Alarming Eating Behaviours among Adolescents in Egypt

Prevalence and Determinants of Obesity and Overweight Among Children and Adolescents in the Middle East and North African Countries: An Updated Systematic Review

In recent years, the countries of the Middle East and North Africa (MENA) region have experienced alarming increases in the prevalence of childhood overweight and obesity. This updated systematic review sought to measure the prevalence and determinants of obesity and overweight among children and adolescents in MENA countries. A literature search for relevant observational studies published in English was conducted using PubMed, Web of Science, Google Scholar, and Saudi Digital Library. The risk of bias was evaluated using the Newcastle-Ottawa Scale. Twenty-one published articles during the past five years were included in the systematic review. Varied approaches were used to diagnose childhood overweight and obesity, including the International Obesity Taskforce (IOTF), Centre for Disease Control (CDC), World Health Organization (WHO), and Saudi Growth Pattern Curves. We found that the combined prevalence of childhood overweight and obesity in the Middle East is up to 49.4%, depending on the methods applied in their studies. Risk factors identified were age, male gender, lack of sufficient physical activity, consumption of fried food, perceived stress level, number of family members, family size, mother's occupation, education level, family history of obesity, high energy consumption from carbohydrates, ≥2 hours spent on watching television on weekend days with overweight, and always eating breakfast while watching television with obesity. The results of this review indicate that the issue of childhood and adolescent overweight and obesity in the Middle East is substantial and concerning. Most of the risk factors identified are modifiable and, if given appropriate attention, could significantly reduce the burden of associated chronic complications.

Nutrition Profile for Countries of the Eastern Mediterranean Region with Different Income Levels: An Analytical Review

The World Health Organization's (WHO) Eastern Mediterranean Region (EMR) is suffering from a double burden of malnutrition in which undernutrition coexists with rising rates of overweight and obesity. Although the countries of the EMR vary greatly in terms of income level, living conditions and health challenges, the nutrition status is often discussed only by using either regional or country-specific estimates. This analytical review studies the nutrition situation of the EMR during the past 20 years by dividing the region into four groups based on their income level-the low-income group (Afghanistan, Somalia, Sudan, Syria, and Yemen), the lower-middle-income group (Djibouti, Egypt, Iran, Morocco, Pakistan, Palestine, and Tunisia), the upper-middle-income group (Iraq, Jordan, Lebanon, and Libya) and the high-income group (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates)-and by comparing and describing the estimates of the most important nutrition indicators, including stunting, wasting, overweight, obesity, anaemia, and early initiation and exclusive breastfeeding. The findings reveal that the trends of stunting and wasting were decreasing in all EMR income groups, while the percentages of overweight and obesity predominantly increased in all age groups across the income groups, with the only exception in the low-income group where a decreasing trend among children under five years existed. The income level was directly associated with the prevalence rates of overweight and obesity among other age groups except children under five, while an inverse association was observed regarding stunting and anaemia. Upper-middle-income country group showed the highest prevalence rate of overweight among children under five. Most countries of the EMR revealed below-desired rates of early initiation and exclusive breastfeeding. Changes in dietary patterns, nutrition transition, global and local crises, and nutrition policies are among the major explanatory factors for the findings. The scarcity of updated data remains a challenge in the region. Countries need support in filling the data gaps and implementing recommended policies and programmes to address the double burden of malnutrition.

Mahfouz N, Abushady MM, El-Alameey IR. Relation of Serum Micronutrients to Growth and Nutritional Habits of School-Aged Children in Egypt

Proper growth of children depends on several micronutrients. A fundamental role of Zinc and vitamins as A, B12 and D is crucial to prevent a failure to thrive. To study the relationship between Egyptian school aged children growth, nutritional habits and micronutrients deficiencies. Materials and methods: A case control research involved 60 school aged children (age ranged from 6 to 12 years). Group 1 (malnourished) compared with group II (apparently healthy children of matched peers). Serum concentrations of Zinc, Copper, and vitamins as A, B12, and D were measured using ELISA kits. Compared to controls, the cases showed significantly lower serum concentrations of Zinc, vitamin A, B12, and D (P<0.000 in all), while serum concentration of Copper was significantly higher. In the patient's group, serum vitamin B12, and Zinc concentrations showed significant positive correlation with height for age z- score, while serum Copper concentration showed significant negative correlation with BMI for age z- score. Serum Zinc, vitamin B12, and D concentrations were significantly correlated positively with serum vitamin A. Multiple logistic regression showed statistically significant association of high serum Copper and weekly consumption of sweetened beverages among the studied patients (P < 0.01). Vitamins and Zinc deficiencies showed high prevalence among the school children. Serum vitamin B12 and Zinc concentrations showed significant positive correlation with height. The significant association between high serum Copper and sugary beverages among the studied patients may be due to contained preservatives.

The association between later eating rhythm and adiposity in children and adolescents: a systematic review and meta-analysis

CONTEXT

Childhood adiposity, an important predictor of adult chronic disease, has been rising dramatically. Later eating rhythm, termed night eating, is increasing in adults but rarely studied in younger ages.

