Overweight and Obesity in the Eastern Mediterranean Region
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RESULTS: The prevalence of abdominal obesity, hypertriglyceridemia, high total cholesterol, high blood pressure and high fasting plasma glucose was, respec vely, 9%, 23%, 24%, 45% and 15% in men and 33%, 19%, 29%, 44% and 15% in women. The prevalence of the cluster was more frequent in women than in men (18% versus 13%, P<0.001) and in those living in urban communi es (21% in women, 16% in men) rather than rural communi es (11% in women, 8% in men) (P<0.001). The prevalence also increased significantly with age (P<0.001). CONCLUSION: The cluster of metabolic abnormalities and its components are common in the Tunisian adult population and prevalence increases significantly with female sex, urban residency and age.
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Diabet Med. 2006 Apr;23(4):441-4. The Metabolic Syndrome in an Arab Population: A First Look at the New International Diabetes Federation Criteria. Harzallah F, Alberti H, Ben Khalifa F. Endocrinology-Diabetology Department, La Rabta Hospital, Tunis, Tunisia and School of Clinical Medical Sciences, University of Newcastle, Newcastle upon Tyne, UK.
and women using the new International Diabetes Federation (IDF) criteria, and to compare this with the prevalence using the 1999 World Health Organiza on (WHO) and 2001 Na onal Cholesterol Educa on Program Adult Treatment Panel III (NECP ATPIII) definitions.
aged > or = 40 years living in Tunis, Tunisia, taken from an initially randomized, population sample.
was found to be 45.5%; 55.8% in women and 30.0% in men (P < 0.001), higher than the rates of 28.7% (WHO) and 24.3% (NECP ATPIII) using the previous definitions. Using all the definitions, the prevalence was higher in women than in men predominantly because of significant differences in central obesity and high-density lipoprotein (HDL) cholesterol and, to a lesser extent, hypertension.
with the 1999 WHO criteria and the 2001 NCEP ATPIII defini ons is striking and has huge implications for public health worldwide. The major reason for the higher rate using the new definition seems to be the predominant focus placed on central obesity. Using tighter criteria for fasting glycaemia has also played a factor. The question remains as yet unanswered as to whether the new IDF criteria are better at predicting hard outcomes such as diabetes mellitus and cardiovascular diseases.
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East Mediterr Health J. 2006;12 Suppl 2:S168-77. [Distribution of Anthropometrical Parameters in Infants in the Monastir Region, Tunisia]. [Article in French] Ben Salem K, Mandhouj O, Letaief M, Mtar A, Soltani M. Department de Medecine communautaire, Faculte de medecine de Monastir , Monastir , Tunisie. kamel.bensalem@fmm.rnu.tn Abstract We evaluated the distribution of anthropometrical parameters in infants in Monastir and compared them with the National Center of Health Statistics reference. Our prospec ve study included 3033 infants a ending primary health care centres for vaccina ons who were followed for 18 months. In each visit, we measured weight-for-age, height-for-age and weight-for- height. We found a difference between our distribution curve and the NCHS reference. The prevalence of growth retardation increased with age. The prevalence of under-weight and of was ng were less than 10%. Obesity was seen 6.2% of infants aged 3 months and 11.6% aged 9 months.
Diabetes Metab. 2005 Apr;31(2):119-23. The Peroxisome Proliferator Ac vated Receptorgamma2 (Ppargamma2) Pro12Ala Variant: Lack of Associa on with Type 2 Diabetes in Obese and Non Obese Tunisian Patients. Zouari Bouassida K, Chouchane L, Jellouli K, Chérif S, Haddad S, Gabbouj S, Danguir J. Service of Experimental Nutrition, Institute of Nutrition, Tunis, Tunisia. Abstract OBJECTIVES: Peroxisome proliferator ac vated receptorgamma2 (PPARgamma2) is a nuclear receptor that regulates adipocyte differentiation, lipid metabolism and probably insulin sensitivity. There have been several reports on the rela onship between the PPARgamma2 Pro12Ala genotype and the development of obesity or type 2 diabetes. We designed a case-controlled study to investigate the potential association of 659
the gene c varia on of the PPARgamma2 gene with type 2 diabetes in Tunisians. METHODS: We used the polymerase chain reaction and restriction enzyme diges on to characterize the varia on of the Pro12Ala polymorphism of the PPARgamma2 gene in 242 unrelated Tunisian pa ents with type 2 diabetes and 246 healthy control subjects. RESULTS: Analysis of the Pro12Ala polymorphism of the PPARgamma2 gene in pa ents with type 2 diabetes and in control subjects revealed no significant differences in the PPARgamma2 allele frequencies between diabetic patients and control subjects. However the PPARgamma2 Ala12 allele was found significantly associated with a high level of systolic blood pressure in diabetic patients. Stratification of diabetic patients on obese and non obese subjects showed non significant differences in the PPARgamma2 Ala12 frequency between the two groups. CONCLUSION: These results suggest that the PPARgamma2 gene is unlikely a major gene for type 2 diabetes mellitus or obesity in Tunisian subjects.
