Haleama Al Sabbah

Weight control behaviors among overweight, normal weight and underweight adolescents in Palestine: Findings from the national study of Palestinian schoolchildren (HBSC‐WBG2004)

OBJECTIVE The objective of the study is to examine the relationship between weight-control behaviors and self-reported sociodemographic characteristics, weight status, and perception of body weight in a large, representative sample of adolescents in the West Bank and Gaza Strip territories of Palestine. METHOD Self-report measures of sociodemographic characteristics, body weight perception, height and weight, and weight-control behaviors were completed by 8,885 male and female students aged 12-18 years from 405 randomly selected schools as part of the 2003/2004 Palestinian Health Behavior in School-aged Children Study (HBSC). RESULTS In both genders, dieting to lose weight was common among adolescents and significantly higher among overweight than among underweight or normal weight adolescents. Extreme weight-control behaviors (vomiting, diet pills, or laxatives) and smoking were more common among boys than girls, and extreme weight-control behaviors were particularly common among underweight boys. Older adolescents were less likely than younger adolescents to engage in weight-control behaviors. Perception of body weight as too fat was an influential factor in following an unhealthy diet to lose weight. DISCUSSION Practices to control weight, particularly extreme and unhealthy weight-control behaviors, are common among adolescents in the Palestinian territories. These findings suggest the need to design appropriate prevention and early intervention programs for adolescents in Palestine.

Overweight and Obesity among Palestinian Adults: Analyses of the Anthropometric Data from the First National Health and Nutrition Survey (1999-2000).

Background. A cross-sectional survey was designed to provide a baseline data on the prevalence and distribution of overweight and obesity and their associations among adults in Palestine. Methods. A random representative sample of 3617 adults aged 18–64 years was collected between October 1999 and October 2000. Results. The prevalence of overweight was 35.5% in women and 40.3% in men, obesity was 31.5% in women and 17.5% in men. Adults aged 45–54 years old were significantly more likely to be obese (29.2% in men and 50.2% in women) or overweight (48.1% in men and 37.2% in women). When compared with women, men showed significantly more normal BMI level (40.5% versus 31.6%; P < 0.05). Cut-off points for a high waist circumference and high waist-to-hip ratio identified 57.8% and 47.2% of the population, respectively, to be at an increased and high risk for cardiovascular disease. Sociodemographic factors (age, sex, educational level, and marital status) were also found to be significantly related to BMI. Conclusion. Obesity and overweight are enormous public health problems in Palestine. Population-based research at the national level to investigate the social and cultural factors associated with high prevalence of overweight and obesity among Palestinian adults should be implemented.

Unintentional Injuries among School-Aged Children in Palestine: Findings from the National Study of Palestinian Schoolchildren (HBSC-WBG2006)

Purpose. This study describes the nonfatal injuries among adolescents in Palestine. Methods. The 2006 Palestinian Health Behaviour in School-aged Children (HBSC) is a cross-sectional survey. Students of grades 6, 8, 10, and 12 completed a modified version of the international HBSC questionnaire, resulting in 15,963 students (47.3% boys and 52.7% girls) included in this study (56.9% from the West Bank and 43.1% from Gaza). Results. Of the total 15,963 adolescents, 47.6% were injured, with boys (53.5%) being statistically higher than girls (42.1%) (). The prevalence of those injured more than once decreased by age and was also found significantly higher in boys than in girls (27.3% and 17.9%, resp.) (). Children living in low FAS families showed significantly lower ratios of injuries than those living in moderate and high FAS families (). Injuries while biking were significantly higher among boys (46.3%) than girls (41.7%) (), and injuries while walking/running were more prevalent among girls (32.5%) than boys (28.0%) (). Conclusion. Despite these considerably high rates, injury remains relatively underappreciated. Results of this study are useful to develop a national injury prevention program aimed at enhancing the safety of Palestinian adolescents.

