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Mohammad A, Ziyab AH, Mohammad T. Anthropometric and DXA-derived measures of body composition in relation to pre-diabetes among adults. BMJ Open Diabetes Res Care 2023; 11:e003412. [PMID: 37793678 PMCID: PMC10551999 DOI: 10.1136/bmjdrc-2023-003412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/08/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Abdominal obesity is the most common risk factor of pre-diabetes and diabetes. Currently, several types of indices are used for the determination of visceral fat-related abdominal obesity. To better understand the effect of the different adiposity indices, we sought to evaluate the association of different adiposity measurements, assessed using dual-energy X-ray absorptiometry (DXA), and pre-diabetes. RESEARCH DESIGN AND METHODS This cross-sectional study included 1184 adults between 18 and 65 years who participated in the Kuwait Wellbeing Study. Anthropometry measurements included body mass index (BMI) and waist-to-hip ratio. Total body fat (TBF) mass, android fat mass, gynoid fat, and visceral adipose tissue (VAT) mass were measured using the Lunar iDXA. Pre-diabetes was defined as 5.7≤HbA1c%≤6.4. Adjusted prevalence ratios (aPRs) and 95% CIs were estimated. Area under the curve (AUC) was estimated for each adiposity measurement as predictor of pre-diabetes. RESULTS A total of 585 (49.4%) males and 599 (50.6%) females were enrolled in the study. Increased BMI (aPR obese vs normal=1.59, 95% CI: 1.19 to 2.12), waist-to-hip ratio (aPR Q4 vs Q1=1.25, 0.96 to 1.61), TBF (aPR Q4 vs Q1=1.58, 1.20 to 2.07), android fat (aPR Q4 vs Q1=1.67, 1.27 to 2.20), gynoid fat (aPR Q4 vs Q1=1.48, 1.16 to 1.89), android-to-gynoid fat ratio (aPR Q4 vs Q1=1.70, 1.27 to 2.28), and VAT mass (aPR Q4 vs Q1=2.05, 1.49 to 2.82) were associated with elevated pre-diabetes prevalence. Gynoid fat was associated with pre-diabetes among males (aPR Q4 vs Q1=1.71, 1.22 to 2.41), but not among females (aPR Q4 vs Q1=1.27, 0.90 to 1.78). Moreover, in terms of AUC, VAT had the highest estimated AUC of 0.680, followed by android-to-gynoid fat ratio (AUC: 0.647) and android fat (AUC: 0.646). CONCLUSIONS Pre-diabetes prevalence increased as adiposity measurements increased, with VAT mass demonstrating the highest AUC for pre-diabetes.
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Affiliation(s)
- Anwar Mohammad
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, Kuwait City, Kuwait
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Alawadhi EM. Thermal comfort analyses on jogging trails: The effect of trail direction and tree shading on trial surface and physiological equivalent temperatures. J Therm Biol 2022; 110:103358. [DOI: 10.1016/j.jtherbio.2022.103358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/11/2022] [Accepted: 09/28/2022] [Indexed: 11/29/2022]
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Ziyab AH, Almari M, Mohammad A, Al-Taiar A, Karmaus W. Sex Differences in the Association of Sibship Size and Position in Sibship with Lipid Profile during Adolescence: A Cross-Sectional Study. Int J Endocrinol 2022; 2022:8727922. [PMID: 36204482 PMCID: PMC9532113 DOI: 10.1155/2022/8727922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/17/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Epidemiologic studies have reported associations of sibship size and position of the child in the sibship with multiple health outcomes, including adiposity and diabetes. However, little is known about sibling effects on lipids. Hence, this study sought to evaluate associations of the number of total, older, and younger siblings with lipid profile among adolescents. METHODS In a cross-sectional study among high school students aged 14 to 19 years, lipid levels were measured in capillary blood. Parents reported the number of siblings (total, older, and younger). Geometric means of lipids were calculated, and linear regression was used to estimate the ratio of geometric means (RoGM) and 95% confidence intervals (CI). Analyses were sex stratified. RESULTS Of the total study sample (n = 1,584), 758 (47.9%) were boys and 826 (52.1%) were girls, with median age of 16.0 years. Total cholesterol (TC) was lower by 8% (adjusted-RoGM = 0.92, 95% CI: 0.88-0.96) among boys with ≥3 older siblings compared to those with no older siblings. Similarly, boys with ≥3 younger sibling compared to those with no younger siblings had reduced TC by 7% (adjusted-RoGM = 0.93, 0.87-0.99). Moreover, an increased number of total siblings (≥4 vs. 0/1: adjusted-RoGM = 0.80, 0.67-97) and older siblings (≥3 vs. 0: adjusted-RoGM = 0.90, 0.82-0.98) were associated with reduced low-density lipoprotein cholesterol (LDL-C) among boys. Similarly, lower levels of triglycerides (TG) were seen among boys with ≥3 older siblings compared to those with no older siblings (adjusted-RoGM = 0.87, 0.78-0.96). A higher number of younger siblings was associated with increased high-density lipoprotein cholesterol (HDL-C) among boys (≥3 vs. 0: adjusted-RoGM = 1.08, 1.01-1.17). Sibship characteristics were not associated with lipids among girls. CONCLUSIONS Increased number of total, older, and younger siblings were associated with favorable lipid profiles among adolescent boys, but not girls. Mechanisms underlying these associations need further investigations.