Diabetes Metab. 2004 Apr;30(2):175-80. Polymorphism of Stress Protein HSP70-2 Gene in Tunisians: Suscep bility Implica ons in Type 2 Diabetes and Obesity. Zouari Bouassida K, Chouchane L, Jellouli K, Chérif S, Haddad S, Gabbouj S, Danguir J. Service de Nutrition expérimentale, Institut de Nutrition, Tunis, Tunisie. Abstract OBJECTIVES: Tumor necrosis factor alpha (TNFalpha) is expressed primarily in adipocytes and elevated levels of this cytokine have been linked to obesity and insulin resistance. Several studies have shown statistical evidence of linkage between obesity and the chromosomal region encompassing the TNFalpha gene, suggesting that TNF alpha and/or a nearby gene is involved in the pathogenesis of obesity. Recently we analyzed the -308 TNFalpha polymorphism and that of HSP70-2 gene in Tunisian patients with obesity and no significant difference in allele frequencies of the -308 TNFalpha polymorphism was found between obese pa ents and controls. In contrast, polymorphism in HSP70-2 gene was found to be highly associated with obesity. Both TNFalpha and HSP70-2
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genes have been mapped within the major histocompatibility complex (MHC). We designated a case-controlled study to investigate a potential association of genetic variation of the TNFalpha and that of the heat shock protein 70-2 (HSP70-2) with type 2 diabetes. METHODS: We used the polymerase chain reaction and restriction enzyme to characterize the variation of the TNFalpha promoter region and that of the HSP70-2 gene in 280 unrelated Tunisian pa ents with type2 diabetes and 274 healthy control subjects. RESULTS: Analysis of the -308 TNFalpha polymorphism in patients with type 2 diabetes and in control subjects revealed that the heterozygous TNF1/TNF2 genotype was significantly less frequent in the pa ent group (p=0.003), sugges ng that TNF1/TNF2 may be considered as a protec ve marker against type 2 diabetes (OR=0.58). In contrast, a significant rela ve risk of type 2 diabetes was found associated with the P2-HSP70-2 homozygous genotype in non obese diabe c subjects (OR=1.97; p=0.0012).
HSP70-2 genotype in obese Tunisians, suggest that HSP70-2 polymorphism has susceptibility implications in both obesity and diabetes.
East Mediterr Health J. 2003 Jan-Mar;9(1-2):70-7. Clustering of Cardiovascular Risk Factors among Obese Urban Schoolchildren in Sousse, Tunisia. Ghannem H, Harrabi I, Ben Abdelaziz A, Gaha R, Mrizak N. Department of Epidemiology, Farhat Hached University Hospital, Sousse, Tunisia. Abstract Against a background of increasing obesity among Tunisians, we conducted a transversal survey of 1569 children aged 13-19 years selected by multistage cluster sampling to evaluate the prevalence of obesity and clustering of cardiovascular risk factors among obese schoolchildren in the urban area of Sousse. Obese children were found to have higher blood pressure, higher triglyceride levels and lower high-density lipoprotein cholesterol levels than children of normal weight. In both genders, the mean height and weight across all age groups was significantly higher in urban than in rural children. Our study indicates that obesity and the adverse effects of being over the ideal body weight are no longer limited to industrialized countries. 661
Tunis Med. 2002 Sep;80(9):542-7. Obesity and Life Style in a Population of Male School Children Aged 6 to 10 Years in Ariana (Tunisia). [Article in French] Ben Slama F, Achour A, Belhadj O, Hsairi M, Oueslati M, Achour N. Institut National de la Santé Publique, Faculté des Sciences de Tunis. Abstract The increase of the prevalence of the obesity in childhood puts in reason some factors of the environment and the way of life of the child that encourage the hold of weight at these topics of as much more that if they are exposed gene cally. A prospec ve survey has been done close to 3148 school boy aged of 6 to 10 years and who were schooled in the gouvernorat of Ariana showed that the prevalence of the obesity is around 3.7%. A survey case/witness has been achieved in a second time on the way of life of the group of the obese matched to a group of children no obese. An intended questionnaire to parents of children of these 2 groups permi ed to collect some informations concerning the weight and the present size of parents, habits of life of their children. The weight to the birth has been searched for in the school medical file or from the notebook of health of the child. The obesity of parents is one factor of risk of the child obesity. The short length of sleep (< 8 hours), the erosion between meals especially in the evening after the dinner, the daily consumption of sugary foods and sparkling drinks is the important risk factors exposing to the infantile obesity this group of age. These behaviours can be corrected by a strategy of prevention and nutritional education.
