A review of adult obesity prevalence, trends, risk factors, and epidemiologic methods in Kuwait

Complications Post Abdominoplasty After Surgical Versus Non-surgical Massive Weight Loss: a Comparative Study

PURPOSE

This study aims to investigate the rate of short- and long-term complications as well as the need for operative revisions after abdominoplasty for patients following surgical versus non-surgical weight loss methods.

METHODS

This is a retrospective chart review that enrolled consecutive patients undergoing abdominoplasty across a 5-year period, aged 18 years and above, opting for abdominoplasty after weight loss achieved through bariatric surgery or diet and exercise alone.

RESULTS

A total of 364 patients lost weight through bariatric surgery and 106 by diet and exercise alone. There were no significant differences in comorbidity status, but past body mass index (BMI) was higher for the surgical weight loss (SW) group (47.6 ± 10.2 and 40.4 ± 8.6, respectively; p value < 0.0001). Percent excess weight loss (EWL) was 68 ± 14.5 for the SW group and 55.7 ± 19.4 for the NSW group, p value < 0.0001. Pre- and postoperative blood hemoglobin levels were significantly lower in the SW group (p < 0.05). Neither short-term complications (thromboembolic events, wound complications, or infections) nor long-term complications (umbilical deformity, delayed wound healing, or infection) and operative revisions were significantly different across both groups (p > .05).

CONCLUSION

Bariatric surgery does not increase the risk of short- or long-term complications or the need for operative revision after abdominoplasty.

The Multifaceted Actions of Curcumin in Obesity

Obesity remains a pervasive health concern worldwide with concomitant comorbidities such as cardiovascular diseases, diabetes, inflammation, and other metabolic disorders. A wealth of data validates dietary and lifestyle modifications such as restricting caloric intake and increasing physical activity to slow the obesity development. Recently, the advent of phytochemicals such as curcumin, the active ingredient in turmeric, has attracted considerable research interest in tracking down their possible effects in protection against obesity and obesity-related comorbidities. According to the existing literature, curcumin may regulate lipid metabolism and suppress chronic inflammation interacting with white adipose tissue, which plays a central role in the complications associated with obesity. Curcumin also inhibits the differentiation of adipocyte and improves antioxidant properties. In the present review, we sought to deliberate the possible effects of curcumin in downregulating obesity and curtailing the adverse health effects of obesity.

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.

Identification of public health priorities, barriers, and solutions for Kuwait using the modified Delphi method for stakeholder consensus

The rapid modernization and economic developments in Kuwait, have been accompanied by substantial lifestyle changes such as unhealthy diet and physical inactivity. These modifiable behaviours have contributed to increased rates of non-communicable diseases including diabetes and cardiovascular diseases. Delphi Consensus Method was implemented in the current study to draw stakeholders from all sectors together to develop a consensus on the major public health priorities, barriers and solutions. The process involves administration of a series of questions to selected stakeholders through an iterative process that ends when a consensus has been reached among participants. Results of the iteration process identified obesity, diabetes, cardiovascular diseases along with lack of enforcement of laws and regulation as priority health issues. Results also identified lack of national vision for the development of a public health system, lack of multidisciplinary research investigating sources of disease and methods of prevention and improving efficiency with existing resources in implementation and efficiency as the main barriers identified were. Solutions suggested included investing in healthcare prevention, strengthening communication between all involved sectors through intersectoral collaboration, awareness at the primary healthcare setting and use of electronic health records. The results offer an important opportunity for stakeholders in Kuwait to tackle these priority health issues employing the suggested approaches and solution.

