Prevalence of obesity among school-age children and adolescents in the Gulf cooperation council (GCC) states: a systematic review

An examination of the predictors of change in BMI among 38 026 school students in Makkah, Saudi Arabia

BACKGROUND

The prevalence of childhood obesity has substantially increased in the Gulf Cooperation Council countries, including Saudi Arabia. The Rashaka initiative is a Saudi national school-based multicomponent intervention that was introduced in the school year 2016-2017 to address childhood overweight and obesity. This study aims to examine the effect of the Rashaka initiative on students' body mass index (BMI) for two academic years (2016-2017 and 2018-2019) and to analyse predictors of BMI change.

METHODS

Secondary data for this pre-post study was provided by the Ministry of Health for 38 026 students from 89 intermediate and secondary schools that implemented the initiative in Makkah City, Saudi Arabia. It was analysed using non-parametric tests and multiple regressions at a 5% level of significance.

RESULTS

Over 2 y of implementation, BMI was reduced significantly across the schools (p < 0.001). Based on the regression modelling, school gender and education stage were found to be the only significant predictors of BMI change. Girls and intermediate schools had greater BMI reductions than boys and secondary schools (p < 0.001 and p = 0.031).

CONCLUSIONS

This study provides tentative evidence for the effectiveness of the Rashaka intervention in Makkah City. In addition, our study has identified that the Rashaka initiative may require modification to improve its effect on boys and students in secondary schools.

A systematic review of school-based weight-related interventions in the Gulf Cooperation Council countries

BACKGROUND

The prevalence of childhood overweight and obesity has increased at alarming levels in the Gulf Cooperation Council (GCC) countries (Saudi Arabia, United Arab Emirates (UAE), Kuwait, Bahrain, Oman, and Qatar). Weight-related interventions are urgently required in these countries to tackle childhood overweight and obesity and their-related consequences. To date, no systematic review has synthesised school-based weight-related interventions in the six GCC countries. This study aims to systematically review school-based, weight-related interventions conducted in the GCC countries, investigating the intervention characteristics, components, and outcomes.

METHODS

Medline, Scopus, and ProQuest databases were searched for peer-reviewed literature published in English without date restriction and Google Scholar for grey literature using combined Medical Subject Heading (MeSH) terms and keywords under five relevant concepts including population, setting, interventions, outcomes, and geographical location. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), records were identified, screened for eligibility, and included in this review. Using the Effective Public Health Practice Project tool, the methodological quality of the included studies was assessed independently by two authors.

RESULTS

Out of 1303 initially identified records, eight peer-reviewed articles and three doctoral theses were included in this review. The age of the students in the included studies ranged between 5 to 19 years, and the sample sizes between 28 and 3,967 students. The studies included between one and thirty public and private schools. Of the included studies, six were randomised controlled trials, four pre-post studies and one used a post-study design. Only four of the eleven studies were theory based. The included studies reported various improvements in the students' weight or weight-related lifestyle behaviours, such as healthier dietary choices, increased physical activity, and decreased sedentary behaviour.

CONCLUSIONS

This review suggests the potential effectiveness of school-based interventions in the GCC countries. However, a thorough evaluation of these studies revealed significant methodological limitations that must be acknowledged in interpreting these results. Future studies in this field should be theory-based and use more rigorous evaluation methods.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42020156535.

Most systematic reviews reporting adherence to AMSTAR 2 had critically low methodological quality: a cross-sectional meta-research study

OBJECTIVES

To analyze the methodological quality and characteristics of systematic reviews (SRs) that reported they were conducted in line with the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews).

STUDY DESIGN AND SETTING

This was a cross-sectional meta-research study. We searched MEDLINE and Embase. We included full reports of SRs reporting the study was conducted, prepared, or designed in line with the AMSTAR 2. Eligible SRs were those published from January 1, 2018, until May 3, 2022. We assessed the methodological quality of the included SRs using AMSTAR 2.

RESULTS

We included a total of 45 records. There were 43 SRs and 2 SR protocols. Among them, most were SRs of interventions that included primary studies on humans. More than half had a meta-analysis. According to our overall AMSTAR 2 assessments of included SRs, 35 SRs were of critically low confidence, 7 SRs were of low confidence, and one SR was of high confidence. There were no SRs of moderate confidence.

