Dietary knowledge among adults with type 2 diabetes - Kingdom of Saudi Arabia

Dietary management is considered as a major step in assessing a patient’s knowledge related to nutritional aspects, treatment, and complications of diabetes. Diabetes patients frequently face difficulty in identifying the recommended diet, including its quality and quantity. In the Kingdom of Saudi Arabia (KSA), sedentary lifestyle, along with food choices and portion sizes, have increased considerably and this has resulted in the soaring risk of diabetes. In addition, there is paucity of literature focusing on the Dietary Knowledge (DK) of type 2 diabetics in KSA. The study aimed to assess and evaluate the DK of type 2 diabetics. An analytical cross-sectional study was conducted among 350 type 2 diabetics using a valid and reliable self-prepared questionnaire comprising of 21 questions. Results showed that type 2 diabetics had an overall poor DK (28.57%). Sub-group analysis further revealed that diabetes patients had poor knowledge related to the consumption of carbohydrates and food choices, whereas they had good knowledge related to lipids and fats, proteins and food types. The role of diet in controlling of diabetes is considered imperative, but still, diabetes patients are unaware how they should approach this issue. The patient empowerment approach can be used to counsel patients with a poor DK. Primary care physicians and dietitians should work together and carry out individualized, tailored and patient-centered dietary education sessions

Global impacts of Covid-19 on lifestyles and health and preparation preferences: an international survey of 30 countries

Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic. Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels. Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised. Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics

Prevalence and risk factors of diabetic retinopathy in Saudi Diabetics in Majmaah City

BackgroundDiabetes mellitus (DM) is one of the most common chronic diseases worldwide. Diabetic retinopathy (DR) is the most common complication of DM and it is the leading cause of blindness in the Kingdom of Saudi Arabia.AimsThe study was conducted to determine the prevalence and risk factors of DR in patients with type II DM in Al Majmaah City, Saudi Arabia.Methods We conducted this cross-sectional study from February 2014 until May 2015. Out of the 1546 diabetic patients registered in the primary care centres of Majmaah city, a random sample of 327 patients were selected. An expert ophthalmologist took a detailed history and performed ophthalmic examination on all patients. Mean ± S.D was measured for quantitative variables. Frequencies and percentages were given for qualitative variables. Logistic regression was applied to associate DR with alleged risk factors.Results The prevalence of DR among the study group was 35.8 per cent. Non-proliferative diabetic retinopathy was prevalent in 31.8 per cent cases. We tested the association between DR and various risk factors. We found that patients, who develop DM when they were between 40 and 60 years, have more chance to develop DR.ConclusionDR is affecting more than one third of diabetic patients in Saudi Arabia. There is an urgent need to establish and promote national screening and management programs for DR. Delaying the onset of DM after the age of 60 may help to lessen that problem

PREVALENCE AND RISK FACTORS OF DIABETIC RETINOPATHY IN SAUDI DIABETICS IN MAJMAAH CITY

Background Diabetes mellitus (DM) is one of the most common chronic diseases worldwide. Diabetic retinopathy (DR) is the most common complication of DM and it is the leading cause of blindness in the Kingdom of Saudi Arabia. Aims The study was conducted to determine the prevalence and risk factors of DR in patients with type II DM in Al Majmaah City, Saudi Arabia. Methods We conducted this cross-sectional study from February 2014 until May 2015. Out of the 1546 diabetic patients registered in the primary care centres of Majmaah city, a random sample of 327 patients were selected. An expert ophthalmologist took a detailed history and performed ophthalmic examination on all patients. Mean ± S.D was measured for quantitative variables. Frequencies and percentages were given for qualitative variables. Logistic regression was applied to associate DR with alleged risk factors. Results The prevalence of DR among the study group was 35.8 per cent. Non-proliferative diabetic retinopathy was prevalent in 31.8 per cent cases. We tested the association between DR and various risk factors. We found that patients, who develop DM when they were between 40 and 60 years, have more chance to develop DR. Conclusion DR is affecting more than one third of diabetic patients in Saudi Arabia. There is an urgent need to establish and promote national screening and management programs for DR. Delaying the onset of DM after the age of 60 may help to lessen that problem

Dietary attitude of adults with type 2 diabetes mellitus in the Kingdom of Saudi Arabia: A cross-sectional study