Global associations of national economic wealth are more robust with inflammatory bowel diseases than with obesity

The inflammatory bowel diseases consisting of Crohn's and ulcerative colitis have expanded into previously low incidence areas of the world. The spread follows the relatively recent pandemic of global obesity. Pathological relations have been proposed between these two diseases. Both inflammatory bowel diseases and obesity originated in wealthier western societies marked by high gross domestic product per capita. The pathogenic influence of national wealth on the inflammatory bowel diseases has been recognized but are less clear with obesity. Parallel correlations of national wealth with obesity would further strengthen relations between these two diseases. Alternatively, diverging relations could suggest that obesity is less dependent on wealth. As such it would supports another earlier hypothesis that obesity depends on adoption of western diet which precedes national acquisition of wealth. Previously ecological modifiers of global disease patterns, including latitude and lactose digestion status have shown different influences on IBD compared with obesity. We evaluate. the influence of the Gross Domestic Product on these two diseases taking into consideration the former's relationship with ecological markers. Patterns of correlations could suggest contributing mechanisms how these ecological parameters influence some disease distributions. The literature and internet were searched for national rates of obesity, inflammatory bowel diseases, national gross domestic product per capita and national lactase distribution rates. National average latitudes were calculated previously. Pearson correlations were used to compare variables in three regions; global, European and Asian theaters. SAS statistical package was used and statistical significance was accepted at p < 0.05. Globally and in Europe correlations of gross domestic product were moderate and significant r = 0.55 and r = 0.6 respectively with Crohn's disease but weaker with ulcerative colitis. The results were negligible in Asia. Obesity was weakly correlated with gross domestic product globally r = 0.32 and negligible in Europe and Asia. In addition, gross domestic product was moderately correlated with latitude r = 0.6, and inversely with lactase non persistence r = -0.6 both globally and in Europe. This relationship is similar to that with inflammatory bowel diseases, but less related to obesity. Overall results suggest unequal effect of national wealth and industrialization on obesity and inflammatory bowel diseases. It has been suggested that western type diet precedes full industrialization and this could promote obesity.

Demographics, Clinical Characteristics, and Management of Idiopathic Intracranial Hypertension in Kuwait: A Single-Center Experience

Background: Idiopathic intracranial hypertension (IIH) affects predominantly obese females during their reproductive age period. The demographics of this condition has not been studied in Kuwait before. Objectives: To determine the demographics, clinical features, risk factors, and treatment modalities of IIH in the main neurology tertiary referral hospital in Kuwait and to compare our data with literature. Methods: A retrospective study was conducted to identify cases of IIH seen between January 1, 2018, and December 31, 2018. Patients were diagnosed in and referred from the neurology and neuro-ophthalmology clinics. Results: Our cohort consisted of 139 patients. We estimated a crude annual incidence rate of IIH of 3.28 per 100,000 population. Female-to-male ratio was 9.6:1. Mean age was 32.1 ± 10.8 years. Mean age of males was 31.46 ± 12.63 and that of females was 32.11 ± 10.67. The median of the duration from the first symptoms till diagnosis was 6 weeks (2-10 weeks). Headache was the most common symptom in 134 (96.4%) patients, followed by visual disturbances in 85 (61.2%) patients, transient visual obscurations (TVOs) in 84 (60.4%) patients, pulsatile tinnitus in 72 (51.8%) patients, diplopia in 22 (15.8%) patients, other symptoms (e.g., nausea, vomiting, radicular neck, and back pain) in 19 (13.7%) patients, and 1 (0.7%) patient had facial weakness. High body mass index (BMI) was seen in 89.9% of patients, either overweight or obese, and it was the most common risk factors in both males (46.2%) and females (61.1%). Anemia was found in 38.1%; 21.6% of patients used OCPs and 7.9% used vitamin A. Bilateral transverse sinus stenosis (BTSS) was detected in 47 (33.8%) patients. Only 2 (1.4%) patients developed "fulminant IIH" characterized by rapidly progressive disease. All the patients received medical treatment and only 12 (8.6%) needed surgical management. Conclusion: Incidence of IIH in Kuwait is similar to other regional studies but higher than Western studies. Demographics and clinical features of IIH in our study are comparable to international and regional figures. Most of our patients had a benign course. IIH is more prevalent in females and strongly associated with obesity.