CONCLUSION

Even when authors indicate in their manuscripts that the SR was conducted/prepared/designed in line with the AMSTAR 2, it does not necessarily imply it is of high or even moderate confidence according to AMSTAR 2. A self-assessment with AMSTAR 2 could be required for submission and carefully checked by the editors/peer reviewers.

Adolescent obesity and ANGPTL8: correlations with high sensitivity C-reactive protein, leptin, and chemerin

Angiopoietin-like proteins (ANGPTLs) mediate many metabolic functions. We had recently reported increased plasma levels of ANGPTL8 in obese adults of Arab ethnicity. However, data on ANGPTL8 levels in adolescent obesity is lacking. Arab population is characterized by a rapid transition, due to sudden wealth seen in the post-oil era, in lifestyle, food habits and extent of physical activity. We adopted a cross-sectional study on Arab adolescents from Kuwait to examine the role of ANGPTL8 in adolescent obesity. The study cohort included 452 adolescents, aged 11-14 years, recruited from Middle Schools across Kuwait. BMI-for-age growth charts were used to categorize adolescents as normal-weight, overweight, and obese. ELISA and bead-based multiplexing assays were used to measure plasma levels of ANGPTL8 and other inflammation and obesity-related biomarkers. Data analysis showed significant differences in the plasma levels of ANGPTL8 among the three subgroups, with a significant increase in overweight and obese children compared to normal-weight children. This observation persisted even when the analysis was stratified by sex. Multinomial logistic regression analysis illustrated that adolescents with higher levels of ANGPTL8 were 7 times more likely to become obese and twice as likely to be overweight. ANGPTL8 levels were correlated with those of hsCRP, leptin and chemerin. ANGPTL8 level had a reasonable prognostic power for obesity with an AUC of 0.703 (95%-CI=0.648-0.759). These observations relating to increased ANGPTL8 levels corresponding to increased BMI-for-age z-scores indicate that ANGPTL8, along with hsCRP, leptin and chemerin, could play a role in the early stages of obesity development in children. ANGPTL8 is a potential early marker for adolescent obesity and is associated with well-known obesity and inflammatory markers.

School-based physical activity interventions among children and adolescents in the Middle East and Arabic speaking countries: A systematic review

BACKGROUND

It is widely recognised that noncommunicable diseases are on the rise worldwide, partly due to insufficient levels of physical activity (PA). It is a particularly concerning health issue among children and adolescents in Arabic countries where cultural and environmental factors may limit their opportunity for engaging in physical activities.

AIM

This review sought to assess the effectiveness of school-based PA interventions for increasing PA among schoolchildren aged six to 18 years in Middle Eastern and Arabic-speaking countries.

METHODS

A systematic literature search was developed to identify studies reporting the evaluation of school-based PA interventions in Arabic-speaking countries. Four different databases were searched from January 2000 to January 2023: PubMed/MEDLINE, Web of Science, Scopus and CINAHL. Article titles and abstracts were screened for relevance. Full article scrutiny of retrieved shortlisted articles was undertaken. After citation searches and reference checking of included papers, full data extraction, quality assessment and narrative synthesis was undertaken for all articles that met the inclusion criteria. This review adhered to PRISMA guidelines for conducting systematic reviews.

RESULTS

Seventeen articles met the inclusion criteria. Eleven articles reported statistically significant improvements in the levels of PA among their participants. Based largely on self-reported outcomes, increases in PA between 58% and 72% were reported. The studies with a follow-up period greater than three months reported sustained PA levels. There are a limited range of types of programmes evaluated and evaluations were only identified from 30% of the countries in the region. Relatively few studies focused solely on PA interventions and most of the interventions were multi-component (lifestyle, diet, education).

CONCLUSIONS

This review adds to the existing body of research about the efficacy of school-based interventions to increase physical activity levels. To date, few evaluations assess PA specific interventions and most of the interventions were multi-component including education components on lifestyle and diet. Long-term school-based interventions combined with rigorous theoretical and methodological frameworks are necessary to develop, implement and evaluate PA interventions for children and adolescents in Arabic-speaking countries. Also, future work in this area must also consider the complex systems and agents by which physical activity is influenced.

