High prevalence of metabolic syndrome among Kuwaiti adults--a wake-up call for public health intervention

Low dietary magnesium and fiber intakes among women with metabolic syndrome in Kuwait

Introduction

Metabolic syndrome (MetS) is a growing health concern among Kuwaiti women. Dietary magnesium and fiber have been implicated in reducing the risk of MetS; however, their specific effects on this population remain underexplored. This study aimed to investigate the association of dietary magnesium and fiber intake with the prevalence of MetS and its components among women in Kuwait.

Methods

This study included 170 women aged 18-65 (years) recruited from AL-Adan Hospital, Mubarak Hospital, and Riqqa Polyclinic. Data were collected using a modified Semi-Quantitative Food Frequency Questionnaire (SFFQ) to assess dietary intake, and biochemical measurements were performed to evaluate serum magnesium and other metabolic markers. MetS was diagnosed according to International Diabetes Federation (IDF) and Adult Treatment Panel III (ATP III) criteria. Statistical analyses included Mann-Whitney U-tests, chi-square tests, Spearman correlations, logistic and linear regression models, and Cohen's kappa statistics.

Results

The prevalence of MetS was 24 and 18% based on the IDF and ATP III criteria, respectively. Women with MetS had significantly lower dietary magnesium and fiber intakes than those in women without MetS (p < 0.001). A strong positive correlation was found among dietary magnesium intake, fiber intake, and serum magnesium levels (r = 0.957, p < 0.001 for magnesium; r = 0.917, p < 0.001 for fiber). Increased dietary magnesium and fiber intakes were linked to reduced odds of developing MetS and its components, except for blood pressure measurements. Cohen's kappa demonstrated a strong agreement (K = 0.70, p < 0.001) between dietary and serum magnesium inadequacy.

Conclusion

Increased dietary intakes of magnesium and fiber are associated with reduced odds of developing MetS among Kuwaiti women. These findings support the promotion of magnesium- and fiber-rich diets as preventive strategies against MetS.

Cardiovascular Disease Risk in the Obese Population in Kuwait: A Systematic Review and Meta-Analysis

BACKGROUND

The increasing prevalence of obesity and associated cardiovascular diseases (CVDs) in Kuwait requires a comprehensive analysis of its contributing factors and health outcomes. This systematic review and meta-analysis aimed to synthesize the current evidence on the relationship between obesity and CVDs and identify the main factors driving obesity in the Kuwaiti population.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, multiple databases were systematically searched, identifying 980 articles. After removing duplicates and screening the articles against the inclusion criteria (observational or intervention studies published from 2001 to 2024 in English, conducted in Kuwait or on Kuwaitis, examining obesity (body mass index or validated measures) and CVDs (coronary artery disease, stroke, heart attack, hypertension, dyslipidemia, diabetes), 44 published studies from 2001 to 2024 were included in the final analysis. The studies varied widely in design and population, complicating the estimation of the total number of participants.

RESULTS

The pooled prevalence of overweight patients was 36% (95% CI: 25-47) with high heterogeneity (I2=99.86%) and a statistically non-significant difference (p>0.01). Likewise, the pooled prevalence of overweight patients was 31% (95% CI: 23-40, I2=99.03%), with a statistically non-significant difference (p>0.01). The key factors contributing to obesity in Kuwait include a sedentary lifestyle, unhealthy diet, poor sleep quality, stress, genetic predisposition, metabolic disorders, environmental factors, and cultural factors. Sedentary behavior and unhealthy diets, exacerbated by rapid urbanization and economic growth, were prominent contributors. Genetic studies have identified specific genetic variants associated with obesity. Stress and poor sleep quality were significant factors, particularly in urban environments. A strong association was found between obesity and various CVD risk factors, including hypertension, dyslipidemia, and diabetes mellitus, with pooled population attributable risk estimates of 15%-18%, 13%-15%, and 10%, respectively.

DISCUSSION

These findings underscore the multifaceted nature of obesity in Kuwait, which is influenced by lifestyle, dietary habits, genetic factors, and socioeconomic changes. Age- and gender-specific analyses revealed higher obesity rates in adults aged 40-60 years and stronger associations with CVD in females. The consistent link between obesity and CVD risk factors highlights the urgent need for targeted public health interventions.

CONCLUSIONS

Obesity contributes significantly to the CVD burden in Kuwait, driven by a combination of lifestyle, genetic, and environmental factors. Comprehensive strategies addressing these determinants are essential to mitigate the obesity epidemic and its associated health risks in the Kuwaiti population.

Association of Nightly Fasting, Meal Frequency, and Skipping Meals with Metabolic Syndrome among Kuwaiti Adults

Mounting evidence suggests that meal timing and frequency are associated with cardiometabolic health by influencing circadian rhythms. However, the evidence is inconsistent and limited, especially in non-Western cultures. This cross-sectional study aims to investigate the association between temporal habits of dietary intake, such as nightly fasting duration and meal frequency, and metabolic syndrome among Kuwaiti adults. A 24-hour recall was used to assess temporal habits of dietary intake. Meal frequency was defined as the number of daily eating episodes. The study included a total of 757 adults aged 20 years and older. The participants' mean age was 37.8 ± 12.3 years. After adjusting for all confounders, higher meal frequency was found to be associated with a lower prevalence of metabolic syndrome in adults (OR, 0.43; 95%CI, 0.19-0.96) and a lower prevalence of elevated triglycerides in men only (OR, 0.23; 95%CI, 0.09-0.60). No association was found between nightly fasting and metabolic syndrome, but a longer fasting duration was associated with a lower prevalence of elevated triglycerides (OR, 0.19; 95%CI, 0.06-0.63). The findings suggest that having frequent meals and longer durations of nightly fasting may help decrease the risk of metabolic syndrome and elevated triglycerides.