Changing Patterns of Relationships Between Geographic Markers and IBD: Possible Intrusion of Obesity

Background

Latitude and lactase digestion status influence incidence and prevalence rates of some noncommunicable diseases. Latitudinal correlations helped define beneficial roles of vitamin D in many diseases like inflammatory bowel disease (IBD). In view of recent global expansion of IBD and population migrations, we reexamine relations with these markers. As these changes also paralleled the pandemic of obesity, we explore possible interactions with IBD.

Methods

We undertook a literature review to compare rates of obesity, Crohn's disease and ulcerative colitis with the geographic markers of lactase digestion status, average population-weighted national latitude, and national yearly sunshine exposure. Pearson correlations were used throughout to determine r correlation factors. Statistical significance was accepted at P <0.05 using 2-tailed tests.

Results

Forty-seven countries were matched with various data sets that could be analyzed (range of availability was 49%-85%). While global correlations of IBD with latitude and lactase status remain similar to previous analyses, in Europe and Asia, outcomes were different. Global outcome contains a statistical paradox related to combining countries from Europe and Asia. Obesity showed moderate global correlations with IBD but weak and negligible correlations in Europe and Asia. There was also a weak global correlation with latitude.

Conclusions

It is suggested that global correlations point to parallel geographic spread of IBD and obesity. The lack of latitudinal relations with obesity suggests reduced vitamin D effect. The paradox supports epidemiological differences in western and eastern IBD. Obesity combined with IBD may contribute to different relations, partly due to variable vitamin D effects.

Impact of nutritional knowledge on dietary behaviors of students in Kuwait University

Increasing nutritional knowledge is an important component of broader societal efforts to address the high prevalence of nutrition-related diseases. In Kuwait, university students are a critical target group since many of their lifestyle behaviors are shaped during college and may continue throughout their life. The aim of this study was to explore the effects of nutritional knowledge on the dietary behavior of 700 undergraduate students of Kuwait University. Nutritional knowledge and dietary behavior of Kuwait University undergraduate students were evaluated using paper-based questionnaires to assess lifestyle and nutrition behavioral changes. Students who experienced better dietary habits had better nutritional knowledge. However, the strength of the association was considered weak (r=0.229). The findings suggest that nutritional knowledge can slightly assist in adopting healthier eating habits, which may reduce nutrition-related diseases. Therefore, nutrition education programs and nutritional activities in classes should be recommended among students to promote healthy lifestyles.

In Vitro Antidiabetic and Antiobesity Activities of Traditional Kochujang and Doenjang and Their Components

In this study we investigated the antidiabetic and antiobesity effects of aqueous ethanol extracts of traditional kochujang and doenjang. The average α-glucosidase inhibitory activity and adipogenesis inhibitory activity for the kochujang samples were 29.6% and 20.8%, respectively, while those of the doenjang samples were 46.3% and 11.6%, respectively. Therefore, antidiabetic activity is high in doenjang and antiobesity activity is high in kochujang. Kochujang and doenjang components responsible for suppressing the functional effects were investigated by metabolomic analysis. For kochujang, p-coumaric acid, N6,N6,N6-trimethyllysine, threonine, and methionine positively correlated with inhibition of adipogenesis activity, whereas for doenjang, betaine and betaine aldehyde were thought to be responsible for the antidiabetic effects. As p-coumaric acid and betaine were the most probable candidates with functional effects, these two compounds were selected for further analysis. Inhibition of adipogenesis was shown to be 14.0±1.85% for betaine chloride and 38.3±3.27% for p-coumaric acid, suggesting that p-coumaric acid is more effective than betaine against obesity. However, betaine exhibited higher α-glucosidase inhibitory activity than p-coumaric acid. Our results suggest that both kochujang and doenjang can be used against diabetes and obesity. However, clinical trials are necessary to support these results.

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.

Gender differences in weight status, dietary habits, and health attitudes among college students in Kuwait: A cross-sectional study

Background:

A better understanding of the factors involved in health and wellness among college students can aid in the design of interventions that can reduce the rate of weight gain during young adulthood.

Aim:

The aim of this study was to determine the gender differences in weight status, dietary habits, and health attitudes in a sample of college students at Kuwait University (KU).