Pregnant Women's Perception and Knowledge of the Impact of Obesity on Prenatal Outcomes-A Cross-Sectional Study

The prevalence of obesity and overweight has been rapidly increasing and is significantly higher among adult females in the Arab States. The aim of the present study was to explore pregnant Emirati women's perception of their weight, their knowledge of the healthy gestational weight gain, and the possible weight-related pregnancy complications. A total of 526 self-administered questionnaires were obtained with a response rate of 72%. The majority (81.8%, n = 429) entered pregnancy as overweight or obese. The percentage of pregnant women who underestimated their weight category was 12.1% in normal weight participants, 48.9% in overweight participants, and 73.5% in obese participants (p < 0.001). The overweight and obese participants were 13 times more likely to underestimate their weight status and 3.6 times more likely to correctly select their healthy gestational weight gain. Women's awareness of pregnancy-related complications due to weight varied from 80.3% for diabetes to 44.5% for fetal complications; their awareness of breastfeeding difficulty was the lowest at 2.5%. Moreover, there was a misconception about personal BMI and the appropriate range for gestational weight gain (GWG). Healthy lifestyle counselling urgently needs to be addressed in preventative health programs such as pre-marital and preconception counselling.

Unlocking the Secrets of Longevity: Exploring the Impact of Socioeconomic Factors and Health Resources on Life Expectancy in Oman and Qatar

In an era marked by a sweeping pandemic and the encroaching shadow of an energy crisis, the well-being and lifespan of global populations have become pressing concerns for every nation. This research zeroes in on life expectancy (LE), a powerful indicator of societal health in Oman and Qatar. Our study juxtaposes 3 key factors affecting LE: health status and resources (HSR), macroeconomics (ME), and sociodemographic (SD) factors. To achieve this, we tapped into a comprehensive data set from the World Bank, encompassing a transformative 3-decade span from 1990 to 2020. The intricate interplay between these factors and LE was deciphered through robust Structural Equation Modeling (SEM). Our findings construct a compelling narrative: ME has an indirect yet considerable influence on LE-manifesting with an effect of 0.602 for Oman and 0.676 for Qatar. This influence is mediated by SD and HSR components. Similarly, SD elements impact LE indirectly-with an effect of 0.653 for Oman and 0.759 for Qatar- this effect is mediated by HSR. In contrast, HSR themselves wield a robust and direct influence on LE, indicated by an effect of 0.839 for Oman and 0.904 for Qatar. All these aforementioned effects were statistically substantial (P < .001). Our research magnifies the robust direct influence of HSR on LE in both Oman and Qatar, simultaneously highlighting the noteworthy indirect role of ME and SD factors. This emphasizes the significance of adopting an integrated policy approach that considers all the SD, ME, and HSR factors to improve the population health in both countries, which are also crucial for promoting LE growth in the Gulf Cooperation Council region.

Increased LRG1 Levels in Overweight and Obese Adolescents and Its Association with Obesity Markers, Including Leptin, Chemerin, and High Sensitivity C-Reactive Protein

Leucine-rich α-2 glycoprotein1 (LRG1) is a member of the leucine-rich repeat (LRR) family that is implicated in multiple diseases, including cancer, aging, and heart failure, as well as diabetes and obesity. LRG1 plays a key role in diet-induced hepatosteatosis and insulin resistance by mediating the crosstalk between adipocytes and hepatocytes. LRG1 also promotes hepatosteatosis by upregulating de novo lipogenesis in the liver and suppressing fatty acid β-oxidation. In this study, we investigated the association of LRG1 with obesity markers, including leptin and other adipokines in adolescents (11−14 years; n = 425). BMI-for-age classification based on WHO growth charts was used to define obesity. Plasma LRG1 was measured by ELISA, while other markers were measured by multiplexing assay. Median (IQR) of LRG1 levels was higher in obese (30 (25, 38) µg/mL) and overweight (30 (24, 39) µg/mL) adolescents, compared to normal-weight participants (27 (22, 35) µg/mL). The highest tertile of LRG1 had an OR [95% CI] of 2.55 [1.44, 4.53] for obesity. LRG1 was positively correlated to plasma levels of high sensitivity c-reactive protein (HsCRP) (ρ = 0.2), leptin (ρ = 0.2), and chemerin (ρ = 0.24) with p < 0.001. Additionally, it was positively associated with plasma level of IL6 (ρ = 0.17) and IL10 (ρ = 0.14) but not TNF-α. In conclusion, LRG1 levels are increased in obese adolescents and are associated with increased levels of adipogenic markers. These results suggest the usefulness of LRG1 as an early biomarker for obesity and its related pathologies in adolescents.

