Abdulrahman Al-Nuaim

Overweight and obesity in Saudi Arabian adult population, role of socio-demographic variables

The objectives of this Community-based National Epidemiological Household Survey, conducted between 1990–1993, were to estimate the prevalence of overweight and obesity in Saudi Arabia and to examine its association with the socio-demographic characteristics of the adult population. A sample of Saudis 20 years and over was selected using a multistage stratified cluster sampling technique with probability proportionate to size. The selected subjects were requested to visit primary health care centers in their localities. Physicians in these clinics took measurements of heights and weights and collected other relevant data. Obesity was measured by the Body Mass Index, using the Quetelet Index. The results showed the sample of 10,651 subjects of which 50.8% were males, had a mean age of 35.8 years (SD = 14.27 years). The prevalence of overweight was 31.2% (95% confidence interval: 30.3%, 32.1%); 33.1% for males and 29.4% for females. For obesity, the overall prevalence was 22.1%; males 17.8% and females 26.6%. The study design suggested that these estimates could be closer to the true values. The multiple logistic regression analysis showed that age, residential area, region, income, gender, and education are statistically significant predictors of obesity. The prevalence of obesity was higher in females than males, lower in subjects living in rural areas with traditional lifestyles than those in more urbanized environments, and increased with increasing age. The observed prevalence and pattern of overweight and obesity with age and gender is similar to those observed in the Arab community and some Western nations. There is a need for increased physical activity and better nutrition education programs to reduce the extent of obesity and to pre-vent the serious health consequences, especially, in the middle age group.

The effect of ramadan fasting on diabetes control in type II diabetic patients

Abstract The effect of Ramadan fasting—defined as abstinence from eating or drinking from dawn till sunset during this lunar month—on the control of diabetes mellitus was studied in 47 type II diabetic patients and in a group of non-diabetic subjects. Body weight, glycosylated hemoglobin were determined before and immediately after Ramadan in both groups while glycosylated protein was also measured in 9 diabetic patients. In the diabetic patients, there was no significant change in their weights 75.2±12.8 vs 74.1±12.4 kgs., P=NS; glycosylated hemoglobin (10.9±3.1% vs 10.5±2.8%, P=NS; glycosylated protein (1.19±0.35 vs 1.17±0.39, P=NS) after the 30 day Ramadan fast. In the non-diabetic controls, there was a statistically significant loss in weight during the Ramadan fast 74.2 ±10.4 kgs. vs 72.5±10.2 kgs., p

Congenital hypothyroidism: increased incidence in Najran province, Saudi Arabia.

Neonatal screening for congenital hypothyroidism using cord serum thyroid-stimulating hormone (TSH) was initiated in Najran health region in September 1990. A total of 30810 newborn infants were screened by April 1995. Of the 24 infants with abnormal thyroid function tests on recall, 22 had permanent primary congenital hypothyroidism (incidence; 1:1400) and in two male siblings transient congenital hypothyroidism (incidence; 1:15400) was proved on follow-up. There was a significantly higher incidence of dyshormonogenesis. Eight (57 per cent) of the 14 infants who were adequately studied thyroid scan revealed ectopic glands with increased 99mTc uptake, while thyroid ectopy and aplasia were present only in three (22 per cent) infants each. Furthermore, goiter was evident clinically in two other patients.

Neonatal screening for congenital hypothyroidism: Incidence, imaging, feasability, and difficulties of a nationwide program.

A pilot project was carried out in Riyadh to study the incidence and pattern of congenital hypothyroidism (CH) among newborn delivered at the Ministry of Health (MOH) hospitals. Cord blood was assayed for thyroid stimulating hormone (TSH). For affected infants, Tc-99m pertechnetate thyroid scintigraphy and perchlorate discharge test (PDT) using I(123) were performed to determine the caused of congenital hypothyroidism. Fifteen affected newborns were diagnosed among 40,000 newborns screened giving an incidence of 1:2666. Tc-99m thyroid scan revealed athyreosis in five infants; the thyroid gland was ectopic in eight and thyroid in two infants. In eight infants thyroid tissue was visualized, PDT was performed and the test was positive in seven cases (two eutopic and five ectopic). We concluded that the incidence of CH was higher compared with other parts of the world. Thyroid scintigraphy has a primary role in the evaluation of infants with congenital hypothyroidism and should be part of the protocol for the screening program. As early initiation of thyroxine therapy will prevent neurological and physical handicaps of the disease, the decision was made to have a nationwide screening program established in Saudi Arabia. The organization and difficulties of the screening program are being discussed.

Neonatal screening for congenital hypothyroidism in Saudi Arabia: results of screening the first 1 million newborns

Abstract Introduction : Since the initiation of pilot screening programs to detect congenital hypothyroidism (CH) in 1972, newborn screening has become routine in the developed world. A national screening program for CH was established in Saudi Arabia in November, 1989. Methods: The program utilizes cord serum thyroid stimulating hormone (TSH), tested by the Delfia method, supplemented when necessary with thyroxine (T4) assay, also by the Delfia method. TSH values above 60 mU/l alone were considered suggestive of CH and initiated recall of the infant. TSH values of 30–60 mU/l initiated T4 measurement. If the latter was below 80 nmol/l, the infant was also recalled. Results: Between November 1989 and April 1995, a total of 1007 350 infants were screened. The mean recall rate was 0.18% (range 0.05–0.3%). Of those, 306 infants were confirmed to have CH, indicating an incidence for CH in Saudi Arabia of 1:3292. However, a regional variation in incidence was noted. Of all the infants with congenital hypothyroidism who were adequately studied, 47.5% were found to have ectopic thyroid glands, 31.7% eutopic glands with increased 99m Tc uptake and 20.8% athyreotic. The mean age at the time of recall was 19.4 days (range 2–130). The average cost of screening was US S3.20 per specimen. Discussion: Several of the organizational and administrative difficulties which were encountered during the operation were discussed and solved at regional levels and during the annual general meetings.