Background and objectives: There is a paucity of literature on the dietary attitude (DA) of patients with type 2 diabetes in the Kingdom of Saudi Arabia (KSA). Although the prevalence of diabetes mellitus (DM) is high in Gulf countries, there remains a lack of understanding of the importance of dietary behavior in diabetes management among patients. Understanding the behavior of patients with diabetes towards the disease requires knowledge of their DA. Therefore, this study aimed to assess and evaluate the DA of type 2 diabetes patients, and it is the first of its kind in the KSA. Material and Methods: An analytical cross-sectional study was conducted among 350 patients with type 2 diabetes. A self-administered DA questionnaire was used to collect the data. Psychometric properties of the questionnaire were assessed by face validity, content validity, exploratory factor analysis, and internal consistency reliability. The data were collected using a systematic random sampling technique. Results: The overall DA of the patients was inappropriate (p = 0.014). Patients had an inappropriate DA towards food selection (p = 0.003), healthy choices (p = 0.005), food restraint (p < 0.001), health impact (p < 0.001), and food categorization (p = 0.033). A poor DA was also observed in relation to the consumption of red meat (p <0.001), rice (p < 0.001), soup and sauces (p = 0.040), dairy products (p = 0.015), and junk food (p < 0.001). Conclusions: It is highly recommended that patients with diabetes receive counseling with an empowerment approach, as this can bring about changes in their dietary behavior, which is deeply rooted in their daily routine. Healthcare providers should also be well-informed about patients’ attitudes and beliefs towards diabetes to design tailored educational and salutary programs for this specific community. Diabetes self-management educational programs should also be provided on a regular basis with a special emphasis on diet and its related components

Key lifestyles and interim health outcomes for effective interventions in general populations: A network analysis of a large international observational study

Background: The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences. Methods: An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic. Results: Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values \u3e0.05 after Holm-Bonferroni correction). Conclusions: Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation

Key lifestyles and health outcomes across 16 prevalent chronic diseases: A network analysis of an international observational study

Background Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements. Methods We surveyed 16512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables’ significantly higher indices through a centrality difference test. Findings Among the 48 networks, 44 were validated (all correlation-stability coefficients?\u3e0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P\u3c0.05). Conclusion To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies

Global impacts of COVID-19 on lifestyles and health and preparation preferences: An international survey of 30 countries

Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents\u27 perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic. Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels. Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised. Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics

International survey for assessing COVID-19’s impact on fear and health: study protocol

Introduction COVID-19, caused by the SARS-CoV-2, has been one of the most highly contagious and rapidly spreading virus outbreak. The pandemic not only has catastrophic impacts on physical health and economy around the world, but also the psychological well-being of individuals, communities and society. The psychological and social impacts of the COVID-19 pandemic internationally have not been well described. There is a lack of international study assessing health-related impacts of the COVID-19 pandemic, especially on the degree to which individuals are fearful of the pandemic. Therefore, this study aims to (1) assess the health-related impact of the COVID-19 pandemic in community-dwelling individuals around the world; (2) determine the extent various communities are fearful of COVID-19 and (3) identify perceived needs of the population to prepare for potential future pandemics.Methods and analysis This global study involves 30 countries. For each country, we target at least 500 subjects aged 18 years or above. The questionnaires will be available online and in local languages. The questionnaires include assessment of the health impacts of COVID-19, perceived importance of future preparation for the pandemic, fear, lifestyles, sociodemographics, COVID-19-related knowledge, e-health literacy, out-of-control scale and the Patient Health Questionnaire-4. Descriptive statistics will be used to describe participants’ characteristics, perceptions on the health-related impacts of COVID-19, fear, anxiety and depression, lifestyles, COVID-19 knowledge, e-health literacy and other measures. Univariable and multivariable regression models will be used to assess the associations of covariates on the outcomes.Ethics and dissemination The study has been reviewed and approved by the local ethics committees in participating countries, where local ethics approval is needed. The results will be actively disseminated. This study aims to map an international perspective and comparison for future preparation in a pandemic

Key lifestyles and interim health outcomes for effective interventions in general populations: A network analysis of a large international observational study

Background The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences. Methods An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic. Results Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction). Conclusions Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation