Dysglycemia risk score in Saudi Arabia: A tool to identify people at high future risk of developing type 2 diabetes

Abstract Aims/Introduction To develop a non-invasive risk score to identify Saudis having prediabetes or undiagnosed type 2 diabetes. Methods Adult Saudis without diabetes were recruited randomly using a stratified two-stage cluster sampling method. Demographic, dietary, lifestyle variables, personal and family medical history were collected using a questionnaire. Blood pressure and anthropometric measurements were taken. Body mass index was calculated. The 1-h oral glucose tolerance test was carried out. Glycated hemoglobin, fasting and 1-h plasma glucose were measured, and obtained values were used to define prediabetes and type 2 diabetes (dysglycemia). Logistic regression models were used for assessing the association between various factors and dysglycemia, and Hosmer?Lemeshow summary statistics were used to assess the goodness-of-fit. Results A total of 791 men and 612 women were included, of whom 69 were found to have diabetes, and 259 had prediabetes. The prevalence of dysglycemia was 23%, increasing with age, reaching 71% in adults aged ≥65 years. In univariate analysis age, body mass index, waist circumference, use of antihypertensive medication, history of hyperglycemia, low physical activity, short sleep and family history of diabetes were statistically significant. The final model for the Saudi Diabetes Risk Score constituted sex, age, waist circumference, history of hyperglycemia and family history of diabetes, with the score ranging from 0 to 15. Its fit based on assessment using the receiver operating characteristic curve was good, with an area under the curve of 0.76 (95% confidence interval 0.73?0.79). The proposed cut-point for dysglycemia is 5 or 6, with sensitivity and specificity being approximately 0.7. Conclusion The Saudi Diabetes Risk Score is a simple tool that can effectively distinguish Saudis at high risk of dysglycemia.Peer reviewe

Association Between Anthropometric Indices and Nonanthropometric Components of Metabolic Syndrome in Saudi Adults

Context: Waist circumference (WC) is used in screening for metabolic syndrome (MetS) based on its association with cardiometabolic risk.This might apply differently in ethnically different populations. Associations with other measures are also unclear. Objective: This work aimed to investigate the association between neck circumference (NC), WC, WC:hip circumference, WC:height (VVC:Ht), NC:Ht, fat percentage, body mass index (BMI), conicity index, abdominal volume index, and weight-adjusted waist index with nonanthropometric components of MetS in nondiabetic Saudi adults. Methods: This cross-sectional study took place in public health centers in Jeddah, comprising 1365 Saudi adults (772 men and 593 women) aged 18 years or older not previously diagnosed with diabetes. Main outcome measures included the presence of 2 or more nonanthropometric components of the MetS were used to define clinical metabolic abnormality (CMA). The predictive ability of studied anthropometric indices for CMA was determined using the area under receiver operating characteristics (AUC) curve and binary logistic regression. Results: A total of 157 men and 83 women had CMA. NC and NC:Ht had the highest predictive ability for CMA in men (odds ratio [OR](NC) = 1.79, P < .001 and ORNC:Ht = 1.68, P < .001; AUC(NC) = 0.69 [95% CI, 0.64-0.74] and ALS, = 0.69 [95% CI, 0.64-0.73]). In women, WC had the highest predictive ability ORWC = 1.81, P< .001; AUC(WC) = 0.75 [95% CI, 0.69-0.80]). Conclusion: Upper-body anthropometric indicators that were associated with subcutaneous fat had the highest predictive ability for CMA in men whereas abdominal obesity indictors had the best predictive ability in women, suggesting that fat distribution might contribute to CMA in a sex-specific manner.Peer reviewe

The association between hypertension and other cardiovascular risk factors among non-diabetic Saudis adults-A cross sectional study

