Do routinely measured risk factors for obesity explain the sex gap in its prevalence? Observations from Saudi Arabia

The association of early feeding practices with eating behaviors and maternal indulgent feeding behaviors among Saudi preschoolers

Evidence from previous work suggest that feeding practices during the first years of life may influence the development of eating behaviors later in childhood. Early feeding practices may also predict later maternal feeding behaviors. Mothers from an Arab/Middle Eastern background may adopt unique early feeding practices. The objective of this study was to examine the association of offering fruit juice and date syrup-milk mixture in a baby bottle during infancy with: 1) Child eating behaviors during preschool years; 2) Maternal indulgent feeding practices during preschool years. Mothers of preschoolers (n = 115) completed questions adopted from the Children's Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire-Arabic (CFQ-A), as well as questions assessing early feeding practices and demographic characteristics. Unadjusted and adjusted logistic regression models were tested to examine the association of early feeding practices with child eating behaviors and maternal indulgent feeding behaviors. Odds ratios (ORs) and respective 95% confidence intervals (CI) were derived. Adjusting for covariates, children who were ever offered fruit juice in a baby bottle as infants were more likely to have high food responsiveness at preschool, compared to children who were not (OR = 2.93, 95% CI = 1.16, 7.42). Mothers who reported ever offering fruit juice in a baby bottle when their children were infants were more likely to adopt greater use of food as a reward when their children were at preschool (OR = 3.25, 95% CI = 1.22, 8.68). Early feeding practices are associated with child eating and maternal feeding behaviors later in childhood. Future longitudinal studies are needed to further establish these associations. Findings from this study can help inform community awareness and education programs to prevent maladaptive feeding practices and promote appropriate feeding strategies throughout childhood.

The Impact of Age, Gender, Temporality, and Geographical Region on the Prevalence of Obesity and Overweight in Saudi Arabia: Scope of Evidence

OBJECTIVES

The objectives of this scoping review are to estimate the prevalence of obesity and overweight in the Saudi community and in different age groups, genders, and geographical location, in addition to the change in prevalence over time.

METHODS

This scoping review of evidence was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and was reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The population of this review was categorized into four age groups: young adults (18-25 years), adults (26-45), (mid-life adults) (46-60) and old people (60+). Each group was then categorized by gender into males and females. We included studies of adults aged 18 years and above. The pooled prevalence of obesity and overweight of the population, based on BMI, was estimated after stratification based on the age, gender, and geographical area. In addition, the change in the prevalence of obesity/overweight over time from 2011 to 2021 was investigated from the pooled data. The Metaprop program in Stata was used for statistical analysis.

RESULTS

A total of 39 studies with 640,952 participants were included in this review. The pooled prevalence of obesity and overweight in the age group of ≤25 years old, including both genders, was 30%. However, it was higher in young males (40%) compared to young females (25%). The prevalence of obesity and overweight among young adults has dropped by over 40% between 2012 and 2021. The overall pooled prevalence rate of obesity and overweight in the age groups >25 years old (adults, mid-life, and old people), including both genders, was 66%, with similar prevalence among males (68%) and females (71%). In addition, a similar prevalence was observed among both adult and old people (62% and 65%, respectively), but was higher in the mid-life group (76%). Furthermore, mid-life women had the highest prevalence among all groups (87%), compared to 77% among males in the same age group. The same difference in prevalence between the gender persisted in older females compared to older males (79% vs. 65%, respectively). There is a noticeable drop in the pooled prevalence of overweight and obesity among adults > 25 years old of over 28% between 2011 and 2021. There was no difference in the prevalence of obesity/overweight by geographical region.

CONCLUSIONS

Despite the noticeable drop in the prevalence of obesity in the Saudi community, the prevalence of high BMI is high in Saudi Arabia irrespective of age, gender, or geographical location. Mid-life women have the highest prevalence of high BMI, which makes them the focus of a tailored strategy for intervention. Further research is needed to investigate which are the most effective interventions to address obesity in the country.

Effect of the COVID-19 pandemic on the proportion of physically active children and adults worldwide: A systematic review and meta-analysis

Introduction

Safety measures implemented to address the COVID-19 pandemic have had a profound impact on the mobility of people worldwide We synthesized the global evidence on physical activity (PA) participation before and during the pandemic.

