Identification of Gut Microbiota Profile Associated with Colorectal Cancer in Saudi Population

Colorectal cancer (CRC) is a significant global health concern. Microbial dysbiosis and associated metabolites have been associated with CRC occurrence and progression. This study aims to analyze the gut microbiota composition and the enriched metabolic pathways in patients with late-stage CRC. In this study, a cohort of 25 CRC patients diagnosed at late stage III and IV and 25 healthy participants were enrolled. The fecal bacterial composition was investigated using V3-V4 ribosomal RNA gene sequencing, followed by clustering and linear discriminant analysis (LDA) effect size (LEfSe) analyses. A cluster of ortholog genes' (COG) functional annotations and the Kyoto Encyclopedia of Genes and Genomes (KEGG) were employed to identify enrichment pathways between the two groups. The findings showed that the fecal microbiota between the two groups varied significantly in alpha and beta diversities. CRC patients' fecal samples had significantly enriched populations of Streptococcus salivarius, S. parasanguins, S. anginosus, Lactobacillus mucosae, L. gasseri, Peptostreptococcus, Eubacterium, Aerococcus, Family XIII_AD3001 Group, Erysipelatoclostridium, Escherichia-Shigella, Klebsiella, Enterobacter, Alistipes, Ralstonia, and Pseudomonas (Q < 0.05). The enriched pathways identified in the CRC group were amino acid transport, signaling and metabolism, membrane biogenesis, DNA replication and mismatch repair system, and protease activity (Q < 0.05). These results suggested that the imbalance between intestinal bacteria and the elevated level of the predicated functions and pathways may contribute to the development of advanced CRC tumors. Further research is warranted to elucidate the exact role of the gut microbiome in CRC and its potential implications for use in diagnostic, prevention, and treatment strategies.

Impaired humoral immune response to hepatitis B vaccine in patients on maintenance hemodialysis

Hepatitis B virus (HBV) infection is a worldwide health problem. We aimed in this study to investigate the humoral immune response derived to HBV vaccine following completing the vaccine series in Madinah. Two hundred and two Saudi hemodialysis (HD) patients were included in this cross-sectional study. Mean concentration of Hepatitis B surface antibody (anti-HBs) was significantly higher among patients who received the vaccination twice compared to patients who received the vaccination only after starting hemodialysis (252 ± 489 mIU/mL vs. 144 ± 327 mIU/mL, respectively, p = 0.008). Almost half of the study sample were non-protected and showed anti-HBs concentration < 10 mlU/mL. In contrast, 20.3% (n = 41) were identified as poor responders (10-100 mlU/mL) and only 28.2% (n = 57) were identified as good responders (10-100 mlU/mL). However, the latter two groups were accounted as protected (48.5%, n = 98). Patients sex was associated with anti-HBs concentration (non-responders; poor responders; good responders), where significantly higher proportion of good responders were females compared to males (p = 0.007). In conclusion, HBV vaccine is efficient to elicit humoral immune response in hemodialysis patients.

Epidemiological Characteristics and Outcomes Predictors for Intensive Care Unit COVID-19 Patients in Al-Madinah, Saudi Arabia. Retrospective Cohort Study

Introduction

The global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) increased the demand for intensive care unit (ICU) services. Mortality and morbidity rates among ICU COVID-19 patients are affected by several factors, such as severity, comorbidities, and coinfections. In this study, we describe the demographic characteristics of COVID-19 patients admitted to an ICU in Saudi Arabia, and we determined the predictors for mortality and prolonged ICU length of stay. Additionally, we determined the prevalence of bacterial coinfection and its effect on the outcomes for ICU COVID-19 patients.

Methods

We retrospectively studied the medical records of 142 COVID-19 patients admitted to the ICU at a tertiary hospital in Madinah, Saudi Arabia. Data on demographics, medical history, mortality, length of stay, and presence of coinfection were collected for each patient.

Results

Neutrophil-to-Lymphocyte ratio (NLR) and intubation were reliable predictors of mortality and ICU length of stay among these ICU COVID-19 patients. Moreover, bacterial coinfections were detected in 23.2% of the patients and significantly (p < 0.001) prolonged their ICU length of stay, explaining the 10% increase in the length of stay for these patients. Furthermore, mortality reached 70% among the coinfected patients, and 60.8% of the isolated coinfecting pathogens were multidrug-resistant (MDR) strains of Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus.

