What is the current status of childhood obesity in Saudi Arabia?: Evidence from 20,000 cases in the Eastern Province: A cross-sectional study

The prevalence rate of those overweight, as well as obesity among children in Saudi Arabia, keeps rising. The aim of the study was to estimate childhood obesity in the Eastern Province, Saudi Arabia.Over the period 2016 to 2017, a cross-sectional campaign was carried out in the Eastern Province of Saudi Arabia. Data were collected from over 20,000 boys’ and girls’ schools. The campaign collected data on birthday/age, weight, height, sex, district in which the school is located, level of education, and blood pressure level.The findings from the present study indicated a prevalence of 25.7% for overweight and obesity among high school-age students. More importantly, ≈35% of the study’s students have either elevated blood pressure or hypertension. The significant predictors of childhood obesity were education level, age, glucose level, and blood pressure.The children in higher school levels originally from the Eastern Province had a high prevalence of overweight and obesity. Recommendations are made on the need of regular screening program among school-age children, as well as to continue raising awareness about childhood obesity.     

Population screening for coeliac disease in a low prevalence area in Italy

Objective. A screening program was proposed for the village of Carcare (population 5700), located in a region of Italy with an apparently low prevalence of coeliac disease (CD): only 1 patient diagnosed out of 2557 inhabitants. The study group comprised 1002 individuals (568?F, 434?M, age range 13–90 years) recruited from blood donors, secondary school pupils and people referred to the local outpatient facilities for routine blood chemistry. Material and methods. Total IgA, IgA anti-tissue transglutaminase (tTG) (ELISA, recombinant human antigen) and IgA antiendomysium (EMA) (IFI, umbilical cord substrate) antibodies were measured in the serum of all participants. All patients with IgA deficiency were investigated for IgG tTG antibodies, and in the case of disagreement between tTG and EMA, they were typed for HLA DQ2-DQ8 haplotypes. Results. Thirteen subjects were positive and 988 negative for autoantibodies (3/988 had IgA deficiency). One serum sample was positive for tTG antibodies but negative for EMA. Ten out of 13 positive subjects consented to undergo duodenal biopsy, which invariably produced evidence of CD despite the absence of clinical signs/symptoms. A post-diagnostic clinical investigation provided evidence showing mild iron deficiency (4 subjects) and osteoporosis (2 subjects). After counselling, all subjects accepted a gluten-free diet. Conclusions. The prevalence of CD in the study group was 1:100 (1.0%; 95% CI: 0.5–1.8%): this indicates that CD is largely underdiagnosed in Carcare. Our results suggest that the low prevalence of CD observed in some regions is likely to be due to underdiagnosis.     

Celiac disease or positive tissue transglutaminase antibodies in patients undergoing renal biopsies

BackgroundAn association between celiac disease and renal diseases has been suggested, but the results are controversial.AimsTo investigate the prevalence of celiac disease autoimmunity among individuals undergoing renal biopsies and to evaluate whether co-existent celiac autoimmunity influences the clinical outcome of the renal disease.MethodsThe prevalence of celiac autoimmunity (previous diagnosis of celiac disease or positive tissue transglutaminase antibodies) was determined in 827 consecutive patients undergoing kidney biopsies due to clinical indications. Up to 15 years’ follow-up data on kidney function and co-morbidities were obtained.ResultsCeliac autoimmunity was found in 45 (5.4%) patients. Among the IgA nephropathy patients, 8.2% of had celiac autoimmunity. At the time of kidney biopsy and after a median follow-up of 5 to 6 years, renal function measured by estimated glomerular filtration rate (eGFR) was inferior in IgA nephropathy patients with celiac autoimmunity compared to those without it (P = 0.048 and P = 0.022, respectively).ConclusionThe prevalence of celiac autoimmunity seems to be high in patients undergoing renal biopsies, especially in patients with IgA nephropathy. Such autoimmunity may be associated with worse renal function in IgA nephropathy. Hence the co-existence of celiac disease should be taken into consideration when treating patients with renal diseases.     