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Arch Pediatr. 2002 Jun;9(6):566-71. Study of Overweight and Obesity in a Population of Urban School Children in Sousse, Tunisia. [Article in French] Gaha R, Ghannem H, Harrabi I, Ben Abdelazi A, Lazreg F, Fredj AH. Service d'épidémiologie, CHU Farhat-Hached, 4000 Sousse, Tunisie. Abstract AIM: The aim of this study was to assess the prevalence of obesity and overweight and their relationship with cardiovascular disease risk factors. METHODS: Epidemiological survey based on a representative sample of 1569 urban school children of Sousse, Tunisia. RESULTS: Overweight (BMI > or = 25) was significantly higher in girls (16.1%) than in boys (11.6%); (chi 2 = 8.2; p = 0.004). Obesity (BMI > or = 30) was slightly higher in girls (3.7%) than in boys (2.7%); (chi 2 = 0.89; p = 0.34). Girls had significantly higher BMI, diastolic blood pressure, cholesterol and HDL cholesterol levels than boys who had however significantly higher levels of systolic blood pressure. Overweight was significantly higher in children who did not prac ce sport at school: 22 versus 13.1% (p < 0.002), in groups of youngsters who were not affiliated to school sport or city associations. Overweight children had a significantly higher levels of cholesterol, HDL cholesterol and means of systolic and diastolic blood pressures.
health promotion at schools.
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Arch Pediatr. 2002 Jun;9(6):566-71. [Study of Overweight and Obesity in a Population of Urban School Children in Sousse, Tunisia]. [Article in French] Gaha R , Ghannem H, Harrabi I, Ben Abdelazi A, Lazreg F, Fredj AH. Service d'épidémiologie, CHU Farhat-Hached, 4000 Sousse, Tunisie. Abstract AIM: The aim of this study was to assess the prevalence of obesity and overweight and their relationship with cardiovascular disease risk factors. METHODS: Epidemiological survey based on a representative sample of 1569 urban school children of Sousse, Tunisia. RESULTS: Overweight (BMI≥25) was significantly higher in girls (16.1%) than in boys (11.6%); (χ 2 =8.2; p=0.004). Obesity (BMI≥30) was slightly higher in girls (3.7%) than in boys (2.7%); (χ 2 =0.89; p=0.34). Girls had significantly higher BMI, diastolic blood pressure, cholesterol and HDL cholesterol levels than boys who had however significantly higher levels of systolic blood pressure. Overweight was significantly higher in children who did not prac ce sport at school: 22 versus 13.1% (p<0.002), in groups of youngsters who were not affiliated to school sport or city associations. Overweight children had a significantly higher levels of cholesterol, HDL cholesterol and means of systolic and diastolic blood pressures.
health promotion at schools. 664
Int J Obes Relat Metab Disord. 2001 Apr;25(4):462-6. Gene c Varia on in the Stress Protein Hsp70-2 Gene Is Highly Associated with Obesity. Chouchane L, Danguir J, Beji C, Bouassida K, Camoin L, Sfar H, Gabbouj S, Strosberg AD. Laboratoire d'Immuno-Oncologie Moléculaire, Faculté de Médecine de Monastir, Monastir, Tunisia. lotfi.chouchane@planet.tn
increased in adipose tissue of both rodent models of obesity and obese humans. It has therefore been considered as a candidate gene for obesity. Several studies have indeed shown statistical evidence of linkage between obesity and the chromosomal region encompassing the TNF-alpha gene, suggesting that TNF-alpha and/or a nearby gene (eg hsp70 gene) is involved in the onset and progression of weight gain. We designed a case-controlled study to investigate the potential association of polymorphism of the TNF- alpha and that of a stress protein (hsp70-2) with obesity.
