Prevalence and Determinants of Metabolic Syndrome in Qatar: Results from a National Health Survey

OBJECTIVES: To determine optimum measurements for abdominal obesity and to assess the prevalence and determinants of metabolic syndrome in Qatar. DESIGN: National health survey. SETTING: Qatar National STEPwise Survey conducted by the Supreme Council of Health during 2012. PARTICIPANTS: 2496 Qatari citizens aged 18-64 representative of the general population. PRIMARY AND SECONDARY OUTCOME MEASURES: Measure of obesity (body mass index, waist circumference or waist-to-height ratio) that best identified the presence of at least 2 other factors of metabolic syndrome; cut-off values of waist circumference; frequency of metabolic syndrome. RESULTS: Waist circumference ≥102 for men and ≥94 cm for women was the best predictor of the presence of other determinants of metabolic syndrome (raised blood pressure, fasting blood glucose, triglycerides and reduced high-density lipoprotein cholesterol). Using these values, we identified 28% of Qataris with metabolic syndrome, which is considerably lower than the estimate of 37% calculated using the International Diabetes Federation (IDF) criteria. Restricting the analysis to participants without known elevated blood pressure, elevated blood sugar or diabetes 16.5% would be classified as having metabolic syndrome. In a multivariable logistic regression analysis, the prevalence of metabolic syndrome increased steadily with age (OR=3.40 (95% CI 2.02 to 5.74), OR=5.66 (3.65 to 8.78), OR=10.2 (5.98 to 17.6) and OR=18.2 (7.01 to 47.5) for those in the age group \u2730-39\u27, \u2740-49\u27, \u2750-59\u27, \u2760-64\u27 vs \u2718-29\u27; p CONCLUSIONS: Waist circumference was the best measure of obesity to combine with other variables to construct a country-specific definition of metabolic syndrome in Qatar. Approximately 28% of adult Qatari citizens satisfy the criteria for metabolic syndrome, which increased significantly with age. Education and physical activity were inversely associated with this syndrome

Characterizing epidemiology of prediabetes, diabetes, and hypertension in Qataris: A cross-sectional study

Objectives To characterize the epidemiologic profiles of prediabetes mellitus (preDM), diabetes mellitus (DM), and hypertension (HTN) in Qataris using the nationally representative 2012 Qatar STEPwise Survey. Methods A secondary data analysis of a cross-sectional survey that included 2,497 Qatari nationals aged 18–64 years. Descriptive and analytical statistical analyses were conducted. Results Prevalence of preDM, DM, and HTN in Qataris aged 18–64 years was 11.9% (95% confidence interval [CI] 9.6%-14.7%), 10.4% (95% CI 8.4%-12.9%), and 32.9% (95% CI 30.4%-35.6%), respectively. Age was the common factor associated with the three conditions. Adjusted analyses showed that unhealthy diet (adjusted odds ratio (aOR) = 1.84, 95% CI 1.01–3.36) was significantly associated with preDM; that physical inactivity (aOR = 1.66, 95% CI 1.12–2.46), central obesity (aOR = 2.08, 95% CI 1.02–4.26), and HTN (aOR = 2.18, 95% CI 1.40–3.38) were significantly associated with DM; and that DM (aOR = 2.07, 95% CI 1.34–3.22) was significantly associated with HTN. Population attributable fraction of preDM associated with unhealthy diet was 7.7%; of DM associated with physical inactivity, central obesity, and HTN, respectively, was 14.9%, 39.8%, and 17.5%; and of HTN associated with DM was 3.0%. Conclusions One in five Qataris is living with either preDM or DM, and one in three is living with HTN, conditions that were found to be primarily driven by lifestyle factors. Prevention, control, and management of these conditions should be a national priority to reduce their disease burden and associated disease sequelae.This publication was made possible by NPRP grant number 10-1208-160017 from the Qatar National Research Fund (a member of Qatar Foundation)

Type 2 diabetes epidemic and key risk factors in Qatar: A mathematical modeling analysis

