Azza A. Shaltout

Factors associated with obesity in Kuwaiti children

The prevalence of adult obesity in Kuwait is among the highest in the Arab peninsula, and cardiovascular disease, for which obesity is a risk factor, is the leading cause of death. This study reports familial and environmental factors associated with childhood obesity; in addition to adverse effects of obesity on childrens serum lipids, lipoproteins, apolipoproteins, insulin, and blood pressure profiles. The authors carried out a pair-matched case–control study including 460 obese (body mass index >90th percentile of the age/sex specific reference value of the National Center for Health Statistics), school children 6 to 13 years old matched by age and gender to 460 normal weight controls. We ascertained obese children in a cross-sectional survey of a representative sample of 2400 school children selected from 20 schools by multistage stratified random sampling. Biochemical variables and blood pressure were adversely affected in obese children. The conditional logistic regression analysis showed that family history of obesity, and diabetes mellitus, respiratory and bone diseases in child were significant associated factors with obesity after adjusting for social and behavioural factors. Physical activity and parental social class were not significant. We recommend early preventive measures with emphasis on families in which one or both parents are overweight.

High incidence of childhood-onset IDDM in Kuwait

OBJECTIVE To determine the incidence of insulin-dependent diabetes mellitus (IDDM) in children aged 0–14 years in Kuwait, as part of the World Health Organization Multinational Collaborative Study (DIAMOND), and to determine if the incidence rates have increased. RESEARCH DESIGN AND METHODS All cases of IDDM diagnosed before the childs 15th birthday between 1 January 1992 and 31 December 1993 were recorded. Prospective notification of all children with newly diagnosed diabetes who were admitted to hospitals and periodic review of hospital medical records provided the primary source; notification by physicians working in diabetic clinics, in which registry of all new cases is mandatory, provided the secondary source of ascertainment. RESULTS The degree of ascertainment was 92.2%. The annual incidence of IDDM for children aged 0–14 years over the 2-year period was 15.4/100,000 (95% confidence interval, 12.4–19), with a male:female ratio of 1.2:1. The age-specific annual incidence rates for the age-groups 0–4, 5–9, and 10–14 years were 12.8, 15.1, and 18.3/100,000, respectively, with a male:female ratio of 1.45:1 in the 0- to 4-year-old age-group and an equal sex ratio in the 5- to 9- and 10- to 14-year-old age-groups. No significant difference was detected between incidence rates of IDDM in boys and girls in the three age-groups. There was no significant linear trend toward an increase in IDDM incidence rates as age advanced. Compared with a previous study by Taha et al. (Taha T, Moussa M, Rashed A, Fenech F: Diabetes mellitus in Kuwait: incidence in the first 29 years of life. Diabetologia 25:306–308, 1983), there was a nearly fourfold increase of IDDM in the age-group 0–14 years, mainly in those children < 5 years old, suggesting a rapid increase in a short period of time. CONCLUSIONS Kuwait has the highest incidence of IDDM in children in the region, and an apparently increasing incidence has been demonstrated over the last decade.

Lead encephalopathy in infants in Kuwait. A study of 20 infants with particular reference to clinical presentation and source of lead poisoning.

Twenty patients aged between one and eighteen months (mean six months) were found to have lead encephalopathy. They were seen in one 30-bed ward during a four year period from 1977 to 1980. Blood lead was determined in 19 children and ranged between 2.9 and 12.4 mumol/l (60 and 257 micrograms/dl) mean 5.42 mumol/l (113 micrograms/dl). Two patients died before starting treatment. Of the 18 patients treated with B.A.L. (2.3 dimercaptopropanol) and EDTA (ethylenediaminetetra-acetic acid), three died. Eleven patients made an apparently complete recovery and four had neurological sequelae. The source of lead was traced in 18 patients: in 11 it was due to the liberal use of Kohl (also known as surma) commonly used as an eye cosmetic in the Arabian peninsula. Other local sources of lead poisoning are discussed.

Pattern of protracted diarrhoea among children in Kuwait.