Congenital hypothyroidism: Clinical and laboratory characteristics in infants detected by neonatal screening.

A pilot cord serum thyroid-stimulating hormone (TSH) screening program for congenital hypothyroidism began in December 1988 at the Ministry of Health Maternity Hospitals in Riyadh. Out of 40,000 infants screened, 15 infants with congenital hypothyroidism have been detected. Of these, five had athyreosis, eight with ectopic thyroid glands, interestingly five of which had positive perchlorate discharge test suggestive of organification defects, and two had normally located glands with perchlorate discharge test suggestive of organification defects. The female to male ratio was 1.5:1. The clinical characteristics in our cases were not different from that previously reported. Although there was no significant difference in the mean cord T4 values among the different groups, the mean T4 values at recall in the aplastic group is significantly (P<0.001) lower than the cord results, (60.3 versus 15.3) and that is of recall for the ectopic group (15.3 versus 47.0). There was no significant difference in the mean TSH among the different groups in the cord and recall samples. The skeletal maturation was more delayed in the athyrotic group. The mean age at the time of recall was 17.8 days (range 6 to 64) and the mean age at the start of therapy was 20 days (range 8 to 64).

Bone mineral content and bone mineral density values measured by single photon absorptiometry among healthy Saudi population.

Several noninvasive methods for assessing bone mass have emerged over the last two decades, namely, single photon absorptiometry (SPA), dual photon absorptiometry, and quantitative computerized tomography. These techniques have proved to be sensitive and reproducible, with absorptiometry causing minimal radiation exposure. Several studies on osteoporosis have shown that its frequency varies in different racial groups; for example, Hispanics and Blacks in the USA appear to be the least affected by osteoporosis. It was therefore important to establish the normal standard of measurements of bone mass among healthy Saudi population using SPA to be used for clinical applications such as predicting the risk of fractures, monitoring the response to therapy, and quantitating the severity of metabolic bone disease.

Iodide concentrations in Saudi waters: A cause for concern.

Samples of tap water and drinking mineral water from different regions of Saudi Arabia were analyzed for iodide content. Low iodide concentrations were found in all samples. This finding may reflect an overall low iodide content in the soil and consequently also in locally grown food, which could predispose to endemic goiter. In the absence of data on the prevalence of endemic goiter, we recommend the routine use of iodized salt in Saudi Arabia.

Elevated serum creatinine level in thyroid cancer patients undergoing withdrawal of thyroxine therapy for radioiodine scan/treatment.

Chronic hypothyroidism is known to cause a significant reversible decrease in glomerular filtration rate (GFR). However, the effect on GFR of acute hypothyroidism, routinely induced in thyroid cancer patients in preparation for radioiodine scan/treatment, is not known. We studied the prevalence of abnormal serum creatinine level and the degree of its increase in hypothyroid patients with thyroid cancer four weeks after the withdrawal of thyroxine therapy. Creatinine level was measured in 116 patients on 191 hypothyroid episodes and in 56/116 and 18/116 patients while euthyroid or mildly hyperthyroid respectively. Abnormal creatinine level was significantly more prevalent in the hypothyroid state (34.5% vs 4% in the euthyroid or mildly hyperthyroid states) and significantly more common in males (50% vs 29% in females), in patients </=31 years old (48% vs 26% in older patients) and in patients with a TSH level >150 mU/L (55% vs 30% with TSH </=150 mU/L). Analyzing data on females only or including all hypothyroid episodes did not significantly alter the results. Further, compared to patients with normal creatinine level, patients with abnormal creatinine levels were significantly younger (in the whole group, mean age 35.1 vs 42.5 years; in the subgroup of patients with a TSH level > 150 mU/L, 29.8 vs 41.4 years; in females, 28.3 vs 42.5 years) and there was a significant negative association between the presence of abnormal creatinine levels and different age groups. Compared to levels obtained in the euthyroid or mild hyperthyroid states, creatinine levels increased in the hypothyroid state on average 32% (23microM/L, P=0.0001) with 24% of patients having >/=50% increase. Elevated serum creatinine levels are rather common in thyroid cancer patients undergoing temporary withdrawal of thyroxine treatment and more so in males, younger patients or in association with higher TSH levels. Since the clearance of iodine is linearly related to GFR, our study suggests that in the setting of hypothyroidism, the bioavailability of a given dose of radioiodine may have significant individual variation.

Thyroid Gland Dyshormonogenesis: A Report of Five Cases with a Review of the Literature

Thyroid gland dyshormonogenesis is an inborn error of thyroid metabolism. Variable defects have been described. We present clinical, laboratory, and radiologic data of five patients with thyroid dy...