Prevalence of dyslipidemias in the Middle East region: A systematic review & meta-analysis study

BACKGROUND AND AIMS

Dyslipidemia is a known main risk factor for cardiovascular diseases, and it can be controlled to reduce the incidence of cardiovascular diseases. This meta-analysis aimed to estimate the prevalence of dyslipidemias in the Middle East.

METHODS

The relevant published articles between 2000 and 2021 that investigated the prevalence of dyslipidaemias in the Middle East were found through international data sources such as Medline, PubMed, and Google Scholar. The random-effects model was used to estimate the pooled prevalence with 95% confidence intervals.

RESULTS

The pooled prevalence of dyslipidemias, hypertriglyceridemia, hypercholesterolemia, high levels of low-density lipoprotein cholesterol and low levels of high-density lipoprotein cholesterol in the Middle East were 54.08% (95% CI: 43.83-66.71), 32.51% (95% CI: 28.59-36.43), 29.44% (95% CI: 18.74-40.13), 32.09% (95% CI: 22.17-42.01), 44.71% (95% CI: 37.86-51.57), respectively. During the last two decades, an increasing trend in the prevalence of dyslipidemias was observed overall and in both sexes. Also, the age groups over 30 significantly had the highest prevalence of hypercholesterolemia, high levels of low-density lipoprotein cholesterol, and low levels of high-density lipoprotein cholesterol (p < 0.05).

CONCLUSIONS

The increasing trend in the prevalence of dyslipidemias during the last two decades is an alarming and significant concern in the Middle East. Therefore, special measures are needed to deal with dyslipidemias as a health priority in the Middle East.

Dietary Habits, Meal Timing, and Meal Frequency in Kuwaiti Adults: Analysis of the Kuwait National Nutrition Surveillance Data

Dietary habits, including meal frequency, meal timing, and skipping meals, have been extensively studied due to their association with the development of noncommunicable diseases (NCDs). This study describes dietary habits, meal timing, frequency, skipping meals, and late-night eating in Kuwaiti adults. Kuwait National Nutrition Surveillance System data were utilized to reach the objectives of this study. The findings reveal that approximately 54% of the adults in Kuwait eat after 10 p.m., 29% skip breakfast, and 9.8% skip dinner. Furthermore, adults in Kuwait consume 4.4 meals per day on average. Women skip breakfast more often and have more extended night fasting than men (p < 0.001). Married adults skip breakfast and dinner less than unmarried adults (p < 0.001). In conclusion, this descriptive study provides valuable insights into the dietary habits of Kuwaiti adults, emphasizing the importance of further investigating the association between meal timing, meal frequency, and the prevalence of NCDs in Kuwait.

Cardiometabolic deaths attributable to poor diet among Kuwaiti adults

BACKGROUND

Nutrition transition towards a Western diet is happening in parallel with the rapidly increasing rates of cardiovascular disease and its risk factors in Kuwait. The cardiometabolic deaths attributable to poor diet have not been quantified among Kuwaiti adults.

METHODS

Using a Comparative Risk Assessment model that incorporated dietary intake data from Kuwait's first national nutrition survey, number of cardiometabolic deaths from the World Health Organization, and estimated associations of diet with cardiometabolic deaths from the Global Burden of Disease project, we estimated the number and proportion of cardiometabolic deaths attributable to suboptimal intake of 10 dietary factors among Kuwaiti adults ages 25+ years, and by population subgroups.

FINDINGS

An estimated 1,308 (95% uncertainty interval [UI] = 1,228-1,485) cardiometabolic deaths were attributed to suboptimal diet, accounting for 64.7% (95% UI = 60.7%-73.4%) of all cardiometabolic deaths in Kuwait in 2009. The low intake of nuts/seeds was associated with the highest estimated number and proportion of cardiometabolic deaths (n = 380, 18.8%), followed by high intake of sodium (n = 256, 12.6%), low intake of fruits (n = 250, 12.4%), low intake of vegetables (n = 236, 11.7%), low intake of whole grains (n = 201, 9.9%), and high intake of sugar-sweetened beverages (n = 201, 9.9%). The estimated proportions of cardiometabolic deaths attributable to suboptimal diet were higher in men (67.7%) than women (57.8%) and in younger adults aged 25-34 years (84.5%) than older adults aged ≥55 years (55.6%).

CONCLUSION

Suboptimal dietary intake was associated with a very substantial proportion of cardiometabolic deaths among Kuwaiti adults in 2009, with young adults and men experiencing the largest proportion of diet-associated cardiometabolic deaths in Kuwait.