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Affiliation(s)
- Ali H. Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Mohammad Almari
- Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Safat, Kuwait
| | - Anwar Mohammad
- Biochemistry and Molecular Biology Department, Research Division, Dasman Diabetes Institute, Kuwait, Kuwait
| | - Abdullah Al-Taiar
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
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Hussein SH, Albatineh AN, Almajran A, Ziyab AH. Association of health literacy and other risk factors with glycemic control among patients with type 2 diabetes in Kuwait: A cross-sectional study. Prim Care Diabetes 2021; 15:571-577. [PMID: 33573893 DOI: 10.1016/j.pcd.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Poor health literacy (HL) has received much attention recently as a risk factor for poor health outcomes especially among patients with chronic diseases. The degree to which HL affects health outcomes is unknown among patients with type 2 diabetes mellitus (T2DM) in Kuwait. This study aimed to investigate the association between HL and glycated hemoglobin (HbA1c) among patients with T2DM. METHODS 356 patients with T2DM were selected from 27 primary care clinics covering the state of Kuwait. HL was measured by the Short Test of Functional Health Literacy in Adults (STOFHLA). Prevalence of uncontrolled HbA1c was estimated and its association with HL was modeled and tested using Poisson regression with log-link function and robust variance-covariance matrix, while adjusting for several confounders. RESULTS The prevalence of uncontrolled HbA1c was 77.8%. Among those with inadequate or marginal HL, about 50.7% have uncontrolled HbA1c. The prevalence of uncontrolled HbA1c among those on diet alone was 36.3% lower compared to those on mixed treatment regimen (APR = 0.637, 95% CI: 0.455-0.891, PV = 0.008). The prevalence of uncontrolled HbA1c among patients on oral hypoglycemic (OH) drugs alone was 22.3% lower compared to those on mixed treatment (OH plus Insulin) regimen (APR = 0.777, 95% CI: 0.697-0.865, PV < 0.001). For every one-year increase in age, there is 1.4% reduction in the prevalence of uncontrolled HbA1c (APR = 0.986, 95% CI: 0.978-0.994, PV < 0.001). For one STOFHLA score increase, there is 0.3% reduction in the prevalence of uncontrolled HbA1c (APR = 0.997, 95% CI: 0.994-1.00, PV = 0.055). Finally, for every year increase since T2DM onset, there is 1.1% increase in the prevalence of uncontrolled HbA1c (APR = 1.011, 95% CI: 1.003-1.019, PV = 0.008). CONCLUSIONS The prevalence of uncontrolled HbA1c among patients with T2DM in Kuwait is high. Half of T2DM with inadequate or marginal HL have uncontrolled HbA1c. Patients on diet alone or OH alone have lower prevalence of uncontrolled HbA1c compared to those on mixed treatment regimen. Older T2DM patients or those with higher STOFHLA score have lower prevalence of uncontrolled HbA1c, while those with longer T2DM onset have higher prevalence of uncontrolled HbA1c. Future interventions should focus on younger patients, improve HL, and establish better communications between physicians and patients with T2DM for better glycemic control.
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Affiliation(s)
- Shaimaa H Hussein
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Ahmed N Albatineh
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait.
| | - Abdullah Almajran
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait
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Mohammad A, Ziyab AH, Mohammad T. Prevalence of Prediabetes and Undiagnosed Diabetes Among Kuwaiti Adults: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2021; 14:2167-2176. [PMID: 34040403 PMCID: PMC8140943 DOI: 10.2147/dmso.s296848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/09/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE This study aimed to estimate the prevalence of prediabetes and undiagnosed type 2 diabetes mellitus (T2DM) according to fasting plasma glucose (FPG), 2-h plasma glucose (PG) during oral glucose tolerance test (OGTT), and glycated hemoglobin (HbA1c) among a sample of Kuwaiti adults. In addition, associations of prediabetes and undiagnosed T2DM with sex, age, and body mass index (BMI) were assessed. METHODS A cross-sectional study enrolled 1238 subjects aged 18-65 years who reported no prior history of DM. After overnight fasting, FPG and HbA1c were measured in the total study sample, and 2-h PG during a 75-g OGTT was measured in a subsample of 155 subjects. Prediabetes and undiagnosed T2DM were defined according to the American Diabetes Association criteria. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated. RESULTS We enrolled a total of 618 males and 620 females, with an average age of 43.0 years. The prevalence of prediabetes was estimated to be 47.9% (588/1228) by FPG, 36.8% (57/155) by 2-h PG OGTT, and 31.0% (355/1144) by HbA1c. The prevalence of undiagnosed T2DM was 6.9% (85/1228) by FPG, 11.0% (17/155) by 2-h PG OGTT, and 4.9% (56/1144) by HbA1c. Sex-related differences in the prevalence of prediabetes and undiagnosed T2DM were observed. Prediabetes and undiagnosed T2DM prevalence estimates showed increasing trends as age and BMI increased. For instance, obese subjects compared to under/normal weight subjects had an increased HbA1c-defined prediabetes prevalence (aPR = 1.62, 95% CI: 1.21-2.16). CONCLUSION Prediabetes and undiagnosed T2DM affect a considerable proportion of Kuwaiti adults, and variations across sex, age, and BMI exist. Hence, early identification and management of affected individuals may help reduce the public health burden.
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Affiliation(s)
- Anwar Mohammad
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
- Correspondence: Anwar Mohammad Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Al-Soor Street, Kuwait City, Kuwait Email
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Talal Mohammad
- St. Antony’s College, University of Oxford, Oxford, UK
- Department of Biological Anthropology, University of Cambridge, Cambridge, UK
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Almari M, Mohammad A, Abubaker J, Ziyab AH. Obesity and Prediabetes are Jointly Associated with Lipid Abnormalities Among Adolescents: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2021; 14:345-353. [PMID: 33519222 PMCID: PMC7837585 DOI: 10.2147/dmso.s290383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/24/2020] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Obesity and prediabetes are common among adolescents; however, it is unclear whether they jointly influence lipid levels. Hence, this study sought to assess whether obesity and prediabetes independently or jointly influence lipid levels among adolescents. METHODS A cross-sectional study enrolled school students aged 14-19 years (n = 1584). Body mass index (BMI)-for-age z-scores were estimated, and glycated hemoglobin A1c (HbA1c) and lipid profile were measured in capillary blood. Prediabetes was defined as 5.7≤ HbA1c% ≤6.4. Geometric means of lipids were calculated, and linear regression was used to estimate the ratio of geometric means (RoGM) and their 95% confidence intervals (CI). All analyses were stratified by sex. RESULTS Of the total study participants, 52.1% (826/1584) were females and the majority were aged between 14.0 (5th percentile) and 18.0 (95th percentile) years. Based on BMI-for-age categories, 356 (22.5%) and 494 (31.2%) participants were classified as overweight and obese, respectively. Moreover, 34.3% (543/1584) of the study participants met the prediabetes definition. Compared to those with normal BMI and no prediabetes (reference category), participants classified as obese and having prediabetes had elevated levels of total cholesterol (TC; RoGM=1.09, 95% CI: 1.06-1.13), low-density lipoprotein cholesterol (LDL-C; 1.21, 1.13-1.29), non-high-density lipoprotein cholesterol (non-HDL-C; 1.20, 1.14-1.26), and triglycerides (TG; 1.18, 1.09-1.27) and reduced HDL-C (0.91, 0.88-0.95) levels. Independent of prediabetes, obesity was associated with all the investigated lipids. Prediabetes alone was associated with reduced levels of LDL-C and increased levels of HDL-C only among females. CONCLUSION Obesity independently and in combination with prediabetes demonstrated unfavorable effects on lipids among male and female adolescents, whereas prediabetes independently influenced LDL-C and HDL-C favorably only among females.