Celiac Disease Prevalence in Brazilian Dilated Cardiomyopathy Patients

Celiac disease (CD) is a permanent condition of gluten intolerance and a number of autoimmune diseases have been associated with it. In the past few years, a relation between CD and dilated cardiomyopathy (CM) was described in Europe and United States. The aim of this study was to evaluate the prevalence of CD among south Brazilian precardiac transplant patients with advanced CM. A total of 74 patients on a list for heart transplantation were evaluated for the presence CD. The presence of anti-endomisial antibody (IgA-EmA) was determined by indirect immunofluorescence and for the anti-transglutaminase antibody (IgA anti–h-tTG) by ELISA. Serologically positive patients were submitted to upper endoscopy with intestinal biopsy. Two individuals (2.63%) were positive for IgA-EmA and 5 (6.75%) for IgA anti–h-tTG; 1 (1.35%) had both tests positive. Histologic confirmation of CD occurred only in the IgA-EmA positive patients. In conclusion, data from the present study allows recommend the screening for CD in patients with CM using IgA-EmA test as the method of choice.     

Lifestyle factors and macro- and micro-vascular complications among people with type 2 diabetes in Saudi Arabia

AimsThe aim of this study is to identify lifestyle factors that place people with type 2 diabetes in Saudi Arabia at a greater risk of macro- and microvascular complications.MethodsA survey was conducted among adults with type 2 diabetes who attended diabetes centres in three major cities in Saudi Arabia. Participants were interviewed and their medical files were reviewed for lab test results and documented comorbidities. Associations between complication and lifestyle factors were assessed using multiple logistic regression analysis.ResultsA total of 1121 participants were recruited. Mean age was 57.6 (±11.1) years. The prevalence of coronary artery disease, diabetic foot, and stroke was 17.0%, 13.1% and 3.7%, and that of neuropathy, renal impairment, and retinopathy was 20.3%, 14.5%, and 42.8% respectively. Lifestyle factors associated with one or more of the complications were inadequate physical activity, longer sitting time, obesity, current or past smoking, passive smoking, hypertension, poor glycaemic control, low HDL and high triglycerides.ConclusionsDiabetes complications are common among people with type 2 diabetes in Saudi Arabia. Life style factors such as inadequate physical activity, longer sitting time, obesity, smoking, hypertension, and poor control of blood glucose and lipids should be assimilated into complications prevention program.     

Prevalence and socioeconomic risk factors of obesity among urban female students in Al-Khobar city, Eastern Saudi Arabia, 2003

The aim of this study was to determine the prevalence and the socioeconomic risk factors associated with obesity among female school-aged children and adolescents in primary and intermediate schools in Al-Khobar city, Kingdom of Saudi Arabia. This is a cross-sectional study conducted in Al-Khobar city, which is located in the eastern part of Saudi Arabia, during the period of January to March 2003. It involved 2239 female schoolchildren randomly selected from 30 regular government and private primary and preparatory schools. The students' ages ranged from 6 to 17 years, with a mean of 10.49 +/- 2.64 years. A multistage stratified random sampling technique with proportional allocation was used. Data were collected using questionnaires and anthropometric measurements. Body mass index interpretation was based on using a table of standard definitions for overweight and obesity in children (Cole's). The spss version 10 (SPSS Inc., Chicago, IL, USA) was used for data entry and analysis. A chi-squared test was used in cross-tabulation analysis to test the significance of association between body mass index and socioeconomic variables. The prevalence of overweight and obesity were 20% and 11%, respectively. The prevalence of overweight was higher among schoolchildren with father in private work (P<0.01) and the prevalence of overweight and obesity was higher among schoolchildren with highly educated mothers (P=0.008). The prevalence of overweight and obesity among female school-aged children and adolescents in the Al-Khobar city was very high. Accordingly, it is recommended that health education programmes regarding obesity should be provided to all schoolchildren, their families and teachers.     

Prevalence of nutritional disorders in Saudi children with inflammatory bowel disease based on the national growth reference

Background and study aimThe prevalence of nutritional disorders in Saudi children with inflammatory bowel diseases (IBDs) has been reported using the World Health Organization (WHO) reference. Our aim was to provide more accurate definition of the prevalence of nutritional impairment in Saudi children with IBDs based on the national growth reference and to demonstrate the effect of using a reference from other populations on the prevalence rates.Patients and MethodsWeight, height, and body mass index data, from the multicenter study of IBDs in Saudi children and adolescents, were plotted on the new Saudi national growth reference. Statistical analyses included frequency calculations and z-test for proportions to investigate the significance of the difference in prevalence. A p-value of < 0.05 was considered significant.ResultsAmong a total of 374 patients, 119 (32%) had ulcerative colitis (UC) and 255 (68%) had Crohn’s disease (CD). Compared with the WHO reference, the Saudi national reference produced a significantly lower prevalence of thinness in patients with UC (24% vs. 8%, p = 0.001), CD (35% vs. 20%, p = 0.002), and of short stature in patients with CD (28% vs. 11%, p < 0.001). The difference in the prevalence of overweight was not significant.ConclusionsWe provide more accurate prevalence estimate of nutritional disorders in Saudi children with IBDs based on national reference. The use of the WHO reference overestimated the prevalence of thinness and short stature in Saudi children. Prevalence estimates based on references from other populations should be interpreted with caution.     

Screening for celiac disease in Danish adults

Abstract

Objective. The prevalence of celiac disease (CD) as recorded in the Danish National Patient Registry is ～50/100,000 persons. This is much lower than the reported prevalence of CD in other Nordic countries and underdiagnosis is suspected. Our aim was to estimate the prevalence of CD in a population-based study of Danish adults. Methods. A total of 2297 adults aged 24–76 years living in the southwestern part of Copenhagen were screened for CD by immunoglobulin (Ig)A and IgG antibodies to transglutaminases and deamidated gliadin. IgA/IgG-positive participants were invited to a clinical evaluation, including biopsies, by a gastroenterologist. Results. Of the invited 56 participants, 40 underwent a full clinical evaluation and 8 persons were diagnosed with CD; 2 of the 16 persons, who did not complete the clinical evaluation, were considered by experts to have probable CD. None of the above 56 participants had a known history of CD or a recorded diagnosis of CD in National Patient Registry. By combining cases of biopsy-proven CD (n = 8), probable CD (n = 2), and registry-recorded CD (n = 1), the prevalence of CD was estimated to be 479/100,000 (11/2297) persons (95% CI: 197–761). Conclusion. In this general adult population, the prevalence of CD as estimated by screening and clinical evaluation was 10 times higher than the registry-based prevalence of CD. Of 11 participants diagnosed with CD in our screening study, 10 were unaware of the diagnosis prior to the study. Thus, our study suggests that CD is markedly underdiagnosed in Danish adults.     

Positive IgA against transglutaminase 2 in patients with distal radius and ankle fractures compared to community-based controls

Background: Patients with celiac disease (CD), including adults with subclinical disease, have low bone mineral density (BMD), deteriorated bone microarchitecture and meta-analysis show an increased risk of fracture. Immunoglobulin A (IgA) against transglutaminase 2 (IgA TG2) is a highly reliable marker to detect CD.

Main objective: To explore the prevalence of positive IgA TG2 and CD in patients with distal radius and ankle fracture compared to community-based controls.

Methods: Four hundred patients aged 40 years or above with distal fractures were included in a case–control study. About 197 controls were identified from the National Population Registry, those included had never suffered a fracture. BMD was measured, and comorbidities, medications, physical activity, smoking habits, body mass index (BMI) and nutritional factors were registered. Blood analysis to detect common causes of secondary osteoporosis was performed.

Results: About 2.5% of the fracture patients had positive IgA TG2, compared to 1% in the control group. The odds ratio, adjusted for sex and age, of having positive IgA TG2 was 2.50 (95% CI 0.54–11.56).

Conclusions: There were no significantly increased odds of CD in adult patients with fractures compared to controls; however, results imply that positive IgA TG2 is more prevalent in fracture patients than in controls. This study indicates that universal screening for CD in fracture patients is not warranted, but supports current clinical practice in Norway to suspect and investigate for CD in patients with fracture, osteoporosis and other risk factors for CD.     

Seroepidemiology of hepatitis B virus infection in Saudi Arabian children: a baseline survey for mass vaccination against hepatitis B.