Hypomagnesemia and the Metabolic Syndrome among Apparently Healthy Kuwaiti Adults: A Cross-Sectional Study

Magnesium plays a key role in metabolic disorder development, and hypomagnesemia may be implicated in the pathogenesis of metabolic syndrome (MetS) and its components. In this cross-sectional study, we investigated the associations between hypomagnesemia, MetS, and MetS components among 231 adults (193 women and 38 men) living in Kuwait who were apparently healthy without chronic diseases. We used the International Diabetes Federation (IDF) and the United States National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria to define participants with MetS. The Ministry of Health cutoff for hypomagnesemia (<0.74 mmol/L) was employed. IDF- and ATP III-defined MetS prevalence was 22.1% and 15.2%, respectively. Hypomagnesemia occurred in 33.3% of all participants and 53.2% of participants with MetS (p < 0.001). Magnesemia correlated negatively with body mass index, waist circumference, systolic blood pressure [SBP], diastolic blood pressure (DBP), fasting blood glucose (FBG), low-density lipoprotein cholesterol level, and triglyceride level; magnesemia correlated positively with high-density lipoprotein cholesterol (HDL-C) levels (p < 0.001). Multivariate logistic regression, adjusting for BMI, age, and sex, showed that hypomagnesemia was associated with a 12- and 5-fold greater odds of getting IDF-defined (adjusted odds ratio [aOR] 11.70; 95% confidence interval [CI] 4.87−28.14) and ATP-defined (aOR 5.44; 95% CI 2.10−14.10) MetS, respectively, in the study population. Hypomagnesemia was significantly associated with a 3.62, 9.29, 7.01, 2.88, 3.64, and 3.27 higher odds of an increased waist circumference (95% CI 1.48−8.85), elevated serum triglyceride level (95% CI 3.97−21.73), elevated FBG (95% CI 3.25−15.11), elevated SBP (95% CI 1.16−7.11), elevated DBP (95% CI: 1.22−10.89), and lowered HDL-C level (95% CI 1.69−6.32), respectively. Hypomagnesemia could be a consequence of the pathophysiology of MetS and its individual components among adults in Kuwait.

Anthropometric cut-points for discriminating diabetes and the metabolic syndrome among Arabs and Asians: the Kuwait Diabetes Epidemiology Program

This study aimed to determine anthropometric cut-points for screening diabetes and the metabolic syndrome (MetS) in Arab and South Asian ethnic groups in Kuwait and to compare the prevalence of the MetS based on the ethnic-specific waist circumference (WC) cut-point and the International Diabetes Federation (IDF) and American Heart Association/National Heart, Lung, and Blood Institute WC criteria. The national population-based survey data set of diabetes and obesity in Kuwait adults aged 18-60 years was analysed. Age-adjusted logistic regression and receiver operating characteristic (ROC) analyses were conducted to evaluate for 3589 individuals the utility of WC, waist:height ratio (WHtR) and BMI to discriminate both diabetes and ≥3 CVD risk factors. Areas under the ROC curve were similar for WC, WHtR and BMI. In Arab men, WC, WHtR and BMI cut-offs for diabetes were 106 cm, 0·55 and 28 kg/m2 and for ≥3 CVD risk factors, 97 cm, 0·55 and 28 kg/m2, respectively. In Arab women, cut-offs for diabetes were 107 cm, 0·65 and 33 kg/m2 and for ≥3 CVD risk factors, 93 cm, 0·60 and 30 kg/m2, respectively. WC cut-offs were higher for South Asian women than men. IDF-based WC cut-offs corresponded to a higher prevalence of the MetS across sex and ethnic groups, compared with Kuwait-specific cut-offs. Any of the assessed anthropometric indices can be used in screening of diabetes and ≥3 CVD risk factors in Kuwaiti Arab and Asian populations. ROC values were similar. The WC threshold for screening the MetS in Kuwaiti Arabs and South Asians is higher for women.

Gender differences in quality of life, physical activity, and risk of hypertension among sedentary occupation workers

PURPOSE

This study aimed to explore gender differences among sedentary occupation workers with regard to their quality of life (QoL), physical activity, and risk for high blood pressure, and to identify factors associated with QoL.

METHODS

A convenience sample of 2562 employees from randomly selected ten ministries in Kuwait completed self-administered questionnaires. Collected data included employees' socio-demographic characteristics, levels of QoL (using World Health Organization QoL-Brief tool), and physical activity (using the New Zealand Physical Activity Questionnaire Short Form), and anthropometric measures of weight, height, and blood pressure. Multinomial regression analysis, Chi-square, ANOVA, and student's t tests were implemented. A p value of 0.05 was considered significant.

RESULTS

Participants' mean age was 35.3 years. QoL mean scores were total QoL (74.7), physical health (81.1), psychological health (75.4), social relationship (71.1), and environment (70.8). Females showed worse level of QoL, better physical activity, and higher prevalence of hypertension relative to males. Multinomial regression analysis revealed that female gender, low educational attainability, poor income, high job ranks, shorter working years, obesity, physical inactivity, hypertension, or having at least one chronic illness significantly correlated to fair and poor QoL.

CONCLUSION

Sedentary occupation workers reported modest level of QoL and were at high risk of hypertension. Socio-demographic factors, physical activity, and health status were correlated to QoL. Gender differences existed in QoL, physical activity, and risk of hypertension. Improving employees' QoL through adopting strategies to promote healthy lifestyle in work settings should be activated. Further studies are recommended to explore cultural factors that drive gender differences in QoL.