Obesity among children and adolescents in Qatar: protocol for a scoping review

INTRODUCTION

Approximately half of the school-aged children are overweight or obese in Qatar. Childhood obesity is associated with health conditions in adulthood, such as hypertension, diabetes, metabolic defects, cardiovascular risks and psychological challenges. Existing obesity studies have limitations; thus, there is a need for further research with improved quality, wider representation of population including children and adolescents and methodological diversity. As Qatar moves towards a preventive evidence-based approach in tackling obesity, this scoping review aims to support the efforts of obesity prevention among children and adolescents in Qatar by providing an up-to-date research map that systematically highlights existing knowledge, research gaps and methodological range. In addition, this will be the first scoping review that analyses how obesity research has evolved in Qatar since 2000.

METHODS AND ANALYSIS

This scoping review follows the guidelines of Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews for both developing the protocol and reporting the findings. It will use the System for the Unified Management, Assessment and Review of Information-JBI software for synthesis. The review will include any study in Arabic or English published between 1 January 2000 and 31 December 2021 on obesity/overweight among children and/or adolescents in Qatar. Studies without specific data on the concept of obesity, the population of children and adolescents or the context of Qatar will be excluded. The following databases will be searched: PubMed, Embase, Web of Science, IBSS, Scopus, J-STOR, APA PsycNET and Google Scholar. In addition, Arabic literature via Dar Almanthomah, Dar Almanhal and E-Marefah will be searched. A search strategy to identify grey literature will be adopted for a wider reach. The screening process will be conducted by two independent reviewers. Extracted data will be analysed descriptively and analytically using simple frequency counts and qualitative content analysis. The results will be presented using maps, tables and diagrams.

ETHICS AND DISSEMINATION

Ethics approval is not required as data will be collected from publicly available published research. The results of this review will be disseminated via a peer-reviewed publication, national and international conferences, workshops and knowledge mobilisation activities among key stakeholders.

Prevalence of Metabolic Syndrome and Associated Risk Factors in the United Arab Emirates: A Cross-Sectional Population-Based Study

Aims

To estimate the prevalence of metabolic syndrome (MetS) and its associated risk factors among the United Arab Emirates (UAE) residents.

Methods

A cross-sectional population-based study was conducted among adults living in Sharjah and Northern Emirates using the UAE National Diabetes and Lifestyle Study (UAEDIAB) data. Anthropometric measurements and fasting blood samples were obtained. The National Cholesterol Education Program's Adult Treatment Panel III (NCEP/ATP III) guidelines were used to define metabolic syndrome (MetS).

Results

A total of 3,212 subjects (74.1% men, 25.9% women, mean age 39 ± 11.3 years old) were included in this study. The overall prevalence of MetS was 37.4% (32.7% in women and 39% in men). The prevalence was 33.6% in the Emirati population (38.7% in women and 28.8% in men), 34.5% in the Arab non-Emirati population (29.8% in women and 36.3% in men) and 40.7% in the Asian non-Arab population (25.8% in women and 43.1% in men). Age, gender, ethnicity, educational level, marital status and body mass index were positively associated with MetS.

Conclusions

This study indicates a high burden of MetS in the UAE, particularly among Emirati women and Asian non-Arab men. The young adult population in the UAE has a high prevalence of MetS compared to global estimates in the same age group. Aggressive intervention strategies targeting the whole population as well as individuals at a high risk are recommended to prevent the development of cardiovascular diseases.

Prevalence of overweight and obesity among Kuwaiti adolescents and the perception of body weight by parents or friends

Objective

Recently, the State of Kuwait has witnessed a steady rise in the prevalence of obesity among children and adolescents. The present study aims to provide an update on the rate of overweight or obesity among Kuwaiti adolescents and examines the associations between adolescents’ overweight/obesity levels and their perception of body weight as seen by parents or friends.