Saudi Arabia is considered to be an area of endemic hepatitis B virus (HBV) infection. By adult age, 7% persons have hepatitis B surface antigen (HBsAg) and about 70% have one or more HBV markers. In order to provide a baseline for the integration of hepatitis B vaccine into the extended programme of immunisation (EPI), a population-based survey of HBV markers was made among Saudi children. The overall prevalence of HBsAg was 6.7%, with at least one HBV marker being positive in 19.7% persons tested. Two peaks of HBV prevalence were observed in the 7- and 10-year-old children respectively. The prevalence of HBsAg was steady in all age groups with identifiable but insignificant peaks in children aged 4 and 7 years respectively. Despite the apparent homogeneity of the Saudi population, the prevalence rates of HBV varied among the regions and were higher in urban dwellers. There was no significant difference in the HBsAg prevalence for the sexes (7.3% for males and 6.0% for females). Socioeconomic factors and family size did not significantly influence the prevalence of HBV among children. Of 307 HBsAg-positive children, 55 (17.9%) were positive for HBeAg. The early acquisition of HBV in the Saudi population is confirmed. The most effective strategy for HBV control, therefore, is by mass vaccination of all Saudi infants. An extension of the immunisation programme so as to include all pre-school children should further reduce the reservoir of HBV in Saudi Arabia. A repetition of a similar survey after 5 and 10 years should be made in order to measure this reduction.     

Splenic function in children with sickle cell disease: two different patterns in Saudi Arabia

Splenic function in 35 Saudi children homozygous for sickle cell disease (age range 3-9 years) was studied using radioactive colloid scans. Two different patterns emerged. Splenic dysfunction was demonstrated in more than 80% of children who were originally from the south-western part of the country. They were found to have low HbF levels. In contrast normal or nearly normal splenic function was found in all patients from the Eastern Province in whom HbF levels were high. These different patterns of splenic function may contribute to the severe and mild forms of sickle cell disease seen in Saudi Arabia.     

Nationwide community survey of tuberculosis epidemiology in Saudi Arabia

In the first nationwide community-based survey of the epidemiology of tuberculosis in Saudi Arabia, 7721 subjects were screened in the 5 provinces (using an equal proportional allocation formula) for 2 parameters: (1) prevalence of positive Mantoux test in non BCG vaccinated subjects; (2) prevalence of bacillary cases on sputum culture.The prevalence of positive Mantoux reaction in children aged 5–14 years was 6% ±1.8; higher in urban areas (10%), and lower in rural areas (2%), thus classifying Saudi Arabia among the middle prevalence countries. These relatively good results (by Third World standards) could reflect the rise of the standard of living and wide availability of free treatment for active cases with a lowered risk of infection in the community. This view is supported by the fact that in our survey, only one subject grew Mycobacterium tuberculosis in the sputum.However, there were foci of high prevalence of Mantoux reaction in the urban communities in the Western province (20% ± 8.7 urban; 1% ± 1.9 rural). The problem may be caused by the fact that the province receives every year over a million pilgrims, some of whom are known to settle illegally and escape the usual screening for tuberculosis imposed on foreign labourers. In conclusion, even in the absence of an enforceable national programme for the eradication of tuberculosis, the economic standard and wide availability of free treatment for active cases has resulted in relatively low rates of prevalence of tuberculin sensitivity in children. The foci of high prevalence in the Western Province require special screening arrangements.     

COVID-19 among people with diabetes mellitus in Saudi Arabia: Current situation and new perspectives

Background and aimThis review aims to report the current status of COVID-19 among people with diabetes, newly diagnosed diabetes, diabetic ketoacidosis, and programmatic efforts including vaccinations.MethodsWe conducted a literature search using PubMed, Google, and Scopus until July 15, 2021.ResultsIn Saudi Arabia, most studies have reported diabetes as one of the highly prevalent comorbidities among patients with COVID-19. Currently, there are limited studies from Saudi Arabia on the newly diagnosed diabetes and diabetic ketoacidosis caused by COVID-19. The Saudi ministry has taken several measures to control the impact of COVID-19 among people with diabetes, including comprehensive guidelines and prioritized vaccinations. During the COVID-19 pandemic, the use of telehealth services dramatically increased in diabetes clinics in Saudi Arabia.ConclusionsFocused and evidence-based interventions are essential to control the impact of COVID-19 among people with diabetes.     