digestion to characterize the variation of the TNF-alpha promoter region and that of the hsp70-2 gene in 343 unrelated Tunisian pa ents with obesity and 174 healthy control subjects. RESULTS: Analysis of the -308 TNF-alpha polymorphism in patients with obesity and in control subjects did not reveal an association between TNF- alpha alleles and obesity. In contrast, polymorphism analysis of the hsp70-2 gene in patients with obesity demonstrated highly significant differences in genotypic distribution of this bi-allelic locus compared to the control subject group. Homozygosity for one hsp70-2 allele was highly associated with obesity (r2=7.12; P<10(-6)).
gene may have an increased risk of obesity.
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UNITED ARAB EMIRATES Eur J Clin Nutr. 2011 Jul 20. doi: 10.1038/ejcn.2011.135. [Epub ahead of print]
Ng SW, Zaghloul S, Ali H, Harrison G, Yeatts K, El Sadig M, Popkin BM. Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA. Abstract Background/Objectives:The United Arab Emirates has undergone remarkable economic and social transformations over the past few decades. We present findings on the prevalence of overweight and obesity, dietary and ac vity pa erns among Emira s in 2009/10, and explore associated urbanization and wealth factors.Subjects/Methods:A cross- sec onal study was conducted in 628 randomly selected households in all seven emirates. Sociodemographics, 24-h dietary recalls, physical activity and anthropometric data were collected from adult females ( 19 years), adolescents (11-18 years) and children (6-10 years) in each family via in- person interviews using validated ques onnaires.Results:In 2009/10, 65% of adult women, 28% of male adolescents and 40% of female adolescents, 25% of male children and 41% of female children were overweight or obese. 43% of girls and 38% of boys (6-10 years) consumed more calories than their estimated energy requirements. Snacking represents a major source of Emira caloric intake (>20%) of total calories. In addi on, caloric beverages account for 8-14% of total calories. Meanwhile, physical ac vity levels are low, especially among females Emiratis and those living in urban areas.Conclusions:These trends represent the potential risk for severe cardiometabolic problems in the United Arab Emirates. The significant gender differentials among children and adolescents are driven by diet and activity differences. More attention should be paid to educate the public on nutrition (for example, limit the consumption of sugared sodas, fruit drinks and whole milk, promote water and low-fat/skim milk consumption instead) and encourage physical activity from a young age, especially among females. Built environments and social support for improved lifestyle choices by individuals are needed.European Journal of Clinical Nutri on advance online publica on, 20 July 2011; 666
East Mediterr Health J. 2011 May;17(5):382-6. Anthropometric Characteristics and Obesity among Adolescents in The United Arab Emirates. Zaal AA, Brebner J, Musaiger AO, Souza RD. Department of Preventive Medicine, Ministry of Health, Dubai, United Arab Emirates. Abstract Anthropometric measurements and the prevalence of overweight and obesity were studied in 661 adolescents aged 12-17 years from Dubai, United Arab Emirates. Mean values for height and weight increased steadily with age in both sexes. Mean values for waist circumference ranged from 70.8-76.6 cm in males and 64.0-68.8 cm in females. Hip circumference varied from 84.8-91.2 cm in males and 84.9-91.2 cm in females. Body mass index was generally higher in males than in females (range 21.9-23.6 kg/m2 and 19.8-24.1 kg/m2 respec vely). The overall prevalence of overweight and obesity was 19.3% and 21.6% in males and 12.3% and 19.5% in females. This study confirms the high incidence of overweight and obesity in Dubai adolescents.
Int J Food Sci Nutr. 2011 May 16. [Epub ahead of print] UAE Population Reference Standard Charts for Body Mass Index and Skinfold Thickness, at Ages 0-18 Years. Abdulrazzaq YM, Nagelkerke N, Moussa MA. Department of Paediatrics.
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