Population specific associations between cardiovascular disease with various risk factors including pre-hypertension and hypertension were reported. We aimed to investigate the association of higher than optimal blood pressure with measures of dysglycemia, dyslipidemia, and markers of inflammation in non-diabetic Saudi adults hoping to improve current Saudi guidelines to prevent cardiovascular disease. Volunteers were recruited randomly from public healthcare centers in Jeddah. Demographic information, blood pressure (BP), and anthropometric measurements were taken. Fasting blood samples were drawn, then again following 1-hour oral glucose tolerance test. Glycated hemoglobin, fasting plasma glucose (FPG), lipid profile, highly sensitive C- reactive protein, gamma glutamyl transferase, and 1-hour plasma glucose were measured. Complete data was found for 742 men and 592 women. Pre-hypertension was found in 47.2% of men, and 24.7% of women, while 15.1% of men, and 14.6% of women were hypertensive. Means of measured variables differed significantly between normotensive, pre-hypertensive, and hypertensive groups of men and women in gender specific manner. Association between measured variables and elevated BP, and hypertension were assessed using logistic regression models. After adjustment for age, body mass index and waist circumference, elevated blood pressure was associated with elevated triglycerides in men, while hypertension was significantly associated with elevated fasting plasma glucose, total cholesterol, triglycerides, low density lipoprotein- cholesterol, and low high density lipoprotein- cholesterol in men, and elevated triglycerides, and total cholesterol in women. Therefore, it is strongly recommended to measure lipid profile, specifically TG, for all diagnosed pre-hypertensive and hypertensive patients in addition to FPG for men.Peer reviewe

The Association between Dyslipidemia, Dietary Habits and Other Lifestyle Indicators among Non-Diabetic Attendees of Primary Health Care Centers in Jeddah, Saudi Arabia

Diet and other lifestyle habits have been reported to contribute to the development of dyslipidemia in various populations. Therefore, this study investigated the association between dyslipidemia and dietary and other lifestyle practices among Saudi adults. Data were collected from adults (>= 20 years) not previously diagnosed with diabetes in a cross-sectional design. Demographic, anthropometric, and clinical characteristics, as well as lifestyle and dietary habits were recorded using a predesigned questionnaire. Fasting blood samples were drawn to estimate the serum lipid profile. Out of 1385 people, 858 (62%) (491 men, 367 women) had dyslipidemia. After regression analysis to adjust for age, body mass index, and waist circumference, an intake of >= 5 cups/week of Turkish coffee, or carbonated drinks was associated with increased risk of dyslipidemia in men (OR (95% CI), 2.74 (1.53, 4.89)p= 0.001, and 1.53 (1.04, 2.26)p= 0.03 respectively), while the same intake of American coffee had a protective effect (0.53 (0.30, 0.92)p= 0.025). Sleep durationPeer reviewe

An educational program about premarital screening for unmarried female students in King Abdul-Aziz University, Jeddah

SummaryThe present study was conducted to assess knowledge and attitude of unmarried female students in King Abdul-Aziz University (KAU) towards premarital screening (PMS) program, to determine predictors of high students’ knowledge scores and to improve their knowledge about PMS through conduction of an educational campaign. Multi-stage stratified random sample method was used with recruitment of 1563 students from all faculties of KAU, during the educational year 2008–2009. The Pre-test included 30 knowledge items and 14 attitude statements with student's response through a 5-point Likert scale. Health education was conducted using audiovisual aids through pre-designed educational materials. Statistical analysis was done by SPSS version 16. Results: Students’ knowledge about the program was generally low before the educational campaign. The predictors of high knowledge scores were being a health science student (aOR=4.15; 95% CI: 2.97–5.81), age ≥20 years (aOR=2.78; 95% CI: 2.01–3.85), family history of hereditary diseases and income ≥10,000 SR/month. Regarding attitude, almost all students (99.0%) agreed on the importance of PMS. After the educational program, students’ knowledge about PMS was markedly improved. The mean students’ knowledge score was 9.85±5.36 in Pre-test and improved to 18.45±4.96 in Post-test, with a highly statistical significant difference (paired t=25.40, p<0.000). Conclusion and recommendations: The educational program was successful in improving students’ knowledge about the PMS. Conduction of similar educational programs and adding PMS in the curriculum of secondary and university education are recommended