Methods

We conducted a systematic review, searching PubMed, Embase, WHO Global literature on coronavirus disease (between January 2020 and April 2022), and reference lists. Meta-analysis and meta-regression were conducted to quantitatively synthesize the data.

Results and discussion

Sixty-three primary studies were included. In children, the global pooled prevalence of PA was 46.4% before the pandemic, 40.6% during the pandemic before movement restriction (MR), and 19.5% during MR. A statistically significant decrease in prevalence was observed between the period before the pandemic and the period during which MR was implemented (p < 0.001). In adults, the global pooled prevalence (both sexes) decreased between the periods before the pandemic (64.7%) and during MR (57.0%). During the period of COVID-19 MR, children had significantly lower odds to meet the WHO PA recommendation than adults (19.5%, 95%CI: 15.8-23.8% vs. 57.0%, 95%CI: 43.3-62.5%; OR = 0.21; p ≤ 0.001). Patient populations were less active than the general population, and their PA levels decreased during the pandemic. Mental and physical health benefits of PA have been well-demonstrated. Prioritizing PA in health campaigns and strategies is critical to address health issues exacerbated during this pandemic.

Protocol registration

doi: 10.17605/OSF.IO/GVABX.

Early feeding practices and body mass index z-score among Saudi preschoolers: a cross-sectional study

Background:

Feeding practices during early years may have long-lasting influences on eating behaviors, growth patterns and body mass index (BMI) trajectory. The objectives of this study were to characterize early feeding practices among mothers in Saudi Arabia and examine their associations with child birthweight and BMI z-score (BMIz) at preschool.

Methods:

This is a cross-sectional study including 209 mother-child dyads who were recruited from different preschools around the city of Jeddah, Saudi Arabia. Mothers completed the study questionnaire over the telephone and preschoolers’ anthropometric measurements were objectively measured using standardized procedures. Primary predictors included variables pertaining to breastfeeding initiation, breastfeeding duration, formula milk introduction, complementary feeding, and offering fruit juice, date syrup-milk mixture, and soda drinks in a baby bottle. The study’s primary outcome was BMIz at preschool. Mothers reported child’s birthweight and sociodemographic characteristics. Descriptive statistics were used to characterize early feeding practices. Bivariate analyses and linear regression analysis were used to examine the association of early feeding practices with child birthweight and BMIz at preschool.

Results:

About half of the mothers reported that they have offered fruit juice and/or date syrup-milk mixture in a baby bottle (52.2% and 45.9% respectively), with an average duration of 11.5 months (SD = 7.73) and 5.90 months (SD = 6.13), respectively. Children who were offered fruit juice and/or date syrup-milk mixture in a baby bottle had significantly lower birthweights compared to children who were not (M = 2.79, SD = 0.59 vs. M = 3.06, SD = 0.69, P < 0.01 and M = 2.79, SD = 0.67 vs. M = 3.03, SD = 0.62, P < 0.01, respectively). There was a negative association between introducing fruit juice in a baby bottle and child BMIz at preschool (β: -0.18, 95% confidence interval (CI): -0.83, -0.11); This association was not significant after adjusting for child birthweight and other covariates (β: -0.10, 95% CI: -0.64, 0.09).

Conclusion:

A large proportion of mothers reported offering fruit juice and date syrup-milk mixture in a baby bottle. Additional research is needed to understand associations with child birthweight and BMIz. Longitudinal and interventions studies can help inform counseling guidelines and community campaigns in order to improve early feeding practices in the region.

Self-health assessments in Saudi Arabia: Directions for an integrated primary healthcare

Background

Public health data for dissemination and discussion in Saudi Arabia, for the purposes of primary healthcare, are limited but the new initiatives of General Authority of Statistics creates many national surveys. One of the most recent one, the Family/Household Health Survey - 2017 aims to fill the gaps, at the same time, aids in discussions on primary healthcare.

Objectives

Analyses done in this research are aimed at appraising the self-assessed health and to examine age-sex and geographic differentials and their probable interconnections with chronic diseases, injuries, and periodic examinations.

Data and Methods

This survey conducted in October-December, 2017 covered both native and foreigner households from all the 13 administrative areas through a random sample procedure involving primary sampling units and secondary sampling units. A portion of the published data on self-assessment of health, chronic diseases, injuries, and periodic medical examinations were analyzed.