Conclusion

Increased NLR and intubation are predictors of mortality and prolonged length of stay in COVID-19 patients admitted to the ICU. Coinfection with MDR bacterial strains potentially results in complications and is a high-risk factor for prolonged ICU length of stay.

Validity and Consistency of the Arabic Version of the Eating Disorder Examination Questionnaire (EDE-Q) among Saudi Adults

The prevalence of eating disorders (EDs) is growing, and early screening is important to prevent related health complications. The Eating Disorder Examination Questionnaire (EDE-Q) has been widely used as a diagnostic tool to identify cases of EDs; however, a validated Arabic version of the tool is needed to help in the screening process of EDs. The aim of this study was to validate the Arabic version of EDE-Q. A cross-sectional study included a sample of 549 adults, who were recruited mainly from the four major provinces in Saudi Arabia. A forward–backward translation method was conducted, and then the tool was validated using the confirmatory factor analysis (CFA). The dataset was split for further convergent analysis using exploratory factor analysis (EFA) and CFA. The results of CFA from the main dataset did not support the four-factor original EDE-Q. The results of EFA from the first data-split suggested a three-factor EDE-Q-14 Arabic version. This was supported by the results of CFA of the second data-split. A total of five items were allocated in each shape and weight concern, and restraint component, with correlations ranging from 0.969 and 0.462 and from 0.847 to 0.437, respectively. A total of four items were allocated in eating concern, with correlations ranging from 0.748 to 0.556. The internal consistency of the global and the three subscales were high, with Cronbach’s α ranging from 0.762 to 0.900. Findings of the current study suggest that the Arabic version of the EDE-Q-14 is a valid and reliable tool to screen for EDs among adults in Saudi Arabia.

Leisure screen time predicts free sugar consumption in children

OBJECTIVE

This study aimed to investigate free sugar consumption (FSC) in relation to leisure screen time in children.

METHODS

Cross-sectional data of 424 healthy Saudi children ages 6 to 12 y were included in this study. Data pertaining to sociodemographic characteristics and leisure screen time (including time spent viewing TV, gaming, and use of electronic devices [e.g., computer, tablet, and smartphone]) in children were collected from mothers via an online questionnaire. A phone interview was later conducted with the mother and child to assess FSC using a previously validated 40-item food frequency questionnaire.

RESULTS

Our data found that a large proportion of children exceeded the maximum limit of screen time recommended for children, of ≤2 h/d (61.7%; n = 262). Child and maternal ages and child's birth order among siblings were significantly associated with the duration of leisure screen time (screen time within the recommendation of ≤2 h/d versus screen time that exceeded the recommendation; P < 0.050). Exceeding the recommendation of screen time predicted an increase of 8.96 g/d of FSC from liquid foods, 10.7 g/d of FSC from solid foods, and 19.3 g/d of total FSC.

CONCLUSIONS

Exceeding the recommendation of screen time is associated with greater FSC in children. Future interventions should be directed toward restricting screen time and FSC in children.

Prevalence and determinants of undiagnosed hypertension in the Western region of Saudi Arabia

Recent data regarding the prevalence and determinants of undiagnosed hypertension in Saudi Arabia are particularly lacking. This study aimed to investigate the prevalence of undiagnosed hypertension and to identify potential associates of hypertension risk among adults in the Western region of Saudi Arabia. Cross-sectional data for 489 Saudi adults were collected from public places in the cities of Madinah and Jeddah. Demographic, anthropometric (height, weight, waist circumference), and blood pressure (assessed by a digital sphygmomanometer) data were collected from all participants during face-to-face interviews. The American College of Cardiology and American Heart Association guidelines were used to evaluate blood pressure status. Sodium intake was assessed using a semi-validated food frequency questionnaire. The prevalence of undiagnosed, elevated blood pressure, stage I, or stage II hypertension was 9.82%, 39.5%, and 17.2%, respectively. The proportions of individuals with undiagnosed hypertension were higher among men and smokers (p < .001 for both). Blood pressure status was positively associated with weight, body mass index, and waist circumference among participants (p < .001 for all). Higher body mass index and waist circumference were associated with increased odds of stage I and stage II hypertension. Sodium intake was not associated with blood pressure status. A strikingly high prevalence of undiagnosed hypertension was observed among the study sample. National intervention programs are necessary to encourage regular screening and follow-up for the early detection and management of hypertension.