Cutaneous leishmaniasis: a 46-year study of the epidemiology and clinical features in Saudi Arabia (1956-2002).

OBJECTIVE: The aim of this study was to evaluate the epidemiology of cutaneous leishmaniasis in the Eastern Province of Saudi Arabia. In addition, the clinical spectrum of the disease was evaluated. METHODS: This is a retrospective study of cutaneous leishmania cases from 1956 to 2002. RESULTS: In the study period, there were 1862 patients with cutaneous leishmaniasis in the Saudi Aramco health care system. The disease is more prevalent in the Al-Hasa Oasis (Eastern Province of Saudi Arabia) and affects males and females equally. Cutaneous leishmaniasis follows a seasonal distribution in parallel with the known activity of the sandfly. The majority (76%) of cases occurred in patients < 15 years of age and the disease affected the extremities more frequently than the face. Seventy-one percent of patients presented with a single lesion and 27% presented with two lesions. Ulcerative cutaneous leishmaniasis was the predominant morphology (89%). CONCLUSION: Cutaneous leishmaniasis attained epidemic proportions in 1973 and subsequently declined and reached a plateau in the mid-1980s. Skin involvement is the major clinical picture, with no evidence of dissemination or viscerotropic syndrome.     

Tuberculosis in Saudi Arabia: epidemiology and incidence of Mycobacterium tuberculosis and other mycobacterial species

The epidemiology of mycobacterial infections was studied in a wide cross-section of the Jeddah population over 2 years (1987-1989). Saudis, non-Saudis and patients from a stable population attending National Guard King Khalid Hospital (NGKKH) were compared. The ratio of Saudi to non-Saudi was 1:2 and males accounted for 65% of the total. The incidence was highest among young adults although the peak varied slightly between Saudi and non-Saudi patients. Extra-pulmonary tuberculosis was also preponderant among young adults, particularly females. Variants of Mycobacterium tuberculosis were investigated for the first time in Saudi Arabia. African and Asian variants were isolated from both Saudi and non-Saudi patients, the former being more numerous. Extra-pulmonary tuberculosis, particularly lymphadenopathy, accounted for a large proportion of mycobacterial infections, 59% at NGKKH. Mycobacterial species other than M. tuberculosis were fully identified and accounted for 9% of the isolates, Mycobacterium fortuitum and Mycobacterium chelonei being the two most prevalent.     

Intestinal parasitic infections in schoolchildren of Abha (Asir), Saudi Arabia.

Stool specimens from 1282 children between the age of 5 and 13 years attending 10 primary schools for boys in the city of Abha, southwestern Saudi Arabia, were examined for the presence of intestinal parasites. Of these, 313, (24.4%) were found infected with one or more species of 11 intestinal protozoa and helminths. The most common pathogenic protozoa being Giardia lamblia (10.9%) followed by Entamoeba histolytica (4.1%). The nonpathogenic protozoan, Entamoeba coli had the highest prevalence rate (11.3%) in the children's stools. Hymenolepis nana was the commonest intestinal helminth (3.0%). Other intestinal helminths, including Ascaris lumbricoides, Trichuris trichiura. Schistosoma mansoni, Dicrocoelium dendriticum were detected to a lesser extent. The distribution of the common intestinal infections among the children surveyed were also analysed according to age, nationality and multiplicity of infection. Prevalence of E. histolytica was found to increase with age whereas Giardia infections were less common among older children. This pair of parasite species were strongly associated. Yemeni children had consistently the highest prevalence of infection with protozoa and helminths, followed by Saudi and non-Saudi children.     