Management of nonalcoholic fatty liver disease in the Middle East

The prevalence of nonalcoholic fatty liver disease (NAFLD) in the Middle East is increasing in parallel to an increase in the prevalence of associated risk factors such as obesity, metabolic syndrome, and type 2 diabetes mellitus. About 20% to 30% of the patients progress to develop nonalcoholic steatohepatitis (NASH), a histological subtype of NAFLD, with features of hepatocyte injury such as hepatocyte ballooning. NASH can progress to fibrosis, cirrhosis, and even hepatocellular carcinoma. NAFLD thus causes a substantial burden on healthcare systems and it is imperative that appropriate strategies are discussed at a regional level to facilitate effective management tailored to the needs of the region. To fulfil this unmet need, expert gastroenterologists, hepatologists, and endocrinologists from the region came together in three advisory board meetings that were conducted in Saudi Arabia, United Arab Emirates, and Kuwait, to discuss current local challenges in NAFLD screening and diagnosis, and the different available management options. The experts discussed the disease burden of NAFLD/NASH in the Middle East; screening, diagnosis, and referral patterns in NAFLD; and available treatment options for NAFLD and NASH. This paper summarizes the discussions and opinion of the expert panel on the management of NAFLD/NASH and also presents an extensive literature review on the topic.

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.

Prevalence of metabolic syndrome in the Gulf Cooperation Council countries: meta-analysis of cross-sectional studies

Metabolic syndrome is a collection of health-related conditions that lead to serious health condition. An individual with metabolic syndrome may acquire greater risk for adult-onset complications such as cardiovascular or neurological disorders. The aim of this study was to review and provide the prevalence of metabolic syndrome in Gulf Cooperation Council countries (GCC). Literature searches were performed on PubMed, Google scholar, and Web of Science Core Collection for English-language articles along with national studies. The following search terms were used during search: “prevalence of metabolic syndrome in GCC,” “prevalence of metabolic syndrome in middle east,” “prevalence of metabolic syndrome in Arab,” and “prevalence of metabolic syndrome name of country.” Thirty-seven studies were selected for final review out of 132 studies. The weighted pooled prevalence of metabolic syndrome was 27.3% with high heterogeneity (I²=98.94%; Cochran Q-test P<0.01). The results showed comparatively high and rising rate of metabolic syndrome in the GCC area. Preventative strategy should be considered to reduce the risk of morbidity or mortality related to metabolic syndrome.

Elevated concentrations of bromate in Drinking water and groundwater from Kuwait and associated exposure and health risks

Drinking water is an important source of human exposure to bromate, an ubiquitous environmental contaminant and a suspect human carcinogen. Nevertheless, little is known with regard to bromate exposure from water produced by thermal desalination of seawater. The purpose of this study was to determine the occurrence of bromate in desalinated drinking water and groundwater from Kuwait and estimate associated exposure and health risks to consumers. In this study, 194 tap and ground water samples collected from Kuwait were analyzed for the presence of bromate and bromide (reduced form of bromine). Bromate was found in almost all tap water samples with a mean concentration of 19.6 μg/L, which is higher than the maximum acceptable contaminant level (MCL) of 10 μg/L. The mean concentration of bromide in tap water samples was 46.2 μg/L. In bottled water, lower mean bromate concentration was found (2.89 μg/L) with mean bromide levels at 76.1 μg/L. Saline brackish water had bromate concentration at 9.48 μg/L while bromate was not detected in saline groundwater/well water samples. The mean estimated daily intake (EDI) of bromate by the Kuwaiti population through tap water and commonly consumed bottled water was 21.7 μg/d and 3.21 μg/d, respectively. Among the five age groups, 3 to 5-year-old children had the highest EDI of bromate at 15.4 μg/d. The excess cancer risk due to ingestion of bromate in tap water was estimated to be 3.92 × 10^-4, which is approximately one order of magnitude higher than the maximum acceptable level of risk (2× 10^-5). This study highlights the significance of desalinated water as a source of bromate exposure.

Association of Overweight and Obesity with High Fast Food Consumption by Gulf Cooperation Council Medical Students

Fast food and sugar-sweetened soft drink consumption, adiposity, and physical activity behavior were determined through a cross-sectional study with 251 medical students from the Gulf Cooperation Council countries. Approximately 38% of the students were overweight or obese, and 56.2% consumed fast food in the past 24 h. Main reasons for consuming fast foods were lack of time to cook healthy food (51%), pleasant taste (26%) and the influence of family and friends (15%). Overweight status or obesity was more prevalent among males (50%), those having greater knowledge about calories in fast-food meals (51.6%), who checked fast food calories before eating (47.7%) or overestimated the amount of sugar in a soft drink (17.82 ± 26.59 spoons). Overweight or obese participants also performed more moderate physical activity (1.73 ± 2.08 days per week) compared to those with normal weight or underweight (p = <0.05). Fast food consumption can be curtailed by improving the availability of and access to healthier foods and implementing behavior change and regulatory interventions.

Overweight and obesity among adults in the Gulf States: A systematic literature review of correlates of weight, weight-related behaviours, and interventions

Obesity has increased to an epidemic level in the Gulf States. This systematic review is the first to explore the scientific evidence on correlates and interventions for overweight (body mass index [BMI] ≥ 25) or weight-related behaviours in the region. A systematic search of peer-reviewed articles was conducted using PubMed and PsycINFO. Ninety-one studies were eligible for this review including 84 correlate studies and seven intervention studies. Correlate studies of overweight focused on sociodemographic factors, physical activity, and dietary habits. Low physical activity, sedentary behaviour, and unhealthy dietary habits were associated with overweight. The most-reported sociodemographic correlates of overweight were increased age, being married, low education, urban residence, and unemployment. Correlate studies of physical activity and dietary behaviours mostly focused on sociodemographic variables. Being female and increased age (the latter less consistently) were associated with low physical activity. Interventions were very heterogeneous with respect to the target group, intensity, and behavioural strategies used. The effectiveness of interventions was difficult to evaluate because of the chosen study design or outcome measure, the small sample size, or high attrition rate. Few studies have investigated sociocognitive and environmental determinants of weight-related behaviours. Such information is crucial to developing health promotion initiatives that target those weight-related behaviours.