Fast-Food Consumption, Dietary Quality, and Dietary Intake of Adolescents in Saudi Arabia

High fast-food consumption is a common public-health concern among adolescents, due to its link to a number of non-communicable diseases. Frequent consumption of fast food may also affect diets of individuals; however, research addressing this issue is lacking in Saudi Arabia. We aimed to investigate the association between fast-food consumption, dietary quality, and dietary intake of adolescents in Saudi Arabia. This is a cross-sectional study of 617 healthy adolescents aged 11-18 years, who were recruited randomly from 16 middle- and high-schools located in Jeddah and Madinah, Saudi Arabia. Sociodemographic data were collected from parents. Dietary data, including the frequency of fast-food consumption, dietary quality (assessed using the short-form food frequency questionnaire), and dietary intake (assessed using multiple 24 h diet recalls from a subsample), were collected from the adolescents. Approximately one-third of adolescents (28.5%) reported frequent fast-food consumption (>two times a week). Results showed that a higher proportion of male adolescents frequently consumed fast-food, compared with female adolescents (32.8% vs. 24.8%, p = 0.039). Adolescents with the highest monthly family-income (≥SAR 21,000 ) reported a significantly higher frequency of fast-food consumption compared with families with a lower monthly income (p = 0.009). Frequency of fast-food consumption predicted lower dietary-quality in adolescents (Beta (B) = -0.27 [95% confidence interval (CI): -0.35 to -0.18]) and higher carbohydrate and free-sugar intake (B = 6.93 [95% CI: 0.78 to 13.1], and B = 3.93 [95% CI: 1.48 to 6.38], respectively). In conclusion, nutrition-intervention programs aiming to limit fast-food consumption and enhance the dietary quality of adolescents in Saudi Arabia, are warranted.

Effectiveness of COVID-19 Vaccines in Patients Under Maintenance Hemodialysis

BACKGROUND

Several published data on the dialysis population showed that antibody levels decreased after COVID-19 vaccinations in comparison to the overall population. We aimed to illustrate the persistence of humoral response after receiving second dose of the Pfizer or AstraZeneca vaccines in patients under maintenance hemodialysis (HD).

METHODS

A total of 119 adult patients on HD who were recruited from a single hemodialysis center in Madinah, Saudi Arabia. An enzyme-linked immunosorbent assay (ELISA) was utilized to measure the specific antibody response to the spike protein in the serum samples.

RESULTS

Mean age of patients was 48.5 ± 13.5 years, while mean time since starting the renal dialysis was 5.09 ± 5.29 years. Blood samples were collected after 89.2 ± 25.7 days of receiving the second dose of the vaccines. A very high positive correlation between anti-S IgG antibodies in pre- and post-dialysis was found (rs= 0.93, p < 0.001). Additionally, there was a high positive correlation between anti-S IgG antibody collected at baseline and follow-up blood samples (30 days apart) (rs= 0.82, p < 0.001). Moreover, patients who received Pfizer had significantly higher mean change in anti-S IgG antibodies compared to patients who received AstraZeneca (0.41 ± 0.94 vs 0.03 ± 0.30, respectively, p = 0.026).

CONCLUSION

The majority of the patients included in this study were able to yield an immune response to the vaccine after receiving the two doses. Persistence of IgG antibodies in the majority of the patients on HD in response to COVID-19 vaccines is encouraging in terms of continuing to vaccinate this category of patients in addition to monitoring them.

Reactogenicity and Immunogenicity of the Pfizer and AstraZeneca COVID-19 Vaccines

Background

The relationships of the coronavirus disease 2019 (COVID-19) vaccination with reactogenicity and the humoral immune response are important to study. The current study aimed to assess the reactogenicity and immunogenicity of the Pfizer and AstraZeneca COVID-19 vaccines among adults in Madinah, Saudi Arabia.

Methods

A cross-sectional study, including 365 randomly selected adult Pfizer or AstraZeneca vaccine recipients who received a homologous prime-boost vaccination between February 1st and June 30th, 2021. Data of height and weight were collected to assess the weight status of percipients. An evaluation of seropositivity for anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies was assessed using enzyme-linked immunosorbent assay (ELISA).

Results

Among the participants, 69% (n = 250) reported at least one vaccine-related symptom. Pain at the injection site was the most frequently reported vaccine-related symptom. The mean total score for vaccine-related symptoms was significantly higher among participants who received the AstraZeneca vaccine, women, and participants with no previous COVID-19 infection (p < 0.05). Spike-specific IgG antibodies were detected in 98.9% of participants after the receipt of two vaccine doses, including 99.5% of Pfizer vaccine recipients and 98.3% of AstraZeneca vaccine recipients. Significantly, higher proportions of participants in the <35-year age group developed a humoral immune response after the first vaccine dose compared with the participants in other age groups.