Methods

A cross-sectional study was conducted in Kuwaiti secondary schools and included adolescents between the ages of 15 and 18 years, using a multistage stratified random sampling method. Body weight and height were measured. A specifically designed self-report questionnaire was used to assess parents’ and friends’ perceptions of an adolescent’s body weight.

Results

A total of 706 adolescents were included the study. The prevalence of overweight or obesity among Kuwaiti adolescents reached nearly 50%, with males (54.3%) having a significantly higher overweight or obesity percentage than females (44.6%). No significant difference in the prevalence of obesity relative to age, from 15 to 18 years, was found. In addition, logistic regression analysis, adjusted for age and gender, revealed that adolescents perceived their parents (p = 0.011 and p < 0.001) or friends (p = 0.002 and p < 0.001) as more likely to classify their weight as overweight or obese, respectively.

Conclusion

Overweight or obesity levels appear to be high among Kuwaiti adolescents, and appears to have reached a plateau recently. Efforts to combat obesity and promote physical activity and healthy nutrition are needed. Future studies should seek to identify important moderators of parental and social underestimation/overestimation of children’s overweight or obesity.

Prevalence of Overweight, Obesity, and Dietary Behaviors among Adolescents in Dubai Schools: A Complex Design Survey 2019

Background: Overweight and obesity in adolescence have become a public health challenge. Health effects due to overweight and obesity appear during adolescence and continue into adulthood. Modifiable factors associated with overweight and obesity include unhealthy dietary behaviors and lack of exercise. Assessment of the prevalence of overweight and obesity and unhealthy dietary behaviors is essential to plan for preventive programs at the population level. Objectives: The aim of the study was to estimate the prevalence of overweight, obesity, and unhealthy dietary behaviors among adolescents of grades 8–12 in Dubai schools, 2019. Method: The Adolescents Risk Behavioral Survey (ARBS) is a 2-stage stratified cluster study. The 1st stage involved randomly selecting schools with a probability proportional to the size and the 2nd stage was randomly selecting classes, and all students in the selected classes were invited to participate; the total participants were 1,683 adolescents from grades 8–12 from 28 private and government schools. Students answered a self-administrated electronic questionnaire. Anthropometric measures including height and weight were assessed by a trained school nurse. Body mass index was calculated and classified according to World Health Organization (WHO) growth charts for sex and age. Data were analyzed with adjustment for weight, primary sampling unit, and stratum. Results: Among the adolescents of Dubai schools studying in grades 8–12, the prevalence of overweight was 25.3% (95% confidence interval [CI]: 22.7–28.2) and obesity was 15% (95% CI: 13.0–18.9). Overweight did not vary between male and female students, but obesity was higher among male students 19.9% (95% CI: 15.4–25.1) than female students 11.8% (95% CI: 8.7–15.6) (p = 0.0261). Age and grade were not found to be associated with overweight or obesity. The prevalence of unhealthy dietary behaviors was common. Examining dietary habits from 30 days prior to the survey, 21.3% of adolescents (95% CI: 17.2–26.1) reported not eating fruits and 19.7% (95% CI: 15.7–24.4) not eating vegetables. With regard to consuming dairy, 3.3% of adolescents (95% CI: 10.9–16.1) did not drink milk or consume dairy products in the 7 days prior to the survey, 31% of adolescents (95% CI: 26.8–35.5) consumed a carbonated drink daily, and 18.4% did not eat breakfast on all 7 days during and before the survey. Eating fast food was high among adolescents as 78.9% reported eating fast food one or more days in the week preceding the survey. Conclusion: School programs for overweight and obesity need further strengthening and to extend their scope to outside of the school community.