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Affiliation(s)
- Mohammad Almari
- Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Safat, Kuwait
| | - Anwar Mohammad
- Department of Biochemistry and Molecular Biology, Research Division, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Jehad Abubaker
- Department of Biochemistry and Molecular Biology, Research Division, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Correspondence: Ali H Ziyab Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait, P. O. Box 24923, Safat13110, Kuwait Tel +96524636545 Fax +96525338948 Email
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Eberle C, Kirchner MF, Herden R, Stichling S. Paternal metabolic and cardiovascular programming of their offspring: A systematic scoping review. PLoS One 2020; 15:e0244826. [PMID: 33382823 PMCID: PMC7775047 DOI: 10.1371/journal.pone.0244826] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is lots of evidence that maternal peri-gestational metabolic, genomic and environmental conditions are closely linked to metabolic and cardiovascular outcomes in their offspring later in life. Moreover, there is also lotsof evidence that underlining mechanisms, such as molecular as well as epigenetic changes may alter the intrauterine environment leading to cardio-metabolic diseases in their offspring postnatal. But, there is also increasing evidence that cardio-metabolic diseases may be closely linked to their paternal metabolic risk factors, such as obesity, Type 2 Diabetes and other risk factors. OBJECTIVE To analyse the evidence as well as specific risk factors of paternal trans-generational programming of cardio-metabolic diseases in their offspring. METHODS Within a systematic scoping review, we performed a literature search in MEDLINE (PubMed) and EMBASE databases in August 2020 considering original research articles (2000-2020) that examined the impact of paternal programming on metabolic and cardiovascular offspring health. Epidemiological, clinical and experimental studies as well as human and animal model studies were included. RESULTS From n = 3.199 citations, n = 66 eligible studies were included. We selected n = 45 epidemiological as well as clinical studies and n = 21 experimental studies. In brief, pre-conceptional paternal risk factors, such as obesity, own birth weight, high-fat and low-protein diet, undernutrition, diabetes mellitus, hyperglycaemia, advanced age, smoking as well as environmental chemical exposure affect clearly metabolic and cardiovascular health of their offspring later in life. CONCLUSIONS There is emerging evidence that paternal risk factors, such as paternal obesity, diabetes mellitus, nutritional habits, advanced age and exposure to environmental chemicals or cigarette smoke, are clearly associated with adverse effects in metabolic and cardiovascular health in their offspring. Compared to maternal programming, pre-conceptional paternal factors might also have also a substantial effect in the sense of trans-generational programming of their offspring and need further research.
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Affiliation(s)
- Claudia Eberle
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda–University of Applied Sciences, Fulda, Germany
- * E-mail:
| | - Michaela F. Kirchner
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda–University of Applied Sciences, Fulda, Germany
| | - Raphaela Herden
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda–University of Applied Sciences, Fulda, Germany
| | - Stefanie Stichling
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda–University of Applied Sciences, Fulda, Germany
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Ziyab AH, Almari M, Al-Taiar A. Exposure to household secondhand smoke among adolescents in Kuwait: Results from two school-based cross-sectional studies. Tob Induc Dis 2020; 18:32. [PMID: 32336970 PMCID: PMC7177388 DOI: 10.18332/tid/119116] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/06/2020] [Accepted: 03/16/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Detrimental effects of secondhand smoke (SHS) exposure are well established; however, data on SHS exposure among adolescents in Kuwait are lacking. Hence, this study sought to estimate the prevalence of household SHS exposure among two samples of adolescents in Kuwait and assess its variation by socioeconomic status and parental education level. METHODS Data from two large school-based cross-sectional studies were analyzed. Adolescents attending public middle (n=3864; aged 11–14 years) and high (n=1959; aged 14–19 years) schools throughout Kuwait were enrolled in 2016-2017, and parental self-reported household SHS exposure was ascertained. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (APRs) and 95% confidence intervals (CIs) were estimated. RESULTS Overall, 45.8% (1755/3836; 95% CI: 44.2–47.3%) of the enrolled middle school students and 51.6% (998/1936; 95% CI: 49.3–53.8%) of the enrolled high school students were exposed to household SHS. Among middle and high school students, the prevalence of household SHS exposure increased as maternal/paternal education level and family income decreased. Among middle school students, paternal educational attainment of middle school or less compared to bachelor’s degree or higher was associated with 1.60 times (95% CI: 1.44–1.79) higher household SHS exposure. Similarly, in the sample of middle school students, the prevalence of household SHS exposure significantly increased from 35.8% among children from families reporting the highest household income to 50.5% among children from families with the lowest reported household income (p-trend<0.001). CONCLUSIONS Household SHS exposure is substantially high among adolescents in Kuwait. Enrolled adolescents from families with low socioeconomic status or with low parental education level have the highest household SHS exposure. These findings highlight the need for national comprehensive tobacco control policies and increasing parental awareness of the impact of SHS exposure on children.
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Affiliation(s)
- Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Mohammad Almari
- Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait
| | - Abdullah Al-Taiar
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, United States
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