Methods:

In this cross-sectional study, 615 students were recruited from KU between November 2013 and March 2014. Components of the study included a self-report questionnaire, assessment of body mass index, and calculation of Healthy Eating Score (HES) to assess eating habits and attitudes. Statistical analyses were performed to assess the gender differences among these domains.

Results:

The findings revealed that a greater proportion of men were overweight and obese compared to women (28.7% and 23.8% vs. 19.9% and 12.1%, respectively). Both genders show equally unhealthy dietary habits, marked by low mean HES scores. Gender-specific dietary patterns were noted, with more men reporting eating >6 oz (168 g) of animal protein per day as compared to women (48.4% vs. 28.9%, p < 0.001). A higher proportion of female students reported regular consumption of potato chips and fatty salty snacks (51.3% and 40.4%, respectively, p = 0.12) and that they ate sweets more than twice a day (52.5% and 39.9%, respectively, p = 0.041).

Conclusions:

Our findings highlight the need for evidence-based gender-specific strategies to reduce the number of overweight and obese college students and promote healthy dietary habits and eating attitudes among this population.

LY3009120, a pan-Raf kinase inhibitor, inhibits adipogenesis of 3T3-L1 cells by controlling the expression and phosphorylation of C/EBP-α, PPAR-γ, STAT‑3, FAS, ACC, perilipin A, and AMPK

Excessive preadipocyte differentiation/adipogenesis is closely linked to the development of obesity. LY3009120 is a pan‑Raf kinase inhibitor and is known for its anticancer activities. In the present study, the effect of LY3009120 on 3T3‑L1 cell adipogenesis was investigated. The differentiation of 3T3‑L1 preadipocytes into adipocytes was measured by Oil Red O staining and AdipoRed assay. Changes of cellular protein expression and phosphorylation levels in differentiating 3T3‑L1 preadipocytes in the absence or presence of LY3009120 were determined by western blotting analysis. Cell count assay was used to assess the cytotoxicity of LY3009120 on 3T3‑L1 cells. At 0.3 µM, LY3009120 markedly inhibited lipid accumulation and decreased triglyceride content in differentiating 3T3‑L1 cells. However, it had minimal effect on the elevated expression and phosphorylation of three Raf kinase isoforms (C‑Raf, A‑Raf, and B‑Raf) observed in the cells. LY3009120 reduced not only the expression of CCAAT/enhancer‑binding protein‑α (C/EBP‑α), peroxisome proliferator‑activated receptor‑γ (PPAR‑γ), fatty acid synthase (FAS), acetyl CoA carboxylase (ACC), and perilipin A, but also reduced the phosphorylation of signal transducer and activator of transcription‑3 (STAT‑3) in differentiating 3T3‑L1 cells. LY3009120 also increased the phosphorylation of adenosine 3',5'‑cyclic monophosphate (cAMP)‑activated protein kinase (AMPK), but did not affect the phosphorylation or expression of liver kinase B1 in these cells. In summary, this is the first report, to the best of our knowledge, demonstrating that LY3009120 has an anti‑adipogenic effect on 3T3‑L1 cells, which may be mediated through control of the expression and phosphorylation of C/EBP‑α, PPAR‑γ, STAT‑3, FAS, ACC, perilipin A, and AMPK.

Validity and Reliability of a Nutrition Knowledge Questionnaire in an Adult Student Population

OBJECTIVE

To assess the validity and reliability of the Kuwait Adult Nutrition Knowledge Questionnaire (KANKQ) in adult students as an initial step to validation in the general adult population.

METHODS

Participants (n = 253; aged ≥21 years) were categorized based on academic background and designated into groups known to differ in nutrition knowledge. Participants completed the questionnaire twice. Independent-samples t test, Pearson correlation coefficients, and Cronbach α were used to assess reliability and validity (P < .05).

