Mohamed A.A. Moussa

Consanguinity among the Kuwaiti population

A total of 5,007 Kuwaitis were ascertained to study the incidence of consanguineous marriages during 1983. The rate of consanguineous mating was found to be 54.3% with estimated population incidence rates 52.9 to 55.7%. First cousin marriages were the most frequent type. The average inbreeding coefficient was 0.0219 which could be considered high.

Non-insulin-dependent diabetes in Kuwait: prevalence rates and associated risk factors

Non-insulin-dependent diabetes mellitus (NIDDM) is a major clinical and public health problem in Kuwait. The objective of the study was to determine prevalence rates of NIDDM among a representative sample of the Kuwaiti adult population aged 20 and older in two out of five governorates and identify the associated risk factors for the disease. A total of 3003 subjects (1105 men and 1898 women) were interviewed and examined by the research team during the period September 1995 to June 1996. A specially designed questionnaire was completed and the physical examination included height, weight and blood pressure measurements. Fasting blood samples were withdrawn, centrifuged immediately and refrigerated. Interpretation of oral glucose tolerance tests were based on the World Health Organisation diagnostic criteria for diabetes mellitus (1985). The denominator used for computing the prevalence was obtained from the 1995 Kuwait census. The overall prevalence of NIDDM in this study was found to be 14.8% (14.7% in men, 14.8% in women). Diabetic subjects presented at a relatively young age, prevalence rate in the age group 20-39 was 5.7% (95% confidence interval, 4.4-7.0) and in the age group 40-59 was 18.3% (95% confidence interval, 16.1-20.6). Obesity was found to be a significant risk factor, P < 0.001. The strong association of family history of NIDDM (adjusted odds ratio = 1.80, P < 0.001) suggests a genetic component. Hypertension was markedly associated with NIDDM and IGT (P < 0.001). With the demographic transition which already started among the Kuwaiti population and if the prevalence of NIDDM remains the same, aging of the population will contribute to even more upward trends in prevalence of abnormal glucose tolerance with its serious impact on morbidity and mortality among the Kuwaiti population. The strong association between hypertension and NIDDM may suggest a common approach to the prevention and control of these two conditions.

The effect of consanguineous marriages on reproductive wastage

A stratified representative sample size of 5,007 Kuwaiti females aged 15 years and above was drawn during 1983 and structurally interviewed to study the influence of consanguineous marriages (up to the second cousin) on reproductive wastage. Losses comprised prenatal deaths (abortions and stillbirths) and neonatal deaths (up to the first month of life). The rate of consanguineous mating in the sample was 54.3% with 95% confidence limits estimated rate 52.9% to 55.7% when projected over the whole Kuwaiti population. First cousin marriages accounted for 30.2% of the sample followed by 22.1 % less than first cousin (first cousin once removed and second cousins) and 2% only double first cousin. The study showed higher prenatal and neonatal losses among consanguineous (14.2%, 2.97%) than nonconsanguineous (13.97%, 2.54%) although not statistically significant. No consistent increase in reproductive wastage was evident as the inbreeding coefficient, F, advances mainly because of decline in the wastage rate among the double first cousin marriages which represents only 2% of our sample.

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.

Association of C-reactive protein with coronary heart disease risk factors in patients with type 2 diabetes mellitus

The assessment of markers of systemic inflammation, such as C-reactive protein (CRP) and interleukin 6 (IL6), could be used to identify persons at high risk of coronary heart disease (CHD). This study evaluates the relationship of CRP and IL6 with CHD risk factors in patients with type 2 diabetes mellitus (DM) with CHD and age and sex matched type 2 DM controls without CHD. CRP, IL-6, total plasma homocysteine (tHcy), lipoprotein (a) [Lp(a)] and sialic acid (SA) were determined in 55 type 2 diabetic patients with CHD and 51 age- and sex-matched type 2 diabetic controls without CHD. Multivariate and logistic regression analyses were used to relate these markers with CHD risk factors. CRP (P=0.02) and tHcy (P=0.03) were significantly higher in patients with CHD compared with the control group even after correction for age and sex. IL6, Lp(a), SA and lipid parameters were not significantly different between the two groups of patients. After adjustment for potential confounders, the odds ratio (OR) for elevated CRP was 2.00 (95% confidence interval [CI], 1.12-3.58) (P=0.02) but the OR for IL6 was 3.41 95% CI, 0.70-17.17 (P=0.14). Partial correlation analyses of CRP and IL6 with other variables showed significant correlation of CRP with tHcy, and SA in patients with CHD only. Our results support the inclusion of CRP (high-sensitivity assay), in the risk assessment of diabetic subjects.

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.