Results

More than half of the persons in the Kingdom, reportedly, are in good health; more so among females than males: proportions decreased with increasing age up to 40 years, thereafter increased sharply. Moreover, the major regions have lesser proportion of people with good health. Prevalence of chronic diseases increases with age, in both total and native population, but with variations across specific diseases - hypertension, diabetes, cancer, and cardiovascular diseases (CVDs) and with geographic differentials. On the other hand, there are injuries (from traffic accidents and others) occurred at house, work/school, public place, and other places; pertinent with geographic variations. Moreover, age, sex, and regional differences in periodic health examinations have a contributing effect on health assessments. Moreover, the median age shows a pattern resembling adults assessing good health; chronic diseases after 50s; injuries before 40s; periodic medical examinations in 50s; with females at a lower age, in both groups of population.

Conclusions

The national health system played an important role not only in health status and health assessments but also in building confidence and trust and thereby enhancing optimism, realism, recognition, self-awareness, and acceptance of physical condition. Thus, age, sex, and regional variations in health assessment are born out of chronic diseases, injuries, and periodic medical examinations and also of expectations and experiences. Generation of such information, effective dissemination, and regular discussions at various levels followed by in-depth analyses raise the primary healthcare and thus the population health.

Changes in Feeding Behavior and Feeding Stress Among Mothers of Preschoolers Before and During the Novel Coronavirus Pandemic

Objective

To examine changes in maternal feeding behaviors (MFB) and maternal feeding stress (MFS) among mothers of preschoolers in Saudi Arabia before and during the novel coronavirus pandemic.

Methods

This is a prospective cohort study including 64 mothers of preschoolers who were drawn from a sample of a 2019 study. Study questionnaire was completed during November–December 2020. MFB were assessed using the Child Feeding Questionnaire-Arabic (CFQ-A) and MFS was assessed using the MFS-mealtimes index and the MFS-maternal resentment/difficult child index. Paired samples t-tests were used to examine changes in MFB and MFS.

Results

Mothers have reported an increase in perceived responsibility (M = 4.09, SD = 0.87 vs. M = 4.33, SD = 0.59, P-value < 0.05) and monitoring (M = 4.23, SD = 0.73 vs. M = 4.48, SD = 0.66, P-value < 0.05) during the pandemic period compared to the period prior to the pandemic. Mothers have reported a decrease in use of food as a reward (M = 4.11, SD = 0.87 vs. M = 2.30, SD = 0.88, P-value < 0.001) and concern about child's diet (M = 3.34, SD = 1.12 vs. M = 2.55, SD = 1.04, P-value <0.001). There was an increase in MFS-maternal resentment/difficult child (M = 2.47, SD = 0.68 vs. M = 2.71, SD = 0.72, P-value < 0.01).

Conclusions

Findings can help inform future research aiming to measure the long-term effects of the pandemic on child outcomes.

The Association between Sibship Composition and Child Eating Behaviors

Development of eating habits and patterns during childhood can have life-long effects on weight and health status. Family structure, functioning, and interactions during mealtimes may influence the development of eating behaviors among children. The objective of this study was to examine the association between sibship composition and child eating behaviors among preschoolers in Saudi Arabia. One hundred and fifteen mothers were recruited through various preschools around the city of Jeddah, Saudi Arabia. A previously validated Arabic version of the Children's Eating Behavior Questionnaire (CEBQ) was completed over the telephone along with questions assessing sibship composition and demographic characteristics. Spearman correlations and adjusted linear regression models were examined to assess the association between sibship composition and child eating behaviors. Adjusting for covariates, number of older siblings was positively associated with emotional over eating, food responsiveness, and the desire to drink. Number of older sisters was positively associated with the desire to drink but negatively associated with food fussiness. Having a greater number of older (rather than younger) siblings may be associated with food-approach eating behaviors. Having a greater number of older sisters may be associated with less food fussiness. Focusing on older siblings in encouraging healthy eating habits and appropriate food choices may be beneficial in promoting adaptive eating behaviors and prevention of excessive energy intake and weight gain. Future longitudinal and mixed-methods research studies with larger sample sizes are needed in order to better understand the underlying mechanisms for the associations between sibship composition and child eating behaviors.

