Patricia Lee

Association between Vitamin D Status and Coronary Heart Disease among Adults in Saudi Arabia: A Case-Control Study

Recent evidence has pointed out an association between vitamin D deficiency and coronary heart disease (CHD). Due to the growing epidemic of CHD and vitamin D deficiency in Saudi Arabia, exploring the role of vitamin D in the prevention of CHD is crucial. The aim of this study was to examine the association between vitamin D status and CHD in Saudi Arabian adults. This case-control study included 130 CHD cases and 195 age-sex matched controls. Study subjects were recruited from three hospitals in the western region of Saudi Arabia. Study participants were interviewed face-to-face to collect data on their socio-demographic characteristics and family history of CHD. Fasting blood samples were collected, and serum levels of vitamin D, glucose, and total cholesterol were measured. Body weight, height, and blood pressure measurements were also recorded. Severe vitamin D deficiency (25(OH)D < 10 ng/mL) was much more prevalent in CHD cases than in controls (46% and 3%, respectively). The results of multivariate logistic regression showed that vitamin D deficiency (25(OH)D < 20 ng/mL) was associated with CHD, with an odds ratio of 6.5 (95% CI: 2.7–15, p < 0.001). The current study revealed that vitamin D deficiency is independently associated with CHD, suggesting an important predictor of CHD among Saudi adults.

Association between Vitamin D Status and Cardio-Metabolic Risk Factorsamong Adults with and without Coronary Heart Disease in Saudi Arabia

Objective: Recent literature has suggested an association between low serum vitamin D levels and the burden of cardio-metabolic risk factors (obesity, diabetes, hypertension, and hypercholesterolemia). In the context of the high prevalence of vitamin D deficiency and cardio-metabolic risk factors in Saudi Arabia, this study was designed to examine the association between vitamin D deficiency and cardio-metabolic risk factors among adults with coronary heart disease (CHD) and without CHD in Saudi Arabia. Methods: A total of 130 CHD subjects and 195 subjects without CHD were recruited from three hospitals in the western region of the Kingdom. Fasting blood samples were collected from each subject to measure serum levels of vitamin D, glucose, and total cholesterol. Anthropometric and blood pressure were also measured. Results: Subjects with CHD had a higher prevalence of diabetes (35.4% and 14%, respectively) and obesity (44% and 22%, respectively) compared with subjects without CHD. However, subjects without CHD had a higher prevalence of cholesterol (13.3% and 5.4%, respectively) and overweight (45% and 24.4%, respectively) than subjects with CHD. The results indicated that vitamin D deficiency [serum 25(OH)D<20 ng/mL] was associated with increased risk of diabetes in CHD subjects (OR: 2.9, 95% CI: 1.02-8.5, p=0.04), while there was no association observed in subjects without CHD (OR:1.4, 95% CI: 0.5-3.8, p=0.616). No significant associations were found between vitamin D deficiency and other cardio-metabolic risk factors including obesity, hypertension, and hypercholesterolemia, in either group. Conclusion: The present study reveals that vitamin D deficiency was associated with a higher risk of diabetes only in subjects with CHD, but not in subjects without CHD. However, this differential association between vitamin D deficiency and other cardio-metabolic risk factors was not observed. Further studies are needed to confirm these findings.

Relationship Between Food Insecurity, Social Support, and Vegetable Intake Among Resettled African Refugees in Queensland, Australia

The objective of this cross-sectional study was to assess the interaction of food insecurity, social support, and vegetable intake among resettled Burundian, Congolese, and Rwandan African refugees in Australia. A total of 71 household food preparers were recruited through purposive sampling. Eighteen percent of the participants experienced food insecurity. Participants with low education and no social support were 5 and 4 times more likely to be food insecure, respectively. There were no significant differences in vegetable intake. Results indicate that food insecurity is more prevalent among postresettlement African refugees compared to the general Australian population and is associated with social support and education. Strategies to enhance education and social support networks for resettled African refugees may work toward alleviating food insecurity among this group.