Physical Activity Levels of 1053 Omani 4th Grade Children: The Importance of Gender and Sport Team Participation in Achieving 60 Minutes of Daily Moderate-to-Vigorous Physical Activity

Sufficient daily physical activity is associated with many positive mental, physical, and societal benefits in children. Unfortunately, most children worldwide do not achieve recommended levels of daily physical activity (PA), and a majority of evidence is from Western countries and based on subjective measures. This study examined the prevalence and correlates of objectively measured PA levels among Omani children in 2017 (pre-pandemic). A two-stage cluster sampling was used to recruit the 4th grade children across five regions of Oman. A final analytic sample included 1053 children (504 boys, 549 girls) with a mean age of 9.21 years old. PA was objectively measured using a wrist-worn Polar Active Watch during three consecutive school days. Screen-based sedentary behaviors and other PA-related behaviors were subjectively measured. On average, boys were less sedentary and more active, with a greater likelihood of meeting current recommendations when compared with girls. The self-reported time spent in screen-based sedentary behaviors was relatively low for both boys and girls and was not associated with PA; however, sports team participation was associated with a greater likelihood of meeting the current recommendation. The present study provides empirical data on objectively measured PA in Omani children. The gender disparities concerning daily PA, including sports team participation, should receive further attention.

Alterations in glutathione redox homeostasis among adolescents with obesity and anemia

The reduced (GSH)-to-oxidized (GSSG) glutathione ratio represents a dynamic balance between oxidants and antioxidants. However, redox status in adolescents with obesity and anemia has not been investigated. This study investigated the association of erythrocyte GSH redox status (GSH, GSH:GSSG ratio, and glutathione peroxidase [GPx] activity) with anemia and adiposity in adolescents. This case–control study nested in a cross-sectional study enrolled 524 adolescents (268 boys; 256 girls). The prevalence of anemia in overweight and obesity (OWOB) was 5.2% in boys and 11.7% in girls. The GSH:GSSG ratio and GPx activity were significantly higher in girls than in boys (p < 0.001), in anemic than in non-anemic subjects (p < 0.001), and in OWOB than in normal-weight subjects (p < 0.001). Similarly, significantly higher GSH: GSSG level (p < 0.001) and GPx activity (p < 0.001) were found in subjects with 90th percentile waist circumference than in those with < 90th percentile. GPx and GSH:GSSG were positively associated with anemia after adjusting for age, sex, and body mass index (adjusted odds ratio, adjOR [95% confidence interval, CI] 2.18 [1.44–3.29]) or tertiles (adjOR [95% CI], T3 = 2.49 [1.03–6.01]). A similar association was noted for GSH and GPx. A compensatory increased redox defense mechanism exists in anemia and obesity among adolescents without metabolic disturbances.

Profiling of Insulin-Like Growth Factor Binding Proteins (IGFBPs) in Obesity and Their Association With Ox-LDL and Hs-CRP in Adolescents

Insulin-like growth factor binding proteins (IGFBPs) are critical modulators of metabolism. In adults, IGFBPs are associated with obesity and insulin resistance. However, the association of IGFBPs with metabolic homeostasis in children and adolescents is not yet fully characterized. In this study we investigated the association of plasma IGFBPs (IGFBP-1, 3 and 7) with weight, central adiposity and cardiovascular disease markers Hs-CRP and Ox-LDL. A total of 420 adolescents (age 11-14 years) were recruited from public middle schools in Kuwait. IGFBPs were measured using bead-based multiplexing while Hs-CRP and Ox-LDL were measured using ELISA. Results showed that levels of IGFBP-1 were significantly lower in obese and overweight children when compared to normal weight children. Correlation analysis showed negative association between the level of IGFBP-1 and waist circumference to height (WC/Ht) ratio. IGFBP-1 level was also negatively associated with Hs-CRP. It was also observed that the levels of IGFBP-3 and IGFBP-7 were negatively correlated with Ox-LDL. Our data demonstrate a strong negative association of IGFBP-1 with overweight/obesity, and the inflammatory marker Hs-CRP. This was not seen with the levels of IGFBP-3 and 7. The association of IGFBP-1 with central adiposity (WC/Ht ratio) was stronger than its association with BMI-for-age z-score. Therefore we suggest that IGFBP-1 could potentially be used as a sensitive biomarker for obesity and its subsequent effects in screening and monitoring of obesity-related metabolic complications in adolescents.