A total of 92 children with protracted diarrhoea were studied over a 3-year period (October 1983 to September 1986). The diagnosis was postgastro-enteritis syndrome in 61 (66.2%), coeliac disease in 17 (18.5%), Giardia lamblia infestation in 5 (5.4%), immune deficiency in 4 (4.4%), congenital chloride diarrhoea in 2 (2.2%), and glucose-galactose malabsorption, Shwachmann syndrome and intestinal lymphangiectasia in one each. Children with the postgastro-enteritis syndrome were young, malnourished and bottle-fed, and suffered a high incidence of antecedent bacterial infections. Six children died, a case fatality ratio of 6.5%.

Prevalence of human leukocyte antigen DQA1 and DQB1 alleles in Kuwaiti Arab children with type 1 diabetes mellitus.

The prevalence of human leukocyte antigen (HLA) DQB1 and DQA1 alleles has been determined in 78 Kuwaiti Arab children with insulin‐dependent diabetes mellitus (IDDM) and in 57 normal healthy controls with similar ethnic background. The typing of HLA‐DQ alleles was carried out using an allele‐specific DNA‐based polymerase chain reaction (PCR) SSP method. DR typing was also performed in 212 control subjects using PCR‐SSP (sequence specific primer) method. A significantly higher frequency of DQB1*0201 allele was found in IDDM cases compared to the controls (p<0.001). There was no significant difference in the prevalence of DQB1 alleles *0302, *0501, and *0602 between IDDM cases and the controls. In contrast, DQB1 alleles *0301, *0402, *0502, *0602, and *0603 were represented at a somewhat higher frequency in controls compared to the IDDM cohort. The frequency of DQA1 allele *0301, which encode for an Arg at codon 52, was significantly higher in the IDDM patients compared to the controls (p<0.001). The frequency of DQA1 allele *0302 was also higher in IDDM cases than controls (p=0.034) but the difference was less pronounced than DQA1*0301. Amongst the Arg52 alleles, no significant difference was detected in the frequency of *0401 between IDDM cases and the controls and the allele *0501 was detected only in controls. For non‐Arg52 alleles *0103, *0104, and *0201, the differences in the two groups were not significant, with the exception of allele *0104 (p=0.024). DR3 was the most common type in the Kuwaiti general population (28%) and DRB1*0301 was detected in 41% of the individuals with DR3 specificity. Analysis of HLA‐DQB1/DQA1 haplotypes from IDDM cases and controls revealed a significantly high frequency of haplotype DQA1*0301/DQB1*0201 between Kuwaiti IDDM cases (49/78, 63%) and the controls (8/57, 14%).

Incidence and severity of ketoacidosis in childhood-onset diabetes in Kuwait

Abstract In 1992, the diabetes registry was started in Kuwait, as part of DiaMond, a WHO multinational collaborative project on the incidence of childhood-onset diabetes. Children (243) aged below 15 years, were identified between 1 January 1992 and 31 December 1995. Children (203) were Kuwaiti and 40 were non-Kuwaiti children but resident of Kuwait. For the years 1992–1993, the annual incidence of childhood onset diabetes for Kuwaiti children was 15.4 per 100 000 (95% confidence interval 12.9–19), and the degree of ascertainment was 92%. Polyuria, polydypsia, weight loss and nocturia were the most frequently reported symptoms; four children were in coma and one in shock at presentation. Nearly half of the children (49%) presented ketoacidosis (venous pH

Association of fasting insulin with serum lipids and blood pressure in Kuwaiti children

To examine the association of hyperinsulinemia with the atherogenic risk profile in children, we studied the relationships of the fasting plasma insulin level with indices of obesity (body mass index [BMI] and sum of triceps and subscapular skinfold thickness [SFT]), body fat distribution (waist to hip ratio [WHR]), serum lipid, lipoprotein, and apolipoprotein levels, and blood pressure in a case-control study of 460 Kuwaiti prepubertal obese children aged 6 to 13 years matched by age and sex to 460 prepubertal non-obese controls. Obese children were ascertained in a representative cross-sectional study of 2,400 school children. Fasting insulin levels were positively correlated (P < .001) with serum triglyceride (TG) and very-low-density lipoprotein (VLDL) cholesterol levels and negatively correlated with high-density lipoprotein (HDL) cholesterol levels. No significant associations were observed between insulin and total cholesterol (TC), cholesterol, low-density lipoprotein (LDL) or apolipoprotein A-I (apo A-I). Stronger associations of insulin levels with lipoprotein fractions were observed in obese versus non-obese controls. Obese children had a higher concentration of apo B and a lower apo A-I:B ratio (P < .001). Insulin and the insulin to glucose ratio increased with age in obese children, whereas there were slight changes in non-obese children. TG and HDL cholesterol levels and systolic blood pressure (SBP) were significantly different across insulin quartiles in boys and girls. We conclude that the fasting plasma insulin level may be used as a marker for the development of obesity-associated metabolic disorders and elevated blood pressure in children.