DUSP1 Is a Potential Marker of Chronic Inflammation in Arabs with Cardiovascular Diseases

Background

Cardiovascular disease (CVD) risks persist in patients despite the use of conventional treatments. This might be due to chronic inflammation as reflected in epidemiological studies associating circulating low-grade inflammatory markers with CVD recurrent events. Here, we explored this potential link by assessing plasma dual-specificity phosphatase 1 (DUSP1) levels and comparing them to high-sensitivity CRP (hsCRP) and oxidized low-density lipoprotein (oxLDL) levels and their associations to conventional CVD risk factors in confirmed CVD patients.

Methods

Human adults with reported CVD (n = 207) and controls (n = 70) living in Kuwait were used in this study. Anthropometric and classical biochemical parameters were determined. Plasma levels of DUSP1, oxLDL, and hsCRP were measured using human enzyme-linked immunosorbent assay kits.

Results

DUSP1 and hsCRP plasma levels and their least square means were higher in CVD cases, while oxLDL plasma levels were lower (p < 0.05). Multivariate logistic regression analysis showed that DUSP1 and hsCRP are independently associated with CVD in the studied population, as reflected by 2-fold and 1.5-fold increased risks with increased levels of DUSP1 and hsCRP, respectively. In our study, DUSP1 levels were found to be associated with CVD despite statin treatment and diabetes status (p < 0.05), whereas hsCRP mainly correlated with obesity markers.

Conclusions

Circulating DUSP1 might be a predictor of chronic subclinical inflammation and residual risk in CVD patients, whereas our data suggest that the association between hsCRP and CVD is largely accounted for adiposity risk factors.

Metabolic Syndrome among Refugee Women from the West Bank, Palestine: A Cross-Sectional Study

This study was carried out among Palestinian refugee women in the West Bank to provide data on the prevalence of metabolic syndrome (MetS) and its correlates. Data were obtained from a cross-sectional study of 1694 randomly selected refugee women from the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) health centers throughout the West Bank during June and July 2010. In this cohort, 30% of the refugee women were overweight, 39% were obese, and 7% were extremely obese. Based on World Health Organization (WHO) criteria, the age-adjusted prevalence of MetS was 19.8%. The results of the binary logistic regression analysis indicated that older age and younger marital age were significantly associated with an increased likelihood of MetS in the women. The high prevalence of obesity and MetS mandates the implementation of national policies for its prevention, notably by initiating large-scale community intervention programs for 5.2 million refugees in Palestine, Jordan, Lebanon, and Syria, to tackle obesity and increase the age at marriage.

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.

Study on body composition and its correlation with obesity: A Cohort Study in 5121 Chinese Han participants

Rare reports can be found about sex- and age-specific body composition survey among Chinese population. The aim of this study is to explore the change of body composition with aging in Chinese males and females respectively.The present cross-sectional study was carried out in Central South University Xiangya School of Medicine Affiliate Haikou Hospital, on a random sample consisting of 5121 participants. Inbody720 body composition analyzer was used to detect the human body composition. Data collection was based on the assessment of anthropometric body composition measurements done with the help of bioelectric impedance. And the data were analyzed with SPSS19.0.We selected 5121 participants, 3276 males and 1845 females. A significant trend (P < 0.05) for all anthropometric indices was observed with age for both genders. Body fat in men and women were 18.33 kg and 19.82 kg, respectively. Body fat percentage in men and women were 25.74% and 34.01%, respectively. Visceral fat area in men and women were 91.98 cm and 77 cm, respectively And, with the increase of age, body fat, body fat percentages and visceral fat area also increased, both in men and in women. Meanwhile, with the increase of BMI, the body fat, body fat percentages, and visceral fat area also increased, both in men and in women.Significant trends were observed for body fat, body fat percentages and visceral fat area for both genders with age and both genders with BMI. Focusing on obesity-related lifestyle and prevent weight gain.

Prevalence of metabolic syndrome in Middle-East countries: Meta-analysis of cross-sectional studies

OBJECTIVE

Metabolic syndrome is an important metabolic disorder which impose noticeable burden on health system. We aimed to review and imply the prevalence of it in Middle-East countries.

METHODS

present study was a systematic review to present overview about metabolic disorder in Middle East. Electronic literature search of Medline database and Google scholar were done for English-language articles without time filtering, as well as for population-based or national studies of the prevalence of metabolic syndrome. The fallowing search terms were used simultaneously: prevalence of ^"metabolic syndrome" and "national study", "prevalence of metabolic syndrome in Middle East", "prevalence of metabolic syndrome" and "name of country", "metabolic syndrome &name of country". Additionally, relevant articles in bibliography were searched. Analysis of data was carried out in STATA version 11.0.

