The future health and economic burden of obesity-attributable type 2 diabetes and liver disease among the working-age population in Saudi Arabia

State of lifestyle medicine education in Saudi medical schools: A descriptive study

BACKGROUND

Lifestyle medicine (LM) is a patient-centric, evidence-based clinical practice supporting adopting and sustaining of healthy behaviours and improving health-related living standards. Unfortunately, even in developed nations, medical curricula have largely ignored the LM concepts. Some LM components have been incorporated into the medical curriculum in the Kingdom of Saudi Arabia to determine the general status of teaching LM competency domains in undergraduate curricula in medical colleges.

METHODS

A cross-sectional, descriptive survey was conducted in English and distributed from January to March 2022. In this study, only administrative position holders were included. The administrative directors (such as deans, vice-deans, and program directors) play a significant role and are responsible for policymaking in medical education. There are 38 undergraduate medical programs across private and public medical colleges in Saudi Arabia. MCQs, OSCE, Essay, SEQ/SAQ, Assignments, and OSPE, were the assessment techniques of the LM domains.

RESULTS

The response rate of the survey was 78.3%. Of all respondents, 61% were aware of LM domains. Twenty-four colleges teach one or more of the LM domains; the nutrition domain was the most common one. Mostly followed the traditional method (75%) and small group learning activities (71%). Programs also used large group learning activities and clinical teaching (35% each), followed by practical laboratory activities (19%) and other methods on very few occasions.

CONCLUSION

The current study also shows that LM is not taught effectively in medical schools in Saudi Arabia, although the results illustrate an increased interest and awareness among administrators. This study identified the general situation of teaching LM in medical schools. These findings provide valuable insights for shaping the future direction of medical education.

The burden of metabolic dysfunction-associated steatotic liver disease and viral hepatitis in Saudi Arabia

BACKGROUND

Globally, viral hepatitis is decreasing, but nonalcoholic fatty liver disease (NAFLD), now metabolic dysfunction-associated steatotic liver disease (MASLD), is increasing. We assessed the burden and trends of MASLD and viral hepatitis in Saudi Arabia.

METHODS

Prevalence, death, and disability data due to MASLD, hepatitis C virus (HCV), and hepatitis B virus (HBV) were obtained from 2019 Global Burden of Disease (GBD) database for Saudi Arabia. Time trends were assessed by annual percent change (APC) from joinpoint regression.

RESULTS

From 2012 through 2019, MASLD prevalence in children and adults increased from 28.02% (n = 8.34 million) to 33.11% (n = 11.83 million); APC +2.43% (95% confidence interval: 2.33% to 2.54%). HBV prevalence decreased from 1.83% (n = 0.54 million) to 1.53% (n = 0.55 million); APC -1.74% (-2.66% to -0.81%). HCV prevalence stabilized from 0.72% (n = 0.21 million) to 0.73% (n = 0.26 million): APC +0.32% (-0.13% to 0.78%). Among adults (>20 years), MASLD prevalence increased from 40.64% to 43.95% (APC = +1.15%, 1.12% to 1.18%), HBV prevalence decreased from 2.67% to 2.05% (APC = -2.96%, -3.90% to -2.01%), and HCV leveled from 0.88% to 0.86% (APC = -0.30%, -0.75% to 0.16%). MASLD liver mortality rate from liver cancer and cirrhosis increased: APC of +1.15% (0.82% to 1.48%) from 1.31 to 1.43 (per 100,000). HBV and HCV liver mortality increased at slower rates (APC = +0.78%, 0.38% to 1.19%): 2.07 to 2.20 (per 100,000) and (APC = +0.55%, 0.09% to 0.89%): 6.32 to 6.61 (per 100,000), respectively.

CONCLUSIONS

MASLD burden is increasing, while HBV and HCV burden is decreasing/remaining stable. Early prevention and diagnosis health policies for MASLD are needed.

Self-Perceived Nutritional Competency of Primary Healthcare Physicians in Qassim, Saudi Arabia

INTRODUCTION

Overnutrition plays a vital role in the development of a spectrum of non-communicable diseases. Diet-related disorders have a huge impact on personal health as well as the country's economy for the management of such disorders. The study aims to assess the primary healthcare physicians' nutrition competency, which will be beneficial for evaluating the current situation and future strategies, training, nutrition care, and disease prevention.

METHODOLOGY

Among 147 primary healthcare physicians by simple random sampling from four cities and two rural areas of Qassim, Saudi Arabia, from December 2022 to December 2023 using a validated (NUTCOMP) tool. Data were entered, cleaned, and analyzed with SPSS software version 21.0 (IBM Corp., Armonk, NY). Informed consent was obtained from all study participants. Chi-square and ANOVA tests were applied to draw the significant differences.