Diabetes education program for people with type 2 diabetes: An international perspective

BACKGROUND In the Palestinian community, lifestyle changes, rapid urbanization and socioeconomic development, stress, smoking, and changes in food habits has increased the risk of non-communicable diseases especially diabetes mellitus. Diabetes complications can be prevented if the glycemic status of patients with diabetes is maintained within a nearly normal range. Therefore, patient education is critical in controlling blood glucose levels within the normal range. OBJECTIVE This study aimed at measuring the effect of diabetes educational intervention program for patients suffering from type 2 diabetes attending the Diabetes Clinic in Tulkarim Directorate of Health. METHODS A short duration observational study involving pre- and post-test educational intervention program was carried out on a relatively small number of type 2 diabetes patients at the Diabetes Clinic in Tulkarim Directorate of Health. In total, 215 patients attended a group-based 4h educational intervention session about diabetes. The program included explaining diabetes mellitus-symptoms, risk factors, types, treatment and complications and main aspects of self-care of the disease (foot care, eye care, and blood glucose monitoring), main aspects of dietary management, weight reduction, blood pressure, smoking cessation, periodic investigations, home monitoring and importance of physical activity. Knowledge evaluation questionnaire were evaluated pre- and post-study. Anthropometric measurements such as body weight (WT), body mass index (BMI) and laboratory tests such as fasting blood glucose (FBG), hemoglobin A1C (HbA1c), cholesterol (Chol), and triglycerides (TG) were measured both at the beginning and at the end of the study. Significance of the results was assessed by paired t-test at 95% confidence interval. RESULTS The participants mean age was 51.07 that ranged between 31 and 70 years. For a total of 215 participants, 41.4% were males and 58.6% were females. The mean weight before educational intervention was 80.81±14.95kg (82.6kg for males and 79.5kg for females) that decreased to 78.9±14.33kg (81.1kg for males and 77.3kg for females) after educational intervention program. The BMI also decreased significantly after educational intervention. The mean fasting blood sugar was 188.65±71.45mg/dL before educational intervention that decreased to 177.7±66.11mg/dL after the educational intervention (p=0.049). The mean glycosylated hemoglobin was 8.57±1.21 before educational intervention that decreased to 7.95±1.42 after educational intervention. The mean value of cholesterol before educational intervention was 183.27±37.74mg/dL that decreased to 169.57±34.23mg/dL after educational intervention. The mean triglycerides value decreased after educational intervention from 209.85±171.04mg/dL to 183.28±152.4mg/dL (p=0.025). The mean score of knowledge questionnaire before educational intervention was 60.6±20.65 that increased to 78.1±13.4 after conducting educational intervention. CONCLUSIONS Diabetes education was found to be effective on BMI, FBG, HbA1c, Chol, TG, and knowledge. RECOMMENDATIONS Diabetes education is a cornerstone in the management and care of diabetes and should be an integral part of health planning involving patients family, diabetes care team, community, and decision makers in the education process.

Lifestyle Modification in Long-Term Management of Chronic Diseases

Nowadays, unfortunately, obesity has been viewed as a cosmetic issue rather than a chronic disease; furthermore, health insurance systems do not include the costs of obesity treatment except if it is associated with a chronic disease such as hypertension and diabetes [1]. Obesity could be defined as an excess amount of energy intake and fat storage through overnutrition and adopting sedentary lifestyle [2, 3]. It can be caused by a combination of several factors including cultural and environmental factors, such as elevated energy diet, low levels of physical activity, eating disorders, and increased portion size. These factors can cause a fundamental change in the structure of adipose tissue leading to “hypertrophy and hyperplasia of adipocytes, inflammation” as well as it causes a change in the secretion of adipokines, which is a biologically active protein that can cause severe impact on the metabolism of glucose and lipids [3, 4]. A study found in UAE indicated that factors that may attribute to low levels of activities are mainly due to the hot climate that can reach up to 45° C in the summer, in addition to the cultural norms that can restrict female outdoor physical activities [5].