Lifestyle knowledge and preferences in preschool children: Evaluation of the Get up and Grow healthy lifestyle education programme

Objective: Early childhood is considered a window of opportunity for lifestyle interventions, as this is a critical life-stage at which children accumulate knowledge and skills around behaviours such as eating and physical activity. This study examined how exposure to a settings-based healthy lifestyle programme influences knowledge and preference of food and physical play in preschool children. Design: Quasi-experimental, pre–post intervention design. Methods: Pre- and post-impact evaluation of a healthy lifestyle intervention using an innovative computerised photo-pair food and exercise questionnaire and an age-appropriate test of executive function. The study included 82 children aged 3–5 years and was structured with an intervention and a control group. Quantitative data were analysed using SPSS v22. Results: For the intervention group, there was a significant improvement in overall knowledge of healthy lifestyle behaviours post-intervention, particularly in the identification of healthy and unhealthy food choices. There was no associated change in behavioural preferences. Conclusion: The study highlighted that age-appropriate lifestyle interventions with preschool-aged children can lead to improved knowledge of healthy lifestyle choices. However, improvement in knowledge of healthy lifestyle behaviours does not necessarily lead to positive changes in food and activity preferences that inform choices.

Applicability of the Existing CVD Risk Assessment Tools to Type II Diabetics in Oman: A Review.

Patients with type II diabetes (T2DM) have an elevated risk for cardiovascular disease (CVD), and it is considered to be a leading cause of morbidity and premature mortality in these patients. Many traditional risk factors such as age, male sex, hypertension, dyslipidemia, glycemic control, diabetes duration, renal dysfunction, obesity, and smoking have been studied and identified as independent factors for CVD. Quantifying the risk of CVD among diabetics using the common risk factors in order to plan the treatment and preventive measures is important in the management of these patients as recommended by many clinical guidelines. Therefore, several risk assessment tools have been developed in different parts of the world for this purpose. These include the tools that have been developed for general populations and considered T2DM as a risk factor, and the tools that have been developed for T2DM populations specifically. However, due to the differences in sociodemographic factors and lifestyle patterns, as well as the differences in the distribution of various CVD risk factors in different diabetic populations, the external applicability of these tools on different populations is questionable. This review aims to address the applicability of the existing CVD risk models to the Omani diabetic population.

Cardiovascular Disease Incidence and Risk Factor Patterns among Omanis with Type 2 Diabetes: A Retrospective Cohort Study

OBJECTIVES Cardiovascular disease (CVD) represents the leading cause of morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). Its incidence and risk factor patterns vary widely across different diabetic populations. This study aims to assess the incidence and risk factor patterns of CVD events among Omanis with T2DM. METHODS A sample of 2 039 patients with T2DM from a primary care setting, who were free of CVD at beseline (2009-2010) were involved in a retrospective cohort study. Socio-demographic data and traditional risk factor assessments at the baseline were retrieved from medical records, after which the first CVD outcomes (coronary heart disease, stroke, and peripheral arterial disease) were traced from the baseline to December 2015, with a median follow-up period of 5.6 years. RESULTS The overall cumulative incidence of CVD was 9.4% with an incidence density of 17.6 per 1000 person-years. Prevalence of poor glycemic control, hypertension, obesity, dyslipidemia, albuminuria, and current smoking were 40.0%, 56.3%, 39.0%, 77.3%, 18.7%, and 7.8%, respectively. The univariate survival analysis showed a significant association between CVD and the following factors: age, diabetes duration, body mass index, glycemic control, hypertension, total serum cholesterol, and albuminuria. CONCLUSIONS This study revealed high incidence of CVD and high prevalence of its traditional risk factors among Omanis with T2DM. In addition, compared to global studies, important differences in the prevalence of some risk factors and their patterns in the univariate association with the cardiovascular outcome have been observed.