RESULTS

out of 456 studies in first-step searching (selecting by title) 59 studies were recruited and reviewed. Prevalence of metabolic syndrome fluctuated by country and time of study. This amount was 2.2-44% in Turkish, 16-41% in Saudi-Arabia, 14-63 in Pakistan, 26-33 in Qatar, 9-36 in Kuwait, 22-50 in Emirate, 6-42 in Iran, and up to 23 in Yemen. Pooled estimate was 25%. Attributable risk for cardiovascular disease, coronary heart disease, and stroke was 15.87, 11.7, and 16.23, respectively.

CONCLUSION

The prevalence rate of metabolic syndrome is high and it is noticeable cause for stroke, coronary heart disease, and cardiovascular disease.

Non-Alcoholic Fatty Liver Disease in Africa and Middle East: An Attempt to Predict the Present and Future Implications on the Healthcare System

Non-alcoholic fatty liver disease (NAFLD) encompasses a group of hepatic diseases that range in severity. NAFLD is increasingly recognized as an epidemic among different populations, including those in Africa and the Middle East. The objective of this narrative review is to document the prevalence of and risk factors for NAFLD in Africa and the Middle East and the potential implications on the healthcare systems. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms "non-alcoholic fatty liver disease" and "non-alcoholic steatohepatitis", in addition to "prevalence and risk factors for NAFLD", with special emphasis on Africa and the Middle East countries. There were three types of epidemiological studies that included prevalence, risk factors and management/complications of NAFLD. There was noticeable variation in the prevalence of NAFLD among different countries, based on the variation in the prevalence of risk factors (type 2 diabetes, obesity, metabolic syndrome and dyslipidemia) and the diagnostic tool used in the study. However, the highest prevalence rate was reported in some Middle East countries. In Africa, there were few studies about NAFLD and most reported variable prevalence rates. There is an increasing prevalence of NAFLD as a result of the increasing risk factors, particularly in the Middle East, while in Africa, the situation is still unclear. Health providers in these regions are faced with many challenges that need urgent plans.

Prevalence of vitamin D deficiency and association with metabolic syndrome in a Qatari population

OBJECTIVES

Despite long hours of sunlight in Qatar and other regions of the Middle East, vitamin D deficiency has been rising. In parallel, the prevalence of metabolic syndrome has also been increasing in Qatar. Vitamin D levels have been associated with metabolic syndrome but the data are inconsistent and no studies have addressed these inter-relationships in a Middle Eastern population where the prevalence of these conditions is high. The objective is to investigate the prevalence of vitamin D deficiency and its association with metabolic syndrome and its components in the Qatar Biobank population.

METHODS

A cross-sectional study of 1205 participants (702 women and 503 men) from the Qatar Biobank, comprising Qataris and non-Qataris between the ages of 18 and 80 years, was used to perform multivariate linear regression analyses to examine the association between metabolic syndrome and prevalence of vitamin D deficiency (defined as <20 ng ml-1 serum vitamin D levels) adjusting for age, sex, ethnicity, season of blood collection, physical activity and education. Odds ratios and 95% confidence intervals were calculated for all analyses.

RESULTS

Approximately 64% of participants were vitamin D deficient (<20 ng ml-1) with more men being deficient (68.6%) than women (61.3%). Serum vitamin D was 8% lower in individuals with metabolic syndrome (RR: 0.92, 95%CI: 0.87-0.98, P-value: 0.01) compared to individuals without metabolic syndrome. Waist circumference and HDL as well as high triglyceride levels were also significantly positively associated with vitamin D deficiency. No association was found between the other components of metabolic syndrome or diabetes and the presence of vitamin D deficiency.

CONCLUSIONS

Vitamin D deficiency is prevalent in this Qatari population. Presence of metabolic syndrome was associated with presence of vitamin D deficiency. Future prospective studies need to be conducted to investigate the potential for causality.

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.

Sociocultural Characteristic, Lifestyle, and Metabolic Risk Factors Among a Sample of Kuwaiti Male University Students

In the past six decades, the Kuwaiti population has been exposed to rapid transformation in the quality of diet intake, daily activities, and career types. This major socioeconomic shift was accompanied by the introduction of both communicable and noncommunicable chronic diseases afflicting people of all ages. This article aims to detect a relationship between sociocultural characteristics—such as physical activity, dietary habits, and smoking—and the prevalence of metabolic syndrome (MetS). A descriptive, cross-sectional survey was conducted among 262 male university students in Kuwait; participants were selected by using a convenient nonrandom opportunistic sample. Associated social and health factors were obtained using a closed-ended questionnaire. BMI and blood tests that include clusters of MetS risk components were drawn from participants in primary health care clinics. More than half of the participants were overweight and obese; 74.4% of the participants reported they did not visit a nutritionist; 69.8% said that they are currently not on a diet; 53.4% of the students were nonsmokers; 42.7% reported moderate to very low daily physical activity. The prevalence of MetS components increased among students with older age, employed, and married (p < .001), higher BMI, higher income, smoking, fewer number of family members living, and belonging to the Shia religious sect (p < .05). The high frequency of MetS among younger students needs to be considered by Kuwaiti community members and the government to highlight the risk factors of MetS on individuals’ well-being, quality of life, and life expectation.

Vitamin D deficiency is associated with high prevalence of diabetes in Kuwaiti adults: results from a national survey

BACKGROUND

Vitamin D homeostasis may play a critical role in glucose metabolism. Little is known on vitamin D deficiency and its association with diabetes in countries of the Arabia Gulf where the population is experiencing a rapid increase in the incidence of diabetes.