RESULTS

Participants with health-related (n = 144) and nutrition-training backgrounds (n = 58) scored significantly higher than did those without them (n = 109 and 178, respectively; P < .001), indicating good construct validity of the KANKQ. Test-retest reliability (r = .67; P < .001) and internal consistency (α = .81) of the questionnaire were moderate to high.

CONCLUSIONS AND IMPLICATIONS

Further testing of the KANKQ in workplaces and public areas is required for validation in the general adult population. Applicability to neighboring countries of similar background is warranted.

Consumption of a High-Fat Diet Alters Perineuronal Nets in the Prefrontal Cortex

A key factor in the development of obesity is the overconsumption of fatty foods, which, in addition to facilitating weight gain, alters neuronal structures within brain reward circuitry. Our previous work demonstrates that sustained consumption of a high-fat diet (HFD) attenuates spine density in the prefrontal cortex (PFC). Whether HFD promotes structural adaptation among inhibitory cells of the PFC is presently unknown. One structure of interest is the perineuronal net (PNN), a specialized extracellular matrix surrounding, primarily, parvalbumin-containing GABAergic interneurons. PNNs contribute to synaptic stabilization, protect against oxidative stress, regulate the ionic microenvironment within cells, and modulate regional excitatory output. To examine diet-induced changes in PNNs, we maintained rats on one of three dietary conditions for 21 days: ad libitum chow, ad libitum 60% high fat (HF-AL), or limited-access calorically matched high fat (HF-CM), which produced no significant change in weight gain or adiposity with respect to chow controls. The PNN “number” and intensity were then quantified in the prelimbic (PL-PFC), infralimbic (IL-PFC), and ventral orbitofrontal cortex (OFC) using Wisteria floribunda agglutinin (WFA). Our results demonstrated that fat exposure, independent of weight gain, induced a robust decrease in the PNN intensity in the PL-PFC and OFC and a decrease in the PNN number in the OFC.

Portomesenteric Vein Thrombosis Post-Laparoscopic Sleeve Gastrectomy: Case Series and Literature Review

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is today one of the leading procedures in bariatric surgery, and portomesenteric vein thrombosis (PMVT) has been reported as one of its rare complications. The purpose of this study is to determine the prevalence, clinical presentation, and outcomes of PMVT in patients undergoing LSG.

METHODS

A retrospective study of a database of all post-LSG patients was conducted on the patients who developed PMVT post-LSG from July 2011 to March 2016, at Amiri Hospital, Kuwait.

RESULTS

A total of 2280 patients underwent LSG during the study period. Nine (0.39%) patients were diagnosed with PMVT post-LSG. Diagnosis was confirmed by CT scan for eight patients, and one had urgent laparotomy. The median age was 34 years (20-50), and there were 7 women and 2 men. Median preoperative body mass index (BMI) was 42 kg/m² (37.5-74.6), and median operative time was 80 min (60-150). The median post-operative anticoagulation duration was 4 days (2-22). The median onset of diagnosis after the surgery was 28 days (18-453), and two patients had a positive thrombophilia study. All patients were treated medically except one patient who underwent urgent laparotomy for small bowel necrosis and eventually had small bowel transplant.

CONCLUSIONS

PMVT post-LSG is a rare but possibly dangerous complication. It should be suspected with patients presenting with unresolving abdominal pain. Treatment is mainly conservative and surgical intervention might be needed for small bowel necrosis. Extended anticoagulation prophylaxis is a hypothesis for patients after LSG, and may play a role in preventing PMVT.

A prospective pilot study of the efficacy and safety of Elipse intragastric balloon: A single-center, single-surgeon experience

BACKGROUND

Elipse™ is the least invasive IGB for weight loss that needs no sedation or endoscopy. It is a swallowable capsule filled with 550 mL of fluid, which stays in the stomach for 16 weeks and is excreted from the gastrointestinal tract. Kuwait is one of the first countries to start using Elipse™ as a weight loss device. This study aims to evaluate the efficacy and safety of Elipse™ intragastric balloon (IGB).