Regional variation of pediatric inflammatory bowel disease in Saudi Arabia: Results from a multicenter study

BACKGROUND Incidence and severity variations of inflammatory bowel disease(IBD)have been reported from Western populations between continents and regions of the same countries.However,no data were available from other countries.AIM To investigate the regional differences in the IBD profiles of pediatric patients from the Kingdom of Saudi Arabia.METHODS Data from a national multicenter IBD study were used.The incidence,time trend,and clinical presentation of Crohn’s disease(CD)and ulcerative colitis(UC)in the Central region(CR),Western region(WR),and Eastern region(ER)were analyzed and compared.Statistical analysis included Poisson regression analysis for incidence variation and Chi-square test for demographic and clinical parameters.A P<0.05 was considered significant.RESULTS The prevalence of positive family history was lower in children with CD from the ER than the CR or the WR.Consanguinity rate was higher in children with CD and UC from the CR and the ER,respectively.The incidences and time trends of CD and UC were not significantly different between regions.In the ER,a significantly higher percentage of children with CD presented with abdominal pain(P<0.001),blood in stools(P=0.048),stricturing or penetrating disease(P=0.029),higher erythrocyte sedimentation rate(P<0.001),higher C-reactive protein(P<0.001),higher anemia(P=0.017),and lower albumin level(P=0.014).For children with UC from the ER,a significantly higher percentage presented with anemia(P=0.006)and a lower percentage with pancolitis(P<0.001).CONCLUSION The most important finding is the identification of significantly more severe presentation of CD in the ER of the Kingdom of Saudi Arabia.Prospective studies are needed to explain such variations.     

AComparison of the Prevalence of Metabolic Syndrome in Saudi Adult Females Using Two Definitions

The aim of this study was to estimate the prevalence of metabolic syndrome in Saudi adult women aged 18 years and above using the criteria of International Diabetes Federation (IDF) and modified National Cholesterol Education Program Adult Treatment Panel III (mNCEPATPIII). A cross-sectional survey was performed involving a group of 2577 non-pregnant Saudi women subjects aged 18-59 years residing in a military city in northern Saudi Arabia recruited from a primary care setting. Anthropometric data, together with a brief medical history, were obtained at initial contact, and laboratory investigations were performed on the following day after fasting for 12 h. Data on all variables required to define the metabolic syndrome according to IDF and mNCEP-ATPIII criteria were available for only 1922 subjects who attended the laboratory for investigations (response rate of 74.6%). Non-respondents were excluded from data analysis. Prevalence rates were estimated according to both definitions. Age-adjusted prevalence of metabolic syndrome was found to be 16.1% and 13.6% by IDF and mNCEP-ATPIII definitions, respectively. Abdominal obesity was the most common component in the study population (44.1% by mNCEP-ATPIII and 67.9% by IDF cut-off points). It was followed by low serum high-density lipoprotein cholesterol (36.0%). About two-thirds of the subjects (66.4% by mNCEP-ATPIII and 67.9% by IDF definitions) exhibited at least one criterion for metabolic syndrome by both definitions. Mean values and prevalence of individual components of the syndrome showed a steady rise with increase in age, general and abdominal obesity, and the presence of diabetes. Since the cut-off values for waist circumference by IDF definition were lower, prevalence rates by this definition were higher than those defined by mNCEP-ATPIII. High prevalence rates in this young sample predict a sharp rise in the prevalence rates of this syndrome among Saudi women over the next few years.     

Nutrition, Physical Activity, and Gender Risks for Adolescent Obesity in Southwestern Saudi Arabia

Background/Aim:

The aim of the study was to investigate gender differences in obesity and related behavior among adolescent school boys and girls in southwestern Saudi Arabia.

Patients and Methods:

A cross-sectional study on a stratified sample of 1,249 adolescent boys and 620 adolescent girls, was conducted in southwestern Saudi Arabia. They were interviewed and examined for weight and height using standardized techniques.

Results:

The prevalence of obesity and overweight in the present study amounted to 23.2% among boys and 29.4% among girls. The following significant risk factors were identified; being a female [adjusted odds ratio (aOR) =1.372, 95% confidence interval (CI) =1.099-1.753] and lack of class physical exercise (aOR =1.452, 95% CI =1.149-2.117).

Conclusion:

Obesity among adolescents is a public health problem in Southwestern Saudi Arabia. The problem is more prevalent among girls. Thus, there is a need for a national programme in the country to prevent and control obesity among adolescents.