RESULTS

A total of 147 participants enrolled in this study, and the mean age and standard deviation (SD) of the study population were 34.38 ± 6.57. More than half of the physicians (n = 76, 51.7%) continued education on nutrition. Significant mean differences were observed between some and focused nutrition content received physicians versus no nutrition content received physicians concerning nutrition skill, communication, and nutrition attitude consecutively (P < 0.0001, P < 0.0001, and P < 0.0001). The mean nutrition knowledge, skill, communication, attitude score, and SD of PHCC physicians were 26.91 ± 5.42 (maximum 35), 31.19 ± 6.18 (maximum 40), 36.73 ± 7.48 (maximum 45), and 34.74 ± 6.23 (maximum 40), respectively.

CONCLUSIONS

Our study results show primary healthcare physicians perceive themselves to have good nutritional competency.

The prevalence and predictors of diabetes in a private health insurance scheme: An analysis of three million beneficiaries in Saudi Arabia

BACKGROUND

Noncommunicable diseases (NCDs) are a leading threat to population health in Saudi Arabia. Addressing NCDs is a priority for health-care transformation, and understanding the current disease prevalence is crucial. The prevalence in other settings is unknown because studies have relied on data from households or public health-care institutions. This study aims to investigate the prevalence and predictors of diabetes in the privately insured population.

MATERIALS AND METHODS

This retrospective study explored the prevalence and predictors of diabetes in beneficiaries aged 15 years or older who sought medical care in 2022. Data were sourced from the National Platform for Health and Insurance Exchange Services, a unified health insurance claim platform. We used the International Classification of Disease-10 to capture the condition. To identify predictors of diabetes, we employed a backward selection approach for logistic regression.

RESULTS

Over 3.3 million beneficiaries sought medical care during the study. The population was relatively young aged 26-39 years, (47.5%) and two-thirds of males. The prevalence of diabetes was 11.0% and varied across regions, with the highest in Bahah (18.4%) and the lowest in Jizan (9.5%). Age, gender, nationality, insurance company size, body mass index, region, hypertension, and coronary heart disease were significant predictors of diabetes. Hypertensive patients were over five times more likely to have diabetes than those without hypertension (odds ratio OR = 5.08; 95% confidence interval CI = 5.02-5.24). Saudis were 30% more likely to have diabetes than other nationalities (OR = 1.3; 95% CI = 1.28-1.31).

CONCLUSION

We found a higher prevalence of diabetes in privately insured beneficiaries than the recent national estimate. This necessitates population health management strategies at all levels (primary, secondary, and tertiary) to mitigate the burden of diabetes in privately insured individuals. This study provides valuable baseline data for the prevalence of diabetes in this population and emphasizes the urgent need for targeted interventions, especially in regions with a higher prevalence.

Economic costs of obesity: a systematic review

INTRODUCTION

Obesity is a growing public health problem leading to substantial economic impact. This study aimed to summarize the economic impact of obesity and to critically analyze the methods used in the cost-of-illness (COI) studies on obesity.

METHODS

We conducted systematic search in PubMed and Scopus from September 1, 2016, to July 22, 2022. Original COI studies estimating the economic cost of obesity and/or overweight in at least one country, published in English were included. To facilitate the comparison of estimates across countries, we converted the cost estimates of different years to 2022 purchasing power parity (PPP) values using each country's consumer price index (CPI) and PPP conversion rate.

RESULTS

Nineteen studies were included. All studies employed a prevalence-based approach using Population Attributable Fraction (PAF) methodology. About half of the included studies (53%) were conducted in high-income countries while the others (47%) were conducted in middle-income countries. The economic burden of obesity ranged between PPP 15 million in Brazil to PPP 126 billion in the USA, in the year 2022. Direct medical costs accounted for 0.7% to 17.8% of the health system expenditure. Furthermore, the total costs of obesity ranged from 0.05% to 2.42% of the country's gross domestic product (GDP). Of the seven studies that estimated both direct and indirect costs, indirect costs accounted for the largest portion of five studies. Nevertheless, a variety in methodology across studies was identified. The number of co-morbidities included in the analysis varied across studies.

CONCLUSIONS

Although there was a variety of methodologies across studies, consistent evidence indicated that the economic burden of obesity was substantial. Obesity prevention and control should be a public health priority, especially among countries with high prevalence of obesity.

How Could Different Obesity Scenarios Alter the Burden of Type 2 Diabetes and Liver Disease in Saudi Arabia?