Introduction We aimed to characterize and forecast type 2 diabetes mellitus (T2DM) disease burden between 2021 and 2050 in Qatar where 89% of the population comprises expatriates from over 150 countries. Research design and methods An age-structured mathematical model was used to forecast T2DM burden and the impact of key risk factors (obesity, smoking, and physical inactivity). The model was parametrized using data from T2DM natural history studies, Qatar's 2012 STEPwise survey, the Global Health Observatory, and the International Diabetes Federation Diabetes Atlas, among other data sources. Results Between 2021 and 2050, T2DM prevalence increased from 7.0% to 14.0%, the number of people living with T2DM increased from 170 057 to 596 862, and the annual number of new T2DM cases increased from 25 007 to 45 155 among those 20-79 years of age living in Qatar. Obesity prevalence increased from 8.2% to 12.5%, smoking declined from 28.3% to 26.9%, and physical inactivity increased from 23.1% to 26.8%. The proportion of incident T2DM cases attributed to obesity increased from 21.9% to 29.9%, while the contribution of smoking and physical inactivity decreased from 7.1% to 6.0% and from 7.3% to 7.2%, respectively. The results showed substantial variability across various nationality groups residing in Qatar - for example, in Qataris and Egyptians, the T2DM burden was mainly due to obesity, while in other nationality groups, it appeared to be multifactorial. Conclusions T2DM prevalence and incidence in Qatar were forecasted to increase sharply by 2050, highlighting the rapidly growing need of healthcare resources to address the disease burden. T2DM epidemiology varied between nationality groups, stressing the need for prevention and treatment intervention strategies tailored to each nationality

Change in the structures, dynamics and disease-related mortality rates of the population of Qatari nationals: 2007–2011

Background: Developing effective public health policies and strategies for interventions necessitates an assessment of the structure, dynamics, disease rates and causes of death in a population. Lately, Qatar has undertaken development resurgence in health and economy that resulted in improving the standard of health services and health status of the entire Qatari population (i.e., Qatari nationals and non-Qatari residents). No study has attempted to evaluate the population structure/dynamics and recent changes in disease-related mortality rates among Qatari nationals. Objective: The present study examines the population structure/dynamics and the related changes in the cause-specific mortality rates and disease prevalence in the Qatari nationals. Methods: This is a retrospective, analytic descriptive analysis covering a period of 5 years (2007–2011) and utilizes a range of data sources from the State of Qatar including the population structure, disease-related mortality rates, and the prevalence of a range of chronic and infectious diseases. Factors reflecting population dynamics such as crude death (CDR), crude birth (CBR), total fertility (TFR) and infant mortality (IMR) rates were also calculated. Results: The Qatari nationals is an expansive population with an annual growth rate of ∼4% and a stable male:female ratio. The CDR declined by 15% within the study period, whereas the CBR was almost stable. The total disease-specific death rate, however, was decreased among the Qatari nationals by 23% due to the decline in mortality rates attributed to diseases of the blood and immune system (43%), nervous system (44%) and cardiovascular system (41%). There was a high prevalence of a range of chronic diseases, whereas very low frequencies of the infectious diseases within the study population. Conclusion: Public health strategies, approaches and programs developed to reduce disease burden and the related death, should be tailored to target the population of Qatari nationals which exhibits characteristics that vary from the entire Qatari population

School children growth monitoring program in the state of Qatar: Observations from two survey rounds in 2016–17 and 2019–20

Abstract Introduction Growth monitoring surveys provide critical anthropometric data to monitor physical growth and various forms of malnutrition among school age children. In the beginning, growth monitoring programs were introduced to identify the extent of undernutrition among children, which were later considered equally useful in the identification of overweight and obesity among school age children. Observing the shifts in weight categories among school age children provides an important insight to design targeted interventions for improving growth and development of children. Methodology The study used growth monitoring survey data among 5–19‐year school children of two academic years (2016–17 and 2019–20) in Qatar where 2016–17 survey included 186,986 students, whereas 2019–20 survey included 215,279 students. A total of 7514 unique records of students aged 5–14 years available in both survey rounds were included in the final analysis. This study documented shift in BMI‐z‐scores to ascertain the movement of students among obese, overweight, normal, thinness, and severe thinness categories. Python version 3.9.5 was used for data analysis along with a pairwise comparison between each of BMI‐z‐score shift to evaluate the effects of specific shifts in BMI‐z‐score category. Results Overall, the proportion of overweight and obese category of students increased from 44% in 2016–17 to 49.3% in 2019–20 with a decrease in the proportion of students in normal BMI‐z‐score category (from 48.8% to 47.8%) and severe thinness and thinness category (from 7.3% to 3%) between two rounds of growth monitoring survey. Statistically significant shifts in BMI‐z‐score categories were noted for students of different age groups, gender, and nationality. Conclusions Shift from normal BMI‐z‐score to obese and overweight category is a cause of concern and an opportunity to develop appropriate interventions. The significant shift among different categories needs to be investigated further to identify associated reasons to effectively develop interventions

A ‘High Risk’ Lifestyle Pattern Is Associated with Metabolic Syndrome among Qatari Women of Reproductive Age: A Cross-Sectional National Study