The Association between Obesity and Chronic Conditions: Results from a Large Electronic Health Records System in Saudi Arabia

This cross-sectional study aimed to estimate the prevalence of obesity and its association with diabetes and hypertension among beneficiaries in the National Guard Health Affairs system of Saudi Arabia. We included individuals aged 17 years and older, and patients were classified as diabetic or hypertensive if they had any visit during the 4 years where the primary diagnosis was one of those conditions or they were taking diabetes or hypertension medications. The association between obesity (body mass index ≥30) and diabetes and hypertension were evaluated using a multiple logistic regression model, adjusting for age, gender, nationality, and region. A total of 616,092 individuals were included. The majority were Saudi nationals (93.1%). Approximately 68% of the population were either obese (38.9%) or overweight (29.30%). Obesity was more prevalent among Saudi nationals (39.8% vs. 26.7%, p < 0.01) and females (45.3% vs. 31.2%, p < 0.01). Obesity was independently associated with diabetes mellitus (OR = 2.24, p < 0.01) and hypertension (OR = 2.15, p < 0.01). The prevalence of obesity in the study population was alarming and more pronounced among women. Our findings call for efforts to intensify preventive measures to reduce obesity and associated conditions. Using electronic records to examine the impact of interventions to reduce obesity and chronic conditions may help monitor and improve population health.

Barriers and Facilitators Associated with Physical Activity in the Middle East and North Africa Region: A Systematic Overview

Increasing physical inactivity levels in the Middle East and North Africa (MENA) region is a public health concern. We aimed to synthesize barriers and facilitators to physical activity and make appropriate recommendations to address physical inactivity. We conducted an overview of systematic reviews on physical activity barriers and facilitators in 20 MENA countries by systematically searching MEDLINE/PubMed and Google Scholar for systematic reviews published between 2008 and 2020. Our overview included four systematic reviews and 119 primary studies with data from 17 MENA countries. Lack of suitable sports facilities, time, social support and motivation, gender and cultural norms, harsh weather, and hot climate were the most commonly reported barriers to physical activity. Socio-demographic factors negatively associated with physical activity participation include advanced age, being female, less educated, and being married. Motivation to gain health benefits, losing/maintaining weight, being male, dietary habits, recreation, and increased Body Mass Index are positively associated with increased levels of physical activity. Interventions promoting physical activity in MENA should target schoolchildren, women and girls, working parents, and the elderly. Country-specific sociocultural and environmental factors influencing physical activity should be considered in the design of interventions. Current and future policies and national interventions must be consistently evaluated for effectiveness and desired outcomes.

Differences in overweight/obesity prevalence by demographic characteristics and self-weight misperception status

BACKGROUND & AIMS

Increasing the prevalence of overweight and obesity is one of the main concerns of health systems of the world. This research was conducted to estimate the prevalence of overweight/obesity and its related factors in the Eastern part of Iran.

METHODS

An analytical, cross-sectional study was conducted among 1048 inhabitants aged between 15 and 64 years who lived in Gonabad and Bajestan, two districts locating in the East of Iran, in 2016. A probability proportional to size stratified sampling was used to select the participants. We applied a checklist to collect the required data. Analyzing the data, we used t-test, χ2, and ANOVA. A significant level of 0.05 was considered in this study.

RESULTS

Total prevalence of overweight/obesity was 43.8%. There were significant associations between overweight/obesity and age (P < 0.001), sex (P = 0.008 in Gonabad, P = 0.004 in Bajestan), marital status (P < 0.001, in Gonabad, P = 0.001 in Bajestan), and job (P < 0.001). There was also a discrepancy between the participants' self-perception of weight and their real weight status.

CONCLUSION

The findings of the present study showed a high prevalence of overweight/obesity among women, government employees, and married individuals. Therefore, focusing on these groups in implementing weight control interventions is recommended. According to the high prevalence of obesity in housewives as well as the role of women to control the normal weight of their family members via providing healthy food, it seems that one of the most effective groups in the programs would be housewives. Besides, strengthening health literacy is recommended to eliminate self-weight misperception.

Perceived Effect of Calorie Count Display on Customers' Eating Behaviors in Food Facilities of Eastern Province, Saudi Arabia: A Mixed Method Study

Background

As the Saudi Food and Drug Authority (SFDA) has recently requested all food facilities to display the calorie count on their menus, this study aimed to identify the perceived changes in costumers’ eating behaviours in response to the calorie count display (CCD) policy in the Eastern Province.