Kawasaki disease : clustering in infants and pre-school children in Kuwait

We report five children who presented within a 2-month period and who all fulfilled at least four of the five criteria essential for the diagnosis of Kawasaki disease. They were three girls and two boys aged between 5 months and 3 years. Two of them had atypical presentations; one mimicked infectious mononucleosis and the other had severe abdominal pain and was later found to have hydrops of the gall bladder. Although treatment was started within the 1st 10 days of the illness, echocardiographic changes were found in three cases: one had myocarditis and the other two showed in the coronary arteries. The occurrence of five cases in such as short period of time is similar to the clusterings of Kawasaki disease reported in Japan and the USA, and strongly suggests the presence of a causative infectious agent.

Prevalence of Obesity among 6- to 13-Year-Old Kuwaiti Children

Objective: To determine the prevalence of obesity among 6- to 13-year-old Kuwaiti children, and to investigate the familial and behavioural factors associated with obesity. Method: A cross-sectional multi-stage stratified random sample of 2,400 schoolchildren (1,256 males and 1,144 females) of ages 6–13 years was selected from the five governorates in Kuwait, between September 1995 and June 1996. Obesity was defined as body mass index (BMI, weight in kilograms per height in metres squared) >90th percentile of the age/sex-specific value of the National Centre of Health Statistics reference population. Data on sociodemographic characteristics, children’s behavioural factors, and family history of related diseases in parents were collected by questionnaire. Results: Prevalence of obesity was 26.5% (95% confidence interval 24.7–28.3%). Obesity was more prevalent among the female children from urban areas. BMI was negatively correlated with the number of siblings and child birth order, and positively correlated with blood pressure, after controlling for age and sex. Logistic regression analysis showed significant associations between obesity and family history of obesity (odds ratio = 3.36, p < 0.0001), family history of hypertension (odds ratio = 1.37, p = 0.024), family history of diabetes (odds ratio = 1.57, p = 0.0004) in parents, child birth order (odds ratio = 1.82, p = 0.0002), and respiratory diseases in children (odds ratio = 2.08, p < 0.0001). Conclusion: The prevalence rate of obesity in Kuwaiti children is considered to be high. Obesity which is related to family, environment, and individual characteristics needs to be detected and corrected at a young age to prevent its consequences in adulthood.

Apolipoproteins A-I and B in Kuwaiti children

To assess the relation of apolipoproteins (Apos) A-I and B (the carrier proteins for high and low density lipoprotein cholesterol, respectively) with the degree of obesity, body fat distribution, serum lipids, glucose and insulin levels, a case-control study was carried out and included 460 Kuwaiti obese children, 6–13 years old, matched by age and sex to 460 normal-weight controls. Obese children were ascertained in a representative cross-sectional study of 2,400 school children. The Apo A-I levels were not different between obese and non-obese boys, while they were significantly lower in obese girls (p < 0.01). The Apo B mean concentrations were significantly higher in obese boys and girls (p < 0.001), while the Apo A-I:B ratio was significantly lower in obese children (p < 0.001). Apo A-I levels were positively correlated with total cholesterol, high- and low-density lipoprotein cholesterol, but were not correlated with very low-density lipoprotein cholesterol, triglycerides, insulin, glucose or insulin:glucose ratio. Apo B levels were negatively correlated with high-density lipoprotein cholesterol and positively correlated with insulin and insulin:glucose ratio (p < 0.01) in obese children. The study documented an adverse Apo profile in obese Kuwaiti children. Since Apo changes are correctable through management of obesity, their identification in childhood offers prospects for prevention of early onset atherogenesis in adulthood.