Differences in educational attainment between obese and non-obese Kuwaiti female university students

Individuals with obesity tend to perform less well than their non-obese peers in tertiary education, but there is little evidence from non-Western countries and recent studies. The present study aimed to test whether academic attainment differed between female undergraduates with obesity (defined by body mass index (BMI)), and those who were non-obese in Kuwait, a country with very high obesity prevalence. In 400 female Kuwaiti first- and second-year Social Science students (mean age 18⋅0, sd 0⋅6 years), educational attainment was defined as the Grade Point Average (GPA) across all subjects (from 1⋅00 to 4⋅00). The mean GPA (2⋅51, sd 0⋅53) among students defined as obese by the BMI (n 163) was significantly lower than among the students defined as non-obese by the BMI (n 237; 2⋅80, sd 0⋅63; P < 0⋅001), and those defined as obese were more likely to be in the lowest quartile for the GPA (OR 3⋅03; 95% CI 1⋅90, 4⋅85), independent of socio-economic status. Similar differences were observed between students defined as having high versus normal body fatness. Female undergraduates in Kuwait with obesity have lower academic attainment than their non-obese peers, and universities should consider measures to mitigate reduced attainment among their female undergraduates.

Interventions promoting physical activity among adults and children in the six Gulf Cooperation Council countries: protocol for a systematic review

INTRODUCTION

Prevalence of overweight, obesity and diabetes are high and rising across the Gulf Cooperation Council (GCC) countries (Oman, Bahrain, Kuwait, Qatar, Saudi Arabia and the United Arab Emirates). In parallel, physical activity (PA) levels are low relative to international standards. PA aids weight control and reduces risk of non-communicable diseases including diabetes and cardiovascular disease. It is likely interventions developed elsewhere will not translate to GCC countries due to unique environmental, social and cultural factors. This protocol is for a systematic review assessing the efficacy of interventions promoting PA within GCC countries among generally healthy adults and children. The primary outcome of interest is change in objectively measured or self-reported PA levels, the secondary outcomes of interest are changes in anthropometry or chronic disease risk factors (eg, blood pressure). Interventions will be compared with no intervention or those of differing PA intensity or duration. The relationships between PA change and the following will be assessed: intervention intensity or duration, season in which intervention occurs, sex, age, nationality and sustainability over time.

METHODS AND ANALYSIS

A systematic search strategy will identify indexed publications on the efficacy of interventions promoting PA. Randomised controlled trials and quasi-experimental studies recruiting predominantly healthy children and adults will be included. Studies of exercise rehabilitation will be excluded. Medline, Embase, Cinahl, Cochrane Library, SportDiscus, Web of Science, Index Medicus for the Eastern Mediterranean Region and Qscience will be searched. Clinical trial registries including the International Clinical Trials Registry Platform, the Iranian Registry of Clinical Trials and ClinicalTrials.gov will be searched for ongoing and unpublished studies. Searches will be ran from database inception until 1 May 2020 and be supplemented by checking references of key articles. Two reviewers will independently screen identified citations then full texts using prespecified inclusion and exclusion criteria. Piloted data extraction forms will be used in duplicate. Inconsistencies in screening or data extraction will be resolved by a third investigator or study author contact. Risk of bias will be independently assessed by two reviewers using validated tools. A narrative summary of findings will be produced supplemented with meta-analyses and exploration of heterogeneity as appropriate.

ETHICS AND DISSEMINATION

The review aims to strengthen the findings of the primary studies it incorporates and explore the impact of setting. It will synthesise existing published aggregate patient data. If publications or data with ethical concerns are identified, they will be excluded from the review. Results of the systematic review will be published in full and authors will engage directly with research audiences and key stakeholders to share findings.

PROSPERO REGISTRATION NUMBER

131817.

Obesity and Cardiovascular Risk in the Arab Gulf States

Purpose of Review

Rapid economic growth in the Gulf Cooperation Council (GCC) states over the last half-century has been associated with a rise in obesity and cardiovascular morbidity and mortality. In this review, we shed some light on the factors driving the obesity epidemic, promising interventions to overcome this public health crisis, and challenges precluding a successful public health impact.