METHODS

In a cross-sectional study of 960 adults enrolled in the first National Nutrition Survey of the State of Kuwait (NNSSK), we examined vitamin D status in association with the prevalence of diabetes and prediabetes. Vitamin D status was measured by serum levels of 25-hydroxyvitami D (25(OH)D). Prevalences of diabetes and prediabetes were determined based on fasting glucose and HbA1C levels.

RESULTS

The median level of serum 25(OH)D in Kuwaiti adults was 13.8 ng/ml. Approximately 56 % of the Kuwaiti adults had vitamin D inadequacy (25(OH)D = 12-19.9 ng/ml), and 27 % had vitamin D deficiency (25(OH)D < 12 ng/ml). The prevalences of prediabetes and diabetes were 40 and 27 %, respectively. Vitamin D inadequacy (OR = 1.7, 95 % CI: 1.0-2.9) and deficiency (OR =2.0, 95 % CI: 1.1-3.3) was each associated with about two-fold increased odds of prediabetes compared to sufficient vitamin D status (25(OH)D ≥ 20 ng/ml). Vitamin D inadequacy (OR =2.1, 95 % CI: 1.2-3.7) and deficiency (OR =2.0, 95 % CI: 1.1-3.9) were also associated with two-fold increased odds of diabetes.

CONCLUSIONS

Data from Kuwaiti's first nutrition nutritional survey suggests a very high prevalence of vitamin D deficiency in Kuwaiti adults. Associations of low vitamin D status and high prevalence of diabetes point to the need of continuous monitoring of vitamin D status and further evaluating potential health consequences in this high-risk population.

Chronic Pain, Comorbid Medical Conditions, and Associated Risk Factors in Kuwait: Gender and Nationality Differences

OBJECTIVE

Chronic pain is an international health problem that imposes enormous costs on societies around the world. There is good reason to suspect that chronic pain is a serious health issue in Kuwait and is associated with comorbid medical conditions like diabetes. The aim of this study is to examine the report of pain and incidence of medical comorbidities among a large convenience sample of patients treated at a private rehabilitation center in Kuwait and to examine differences in patient groups based on age, gender, and Kuwaiti nationality.

METHODS

This study examined intake data from 2,103 patients treated at a rehabilitation center in Kuwait. Most of the subjects were female (55.4%) and averaged 43.3 years of age (±14.5, range 18-88). Sixty nine percent were Kuwaiti citizens and 57.9% were employed.

RESULTS

Marked differences in pain and health-related conditions were found between Kuwaiti nationals and non-Kuwaitis, with significantly increased incidences of hypertension, osteoarthritis, diabetes, asthma, osteoporosis, and cardiac and respiratory problems among the Kuwaitis (P < 0.001). Notable gender differences were also identified with women reporting more intense, widespread pain, and reporting more comorbid medical problems compared with men (P < 0.001).

CONCLUSIONS

This extensive survey study that found female Kuwaitis to have a higher incidence of pain and medical comorbidities than males and non-Kuwaitis highlights the role of cultural factors in contributing to pain and comorbid medical conditions. This information is critical in organizing resources to implement adequate healthcare services and behavioral interventions in Kuwait and other Arab countries to improve pain and health-related conditions.

Importance Attributed to Cardiovascular and Pulmonary Competencies by Public Sector Physical Therapists in Kuwait: A Population-based Exploratory Study

BACKGROUND AND PURPOSE

Indications for cardiovascular and pulmonary (CVP) physical therapy competencies are changing with the epidemic of non-communicable diseases in Kuwait, particularly lifestyle-related conditions. The degree to which the country's physical therapists (PTs) perceive the importance of CVP competencies (assessment/evaluation and clinical and laboratory investigation interpretation) in professional practice is relevant. Our study objectives were to (1) explore the importance attributed to specific CVP competencies by PTs to professional practice in Kuwait and (2) establish whether these are related to practitioner traits, for example, age, sex, practice setting and specialty.

METHOD

The study design was exploratory with a stratified random sample. Questionnaires (n = 221) were distributed to PTs practicing in the facilities of the Ministry of Health, the primary employer of PTs in Kuwait. Questions included participants' demographics and perceived importance of specific CVP competencies (Likert rating scale 1-not important to 5-highly important).

RESULTS

Response rate was 87% (n = 193). Participant mean age was 36(±9) years, 63% were women and 48% were Kuwaiti. Ratings of moderately important or higher were 84% for cardiac assessment/intervention skills, 78.8% for cardiac clinical/laboratory investigations interpretation, 77.2% for pulmonary assessment/intervention skills and 73.6% for pulmonary clinical/laboratory investigations interpretation. PTs in the musculoskeletal area attributed less importance to the competencies than those in other specialties.

CONCLUSIONS

Participants perceived CVP competencies as generally relevant to practice. However, greater importance was attributed to these competencies in relation to management of CVP conditions (e.g. those that address lifestyle-related conditions) rather than across practice areas. Research is needed to elucidate whether this finding reflects the profession's commitment to holistic care, the prevalence of lifestyle-related risk factors and conditions irrespective of a patient's primary complaint presenting to the PT, best evidence-based, non-pharmacologic practice to address these or some combination. Copyright © 2015 John Wiley & Sons, Ltd.