Methods

This was a mixed methods study. The first being quantitative, using a cross-sectional questionnaire which included 400 customers of both genders, aged 10 years and older, and was collected at food facilities from three cities in the Eastern Province. Customers completed a self-administered questionnaire and handed their registered receipts. Collected receipts were used to calculate the total calories ordered per customer. The second method is a qualitative in-depth interview with food facility managers.

Results

Customers who reported checking the CCD were 30.5% of the total sample, and 58.2% of them changed their order accordingly. The mean calories ordered were 36 kcal less in customers checking the CCD than those who do not (P=0.674). Customers who exhibit healthy lifestyle habits calculate their daily consumed calories, knowledgeable of the recommended daily caloric intake (RDCI), dining in a dine-in restaurant, and have an educational level of above high school were more likely to check the CCD. This study found that customers who cared to check the CCD were more likely to change their eating behavior. It has been found that only a small percentage (12% to 18%) of customers were knowledgeable regarding the RDCI. After the implementation of the policy, restaurant managers reported a positive change in customers eating behavior, which was more profound in females and athletes.

Conclusion

There is a significant association between checking the CCD and positive behavioral changes in customers’ eating behaviors. The results of this study suggest that further enforcement and awareness raising are crucial to increase the number of customers checking and using the CCD.

Metabolic syndrome amongst adults in Jordan: prevalence, trend, and its association with socio-demographic characteristics

BACKGROUND

Multiple epidemiological studies were conducted amongst a variety of ethnic groups and showed discrepancies in the prevalence of metabolic syndrome (MeS) and its individual components. This study aimed to determine the prevalence of MeS in Jordan using both the Adult Treatment Panel Guidelines (ATP III) and the International Diabetes Federation (IDF) criteria. The study also aimed to assess the changes in the prevalence of MeS over time and determine its association with sociodemographic variables.

METHODS

Data from the 2017 Cardiovascular Disease Risk Factors Survey were used for this study. Socio-demographic and clinical data were collected using a structured questionnaire. Blood samples were taken for biochemical measurements. Furthermore, anthropometric characteristics were measured by the same team of trained field researchers. A sample of 4,056 individuals aged between 18 and 90 years was included in this study. The findings from the 2017 survey were compared with the findings of a 2009 survey that adopted the same methods and procedures.

RESULTS

According to the IDF criteria, the crude prevalence of Metabolic syndrome was 48.2% (52.9% among men and 46.2% among women; p < 0.001). Using the ATP III criteria, the prevalence was 44.1% (51.4% among men and 41% among women, p < 0.001). The age-standardized prevalence rate of metabolic syndrome was 44% (95% CI 42.7, 45.4) and 39.9% (95% CI 39.6, 41.2), according to both the IDF definition and ATP III criteria, respectively. The Kappa measure of agreement showed excellent agreement between the two definitions (k = 81.9%, p < 0.001). Of all participants, 41.7% met both the IDF and ATP III diagnostic criteria, 6.6% met the IDF criteria only, and 2.5% met the ATP III criteria only. The age-standardized prevalence rate of metabolic syndrome was significantly higher in 2017 (45.7% in men and 44.5% in women) than that in 2009 survey (34.6% in men and 39.8% in women). Gender, age, occupation, region, and marital status were significantly associated with metabolic syndrome.

CONCLUSIONS

The prevalence of metabolic syndrome in Jordan is considerably high and it is increasing. Healthy lifestyle programs encouraging appropriate dietary habits and physical activity are strongly recommended in Jordan.

Physical activity and sedentary behaviour in the Middle East and North Africa: An overview of systematic reviews and meta-analysis

To support the global strategy to reduce risk factors for obesity, we synthesized the evidence on physical activity (PA) and sedentary behaviour in the Middle East and North Africa (MENA) region. Our systematic overview included seven systematic reviews reporting 229 primary studies. The meta-analysis included 125 prevalence measures from 20 MENA countries. After 2000, 50.8% of adults (ranging from 13.2% in Sudan to 94.9% in Jordan) and 25.6% of youth (ranging from 8.3% in Egypt to 51.0% in Lebanon) were sufficiently active. Limited data on PA behaviours is available for MENA countries, with the exception of Gulf Cooperation Council countries. The meta-regression identified gender and geographical coverage among youth, and the PA measurement as predictors of PA prevalence for both adults and youth. Our analysis suggests a significant PA prevalence increase among adults over the last two decades. The inconsistency in sedentary behaviour measurement is related to the absence of standardized guidelines for its quantification and interpretation. The global epidemic of insufficient PA is prevalent in MENA. Lower PA participation among youth and specifically females should be addressed by focused lifestyle interventions. The recognition of sedentary behaviour as a public health issue in the region remains unclear. Additional data on PA behaviours is needed from low- and middle-income countries in the region.