Labor and related injuries among schoolchildren in Palestine: findings from the National Study of Palestinian Schoolchildren (HBSC-WBG2006)

Background. Labor related injuries among Palestinian schoolchildren are a significant undocumented public health concern. This study aimed at documenting the prevalence and nature of work related injuries among schoolchildren as well as identifying sociodemographic factors that predict these injuries. Methods. A cross-sectional survey included 15,963 children of whom 6458 (40.8%) completed an optional package related to labor. Students aged 12–18 years self-completed the international WHO collaborative HBSC valid questionnaires between April and May of 2006. Results. Approximately 73.8% of the students who filled the optional package reported working during the last 12 months, of whom 79.1% sustained a work related injury. Work injuries were significantly higher among boys, younger children, and children enrolled in UNRWA schools and living in Gaza Strip (P < 0.05). Children working ≥3 hours/day were more likely to experience injuries, 1.73 (95% CI, 1.53–1.95), than those working ≤3/day. About half of the children worked in retail trade (51.5%), agriculture (20.0%), and cleaning (11.4%). Injury type was related to the type of work performed. Conclusions. The high prevalence of injuries among working Palestinian schoolchildren confirms its severity as a public health problem. To reduce occupational injuries, policymakers and professionals should develop intervention programs that target the public and health providers.

Consumption patterns and side effects of energy drinks among university students in Palestine