The Association Between Dietary Habits and Other Lifestyle Indicators and Dysglycemia in Saudi Adults Free of Previous Diagnosis of Diabetes

Objective: Study the association of dietary habits and other indicators of lifestyle with dysglycemia in Saudi adults. Methods: In a cross-sectional design, data were obtained from 1403 Saudi adults (> 20 years), not previously diagnosed with diabetes. Demographics, lifestyle variables and dietary habits were obtained using a predesigned questionnaire. Fasting plasma glucose, glycated hemoglobin and 1-hour oral glucose tolerance test were used to identify dysglycemia. Regression analysis was performed to determine the associations of dietary factors and other indicators of lifestyle with dysglycemia. Results: A total 1075 adults (596 men, and 479 women) had normoglycemia, and 328 (195 men, and 133 women) had dysglycemia. Following adjustment for age, BMI and waist circumference, in men the weekly intake of 5 portions or more of red meat and Turkish coffee were associated with decreased odds of having dysglycemia odds ratio (OR) 0.444 (95% CI: 0.223, 0.881;P = .02) and 0.387 (95% CI: 0.202, 0.74;P = .004), respectively. In women, the intake of fresh juice 1 to 4 portions per week and 5 portions or more were associated with OR 0.603 (95% CI: 0.369, 0.985;P = .043) and OR 0.511 (95% CI: 0.279, 0.935;P = .029) decreased odds of having dysglycemia, respectively compared with women who did not drink fresh juice. The intake of 5 times or more per week of hibiscus drink was associated with increased odds of having dysglycemia, OR 5.551 (95% CI: 1.576, 19.55,P = .008) compared with women not using such a drink. Other lifestyle factors were not associated with dysglycemia. Conclusion: Dietary practices by studied Saudis have some impact on risk of dysglycemia, with obvious sex differences.Peer reviewe

Gender Differences in The Factors associated with Hypertension in Non-Diabetic Saudi Adults-A Cross-Sectional Study

The association between lifestyle practices, obesity and increased BP are under-investigated. We aimed to investigate this association to identify the factors associated with hypertension and prehypertension in Saudis. Non-diabetic adults were recruited from public healthcare centers using a cross-sectional design. Recruits were interviewed using a predesigned questionnaire. Weight, height, waist circumference (WC), hip circumference (HC), neck circumference (NC) and BP were measured. The variables were analyzed by comparing the prehypertensive and hypertensive groups with the normotensive group. A total of 1334 adults were included. The study found that 47.2% of men and 24.7% of women were prehypertensive, and 15.1% of men and 14.4% of women were hypertensive. High BMI, WC, NC, and WC: HC ratios were associated with an increased risk of prehypertension and hypertension in men and women. Low physical activity was associated with an increased risk of elevated BP in men, while sleep duration of & LE;6 h and sitting for & GE;4 h were associated with increased risk in women. Women from central Asia, southeast Asia, and those of mixed origin had a higher prevalence of hypertension compared to those from Arabian tribes. In conclusion, prehypertension and hypertension increase with age and obesity. Gender differences were apparent in the association between several lifestyle practices and prehypertension or hypertension among various ethnic/racial groups.Peer reviewe

Factors associated with adherence to Mediterranean diet among Saudi non-diabetic patients attending primary health care centers: A cross-sectional study