Prevalence of Type 2 Diabetes Mellitus among Kuwaiti Children and Adolescents

Objectives: To determine the prevalence of type 2 diabetes among 6- to 18-year-old Kuwaiti children. Subjects and Methods: Children with type 2 diabetes were identified at 182 schools (50 primary, 63 intermediate, and 69 secondary) randomly selected using the 2000/2001 educational districts’ registers as a sampling frame. Prevalence rates were adjusted to the 2002 Kuwaiti population. Diagnosis of type 2 diabetes was based on the World Health Organization and the American Diabetes Association criteria. Results: Type 2 diabetes was identified in 45 of the 128,918 children surveyed, thereby giving an overall prevalence of 34.9 per 100,000 [95% confidence interval (CI) 24.7–45.1]. There was a significant difference in prevalence between males (47.3, 95% CI 28.7–65.8) and females (26.3, 95% CI 14.8–37.8) at p = 0.05 and a significant trend for an increase in prevalence of type 2 diabetes with age (p = 0.026). The overall age-adjusted prevalence rate in the 2002 Kuwaiti population was 33.2 (95% CI 26.6–39.9), 41.6 (95% CI 31.2–52.0) in male and 24.6 (95% CI 16.4–32.7) in female children; the difference was significant at p = 0.013. There was no significant difference in prevalence between regions. Children with type 2 diabetes had a significantly higher frequency (51.1%) of a positive family history of diabetes than children of a similar age without type 2 diabetes (22.2%) (p = 0.004). Conclusion: The prevalence of type 2 diabetes in adult Kuwaitis is spreading to children and adolescents, making it an emergency public health problem. Efforts need to be initiated to address prevention strategies of type 2 diabetes in youth.

Plasma leptin concentration in patients with Type 2 diabetes: relationship to cardiovascular disease risk factors and insulin resistance

Aims  The aim of this study was to evaluate the relationship of obesity, leptin, insulin resistance and C‐reactive protein (CRP) with coronary heart disease (CHD) risk factors in patients with Type 2 diabetes mellitus (DM) with CHD compared with those with Type 2 DM without CHD.

Prevalence of Low Back Pain among Physical Therapists in Kuwait

Objective: To determine the life and point prevalence rates and study the characteristics of work-related and non-work-related low back pain (LBP) among physical therapists in Kuwait and its effect on their regular activities. Subjects and Methods: A specially designed self-administered questionnaire was distributed to 143 physical therapists in Kuwait. The questionnaire included demographic data, history and characteristics of LBP before and after working as a physical therapist, the effect of LBP on regular activities and current LBP. A visual analogue scale was used to score the intensity of the pain. Results: One hundred (70%) of the 143 physical therapists completed the questionnaire; mean age and standard deviation of the respondents were 35.9 ± 8.45 years. The lifetime prevalence of work-related LBP was 70% (61.8% in males and 74.2% in females) and the point (current) prevalence rate was 57% (31.6% in males and 68.4% in females). All the 100 therapists were college graduates who worked full-time and 82% were employed in general hospitals and rehabilitation centers. The most common areas of specialty were orthopedics (32%) and neurology (23%). Fifty percent reported that LBP affected their regular activities, 28.6% reported limitation due to pain and 11.4% changed their work settings because of LBP. The main site of pain was at low back and buttocks. Pain intensity was scored similarly among male and female physical therapists. Conclusion: Work-related and point prevalence rates of LBP among physical therapists in Kuwait are high and affect their daily activities, necessitating changes in work settings.

Associations of plasma homocysteine concentration in subjects with type 2 diabetes mellitus

Abstract. We investigated the potential relationship between hyperhomocysteinemia and the presence of coronary heart disease (CHD) and chronic complications in a consecutive series of 358 (156 men) Kuwaiti type 2 diabetic subjects. The median (2.5th, 97.5th percentiles) fasting plasma concentration of total homocysteine (tHcy) in the patients was 10.2 (5.4, 19.1) μmol/l. Fasting tHcy concentration was significantly (p<0.001) higher among men [11.3 (7.1, 24.6) μmol/l] compared to women [8.8 (5.3, 16.3) μmol/l]. Of the 57 patients with a history of CHD and/or electrocardiographic (ECG) evidence of CHD, 9 (16%) had hyperhomocysteinemia (tHcy ≥15 μmol/l) compared to 8.3% (25 of 301) of patients without evidence of CHD. In univariate analysis, plasma tHcy concentration was significantly (p<0.01) higher in those diabetic subjects with history of CHD and/or abnormal ECG. Although hyperhomocysteinemia was more common in patients with microalbuminuria (15%) compared to patients with normoalbuminuria (12%), there was no significant association between hyperhomocysteinemia and the degree of albuminuria. After controlling for age and sex, multiple regression analyses showed significant associations of plasma tHcy concentration with glycated hemoglobin (p<0.05), plasma concentrations of creatinine (p<0.001) and apolipoprotein-B (p<0.05), but not with smoking, neuropathy or retinopathy. It seems that the association of hyperhomocysteinemia with diabetic microvascular complications is mediated by the confounding effect of other factors like age, sex and plasma creatinine concentration. In conclusion, we have found a univariate association between hyperhomocysteinemia and CHD but not with microalbuminuria, neuropathy and retinopathy. Although routine estimation of plasma homocysteine may be useful, the association with cardiovascular disease or microvascular complications in patients with type 2 DM deserves prospective studies.