OBJECTIVE

The objective of this study was to review the association between later eating rhythm and adiposity in children and adolescents. The aspects of later eating being considered included: energy intake (for evening main meal, evening snack, whole evening period, and around bedtime); timing (any food eaten at later timing); and meal frequency in the evening/night (evening main meal skipping, evening snack consumption).

DATA SOURCES

Five databases (the Cochrane Library, CINAHL, Embase, MEDLINE (via OVID), and Web of Science) were searched for eligible articles published prior to and including August 2020.

DATA EXTRACTION

Data extraction and quality assessment were conducted by 2 reviewers independently.

DATA ANALYSIS

Forty-seven studies were included, all of which were observational. Meta-analysis showed positive associations between both higher energy intake around bedtime (odds ratio [OR] 1.19, 95% CI 1.06, 1.33) and evening main meal skipping (OR 1.30, 95% CI 1.14, 1.48), and adiposity. There was evidence to suggest that consuming evening snacks reduced adiposity, but it was very weak (OR 0.80, 95% CI 0.62, 1.05). No association was seen between eating later and adiposity (OR 1.04, 95% CI 0.68, 1.61). In the narrative analysis, approximately half of the studies suggested that there was no association between later eating rhythm and adiposity, either as a whole or within exposure subsets.

CONCLUSION

The magnitude of the relationship between later eating rhythm and adiposity is very small, and may vary depending on which aspects of later eating rhythm are under consideration; however, the evidence for this conclusion is of very low certainty . Further research with a more consistent definition of "later timing", and longitudinal studies in different populations, may lead to different conclusions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42019134187.

Cystatin and Glomerular Filtration Rate in Obese Versus Non-obese Adolescents

Background: Obesity is well known as an independent risk factor for chronic kidney disease. Thus meticulous assessment of renal function is more essential in obese individuals. Glomerular filtration rate (GFR) is commonly estimated based on serum creatinine (Cr).  However, using Cr as marker of kidney function has some limitations and Cystatin C has been reported as an alternative marker. Aim of work: This study was designed to assess renal function using both GFR and cystatin in obese adolescents. Methods: This case-control study enrolled ninety Egyptian adolescents aged between 10 and 18 years old who were divided equally into two groups according to body mass index (obese and non-obese).  Each participant was subjected to full medical history taking, anthropometric measures, and Laboratory investigation including CBC, serum Cr, estimated GFR and cystatin C. Results:  Serum Cr level was significantly higher in obese adolescents compared to non-obese mean value (0.94) and (0.79) resepectively. Also, eGFR based on Cr was significantly lower in obese group compared to controls (73.1) and ( (85.30)respectively. Cystatin C showed non-significant higher levels in obese group versus controls with mean value (2.28) and (1.85)respectively. Cystatin C at Cut-off value of 1.525 and 95% CI showed sensitivity of 47.2% and specificity of 63.9% for evaluation of kidney affection in obese children and adolescences. Conclusion: GFR is affected in obese adolescence with elevation of serum creatinine and unexpected non significant elevation of cystatin C in obese adolescence when compared by control group. Keywords: Cystatin, Creatinine, Pediatric obesity, GFR, renal function.

Association between Bisphenol A Urine Level with Low-Grade Albuminuria in Egyptian Children and Adolescents

 The glomerulus is the accessible window to visualize the endothelial status of the whole body. Minimal level of albuminuria even below the cutoff point of microalbuminuria might be a marker of endothelial dysfunction. Exposure to Bisphenol A may be a risk factor of developing low-grade albuminuria in pediatrics. Aim: This study investigated the association of exposure to Bisphenol A and the presence of low-grade albuminuria. Methods: A cross-sectional study enrolling 158 children; 91 boys and 67 girls. Children with hepatic disease, kidney disease and endocrinopathies were excluded from the study. Urinary albumin and creatinine were measured in a first morning urine specimen. Urinary albumin/creatinine ratio was calculated in mg/gm and was stratified into: macroalbuminuria of ˃300mg/gm, microalbuminuria of 30-300mg/gm and low grade albuminuria of ˂30mg/gm. Urinary Bisphenol A was measured by high performance liquid chromatography using florescent detector. Results: Low grade albuminuria was detected in 141 participants (89.24%), while microalbuminuria and macroalbuminuria were detected in 15 (9.5%) and 2 (1.26%) participants, respectively. The total urinary Bisphenol A in candidates with low grade albuminuria was categorized into four quartiles (<0.285, 0.285–0.599, 0.600–1.215, >1.215) ng/mL and similarly their low grade albuminuria into (<2.0404, 2.0404–4.0385, 4.0386–7.3870, >7.3870) mg/gm. Children with the highest compared to the lowest quartile of urinary Bisphenol A had comparable mean of low grade albuminuria with insignificant P value. Conclusion: low grade albuminuria was found in 141 out of 158 children. A direct cause effect of exposure to Bisphenol A could not be proved. Further studies are needed to investigate the pathophysiology of low grade   albuminuria and its significance