Recent Findings

Overweight and obesity rates have nearly tripled in the GCC countries over the past four decades. Cardiovascular morbidity and mortality have been rising in parallel. Several sociodemographic, environmental, and behavioral factors have been correlated with sedentary lifestyle and unhealthy diet habits, and ultimately the rise in overweight and obesity rates. Numerous studies have documented factors unique to the population of the Arab Gulf states, but high-quality data is scarce. Despite the growing awareness of the extent of the problem, several barriers to weight loss and physical activity need to be addressed. A few interventions to combat obesity at different levels have been reported with some promising outcomes. Using the social-ecological model (SEM), we review recently published interventions and discuss some challenges to overcome in order to make progress in fighting the obesity epidemic in the GCC.

Summary

Obesity prevalence has been mounting worldwide, and the Arab Gulf states are no exception. This public health crisis is drawing the attention of policymakers and several stakeholders. However, a lot needs to be done to reduce the burden of obesity and improve cardiovascular risks in the Arab Gulf states.

Correlation of circulating ANGPTL5 levels with obesity, high sensitivity C-reactive protein and oxidized low-density lipoprotein in adolescents

Angiopoietin-like proteins (ANGPTL) is a family of eight members known to play an important role in metabolic diseases. Of these, ANGPTL5 is suggested to regulate triglyceride metabolism and is increased in obesity and diabetes. However, its role in metabolic diseases in adolescents is not well-studied. In this study, we tested the hypothesis of a positive association between plasma ANGPTL5, and obesity, high sensitivity C-reactive protein (HsCRP) and oxidized low-density lipoprotein (Ox-LDL) in adolescents. Adolescents (N = 431; age 11–14 years) were randomly selected from middle schools in Kuwait. Obesity was classified by the BMI-for-age based on the WHO growth charts. Plasma ANGPTL5, HsCRP, and Ox-LDL were measured using ELISA. The prevalence of overweight and obesity was 20.65% and 33.18%, respectively. Mean (SD) plasma ANGPTL5 levels were significantly higher in obese, compared with overweight and normal-weight adolescents (23.05 (8.79) vs 18.39 (7.08) ng/mL, and 18.26 (6.95) ng/ml, respectively). ANGPTL5 was positively associated with both HsCRP (ρ=0.27, p < 0.001) and Ox-LDL (ρ = 0.24, p < 0.001). In Conclusion, ANGPTL5 levels are elevated in obese adolescents and are associated with cardiovascular disease risk factors, HsCRP and Ox-LDL. The use of ANGPTL5 as a powerful diagnostic and prognostic tool in obesity and metabolic diseases needs to be further evaluated.

Classification Accuracy of Body Mass Index for Excessive Body Fatness in Kuwaiti Adolescent Girls and Young Adult Women

PURPOSE

Adolescent obesity, as defined by BMI, is amongst the highest in the world in Kuwait. This study aimed to determine the extent to which BMI might be underestimating obesity as defined by excessive fatness in Kuwaiti female adolescents and young adults.

METHODS

A total of 400 apparently healthy Kuwaiti female university students (mean age 18.0 years, SD 0.6) were recruited. Excessive fatness was defined as body fat percentage ≥30, measured using the Tanita model TBF-310 Bio-impedance system with the manufacturer's equation. Obesity was defined as recommended by the WHO in adult participants - those aged ≥19.1 years - as BMI≥30 kg/m². In the adolescent participants (age <19.1 years) obesity was defined as recommended by the WHO as a BMI-for-age Z score of ≥2.00. The accuracy of BMI-defined obesity to identify excessively fat individuals was determined by estimating the prevalence of obesity using high BMI and prevalence of excessive fatness, and by calculating sensitivity and specificity and predictive values.

RESULTS

Median BMI was 27.8 kg/m² (range 15.1-51.2) and median body fat percentage was 32.0 (range 5.0-54.0). The prevalence of excessive fatness was 62% (247/400 individuals were excessively fat), while the prevalence of obesity according to BMI was 42% (169/400 individuals were obese according to their BMI). The sensitivity of BMI to identify the excessively fat individuals was moderate (66%) but specificity was high (96%). The positive predictive value of BMI was 96% and the negative predictive value was 64%.

CONCLUSION

BMI-based measures substantially underestimate the prevalence of excessive fatness in Kuwaiti adolescent females. Obesity is even more prevalent, and requires more urgent attention, than is apparent from BMI-based measures used in most research and national surveys. BMI may also be too crude for use as an exposure or outcome variable in many epidemiological studies of Arab adolescent girls and adult women.