الملخص: أهداف البحث: للتحقيق في العوامل المسؤولة ودرجة الالتزام بحمية البحر الأبيض المتوسط بين المرضى غير المصابين بالسكري من مراجعي مراكز الرعاية الصحية الأولية. طرق البحث: أُجريت دراسة مستعرضة في مراكز الرعاية الصحية الأولية بجدة، بواسطة استبانة مصدقة ذاتية الاستخدام، تقوم بتقييم مستويات الالتزام لـ ١٤ جانبا غذائيا متعلقا بحمية البحر الأبيض المتوسط. تمكِّن الاستبانة من حساب درجة التزام (٠- ١٤)، في حين تم افتراض التزام غير كافي للنتائج ≥٧. وقد شملت عوامل الالتزام الخصائص الديموغرافية الاجتماعية العامة والتاريخ المَرَضي ونمط الحياة وعوامل الخطورة القلبية الوعائية مثل مؤشر كتلة الجسم ونسبة الخصر إلى الورك وضغط الدم والصيام ومستوى الجلوكوز في الدم بعد الأكل بساعة واحدة. النتائج: من بين المشاركين الـ ٢٦٥ (٥٠.٦٪ ذكورا)، سُجِّل عدم الالتزام الكافي في ٧٤.٣٪. وكانت درجات الالتزام أعلى في المشاركين المتزوجين (٦.٨٦ ± ١.٧٤مقابل ٦.٢٤ ± ١.٧٩) والممارسين للنشاط البدني المنتظم (٦.٧٩ ± ١.٩٠مقابل ٦.٣٠ ± ١.٦٣) بالمقارنة مع نظرائهم، على التوالي. علاوة على ذلك، فقد ازداد الالتزام بالحمية المتوسطية مع التقدم في العمر (معامل انحدار غير معياري=٠.٠٢ ومعامل ارتباط= ٠.١٣٣). ومن المثير للاهتمام، أنه لم ترتبط درجات الالتزام بعوامل الخطورة الرئيسة المتعلقة بالقلب والأوعية الدموية، فيما عدا الارتفاع البيّن في ضغط الدم الانبساطي بين المشاركين الملتزمين مقارنة بقرنائهم قليلي الالتزام (٧٧.٩٦± ١٢.٢٠مقابل ٧٤.٠١± ١٢.٢٤، على التوالي). الاستنتاجات: كان لواحد من أصل ٤ مرضى غير مصابين بداء السكري من الذين راجعوا مراكز الرعاية الصحية الأولية، التزام جيد بحمية البحر الأبيض المتوسط دون ارتباط يُذكر بعوامل الخطورة القلبية الوعائية. يُوصى بإجراء المزيد من الدراسات للتحقيق في الوعي والمعرفة حول النظام الغذائي المتوسطي بين السكان السعوديين، ومن بعدها يمكن تفصيل برامج التوعية وفقًا لذلك. Abstract: Objectives: To investigate the degree and factors responsible for adherence to a Mediterranean diet among non-diabetic patients attending primary health care centres (PHCCs). Methods: A cross-sectional study was conducted in Jeddah PHCCs using a validated self-administered questionnaire which assessed adherence levels to 14 dietary aspects related to the Mediterranean diet. The questionnaire enabled calculation of an adherence score (0–14), where inadequate adherence was assumed for scores ≤7. Factors of adherence included general socio-demographic characteristics, medical history, lifestyle, and cardiovascular risk factors such as body mass index, waist-to-hip ratio, blood pressure, and fasting and 1-h postprandial blood glucose levels. Results: Of the 265 participants (50.6% males), inadequate adherence was reported in 74.3%. Adherence scores were higher in married participants than in unmarried ones (6.68 ± 1.74 vs. 6.24 ± 1.79, p = 0.04), as well as in those who engaged in regular physical activity vs. those who did not (6.79 ± 1.90 vs. 6.30 ± 1.63, p = 0.02). Furthermore, Mediterranean diet adherence increased with age (B = 0.02, r = 0.133; p < 0.001). Interestingly, adherence scores were not associated with major cardiovascular risk factors except for a significantly higher diastolic blood pressure in participants with adequate as opposed to low adherence (77.96 ± 12.20 vs. 74.01 ± 12.24, respectively, p = 0.022). Conclusion: One out of 4 non-diabetic patients attending PHCCs exhibited good adherence to a Mediterranean diet without considerable association with cardiovascular risk factors. Further studies are recommended to investigate awareness and knowledge regarding the Mediterranean diet among Saudi populations. Subsequently, awareness programs could be tailored accordingly. الكلمات المفتاحية: حمية البحر الأبيض المتوسط, غير السكري, الالتزام, المملكة العربية السعودية, القلب والأوعية الدموية, Keywords: Adherence, Cardiovascular, KSA, Mediterranean diet, Non-diabete