Hashim Jaddou

Obesity in Jordan.

OBJECTIVES: To study the prevalence of obesity among semi-urban communities in Jordan and its association with a number of factors.DESIGN: A sample of households was systematically selected from four Jordanian towns namely, Sarih, Sikhra, Southern Mazar and Subha-Subhieh. All subjects aged ≥25 y within the selected households, were invited to participate in the study. A total of 2836 subjects were actually included in the study, with an overall response rate of 70.5%. Study procedures were carried out in the local health centres in each town over a one-month period.RESULTS: The overall prevalence of obesity (body mass index, BMI≥30 kg/m2) was 49.7%; 32.7% in males and 59.8% in females. Obesity was more prevalent in the older age groups, illiterate people, diabetic and hypertensive subjects, and those with hypercholesterolaemia (HC), hypertriglyceridaemia (HTG), high level of low density lipoprotein cholesterol (LDL), and low level of high density lipoprotein cholesterol (HDL). After adjusting for age and gender, obesity was associated with diabetes mellitus (DM) (odds ratio (OR) 1.4, 95% confidence limit (CL) 1.1, 1.8), hypertension (HT) (OR 2.2, 95% CL 1.7, 2.8), HC (OR 1.3, 95% CL 1.1, 1.5), HTG (OR 2.3, 95% CL 2.0, 2.8), elevated LDL (OR 1.5, 95% CL 1.2, 1.8) and low HDL (OR 2.3, 95% CL 1.8, 2.9).CONCLUSION: Obesity seems to be a common disorder among adult Jordanians. More attention should be paid to this problem at the national level.

Vitamin D Status in Jordan: Dress Style and Gender Discrepancies

Background/Aims: Vitamin D deficiency is highly prevalent worldwide and has been linked to many diseases. The aims of the present study were to assess the vitamin D status of Jordanians at the national level and to identify groups of the population at high risk for vitamin D deficiency. Methods: Vitamin D status was assessed in a national sample of 5,640 subjects aged ≧7 years. The study involved interviews, laboratory measurements of 25(OH)D and others, and physical measurements. The present report deals, exclusively, with subjects aged >18 years. Results: The prevalence of low vitamin D status [25(OH)D <30 ng/ml] was 37.3% in females compared to 5.1% in males. Dress style in females was independently related to low vitamin D status; women wearing ‘Hijab’ (adjusted OR = 1.7, p = 0.004) or ‘Niqab’ (adjusted OR = 1.5, p = 0.061) were at a higher risk for low vitamin D status than were western-dressed women. Conclusion: The high prevalence of low vitamin D status in females in contrast with a low prevalence in males, together with a higher prevalence in women wearing Hijab or Neqab, calls for action to increase the population’s awareness and to develop strategies to reduce this risk among women, particularly those wearing dress styles that cover most or all of their skin.

Hypertension Prevalence, Awareness, Treatment and Control, and Associated Factors: Results from a National Survey, Jordan

The study examined prevalence, awareness, treatment and control of hypertension (HTN), and associated factors and to evaluate the trend in hypertension between 2009 (period 2) and 1994–1998 (period 1). A national sample of 4117 adults aged 25 years and older was selected. Prevalence rate of HTN (SBP ≥ 140 or DBP ≥ 90 or on antihypertensive therapy) was 32.3% and was higher than the 29.4% prevalence rate reported in period 1. Prevalence rate was significantly higher among males, older age groups, least educated, obese, and diabetics than their counterparts. The rate of awareness among hypertensives was 56.1% and was higher than the 38.8% rate reported form period 1 data. Awareness was positively associated with age, smoking, and diabetes for both men and women, and with level of education and body mass index for men. Rate of treatment for HTN among aware patients was 63.3% and was significantly higher than the 52.8% rate reported in period1. Control rate of HTN among treated hypertensives was 39.6%; significantly higher than the 27.9% control rate in period 1. Control of HTN was positively associated with age but only for women. In conclusion, HTN is still on the rise in Jordan, and levels of awareness and control are below the optimal levels.

National maternal mortality ratio for Jordan, 2007-2008.

To estimate the number of maternal deaths per 100 000 live births during 2007–2008 among Jordanian women; to identify the causes of maternal mortality; and to compare the results with those of the last report for 1995–1996.

Anthropometric cutoff values for detecting metabolic abnormalities in Jordanian adults

Objectives To determine cutoff values for body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) as indicators of metabolic abnormalities in the adult Jordanian population. Methods A structured questionnaire was administered to collect relevant information. Anthropometric measurements and biochemical measurements were carried out. Receiver-operating characteristic curve analyses were used to examine the overall discriminatory power of the four anthropometric indices. Results WC cutoff values varied from 88.5 to 91.8 cm in men and from 84.5 to 88.5 cm in women. The BMI cutoff values varied from 26.2 to 27.2 kg/m2 in men and from 27.2 to 30.0 kg/m2 in women. The WHR cutoff values varied from 0.88 to 0.90 in men and from 80.0 to 0.83 in women. The WHtR cutoff values varied from 0.50 to 0.51 in men and women. Of all anthropometric indices, WHtR had the strongest association with each metabolic abnormality in men and women. Conclusion BMI, WC, WHR, and WHtR were found to be associated with cardiovascular disease risk factors, with WHtR being the better predictor. We recommend that health care professionals use WHtR, with a cutoff value of 0.5 for screening and counseling Jordanian people.