MATERIALS AND METHODS

This is a single-center prospective pilot study of 51 Elipse™ insertions at our clinic. The patients were followed for 4 months to monitor their weight and body mass index (BMI) at 1, 2, and 4 months. Total weight loss, % excess weight loss (%EWL), % total body weight loss (%TBWL), and change in BMI and waist circumference (WC) were recorded at the end of the study. A short survey was administered to evaluate symptoms, complications, and overall satisfaction.

RESULTS

Fifty-one patients participated, of which five had Elipse™ removed because of intolerance. One case vomited the balloon; one had early deflation. The total weight loss was 8.84 kg, %TBWL 10.44%, %EWL 40.84%, change in BMI 3.42 kg/m², and the total WC reduction 8.62 cm. Symptoms after insertion were severe, whereas those during excretion were mild and self-limiting. No serious complications were recorded, and the overall satisfaction was above average.

CONCLUSION

Our data proves that Elipse™ is a safe and effective device for weight loss. Nevertheless, some limitations were observed that need to be overcome for better outcomes. Larger studies are needed to support our findings.

Fractures in Kuwait: incidence and distribution

The absence of descriptive epidemiological data on the frequency and distribution of fractures in a population is serious and may underestimate the actual importance of this public health problem. In this study, we report the crude and standardized incidence rates of fractures in the population of Kuwait during the period 2009-2012. Using the Ministry of Public Health's national registry, demographic data of all fracture cases between 2009 and 2012 were retrieved. These were further categorized into fractures at the hip or any other sites. Average annual incidence rates were calculated and standardized using the world's population in 2010 as a reference. Thus, 18,119 fractures among males and 6,362 among females were recorded. The overall estimated annual incidence rates of fractures per 100,000 person-years were 207 for males and 111.8 for females. Moreover, 13.3% of all fractures were in the hip, with incidence rates of 24.8 for males and 18.9 for females; while 86.7% were in other sites, with corresponding incidence rates of 182.2 and 92.8, respectively. The age-specific fracture incidence rates in females remained below the corresponding rates of males until ≥50 years of age, after which the female age groups showed successively higher rates. The age-standardized incidence rates for all fractures (hip and other sites) were 247.4 for males, 175.4 for females, and 216.2 for both sexes. The burden of this major public health challenge is set to rise, and such population-based incidence data call for an urgent need for action to reduce the projected human impact and socioeconomic costs of fracture.

Unhealthy Phenotype as Indicated by Salivary Biomarkers: Glucose, Insulin, VEGF-A, and IL-12p70 in Obese Kuwaiti Adolescents

OBJECTIVE

Here, we investigated the relationships between obesity and the salivary concentrations of insulin, glucose, and 20 metabolic biomarkers in Kuwaiti adolescents. Previously, we have shown that certain salivary metabolic markers can act as surrogates for blood concentrations.

METHODS

Salivary samples of whole saliva were collected from 8,317 adolescents. Salivary glucose concentration was measured by a high-sensitivity glucose oxidase method implemented on a robotic chemical analyzer. The concentration of salivary insulin and 20 other metabolic biomarkers was assayed in 744 randomly selected saliva samples by multiplexed bead-based immunoassay.

RESULTS

Obesity was seen in 26.5% of the adolescents. Salivary insulin predicting hyperinsulinemia occurred in 4.3% of normal-weight adolescents, 8.3% of overweight adolescents, and 25.7% of obese adolescents (p < 0.0001). Salivary glucose predicting hyperglycemia was found in only 3% of obese children and was not predictive (p = 0.89). Elevated salivary glucose and insulin occurring together was associated with elevated vascular endothelial growth factor and reduced salivary interleukin-12.

CONCLUSION

Considering the surrogate nature of salivary insulin and glucose, this study suggests that elevated insulin may be a dominant sign of metabolic disease in adolescent populations. It also appears that a proangiogenic environment may accompany elevated glucose in obese adolescents.