Most of the world’s population, even in developed countries, has inadequate intake of one or more of the ~30 essential vitamins and minerals (V/M), mostly used as cofactors by the proteins/enzymes of metabolism. A varied and balanced diet should provide enough V/M; an unbalanced diet with too much refined food provides calories, but not enough V/M. Triage theory (1,2) posits that, as a result of recurrent shortages of V/M during evolution, natural selection developed a strategic rationing response to moderate shortages so that the scarce V/M is preferentially retained by V/M-dependent proteins that are essential for short-term survival and reproduction. In contrast, proteins needed for long-term health, which I term “longevity proteins” because they defend against the diseases associated with aging, are starved for the V/M and thus are disabled. Moreover, since the damage from moderate deficiency is insidious, its importance for long-term health is not clinically apparent. Strong support for triage theory comes from our analyses of published data on proteins dependent on vitamin K (3) and on selenium (4). Both of these V/M have built into metabolism a triage-like trade-off between short-term survival and long-term health; each uses a different mechanism to accomplish this end. Mechanistic, genetic, and epidemiological evidence suggests that this metabolic trade-off accelerates aging-associated diseases, such as cancer, cardiovascular disease, immune dysfunction, and cognitive decline. Importantly, by the official U.S. Institute of Medicine measure of inadequacy, the Estimated Average Requirement (EAR), most of the U.S. population is below the EAR for one or more V/M (5). The percentages of the U.S. population that are currently below the EAR (including fortifications and supplements) are (5): vitamin D 70%, vitamin E 60%, magnesium 45%, calcium 38%, vitamin K 35%, vitamin A 34%, vitamin C 25%, zinc 8%, vitamin B6 8%, folic acid 8%, etc. These low intakes are especially true for children, adolescents, elders, and the obese. The U.S. population also has a very low intake of DHA/EPA omega-3 intake. These official estimates of population inadequacy are likely to be underestimates, as EARs do not take long-term triage effects into account, which is likely to lead to increased EAR estimates. An assay for a longevity protein concentration/activity in a finger prick of blood may be useful for early detection of a functional effect of a low intake of each V/M, and could be used for prevention. About half of the proteins we have studied are longevity proteins. This implies an undiscovered class of longevity V/Ms may exist, which we are exploring and discovering (6). Most of the obese eat very poor diets, as judged by the calorie to V/M ratio (7-11). They are starving for V/M, which may overrule satiety signals (10-13). The frequency of every age-associated disease that has been examined is increased in the obese. Our Choribar (V/M-dense, low-calorie, high-fiber, fruit-based) markedly improves metabolism in those with less than optimal diets (most subjects) in many human trials (14).A known to affect product performance, the interactions of water with food components are not well-understood at a fundamental level, particularly in complex systems. There are five major mechanisms of water-solid interaction. These are: adsorption onto the surface of the solid particle, capillary condensation, deliquescence, crystal hydrate formation, and vapor absorption into the bulk of amorphous solids. Of these, absorption into amorphous materials and deliquescence are likely to have the greatest impact on food products and can lead to significant changes in physical and chemical properties, including phase transformations, changes in powder flow and caking, and degradation of bioactive and other ingredients. There are numerous reports of water absorption into amorphous materials and resulting effects in the food science literature. More recent studies by the author have increased awareness of the fundamentals and consequences of deliquescence and deliquescence lowering in crystalline ingredients and blends thereof. However, many powder food products and premixes used for fortification contain multiple solid state forms. Therefore, an understanding of the fundamentals and effects of moisture-mediated interactions in blends containing crystalline and amorphous solids is also important. This presentation will address the chemical and physical stability of vitamin C in a variety of formulations. Vitamin C is a deliquescent crystalline solid and is acknowledged as one of the most unstable vitamins added to foods. The declaration of the percent of the reference daily intake of vitamin C is mandatory on food labels, and therefore understanding its stability is important.Results: In our study, we developed the nanoformulation of a novel alginate enclosed, chitosan coated Fe-bLf loaded ceramic nanocarriers (ACSC NCs). Uptakes of these NCs in vitro in human intestinal epithelial CaCo2 cells were analyzed, by measuring the endocytosis and transcytosis. The results show the NCs was having size range of 200nm with spherical morphology. SDS PAGE followed by western blotting, using specific antibodies against bLf confirms the structural integrity of the protein after the nano formulation. Confocal microscopy and flow cytometry qualitatively and quantitatively determines the internalization of rhodamine labeled NCs, upon treating them on to CaCo2 cells. In this study was carried out with the aim to investigate antiparasitic activities of Fe bLf loaded ACSC NCs in cell based assays and in mice models of Giardia lamblia, a common parasite of children. Initially the experiments were carried out with native Australian bovine lactoferrin (bLf, ~15% saturated with iron). The efficacy of this protein was compared with other forms of Lf: Fe-Lf (100% saturated with iron), Apo-Lf (unsaturated with iron) using different concentrations in comparison to anti-parasitic drug, Metronidazole. The two forms of bovine lactoferrin (bLf)- the apo & native forms showed microbicidal effect on the parasites in vitro and killing was concentration dependent. Apo-bLf showed more inhibitory activity against trophozoites of G. lamblia than native bLf after 12 hrs of incubation with the drug. When the effectiveness of bLf was tested in comparison with metronidazole (40 mM), bLf was found to be more effective in killing the parasites. Fe-bLf loaded ACSC NCs significantly reduced parasitic load in Giardia lamblia infected Balb/c mice. Fe bLf increased the average weight of the spleens of Giardia lamblia infected mice by ~15%, accompanied by a major increase in the numbers of particular leukocyte subsets in the spleen. CD4+, CD8+, NK, IFN-γ+-expressing and dendritic cell numbers in the spleen were significantly (P<0.001) increased compared to corresponding cell numbers for mice maintained on the control diet. Fe-bLf loaded ACSC NCs bound to the intestinal epithelium and was preferentially taken up within Peyer’s patches. It increased the production of Th1, Th2 and Th17 cytokines within the intestines, including TNF, IFN- γ, IL-18, nitric oxide as well as IL17. Importantly, it restored both red and white peripheral blood cell numbers depleted by anti-parasitic chemotherapy, potentially fortifying the mice against Giardia infections. In summary, Fe-bLf loaded ACSC NCs is a potent natural adjuvant and fortifying agent for augmenting anti-parasitic chemotherapy, but needs to be saturated with iron and administered orally in Fe-bLf loaded ACSC NCs to be effective. Bio-distribution of ACSC NCs was determined my MRI and confirmed by other imaging techniques. Taken together, our results are highly encouraging for the development of nano-therapeutic strategies for anti-parasitic infections. Conclusions: Taken together, our results are highly encouraging for the development of nano-therapeutic strategies and drug delivery to provide more potent and targeted therapeutic, for gut infections. Fe-bLf loaded ACSC NCs were observed to be more effective as an anti-microbial agent.