Conclusion

Participants who received the Pfizer COVID-19 vaccine reported fewer vaccine-related complications compared with those who received the AstraZeneca COVID-19 vaccine, but no serious side effects were reported in response to either vaccine. Health status and age were factors that may influence COVID-19 vaccine effectiveness for the generation of antibodies against the SARS-CoV-2 spike protein.

Food Security Status, Coping Strategies, and Health of Women's Welfare Society Beneficiaries in Jeddah, Saudi Arabia: A Facility-Based Study

This study assessed the food security status of low-income women in Jeddah, Saudi Arabia in addition to their coping strategies, health, and well-being. A cross-sectional study was conducted on 113 women receiving food assistance from a women's welfare society. Data were collected using in-person structured interviews. Overall, 50% of the women were food-insecure. Compared with food-secure women, food-insecure women were more likely to utilize many coping strategies. The mean score of coping strategies was significantly greater among food-insecure women, than that of food-secure women (21.0 ± 5.35 and 10.2 ± 5.78, respectively; p < .001). Food-insecure women were also more likely to report poor mental and overall health compared to food-secure women (p = .008 and p < .001, respectively). However, there was no significant difference in life satisfaction between both food security groups (p = .260). Low-income women may use several strategies to cope with food insecurity, which may affect mental and overall health. Further research is needed on the effect of food insecurity on health and well-being of low-income groups in Saudi Arabia. Qualitative data are also needed to better understand the reasons of food insecurity and preventing poor health outcomes among disadvantaged populations in Saudi Arabia.

Use of Plastics with Hot Food among Saudi Pregnant Women Is Associated with Increased Concentrations of A1C, Thyroid-Stimulating Hormone, and Homocysteine and Decreased Concentrations of Vitamins and Minerals

Data regarding association between the use of plastics with hot food and levels of vitamins and minerals, and other biochemical parameters are lacking. Cross-sectional data for 740 healthy pregnant Saudi women were collected from 21 health care centres and 2 hospitals from Madinah, Saudi Arabia. Detailed data regarding the frequency of plastic use with hot food were collected, and laboratory analyses of thyroid-stimulating hormone (TSH), homocysteine (HCY), glycated A1C (A1C), and selected vitamins and minerals were also done. Daily use of plastics with hot food was frequently reported among young mothers (p = 0.002). Plastic use with hot food on a daily basis was positively associated with TSH, HCY, and A1C, while it was negatively associated with concentrations of vitamin E, zinc, and selenium. Future research should address the complex hormonal and metabolic abnormalities that are linked to the release of certain components associated with the use of plastics with hot food. Interventions are urgently needed to eliminate the use of plastics with hot food to prevent health complications that may result from the long-term use of these materials.

Knowledge and Practices Related to Salt Intake among Saudi Adults

In Saudi Arabia, data regarding salt-related knowledge and practices are still lacking. This cross-sectional study aimed to investigate salt-related knowledge and practices and associated factors in Saudi adults. Data on the following variables were collected from 467 participants living in Madinah or Jeddah via face-to-face interviews: demographics, anthropometrics (height and weight), blood pressure (assessed using a digital sphygmomanometer), salt-related knowledge, and practices related to salt intake. Salt-related knowledge and practices were limited among the study participants; however, they were not correlated (rs = 0.10). Multiple linear regression analysis revealed that salt-related practices were negatively associated with sodium intake and positively associated with body mass index (BMI) (p < 0.001 and p = 0.001, respectively), whereas salt-related knowledge was not associated with sodium intake, blood pressure, or BMI. Salt-related knowledge is limited and not linked to practices related to salt intake in Saudi adults. Interventions are needed to increase the accessibility of low-sodium food options and improve practices limiting sodium intake to prevent the occurrence of salt-related diseases among adults in Saudi Arabia.

Knowledge, attitudes, and practices toward added sugar consumption among female undergraduate students in Madinah, Saudi Arabia: A cross-sectional study

OBJECTIVES

This study aimed to evaluate knowledge, attitudes, and practices toward added sugar intake and the associations with nutrient intakes and weight status.

METHODS

This cross-sectional study was conducted among 190 healthy female undergraduate students at Taibah University, Madinah, Saudi Arabia. Demographic, knowledge and attitudes toward added sugar, dietary intake, and anthropometric data (i.e., height, weight, and waist circumference) were collected during face-to-face interviews.

RESULTS

Approximately half of the students (n = 106; 55.8%) were aware of the health consequences of excessive intake of added sugar, but only 32.6% (n = 62) reported making an effort to reduce their added sugar intake. The data indicated that 8.42% of the students (n = 16) consumed carbonated soft drinks daily, 15.8% (n = 30) consumed fruit drinks daily, and 45.8% (n = 87) consumed sweets daily. Underweight students consumed higher quantities of added sugar (expressed as percent of total energy intake) compared with students in all other weight status groups. Results showed negative associations between percentage of added sugar intake and intakes of fiber, iron, zinc, vitamin D, body mass index, and waist circumference.

CONCLUSIONS

Our findings indicated that a large proportion of young women had limited knowledge on the health consequences of excessive added sugar intakes. The observed inverse relationships between added sugar and micronutrient intakes and the weight status highlight the urgent need for expanded efforts to improve added sugar-related knowledge and promote the reduction of added sugar intake among young women.

Reduced serum concentrations of vitamin B12 and folate and elevated thyroid-stimulating hormone and homocysteine levels in first-trimester pregnant Saudi women with high A1C concentrations

Better understanding of the risk factors for diabetes can lead to proper prevention of this devastating metabolic abnormality. It is hypothesized that diabetes pathogenesis is linked to complex metabolic abnormalities involving homocysteine (HCY) pathways and affecting B₁₂, folate, and thyroid-stimulating hormone (TSH) concentrations. This study was conducted to determine the associations between serum concentrations of vitamin B₁₂, folate, TSH, and HCY in pregnant women with normal glycemic control, diabetes, or prediabetes. This cross-sectional study included 1159 healthy first-trimester pregnant women who were randomly selected from antenatal clinics in 2 hospitals and 21 health care centers across Al-Madinah, Saudi Arabia. Data collected included clinical history and blood sample analyses for serum folate, vitamin B₁₂, TSH, HCY, and glycated hemoglobin (A1C). Participants were classified with normal A1C (<5.7%), prediabetes (≥5.7 and <6.5%), or undiagnosed type 2 diabetes (≥6.5%). Results revealed that 79.5% of the participants had normal A1C levels, whereas 19.3% and 1.21% had A1C levels in prediabetic and diabetic ranges, respectively. Serum concentrations of vitamin B₁₂ and folate were lower in prediabetes subjects than in participants with normal A1C concentrations, whereas serum concentrations of TSH and HCY were significantly higher. There was a strong negative correlation among the concentrations of A1C, vitamin B_12, and folate, whereas positive correlations among A1C, TSH, and HCY were reported. Regression analysis identified TSH as having the strongest impact on A1C concentrations. These complex metabolic changes that occur at the prediabetic stage that involve TSH, HCY, folate, and vitamin B₁₂ might direct research on diabetes prevention.

Rapid increase of overweight and obesity among primary school-aged children in the Caribbean; high initial BMI is the most significant predictor

BACKGROUND

To examine predictors of increasing overweight among children in two developing countries.

METHODS

Primary school children (6-10 y at baseline, n = 336) and their caregivers.Longitudinal data were collected in 2012, with follow-up 18 months later. Data on children's height, weight and dietary intake were collected within 8 primary public schools in Trinidad and 7 schools in St. Kitts. Caregivers' demographic and anthropometric data were also collected.

RESULTS

At baseline, children's age and sex and caregivers' BMI, age, and marital status and reported dietary intake were similar across all weight groups. The incidence of overweight and obesity among children was 8.8% and 8.1%, respectively. Dietary intake at baseline was not related to becoming overweight or obese. Similarly there were no differences in reported intake among children who became overweight or obese except that they consumed fewer fruits (0.54±0.92 vs. 0.98±1.66, p = 0.017). Misreporting of energy intake was higher among overweight/obese children as compared to those who were not overweight/obese (27% vs. 17%, p = 0.047). The baseline predictors of increasing BMI (adjusted) of the children were older age, higher baseline BMI z-score and higher height-for-age (HFA) z-score; caregiver BMI, children's energy intake (with adjustment for misreporting) did not predict changes in children's BMI.

CONCLUSIONS

The increasing prevalence of overweight/obesity among children is a serious problem in the Caribbean. Heavier children are at elevated risk of continued rapid increase in their weight status, pointing to the need for early intervention.