Exploring Knowledge and Attitudes about Vitamin D among Adults in Saudi Arabia: A Qualitative Study

Vitamin D deficiency is widespread in Saudi Arabia. The aim of this study was to explore participants’ knowledge about vitamin D and attitudes toward sun exposure. The study also aimed to explore the social and cultural factors that might potentially contribute to vitamin D deficiency in Saudi Arabia. Face-to-face interviews were carried out in the cities of Jeddah and Makkah between May and October 2015. The interview questions were semi-structured, and the data was analyzed using thematic analysis. Study participants showed a reasonable level of knowledge in different areas about vitamin D, including the effect of vitamin D deficiency on bone health and exposure to sunlight as the main source of vitamin D. Participants were also knowledgeable about vitamin D supplements as another source of this vitamin. Nevertheless, there was a shortage of knowledge in relation to dietary sources of vitamin D. In respect to attitudes toward sun exposure, some participants had positive attitudes toward sunlight and were willing to expose themselves to sunlight, but it was restricted to the early morning or late afternoon to avoid the heat. These participants who liked exposure to sunlight were largely exposing only their faces and hands to sunlight. Other participants had negative attitudes toward sun exposure and were avoiding sunlight. Moreover, the study participants identified several barriers to sun exposure, including hot climate, living in high-rise buildings, limited public areas allowing outdoor activities, lifestyle issues such as physical inactivity, and some religious concerns such as wearing the hijab. The study results also demonstrate that females were more enthusiastic about taking actions to improve their vitamin D status in comparison with males. Recommendations for health education interventions that increase awareness about vitamin D sources, especially food sources, are made. Also, educational interventions should focus on increasing awareness about the sufficient time of the day and duration for sun exposure to improve vitamin D status and the importance of the intake of vitamin D supplements as an affordable source to improve vitamin D status. Increasing males’ awareness of the benefits of vitamin D is important to encourage them to adopt behaviors to improve vitamin D.

Cardiovascular risk prediction model for Omanis with type 2 diabetes

AIM To date, no cardiovascular risk assessment tool has been developed specifically for any Arabian population including Omanis. This study aims to develop a suitable cardiovascular risk prediction model in the form of a statistical equation, for Omanis with type 2 diabetes. MATERIALS AND METHODS A sample of 2039 patients with type 2 diabetes selected from primary care settings in the Aldakhiliyah Province of Oman were involved in a retrospective cohort study. All patients were free of cardiovascular disease at baseline (in 2009-2010) and were followed up until: 1) their first cardiovascular event occurred; 2) the patient died, or 3) the end of the data collection in December 2015. RESULTS Among the total sample, 192 cardiovascular disease events were recorded within a mean follow-up period of 5.3-year. The 5-year probability of a cardiovascular event was given as 1-0.9991Exp∑XiBi, where Exp ∑XiBi (hazard ratio)=Exp (0.038 age+0.052 DM duration+0.102 HbA1c+0.201 total cholesterol+0.912 albuminuria [1 if present]+0.166 hypertension [1 if present]+0.005 BMI). CONCLUSION The first cardiovascular risk prediction tool in the Arab world was developed in this study. It may be used to estimate the 5-year cardiovascular risk among Omanis with type 2 diabetes in order to plan patient management and preventive measures. However, further validation studies are required to determine the accuracy of the model.

Time and financial outcomes of private practice dietitians providing care under the Australian Medicare program: A longitudinal, exploratory study

Aim To better understand the income of dietitians delivering Medicare Chronic Disease Management services by comparing the amount of time dietitians spend on activities with remuneration received. Methods Data were collected on time invested and remuneration received for 179 consultations provided by 20 dietitians through the Medicare Chronic Disease Management initiative. Descriptive statistics and t-tests were used to compare time spent and remuneration received. A mixed effects model was performed to assess the significant factors in predicting the mean hourly rate received for consultations. Results Consultations accrued an average of

Biologic susceptibility of hepatocellular carcinoma patients treated with radiotherapy to radiation-induced liver disease

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