Gender-specific association of oxidative stress and inflammation with cardiovascular risk factors in Arab population

Background. The impact of gender difference on the association between metabolic stress and cardiovascular disease (CVD) remains unclear. We have investigated, for the first time, the gender effect on the oxidative and inflammatory stress responses and assessed their correlation with classical cardiometabolites in Arab population. Methods. A total of 378 adult Arab participants (193 females) were enrolled in this cross-sectional study. Plasma levels of CRP, IL-6, IL-8, TNF-α, ROS, TBARs, and PON1 were measured and correlated with anthropometric and cardiometabolite parameters of the study population. Results. Compared to females, males had significantly higher FBG, HbA1c, TG, and blood pressure but lower BMI, TC, and HDL (P < 0.05). After adjustment for BMI and WC, females had higher levels of ROS, TBARS, and CRP (P < 0.001) whereas males had increased levels of IL-8, IL-6, and TNF-α (P < 0.05). Moreover, after adjustment for age, BMI, and gender, the levels of TNF-α, IL-6, and ROS were associated with central obesity but not general obesity. Conclusion. Inflammation and oxidative stress contribution to CVD risk in Arab population linked to gender and this risk is better reflected by central obesity. Arab females might be at risk of CVD complications due to increased oxidative stress.

10-year risk estimation for type 2 diabetes mellitus and coronary heart disease in Kuwait: a cross-sectional population-based study

BACKGROUND

Type 2 diabetes mellitus (T2DM), coronary heart disease (CHD) and metabolic syndrome (MetS) are major healthcare problems in Kuwait. The present study was designed to determine the prevalence of MetS, and to estimate the 10-year risk for developing T2DM and CHD among the general population in Kuwait.

METHODS

A descriptive, cross-sectional survey was undertaken in 1800 individuals without diabetes or a history of cardiovascular disease (CVD). They were selected from six governorates using two stage convenience sampling. The questionnaire was developed using the Finnish Diabetes Risk Score (FINDRISK), Framingham Risk Score [FRS] and the 2009 Joint Statement criteria for diagnosis of MetS as a framework. Descriptive and multivariate logistic regression analyses were used.

RESULTS

The response rate was 89.4%. More than half (60.8%; 95% CI: 58.4-63.2) of responders were either overweight or obese. One hundred and ninety seven (12.2%) subjects had blood pressure (BP) ≥ 140/90 mm Hg. Almost three-in-ten (28.3%: 26.2-30.6) subjects had fasting plasma glucose (FPG) levels ≥ 5.6 mmol/l, of whom 86.0% and 14.0% had impaired fasting glucose (IFG) and screen detected T2DM, respectively. MetS was present in 512 (31.8%; 29.5-34.2) respondents. Just under one third (n = 481; 29.9%; 27.7-32.2) of participants were at moderate, high, or very high risk of developing T2DM, while 283 (17.6%: 15.8-19.6) were at moderate/high 10-year risk of developing CHD. Approximately one-in-ten (8.5%; 7.2-9.9) subjects were at moderate/high/very high 10-year risk of developing both T2DM/CHD. T2DM risk was higher for females compared to males (p < 0.001); however, the pattern was reversed in terms of the risk of developing CHD or T2DM/CHD. The risk of developing T2DM, CHD, or T2DM/CHD was greater among those aged ≥ 45 years, and those having MetS (p<0.001).

CONCLUSIONS

The current findings highlight the need for multifaceted interventions for prevention.

Gene-environment interactions in human health: case studies and strategies for developing new paradigms and research methodologies

THE SYNERGISTIC EFFECTS OF GENES AND THE ENVIRONMENT ON HEALTH ARE EXPLORED IN THREE CASE STUDIES: adult lactase persistence, autism spectrum disorders, and the metabolic syndrome, providing examples of the interactive complexities underlying these phenotypes. Since the phenotypes are the initial targets of evolutionary processes, understanding the specific environmental contexts of the genetic, epigenetic, and environmental changes associated with these phenotypes is essential in predicting their health implications. Robust databases must be developed on the local scale to deconstruct both the population substructure and the unique components of the environment that stimulate geographically specific changes in gene expression patterns. To produce these databases and make valid predictions, new, locally focused, and information-dense models are needed that incorporate data on evolutionary ecology, environmental complexity, local geographic patterns of gene expression, and population substructure.

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

OBJECTIVE

Kuwait is among the countries with the highest obesity rates worldwide; however, little is known about the state of obesity epidemiology research in Kuwait. In this paper, we therefore review the findings and methodology of studies on the prevalence, trends and risk factors of obesity in Kuwait.

METHODS

The PubMed database was searched using the keyword combination: obesity and adults and Kuwait. Out of 111 articles, 39 remained after abstract review, and 18 were selected after full-text review.

RESULTS

The studies were all cross-sectional and published in the last fifteen years (1997-2012). The sample size ranged from 177 to 38,611 individuals. Only 30% of studies used random sampling. The prevalence (BMI ≥ 30) in studies with a nationally representative sample ranged from 24% to 48% overall and in adults >50 years was greater than 52%. Rates were significantly higher in women than those in men. Studies that examined trends showed an increase in obesity prevalence between 1980 and 2009. Multiple risk factors including sociocultural factors were investigated in the studies; however, factors were only crudely assessed.

CONCLUSION

There is a need for future studies, particularly surveillance surveys and prospective cohort studies utilizing advanced methods, to monitor trends and to comprehensively assess the factors contributing to the obesity epidemic in Kuwait.