Understanding the Interrelationship between Education, Income, and Obesity among Adults in Saudi Arabia

OBJECTIVE

To examine the association of sociodemographic variables with the odds of being obese among adults in Saudi Arabia, and to examine whether or not the association between the educational level and the odds of being obese among adults in Saudi Arabia is modified by the income level.

METHODS

A total of 3,925 participants were recruited for this cross--sectional study. Sociodemographic and anthropometric data were collected using standardized procedures. Unadjusted and adjusted logistic regression models were examined, with a dichotomous obesity status variable as the outcome. Furthermore, an interaction term for income level with educational level was tested and appeared significant. Thus, additional regression models were run in order to examine the association between educational level and obesity status separately among the low- and higher-income groups.

RESULTS

Compared to participants with a college degree or higher, illiterate participants and those with an elementary education had higher odds of obesity (OR: 2.76, 95% CI: 1.81-4.22, and OR: 2.68, 95% CI: 1.89-3.82, respectively). However, participants with a low income had lower odds than participants who had a higher income (OR: 0.84, 95% CI: 0.70-0.99). Examining the association between educational level and obesity while stratifying by income revealed that a negative association between education and obesity exists among both income groups. However, the magnitude of the ORs was higher among participants with higher income, suggesting a stronger association between education and obesity among wealthier individuals.

CONCLUSION

Individuals in the highest income bracket with lower levels of education may have greater odds of obesity. Targeting them in intervention programs is warranted.

Sociodemographic factors associated with postpartum physical activity levels in working women

Postpartum physical activity is important but is often neglected owing to conflicting priorities. Given the poor activity levels in the general Saudi population, women are especially likely to have poor postpartum activity levels. This study measured postpartum physical activity of Saudi working women and investigated the relationship between physical activity levels and sociodemographic factors. Study design: Cross-sectional study. This was a cross-sectional study conducted between January and June 2017. Working, postpartum Saudi women completed an online questionnaire including demographic information and the International Physical Activity Questionnaire (IPAQ)-short form. Of 486 women responding to the online invitation, 142 (29.2%) were eligible and participated. Based on IPAQ data, 23 (16.2%), 31 (21.8%), and 88 (62.0%) participants performed high, moderate or low levels of physical activity, respectively. No significant associations were found between the physical activity levels and sociodemographic factors. The most common factors discouraging physical activity were lack of time (21.2%) and childcare responsibilities (19.1%). The majority of participating working Saudi women had low postpartum physical activity levels. No sociodemographic factors were significantly associated with the level of physical activity. Measures may be required to promote postpartum physical activity among Saudi women.

Cardiovascular risk and fruit and vegetable consumption among women in KSA; A cross-sectional study

Objectives

This study aims to assess fruit and vegetable consumption among Saudi women to identify perceived benefits and barriers associated with a healthy diet in cardiovascular disease (CVD) risk prevention and to correlate Framingham risk scores (FRSs) with the perceived barriers.

Methods

A questionnaire adapted from the Health Beliefs Related to Cardiovascular Disease Scale was administered to women attending a primary care centre in KSA. In addition to descriptive statistics, a chi-square test and multiple linear regression analysis were used to determine the association between perceptions of benefit and barriers with FRS categories and between mean FRS and perceived barriers.

Results

A total of 503 women were included in this study, and 75% of the women were older than 45 years. More than 60% of women were obese, and 97% consumed 1–3 fruit and vegetable servings per day, whereas only 1.4% consumed fruits and vegetables 5 or more times per day. The majority of women were aware of the benefits of a healthy diet in CVD prevention. No significant difference between FRS and perceived benefits or barriers was observed. Barriers across the low- to high-risk groups included a lack of knowledge about a ‘healthy diet’, insufficient time to cook, food affordability, and having more important problems. Women who disagreed on barriers had negative beta coefficients for the mean FRS (p < 0.03).

Conclusions

In this study cohort, fruit and vegetable intake was lower than the recommended guidelines. Despite awareness of the benefits of a healthy diet in CVD prevention, very few women understood the true meaning of ‘healthy diet’. A direct association between FRS and perceptions/barriers could not be validated. Perceived barriers could be addressed by integrating innovative educational campaigns to existing models of the Healthy Food Plan.