Association of the insertion allele of the common ACE gene polymorphism with type 2 diabetes mellitus among Kuwaiti cardiovascular disease patients

BACKGROUND AND OBJECTIVES

The D allele of the common angiotensin-converting enzyme (ACE) I/D gene polymorphism (rs4646994) predisposes to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). However, results on which allele predisposes to disease susceptibility remain controversial in Asian populations. This study was performed to evaluate the association of the common ACE I/D gene polymorphism with both T2DM and CVD susceptibility in an Arab population.

METHODS

We genotyped the ACE I/D polymorphisms by direct allele-specific PCR in 183 healthy controls and 400 CVD patients with diabetes (n=204) and without (n=196). Statistical analysis comparing between the different groups were conducted using R statistic package "SNPassoc".

RESULTS

Two genetic models were used: the additive and co-dominant models. The I allele was found to be associated with T2DM (OR=1.84, p=0.00009) after adjusting for age, sex and body mass index. However, there was no association with CVD susceptibility (p>0.05).

CONCLUSION

The ACE I allele is found to be associated with T2DM; however, no association was observed with CVD. The inconsistency between studies is suggested to be attributed to genetic diversity due to the existence of sub-populations found in Asian populations.

The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis

OBJECTIVE/DESIGN

We conducted a comparative risk assessment analysis to estimate the cardiometabolic disease (CMD) mortality attributable to 11 dietary and 4 metabolic risk factors in 20 countries of the Middle East by age, sex and time. The national exposure distributions were obtained from a systematic search of multiple databases. Missing exposure data were estimated using a multilevel Bayesian hierarchical model. The aetiological effect of each risk factor on disease-specific mortality was obtained from clinical trials and observational studies. The number of disease-specific deaths was obtained from the 2010 Global Burden of Disease mortality database. Mortality due to each risk factor was determined using the population attributable fraction and total number of disease-specific deaths.

SETTING/POPULATION

Adult population in the Middle East by age, sex, country and time.

RESULTS

Suboptimal diet was the leading risk factor for CMD mortality in 11 countries accounting for 48% (in Morocco) to 72% (in the United Arab Emirates) of CMD deaths. Non-optimal systolic blood pressure was the leading risk factor for CMD deaths in eight countries causing 45% (in Bahrain) to 68% (in Libya) of CMD deaths. Non-optimal body mass index and fasting plasma glucose were the third and fourth leading risk factors for CMD mortality in most countries. Among individual dietary factors, low intake of fruits accounted for 8% (in Jordan) to 21% (in Palestine) of CMD deaths and low intake of whole grains was responsible for 7% (in Palestine) to 22% (in the United Arab Emirates) of CMD deaths. Between 1990 and 2010, the CMD mortality attributable to most risk factors had decreased except for body mass index and trans-fatty acids.

CONCLUSIONS

Our findings highlight key similarities and differences in the impact of the dietary and metabolic risk factors on CMD mortality in the countries of the Middle East and inform priorities for policy measures to prevent CMD.

Public, environmental, and occupational health research activity in Arab countries: bibliometric, citation, and collaboration analysis

BACKGROUND

The objective of this study was to analyze quantity, assess quality, and investigate international collaboration in research from Arab countries in the field of public, environmental and occupational health.

METHODS

Original scientific articles and reviews published from the 22 Arab countries in the category "public, environmental & occupational health" during the study period (1900 - 2012) were screened using the ISI Web of Science database.

RESULTS

The total number of original and review research articles published in the category of "public, environmental & occupational health" from Arab countries was 4673. Main area of research was tropical medicine (1862; 39.85%). Egypt with 1200 documents (25.86%) ranked first in quantity and ranked first in quality of publications (h-index = 51). The study identified 2036 (43.57%) documents with international collaboration. Arab countries actively collaborated with authors in Western Europe (22.91%) and North America (21.04%). Most of the documents (79.9%) were published in public health related journals while 21% of the documents were published in journals pertaining to prevention medicine, environmental, occupational health and epidemiology.

CONCLUSION

Research in public, environmental and occupational health in Arab countries is in the rise. Public health research was dominant while environmental and occupation health research was relatively low. International collaboration was a good tool for increasing research quantity and quality.

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.