INTRODUCTION

Obesity is a major risk factor for type 2 diabetes (T2DM) and liver disease, and obesity-attributable liver disease is a common indication for liver transplant. Obesity prevalence in Saudi Arabia (SA) has increased in recent decades. SA has committed to the WHO "halt obesity" target to shift prevalence to 2010 levels by 2025. We estimated the future benefits of reducing obesity in SA on incidence and costs of T2DM and liver disease under two policy scenarios: (1) SA meets the "halt obesity" target; (2) population body mass index (BMI) is reduced by 1% annually from 2020 to 2040.

METHODS

We developed a dynamic microsimulation of working-age people (20-59 years) in SA between 2010 and 2040. Model inputs included population demographic, disease and healthcare cost data, and relative risks of diseases associated with obesity. In our two policy scenarios, we manipulated population BMI and compared predicted disease incidence and associated healthcare costs to a baseline "no change" scenario.

RESULTS

Adults <35 years are expected to meet the "halt obesity" target, but those ≥35 years are not. Obesity is set to decline for females, but to increase amongst males 35-59 years. If SA's working-age population achieved either scenario, >1.15 million combined cases of T2DM, liver disease, and liver cancer could be avoided by 2040. Healthcare cost savings for the "halt obesity" and 1% reduction scenarios are 46.7 and 32.8 billion USD, respectively.

CONCLUSION

SA's younger working-age population is set to meet the "halt obesity" target, but those aged 35-59 are off track. Even a modest annual 1% BMI reduction could result in substantial future health and economic benefits. Our findings strongly support universal initiatives to reduce population-level obesity, with targeted initiatives for working-age people ≥35 years of age.

Scoping Review of Population-Based Physical Activity and Sedentary Behavior in Saudi Arabia

BACKGROUND

Saudi Arabia is experiencing rapid development of the built environment and implementing policy changes to promote physical activity (PA) and reduce sedentary behavior (SB) among its population. In light of these developments, this scoping review systematically summarized population levels of PA/SB in Saudi Arabia.

METHODS

The authors searched 6 databases on December 13, 2021, for articles published in English or Arabic from 2018 to the search date. Studies using population-based sampling in Saudi Arabia and measuring PA/SB were included.

RESULTS

Of the 1272 records found, 797 were screened, and 19 studies (9 on children/adolescents age 6-19 y and 10 on adults age 15-75 y) were included. All studies were cross-sectional in design, and 18 studies collected data at only one point in time, ranging from 2009 to 2020. A total of 18 studies relied on self-reporting to assess PA/SB using a variety of questionnaires. Among children/adolescents, approximately 80% to 90% did not attain at least 60 minutes per day of moderate to vigorous PA and 50% to 80% engaged in ≥2 hours per day of screen time or SB. Among adults, approximately 50% to 95% had low or insufficient PA (eg, less than meeting PA guidelines) and about half had a sitting time of ≥5 hours per day. Population-based studies were not found among children <10 years and adults >75 years.

CONCLUSIONS

A high proportion of participants in the reviewed studies did not meet PA recommendations and spent excessive time in SB. Ongoing surveillance efforts for all ages may help identify target populations for interventions and prioritize the national strategy on PA/SB in Saudi Arabia.

Exploring the Validity of Available Markers and Indices in the Diagnosis of Nonalcoholic Fatty Liver Disease (NAFLD) in People with Type 2 Diabetes in Saudi Arabia

Nonalcoholic fatty liver disease (NAFLD) is common among Saudi patients with type 2 diabetes (T2DM). However, recommended clinical procedures to detect it are unavailable in many locations. Therefore, better and more available diagnostic biomarkers for NAFLD are needed. Various serum parameters were suggested, and algorithms that employ routine measurements in clinical practice have been developed for the prediction of fat stores in the liver in different populations. However, no such studies have been conducted on Saudis. We aimed to compare selected biochemical markers and calculated indices in T2DM patients diagnosed with NAFLD and patients without NAFLD to find the best markers associated with NAFLD. A cross-sectional study was employed to recruit 67 people with T2DM from endocrine outpatient clinics at King Abdul-Aziz University Hospital. NAFLD was detected by ultrasonography in 28 patients. Demographic information, anthropometric, and blood pressure (BP) measurements were taken. Fasting blood samples were obtained to measure glucose, glycated haemoglobin, lipid profile, liver function tests, and highly sensitive C-reactive protein. Fatty liver index, hepatic steatosis index, NAFLD-liver fat score, and triglyceride and glucose index were calculated. Following stepwise forward likelihood ratio regression with independent variables included in one model using binary logistic regression with age and waist circumference (WC) entered as covariates, elevated diastolic BP and low high-density lipoprotein- cholesterol remained significantly associated with NAFLD (p = 0.002 and 0.03, respectively). However, none of the investigated indices could be used to diagnose the disease adequately due to low specificity, even after calculating new cut-off values. Investigating novel markers and adjusting existing equations used to calculate indices to improve sensitivity and specificity in our population is needed.