Physical inactivity, gender and culture in Arab countries: a systematic assessment of the literature

Background

Physical inactivity is associated with excess weight and adverse health outcomes. We synthesize the evidence on physical inactivity and its social determinants in Arab countries, with special attention to gender and cultural context.

Methods

We searched MEDLINE, Popline, and SSCI for articles published between 2000 and 2016, assessing the prevalence of physical inactivity and its social determinants. We also included national survey reports on physical activity, and searched for analyses of the social context of physical activity.

Results

We found 172 articles meeting inclusion criteria. Standardized data are available from surveys by the World Health Organization for almost all countries, but journal articles show great variability in definitions, measurements and methodology. Prevalence of inactivity among adults and children/adolescents is high across countries, and is higher among women. Some determinants of physical inactivity in the region (age, gender, low education) are shared with other regions, but specific aspects of the cultural context of the region seem particularly discouraging of physical activity. We draw on social science studies to gain insights into why this is so.

Conclusions

Physical inactivity among Arab adults and children/adolescents is high. Studies using harmonized approaches, rigorous analytic techniques and a deeper examination of context are needed to design appropriate interventions.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5472-z) contains supplementary material, which is available to authorized users.

Obesity and outcome of post-menopausal women receiving adjuvant letrozole for breast cancer

Introduction

Aromatase enzyme activity is predominant in adipose tissue. This has led to speculation that aromatase activity is elevated in obese women and subsequently decreased the clinical activity of adjuvant aromatase inhibitors (AIs) in women with estrogen receptor positive (ER+) breast cancer (BC). We investigated the effect of obesity on the outcome of this population.

Patients and methods

Records of 320 consecutive post-menopausal (PM) women with ER+ BC starting single agent adjuvant letrozole between years 2005 and 2014 were retrospectively reviewed. Tumour and patients characteristic including body mass index (BMI) on the day of starting letrozole were extracted. Endpoints of main interest were: (1) Frequency of obesity; (2) relapse-free survival (RFS) in nonobese (G1; BMI < 30) and obese (G2; BMI ≥ 30) patients.

Results

Obesity (BMI: 30–34.99) and morbid obesity (BMI ≥ 35) were present in 105/320 (32.8%) and 115/320 (35.9%) women, respectively. Median follow-up of patients was 49 months; RFS at 5 years (G1: 69% versus G2: 78%) and at 8 years (G1: 69% versus G2: 71%). Median RFS is not reached in both groups (Log rank; P = 0.097). There was no correlation between BMI and RFS (correlation coefficient r = 0.075; P = 0.174).

Conclusion

In this cohort, more than two-thirds of PM women starting adjuvant AIs are obese. Obesity did not adversely affect the outcome of women on adjuvant letrozole.

Trends in overweight or obesity and other anthropometric indices in adults aged 18-60 years in western Saudi Arabia

BACKGROUND

The prevalence of overweight and obesity has increased considerably in Saudi Arabia in the past two decades. We conducted this study because to examine trends in weight gain with age and related anthropometric measurements in Saudi Arabia such data are limited.

OBJECTIVE

To determine trends in overweight and obesity and examine anthropometric indices by age group.

DESIGN

Analytical cross-sectional study.

SETTING

Universities, malls, and hospitals in the cities of Mecca, Jeddah, and Al-Taif.

METHODS

Participants were selected by convenience sampling. Body weight, body fat percentage, visceral fat percentage, and skeletal muscle percentage were measured with the Omron body composition monitor device. Waist circumference, height, and body mass index (BMI) were also measured.

MAIN OUTCOME MEASURE(S)

Changes in BMI, body fat percentage, visceral fat percentage, and skel-etal muscle with age for both genders.

RESULTS

We selected 2548 Saudis, 1423 males and 1125 females, aged 18 to 60 years. A significant trend (ptrend < .001) for BMI and all anthropometric indices was observed with age for both genders. About 55.1% of the participants were overweight and obese (BMI > 25 kg/m2). Obesity and overweight were more prevalent in men than in women and was observed early in both genders, at the ages of 18-19 in men and 30-39 years for women. In the age range of 40-60 years, muscle mass dropped significantly (P < .05) for both genders. Mean waist circumference and visceral fat were significantly (P < .001) higher in men than in women, but the mean total body fat percentage was higher in females than in males (P < .001).