This study investigated the effect of lifestyle patterns, as a combination of diet, physical activity and smoking, on Metabolic Syndrome (MetS) among Qatari women of childbearing age (n = 418), a population group particularly vulnerable to the health sequela of this syndrome. Using data from the National WHO STEPwise survey conducted in Qatar in 2012, Principal Component Factor Analysis was performed to derive lifestyle patterns with survey variables related to the frequency of consumption of 13 foods/food groups, physical activity levels, and smoking status. MetS was diagnosed using ATPIII criteria. Three lifestyle patterns were identified: ‘High Risk’ pattern, characterized by intakes of fast foods, sweets and sugar sweetened beverages, in addition to lower levels of physical activity and higher smoking prevalence; ‘Prudent’ pattern, driven mainly by higher intakes of fruits, vegetables, fish, and whole grains; and ‘Traditional’ pattern which included beans, meat, dairy products, and a low prevalence of smoking. Among these three lifestyle patterns, only the ‘High Risk’ was associated with MetS, whereby subjects belonging to the third tertile of this pattern’s score had 2.5 times the odds of MetS compared to those belonging to the first tertile. The findings of this study demonstrated the synergy among high risk behaviors among Qatari women in increasing the odds of MetS; the latter being a major risk factor for cardiovascular diseases

Adherence to the Qatar dietary guidelines: a cross-sectional study of the gaps, determinants and association with cardiometabolic risk amongst adults

Abstract Background The Qatar Dietary Guidelines (QDGs) were developed as part of the national strategy to prevent chronic diseases. This study aims at characterizing gaps between the QDGs and usual dietary and lifestyle patterns in Qatar, identifying demographic and socioeconomic determinants of adherence to the QDGs and investigating the association between adherence and cardiometabolic risk. Methods This study is based on the Qatar National STEPwise cross-sectional survey which was conducted on a nationally representative sample of Qatari adults, aged 18 to 64 years (n = 1109). Data collection included socio-demographic characteristics, lifestyle factors, anthropometric (weight, height and waist circumference (WC)), and blood pressure measurements. The dietary intake of participants was evaluated using a non-quantitative food frequency questionnaire (FFQ). Biochemical assessment was performed to measure the fasting levels of blood sugar, triglycerides (TG) and HDL cholesterol. The metabolic syndrome (MetS) was defined as the presence of three or more cardiometabolic risk factors. To examine adherence to the guidelines, each specifc recommendation was matched to corresponding data drawn from the survey. To investigate the association of sociodemographic, lifestyle and cardiometabolic characteristics with adherence to the QDGs, an adherence score was calculated. Results More than 83% of adults did not meet the recommendations for vegetables, fruits, whole grains, legumes and high fibre intakes, 70% were overweight or obese, 50–72% reported frequent consumption of sweetened beverages and sweets, and 47% reported frequent consumption of fast foods. Younger adults, the unemployed, the least educated and those not married had lower adherence to the QDGs. Adherence was inversely associated with elevated WC (OR: 0.88, 95% CI:0.82–0.95) and the MetS (OR:0.84,95% CI:0.74–0.96). Conclusions Building on the identified gaps and vulnerable population groups, the study findings should provide a road map for the prioritization of interventions and the development of culture- specific programs aiming at promoting adherence to dietary guidelines in Qatar, while serving as a model to other countries in the region

Excessive iodine status among school‐aged children in the State of Qatar: Results of the National Iodine Deficiency Disorder Survey

Abstract Background Iodine deficiency poses a significant public health challenge worldwide, particularly in preschool children and pregnant women. Assessing the iodine intake at a population level is essential, as both deficient and excessive iodine status can have adverse health consequences. The main objective of this survey is to understand the iodine deficiency status in schoolchildren aged 6–12 years in the State of Qatar. Methods A cross‐sectional survey was conducted from March to June 2014 among school‐aged children using a two‐stage cluster sampling technique. Anthropometric, biochemical, clinical, and dietary parameters for seafood were collected. Spot urine samples were collected from 967 participants, and a repeat random subsample urine was collected from 288 participants. Overall median urinary iodine concentration (UIC) was calculated. Iodine content in household salt samples was estimated by qualitative and quantitative methods. Mann–Whitney U test was used for comparison. Results The median UIC was 333.2 μg/L (IQR = 228.6). UIC prevalence rates between 300–999 and >1000 μg/L were 56.7% and 2.8%, respectively. The goiter prevalence was 0.4%. A significant difference was noted in overall median UIC levels between boys and girls (p = 0.003). Adequate iodized salt consumption was reported by 74.9% of households, and weekly seafood consumption was reported by one third of the respondents. Conclusion The results indicate an excess intake of iodine among the studied population in the State of Qatar, and national efforts are needed to bring iodine intake and concentration levels within the cutoff value for the concerned survey population's age group. In addition, a surveillance system needs to be set up for continuous monitoring of iodine content and salt intake at the population level in the State of Qatar