Firas S. Azzeh

EVALUATION OF SEVERAL ANTHROPOMETRIC INDICES OF OBESITY AS PREDICTORS OF METABOLIC SYNDROME IN JORDANIAN ADULTS.

INTRODUCTION anthropometric indices have all been tested for their relation to metabolic syndrome (MetS), but with no consistent cut-off points are yet established among different population group. OBJECTIVE this study aims to evaluate the predictive power of several anthropometric indices of central obesity as predictors of MetS in a group of Jordanian adults. METHODS in this cross sectional study, 630 adult subjects (308 men and 322 women) aged between 20-70 years were recruited at the King Hussein Medical Center in Amman (Jordan). The diagnosis of MetS was defined by the International Diabetes Federation criteria. Anthropometric measurements (waist circumference [WC]; waist to hip ratio [WHpR]; waist to height ratio [WHtR]; body mass index [BMI]) were performed and recorded following standard procedures. Receiver operating characteristic (ROC) curves were used to determine the efficacy of anthropometric measurements as predictors of MetS. RESULTS the results indicated that, in men for identifying subjects with MetS risk, area under curve (AUC) from the ROC curves for WC was 0.851, AUC for WHpR was 0.842, AUC for WHtR was 0.85, and AUC for BMI was 0.83. In women, AUC for WC, WHpR, WHtR, and BMI were 0.866, 0.871, 0.872, and 0.831, respectively. CONCLUSION it could be concluded that among anthropometric indices, both WHtR and WC had the strongest predictive power for identifying subjects with MetS in men and women. WHtR appears to be the best indicator of central obesity in women and individuals of short stature.

Vitamin D Is a Good Marker for Disease Activity of Rheumatoid Arthritis Disease.

Aim. This study was conducted to find out the optimal vitamin D cutoff point in predicting activity of RA disease. Materials and Methods. One hundred and two rheumatoid arthritis Saudi patients of both genders were recruited in this study. Vitamin D as 25-hydroxy-vitamin D [25(OH)D] was measured and serum level less than 20 ng/mL defined as deficient patient. Disease activity was measured based on the disease activity score index of a 28-joint count (DAS28) using serum erythrocyte sedimentation rate levels. Receiver operating characteristic (ROC) curves were used to determine the optimal vitamin D cutoff points for identifying disease activity. Results. It has been observed that vitamin D levels were lower (P < 0.05) in patients with high disease activity. A significant inverse correlation between serum 25(OH)D levels and DAS28 (r = −0.277, P = 0.014) was shown. ROC curves results showed that vitamin D less than 12.3 ng/mL predicted high disease activity, and vitamin D more than 17.9 ng/mL predicted low disease activity, with good sensitivity and accuracy results regarding vitamin D. Conclusion. Study results concluded that vitamin D is a good predictor of RA disease activity in Saudi patients.

Hypovitaminosis D in Healthy Toddlers and Preschool Children from Western Saudi Arabia

BACKGROUND Vitamin D deficiency is common in Saudi Arabia. No sufficient data are available on the vitamin D status of preschool children. AIMS To investigate the vitamin D status among toddlers and preschool children and to evaluate the factors associated with hypovitaminosis D in Western Saudi Arabia. METHODS A cross-sectional study was conducted on 503 preschool children in Makkah. The children were divided into two age categories: 1 - 3 years (toddlers) and 3 - 6 years (preschool). Sociodemographic factors, life-style factors, eating habits, body mass index (BMI), 25-(OH)-vitamin D3, parathyroid hormone, calcium, phosphorous, and alkaline phosphatase concentrations were determined. RESULTS Sixty-three % of children had a vitamin D deficiency. Vitamin D in toddlers was significantly higher than in preschool children. Vitamin D levels were negatively correlated with BMI (r = - 0.419, P < 0.001), and duration of breast feeding (r = - 0.270, P = 0.027), but a significant positive correlation with vitamin D intake (r = 0.335, P = 0.021), calcium intake (r = 0.25, P = 0.029), duration of formula feeding (r = 0.354, P = 0.019), and outdoor physical activity (r = 0.381, P = 0.011) was found. Multivariable predictors of hypovitaminosis D were preschool age (OR = 11, [95 % CI: 2.78 - 43.57], P < 0.001), outdoor physical inactivity (OR = 2.44, [95 % CI: 0.93 - 14.12], P < 0.001), obesity (OR = 2.3, [95 % CI: 1.25 - 7.08], P = 0.008), overweight (OR = 2.16, [95 % CI: 1.18 - 6.01], P = 0.039), inadequate vitamin D intake (OR = 1.65, [95 % CI: 1.12 - 2.53], P = 0.012), exclusive formula feeding (OR = 0.53, [95 % CI: 0.41 - 0.72], P < 0.001), and breast and formula feeding (OR = 0.62 [95 % CI: 0.39 - 0.88], P = 0.002). CONCLUSION Hypovitaminosis D is a public health concern, especially in preschool children. Possible determinants of low vitamin D status in preschool children in the Makkah region could be related to age, high BMI, inadequate vitamin D intake, exclusive breastfeeding, and outdoor physical inactivity.

Factors Associated with Not Breastfeeding and Delaying the Early Initiation of Breastfeeding in Mecca Region, Saudi Arabia

The objective of the study was to find the determinants related to not breastfeeding (BF) and others related to the delay in the early initiation of BF in the Mecca region, Saudi Arabia. A cross-sectional study in the Maternity and Children Hospital and primary healthcare centers was performed. A questionnaire was filled by dietitians to 814 asymptomatic Saudi mothers. Determinants related to not BF and the delay in the early initiation of BF were determined by binary logistic regression, and the odds ratio (OR) and 95% confidence interval (CI) were determined. Significant factors associated with not BF were not rooming-in infants in the mother’s room (OR: 2.37; 95% CI: 1.66–3.41) and using a pacifier (OR: 1.62; 95% CI: 1.13–2.33). The most significant determinant of the early initiation of BF was the initiation of bottle feeding (OR: 18.16; 95% CI: 10.51–31.4), followed by not rooming-in infants in the mother’s room (OR: 2.2; 95% CI: 1.52–3.18), initiation of partial feeding (OR: 1.89; 95% CI: 1.3–2.74), uninformed mothers regarding the importance of BF (OR: 1.56; 95% CI: 1.04–2.35), and cesarean sections (OR:1.42; 95% CI: 1.02–1.98). Risk factors affecting BF and the early initiation of BF in Mecca City should be highlighted in national campaigns to increase mothers’ awareness and promote BF practice.

Healthy dietary patterns decrease the risk of colorectal cancer in the Mecca Region, Saudi Arabia: a case-control study

BackgroundColorectal cancer (CRC) is the first most common cancer in males and the third most common cancer in females in Saudi Arabia. Dietary habits are strongly associated with the inhibition or proliferation of malignancy. Therefore, this study is aiming to investigate the risks and protective benefits of dietary factors affecting CRC in the Mecca region of Saudi Arabia.MethodsA case-control study was conducted from June 2014 to March 2015. One hundred thirty-seven patients with colon and/or rectal cancer were recruited in the case group, while 164 healthy participants were recruited in the control group. A questionnaire was completed with the help of trained dietitians to study the effects of several dietary patterns on the risk of CRC.ResultsDairy product intake of 1–5 servings/day, legume intake of 3–5 servings/week, leafy vegetables intake of 1–5 servings/week, olive oil intake of 1–5 servings/week, black tea intake of three or more cups/day, and coffee intake of one or more cups/day was found to decrease the risk of CRC in participants.ConclusionThis study highlights the importance of changing dietary habits to decrease CRC incidence in the Mecca region.

Determinants of Exclusive Breastfeeding and Patterns of Complementary Feeding Practices in Mecca City, Saudi Arabia

Background: The World Health Organization (WHO) recommends optimal feeding practices during infancy and early childhood for better health and growth of children. Objective: To determine the factors affecting exclusive breastfeeding (EBF) duration and the time of introducing complementary feeding (CF) in Mecca City, Saudi Arabia. Methods: This cross-sectional study recruited 814 Saudi mothers. All mothers filled out a closed questionnaire on family sociodemographics, health status of mothers and infants, and postpartum breastfeeding habits and patterns. The patterns of CF and bottle-feeding were examined, and binary logistic regression was performed. Results: The mean ± standard deviation EBF duration was 4.6 ± 2.5 months. The EBF rate showed a sharp decrease from 50.6% at birth to 14.4% at 6 months among children. Employment of mothers, weight at childbirth < 2.5 kg, weight of 2.6–3 kg at child birth, postnatal disease in infants, and pacifier use for infants were associated with a low EBF rate. Intermediate education of the mother was found to increase EBF duration as compared to mothers with higher levels of education. Most mothers introduced plant-based CFs to infants at 4 months of age (median), but animal-based CFs were introduced only after 8 months (median). The median age of starting milk formula was 3 months. Conclusion and Recommendation: The reported rate of EBF is far below the current international recommendations. The patterns of CF practices and bottle-feeding differ widely from the WHO recommendations in Mecca City. National campaigns should be implemented to promote EBF in Saudi Arabia.

Leptin and uric acid as predictors of metabolic syndrome in jordanian adults

BACKGROUND/OBJECTIVES Metabolic syndrome (MetS) is a set of interrelated metabolic risk factors that increase the risk of cardiovascular morbidity and mortality. Studies regarding the specificity and sensitivity of serum levels of leptin and uric acid as predictors of MetS are limited. The aim of this study was to evaluate the serum levels of leptin and uric acid in terms of their specificity and sensitivity as predictors of MetS in the studied Jordanian group. SUBJECTS/METHODS In this cross sectional study, 630 adult subjects (308 men and 322 women) were recruited from the King Hussein Medical Center (Amman, Jordan). The diagnosis of MetS was made according to the 2005 International Diabetes Federation criteria. Receiver operating characteristic curves were used to determine the efficacy of serum levels of leptin and uric acid as predictors of MetS in the studied Jordanian group. RESULTS Study results showed that for identification of subjects with MetS risk, area under the curve (AUC) for leptin was 0.721 and 0.683 in men and women, respectively. Serum uric acid levels in men showed no significant association with any MetS risk factors and no significant AUC, while uric acid AUC was 0.706 in women. CONCLUSION Serum leptin levels can be useful biomarkers for evaluation of the risk of MetS independent of baseline obesity in both men and women. On the other hand, serum uric acid levels predicted the risk of MetS only in women.

Alarming high prevalence of metabolic syndrome among Jordanian adults.

Objective: To evaluate the prevalence and the individual components of metabolic syndrome (MetS) in Jordanian adults. Methods: In this cross sectional study, 630 adult subjects (308 men and 322 women) aged between 20-70 years were recruited from the clinics at the King Hussein Medical Center. The diagnosis of MetS was made according to the International Diabetes Federation (IDF) criteria-2005. Blood samples were collected after 10-12 hours overnight fasting and serum was obtained for biochemical analysis. Results: The prevalence of metabolic syndrome according to IDF criteria was 51% (46.4% in men and 55.3% in women). Prevalence of increased waist circumference in the total sample was 71.6%, 46% for high blood pressure, 42.4% for elevated fasting blood glucose, 43.5% for low high density lipoprotein, and 50.2% for hypertriglyceridemia. Conclusion: The prevalence and individual components of MetS in Jordan were high. Screening of MetS is needed at national level to reduce the incidence of Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD).

Some Socioeconomic Factors and Lifestyle Habits Influencing the Prevalence of Obesity among Adolescent Male Students in the Hail Region of Saudi Arabia

A cross-sectional study was conducted to investigate the effect of some socioeconomic factors and lifestyle habits on the prevalence of obesity among adolescent male students in the Hail region, Saudi Arabia. A questionnaire was filled by 1495 male adolescents distributed among 12 schools in the Hail region. Body weight and height were taken, and the Z-score of students was measured using Anthroplus software with a cutoff 1–2 and +2 standard deviations to determine overweight and obesity, respectively. The study revealed that 21.3% of students were overweight and 27% were obese, respectively. There was a negative association between family size of >8 and obesity (OR: 0.68, CI: 0.48–0.92, p = 0.05). Family income of <5000 SR was negatively associated with obesity (OR: 0.59, CI: 0.36–0.97, p = 0.03). Whether a subject’s mother worked (odds ratio (OR): 1.43, confidence interval CI: 1.03–1.99, p = 0.03) as well as the subject’s mother’s education—whether she can read and write, has a middle school degree, or has done postsecondary studies—were positively associated with obesity. Exercise, regardless of the duration, was negatively associated with obesity. In addition, sleeping <6 h/day had a positive association with obesity. Conclusion: a >8 family size and a low family income were negatively associated with obesity, while having an educated and working mother was positively associated with obesity.

Association of the body mass index with the overall stability index in young adult Saudi males

Objectives Studies have focused on obesity-induced balance instability in the older population, which has been understudied in young adults. This study aimed to determine the impact of obesity on dynamic balance in young adult Saudi males. Methods A cross-sectional study of 704 young adult males aged between 18 and 35 years from Umm Al-Qura University, Makkah, KSA, was performed. The obesity-induced balance was evaluated with a Biodex Balance System apparatus with a movable platform, and the overall stability index (OSI) was measured as an indicator of dynamic balance. Participants with a body mass index (BMI) ≥30 kg/m2 were considered obese. Results The mean age and BMI of the participants was 20 years and 25.6 kg/m2, respectively. The mean OSI of the entire sample was 0.9, and the OSI values increased significantly (p < 0.001) with increasing BMI. The adjusted correlation between OSI and BMI was 0.487 (p < 0.001). Logistic regression showed that for each one-unit increment in BMI, there was an expected rise of 0.115 units in the OSI value. The receiver operating characteristic curve showed that the optimal threshold of the weight and BMI cutoff points that optimized the OSI values were 18.8 kg/m2 and 54.5 kg, respectively, with high sensitivity and specificity values. In addition, BMI affected approximately 23% of the total variability on balance (partial eta squared = 0.227, p < 0.001). Conclusion Obesity has a clear impact on dynamic balance in the selected young males. Weight management programs for obese subjects should be encouraged to optimize BMI and weight, which can attenuate balance stability.