Relationship between 25-hydroxyvitamin D and metabolic syndrome among Jordanian adults

Evidence of the association between 25-hydroxyvitamin D (25(OH)D) and metabolic syndrome (MeS) remains uncertain and incongruent. This study aimed to determine the association between 25(OH)D and MeS among Jordanian adults. A complex multistage sampling technique was used to select a national population-based household sample. The present report deals exclusively with adults aged > 18 years who had complete information on all components of MeS (n = 3,234). A structured questionnaire was used to collect all relevant information. Anthropometric, clinical, and laboratory measurements were obtained. MeS was defined according to the International Diabetes Federation (IDF) definition. Of the total, 42.0% had MeS and 31.7% had 25(OH)D < 30 ng/ml. In a stratified analysis, the prevalence of MeS did not differ significantly between subjects with low and normal 25(OH)D levels for men and women in all age groups. In the multivariate analysis, the odds of MeS were not significantly different between subjects with low and normal 25(OH)D levels (OR = 0.85, 95% CI: 0.70, 1.05, P-value = 0.133). The association between 25(OH)D and MeS remained non-significant when 25(OH)D was analyzed as a continuous variable (OR = 1.004, 95% CI; 1.000, 1.008, P = 0.057) and when analyzed based on quartiles. None of the individual components of MeS were significantly associated with 25(OH)D level. This study does not provide evidence to support the association between 25(OH)D level and MeS or its individual components. Prospective studies are necessary to better determine the roles of 25(OH)D levels in the etiology of MeS.

Metabolic Syndrome and Its Individual Components among Jordanian Children and Adolescents

This study aimed to determine the prevalence of metabolic syndrome (MeS) and its individual components in Jordanian children and adolescents aged 7–18 years and determine the factors that are associated with clustering of metabolic abnormalities. MeS was defined using the International Diabetes Federation (IDF) definition. The prevalence of MeS was estimated from 512 subjects who had complete information on all MeS components. The prevalence of MeS according to IDF criteria was 1.4% in subjects aged between 10 and 15.9 years and 3.6% in subjects aged between 16 and 18 years. When categorized according to body mass index (BMI), the prevalence of the MeS was 15.1% in obese subjects, compared to 0.3% in subjects with normal BMI, and 3.0% in overweight subjects. In conclusion, our results indicate that although the prevalence of MeS is low in Jordanian children and adolescents, a large proportion of them had one or two metabolic abnormalities.

Maternal mortality in Jordan: role of substandard care and delays

Understanding the factors that operate during pregnancy, delivery and postpartum is the key to success in the prevention of maternal mortality. This cross-sectional survey in Jordan for the years 2007-2008 aimed to identify the role of substandard care and delays in maternal deaths. All maternal deaths among women aged 15-49 years over this period (n = 76) were investigated retrospectively through file review and household interviews in all hospitals (n = 102) and forensic medicine departments in Jordan; elements of substandard care and delays at hospital, home and transport levels were evaluated. Substandard care accounted for 52.6% of deaths, delay in seeking care 55.3%, delay in transport 15.8% and delay in hospital care 17.1%. Women who did not recognize the danger signs of pregnancy (OR 6.32), refused medical advice to terminate the pregnancy (OR 1.78) or at a gestational age > 37 weeks (OR 1.85) were significantly more likely to delay seeking care, as were those with larger mean family size.

Metabolic abnormalities associated with obesity in children and adolescents in Jordan

OBJECTIVE To estimate the prevalence of overweight and obesity among Jordanian children and adolescents and to determine their association with metabolic abnormalities. METHODS In a national population-based household survey, a systematic sample of households was selected. All members aged ?7 years in the selected households were invited to participate in the study. Of the respondents, 1,034 subjects were 18 years old or younger. Anthropometric and biochemical measurements were obtained. Overweight and obesity were defined according to age and sex specific cut-off points of BMI defined by the International Obesity Task Force criteria proposed by Cole et al. The metabolic abnormalities were defined for subjects, based on their age, according to the definition of Cook et al. and International Diabetes Federation (IDF) criteria. RESULTS The overall prevalence of overweight and obesity among children were 6.0% and 5.5%, respectively. Among adolescents, the overall prevalence rates of overweight and obesity were 13.7% and 10.0%, respectively. After adjusting for gender and age, overweight was significantly associated with increased odds of having high triglycerides (Odds ratio [OR] = 1.7), low HDL-cholesterol (OR = 1.9), and at least one metabolic abnormality (OR = 2.2). Obesity was significantly associated with increased odds of individual metabolic abnormalities and their clustering. CONCLUSIONS A relatively high proportion of Jordanian children and adolescents had overweight or obesity. Overweight and obesity in children and adolescents were associated with increased odds of metabolic abnormalities and their clustering. Programs addressing eating behavior and physical activity of children and adolescents to maintain a healthy weight are needed in Jordan.

Factor analysis of cardiometabolic risk factors clustering in children and adolescents.

BACKGROUND Research on the clustering and relative importance of the metabolic syndrome components in children and adolescents is scarce. This study was conducted to explore the factor structure of the central metabolic syndrome variables in Jordanian children and adolescents using exploratory factor analysis. METHODS This study included 665 children and adolescents who were identified in a national population-based household survey in Jordan. Their anthropometric and laboratory measurements were obtained. Factor analysis was performed on standardized variables to produce the minimum number of factors that retains as much of the total variance in the original data as possible. RESULTS Factor analysis showed that one common factor is not sufficient to underlie metabolic syndrome. Four factors were extracted in the exploratory factor analysis-adiposity factor, blood pressure factor, lipids factor, and blood glucose factor. The cumulative percent of variance accounted for by the four factors together was 78.7% in male children, 86.9% in female children, 82.5% in male adolescents, and 83.4% in female adolescents. The adiposity factor accounted for the largest proportion of the total variance in the four groups. CONCLUSIONS The factor analysis of cardiovascular risk clustering in Jordanian children and adolescents suggests that multiple factors account for the clustering of the metabolic syndrome components. Obesity accounts for the maximum variance in clustering and appears to be a more powerful correlate of cardiovascular risk in children and adolescents.