS method of smoothing. BMI was very significantly correlated with sum of skinfold thicknesses, and mid-upper-arm circumference. Prevalence of obesity and overweight in ages 13-17 years was respectively 9.94% and 15.16% in females and 6.08% and 14.16% in males. Derived body fat charts were found not to be accurate.

CONCLUSION

A national BMI, upper-arm circumference, and sum of four skinfolds chart has been constructed that can be used as a reference standard for the United Arab Emirates. Sum of four skinfold thickness charts can be used as crude determinants of adiposity in children, but derived body fat charts were shown to be inaccurate.