CONCLUSIONS

Significant trends were observed for BMI, WC, body fat, visceral fat, and muscle mass for both genders with age. National programs should be maintained to encourage physical activity and weight reduction as well as focusing on obesity-related lifestyle and behaviors at early ages to prevent weight gain and possibly muscle wasting with age.

LIMITATIONS

There was an unequal distribution in numbers of subjects between study groups. Convenience sampling was used to recruit the participants.

Growth Profile and Its Association with Nutrient Intake and Dietary Patterns among Children and Adolescents in Hail Region of Saudi Arabia

Hail region of Saudi Arabia (KSA) has the highest adult obesity rates in the entire kingdom and limited information is available about the prevalence and patterns of growth markers. Therefore, it is important to monitor the growth trends to implement effective public health preventive strategies for the region. This study aims to estimate the prevalence of growth profile patterns (stunting, wasting, underweight, and overweight) and its associations with nutrient intake and dietary patterns among children and adolescents. A cross-sectional survey was conducted involving 1420 children and adolescents (2-18 years), selected using a multistage stratified random-sampling technique representing both female and male schools from Hail region, KSA. Growth profile z-scores were generated using 2006 and 2007 WHO growth standards. The overall prevalence of 4.73% moderate and 1.54% severe underweight; 6.65% moderate and 2.59% severe stunting; 6.34% moderate and 2.55% severe wasting was present in the study population. Stunting decreased as age progressed with concurrent increase in the prevalence of overweight and obesity. There was a significantly higher prevalence of overweight (18.55% versus 23.05%; P < 0.001) and obesity (8.7% versus 13.85%; P < 0.001) in adolescents than in school-age children with higher prevalence in females as compared to males. Both stunted and overweight/obesity groups had significantly lower mean intakes for critical micronutrients necessary for growth as compared to normal children.

Health system changes under pay-for-performance: the effects of Rwanda's national programme on facility inputs

Pay-for-performance (P4P) programmes have been introduced in numerous developing countries with the goal of increasing the provision and quality of health services through financial incentives. Despite the popularity of P4P, there is limited evidence on how providers achieve performance gains and how P4P affects health system quality by changing structural inputs. We explore these two questions in the context of Rwanda's 2006 national P4P programme by examining the programme's impact on structural quality measures drawn from international and national guidelines. Given the programme's previously documented success at increasing institutional delivery rates, we focus on a set of delivery-specific and more general structural inputs. Using the programme's quasi-randomized roll-out, we apply multivariate regression analysis to short-run facility data from the 2007 Service Provision Assessment. We find positive programme effects on the presence of maternity-related staff, the presence of covered waiting areas and a management indicator and a negative programme effect on delivery statistics monitoring. We find no effects on a set of other delivery-specific physical resources, delivery-specific human resources, delivery-specific operations, general physical resources and general human resources. Using mediation analysis, we find that the positive input differences explain a small and insignificant fraction of P4P's impact on institutional delivery rates. The results suggest that P4P increases provider availability and facility operations but is only weakly linked with short-run structural health system improvements overall.

Cardiovascular disease risk profile among young Saudi women of Al-Qassim, Saudi Arabia: A cross-sectional study

STUDY OBJECTIVE

The aim of the study was to assess the level of risk for cardiovascular diseases (CVD) among young Saudi women living in Al-Qassim, Saudi Arabia.

METHODS

As part of "The Heart Protection Campaign" in the Al-Qassim region, data were collected from Saudi women using questionnaires as well as objective measurement of height, weight, blood pressure, and blood glucose. Data were analyzed using descriptive statistics.

RESULTS

Only 15% of the sample were free of risk factors, the majority had either one (57.5%) or two (20.8%) risk factors. Additionally, 6.7% were considered to be at high-risk with three or more risk factors. The most common risk factors were physical inactivity (74%) and overweight/obesity, (25%/29%). There was a significant increase in the number of risk factors across age groups. Women over the age of 30 were more likely to have a higher number of risk factors than the younger women (20-24 years).

CONCLUSIONS

Young women in Al-Qassim, Saudi Arabia have an unusually high risk for CVD. Since the number of risk factors increases substantially between the ages of 20 and 35, there is a need to develop prevention programs to lower the CVD risk through diet and exercise.