Overweight and Obesity in the Eastern Mediterranean Region
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Public Health Nutr. 2008 Dec;11(12):1306-17. Epub 2008 Jun 19. Nutritional Status of Tunisian Adolescents: Associated Gender, Environmental and Socio-Economic Factors. Aounallah-Skhiri H, Romdhane HB, Traissac P, Eymard-Duvernay S, Delpeuch F, Achour N, Maire B. Ins tut Na onal de la Santé Publique (INSP), 5-7 rue Khartoum, Tunis, Tunisia.
associated factors. DESIGN: A cross-sectional study based on a national stratified random cluster sample. SUBJECTS AND METHODS: In all, 1,295 boys and 1,577 girls aged 15-19 years, of whom 28.4 % had already le school. Socio-economic characteristics of the parents, anthropometric measurements, food behaviours and physical activity of the adolescents were recorded during home visits.
(WHO/National Center for Health Statistics reference) were, respectively, 8.1 %, 17.4 % and 4.1 % among boys and 1.3 %, 20.7 % and 4.4 % among girls; abdominal obesity was highly prevalent among both sexes. Prevalence of overweight differed by region (from 11.5 % to 22.2 %) and was higher in urban v. rural areas for males (21.7 % v. 10.4 %) but not for females (21.7 % v. 19.2 %). These differences were par ally mediated by socio-economic and lifestyle factors for males. For females, influence of cultural factors is hypothesised. In rural areas, overweight was more prevalent among boys of higher economic level households, having a working mother or a sedentary lifestyle; for girls, prevalence increased with the level of education of the mother. In urban areas, prevalence of overweight was related to eating habits: it was higher for boys with irregular snacking habits and for girls skipping daily meals. Urban girls having left school were also more overweight.
become a true public health problem in Tunisia with the combined effects of cultural tradition for girls in rural areas, and of rapid economic development for boys and girls in cities.
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Diabetes Metab. 2008 Dec;34(6 Pt 1):595-600. Epub 2008 Oct 18. Effects of Two-Month Physical-Endurance and Diet- Restriction Programmes on Lipid Profiles and Insulin Resistance in Obese Adolescent Boys. Ben Ounis O, Elloumi M, Ben Chiekh I, Zbidi A, Amri M, Lac G, Tabka Z. Laboratory of Cardio-Circulatory, Respiratory, Metabolic and Hormonal Adaptations to the Muscular Exercise, Faculty of Medicine Ibn El Jazzar, 4002 Sousse, Tunisia. omar_oda@yahoo.fr
programme of physical endurance and dietary restriction, alone and combined, on plasma lipids and insulin resistance in obese adolescents.
of either dietary restriction (R), physical endurance at the point of maximum lipid oxidation (LIPOX(max)) (E) or diet combined with training (R+E). Anthropometric characteristics, metabolic measures and biochemical analyses were performed in all subjects before and after the interventions. An estimated insulin resistance was calculated using the homoeostasis model assessment (HOMA-IR) index.
group showed greater reductions in body mass index (-3.9+/-0.7 kg/m(2)) and waist circumference (-12.3+/-4.8 cm) (P<0.001) than either the R or E group. A significant decrease (P<0.01) in HOMA-IR index (-2.13+/-0.11), plasma triglycerides, LDL and total cholesterol was also seen in the R+E group. Moreover, at the end of the programme, the ratio of HDL cholesterol to triglycerides was significantly increased from baseline in the R+E group (0.93+/-0.09 vs. 0.68+/-0.11; P<0.01). CONCLUSION: Compared with either moderate physical endurance or dietary restriction, a combination of both resulted in a significant decrease in cardiovascular risk factors and HOMA-IR index in obese adolescent boys.
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Ann Readapt Med Phys. 2008 Nov;51(8):663-70. Epub 2008 Sep 25. [Contribution of Exercise and Diet in the Management of Knee Osteoarthritis in the Obese]. [Article in French] Ghroubi S, Elleuch H, Kaffel N, Echikh T, Abid M, Elleuch MH. Service de médecine physique rééducation réadaptation fonctionnelle, CHU Habib-Bourguiba, Unité de recherche 04/UR/08-07, université du Sud, 3000 Sfax, Tunisia. Abstract OBJECTIVE: Our objective was to determine whether exercise and weight loss are more effective either separately or in combination, in improving pain and physical function in obese adults with moderate knee osteoarthritis (OA). PATIENTS AND METHODS: Forty-five obese adults, with a body mass index greater than 35 kg/m2 or 30 cardiovascular risk factor, suffering from knee pain with evident
radiographic signs of knee OA, were involved in our study. All patients were evaluated at baseline and at the end of the study. The assessment
parameters were weight loss, the bioelectric impedance analysis, pain, six- minute walk distance, cardiovascular parameters, and muscular strength.
The physical function was measured with the Womac and the Lequesne indexes. Pa ents were randomized into four groups, a control group (G1),
exercise only group (G2), diet plus exercise group (G3) and diet only group (G4).
Significant improvement of function (Womac) was noticed in groups performing exercise only (G2) (26%), diet plus exercise (G3) (37.89%) and
diet only (G4) (18.34%). We also no ced an improvement in pain in G2 (p=0.04), G3 (p<0.001) and G4 (p=0.02). The improvement of quadriceps
strength was noted only in G2 (p=0.01) et G3 (p=0.001) without any change in control group and diet only group (G4). The improvement of
cardiovascular parameters was observed only in G2 and G3. Weight loss, decreased BMI and waist circumference was more important in diet plus
exercise group (G3).
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CONCLUSION: The combination of weight loss and exercise provide better improvements in physical function and pain in obese adults with knee OA compared with either intervention alone. Exercise used alone or associated to dietary provides better improvements in physical capacity and muscle strength.
Tunis Med. 2008 Oct;86(10):906-11. Tunisian Children Reference for Body Mass Index and Prevalence of Obesity. Ben Amara H, Jelidi J, Bouguerra R, Ben Rayana C, El Atti J, Achour A, Zouari B, Gaigi S. National Institut of Nutrition, Tunis, Tunisia. Abstract BACKGROUND: The prevalence of obesity in children is known to be increasing rapidly worldwide but few population-based surveys have been undertaken in North Africa and in the Middle East.
the different percentiles in boys and girls by age from a large nationally representative sample of the Tunisian children population. The second aim was to estimate the prevalence of obesity and over weight in children and adolescent using the 85th and 95th body mass index percen le respec vely derived from the U.S.A. first National Health and Nutrition Survey and also the International cut off points for body mass index for overweight and obesity proposed by the International Obesity Task Force and Rolland Cachera.
Nutrition Survey, a cross sectional health study providing a large nationally representa ve sample of the Tunisian popula on including 3885 children and adolescent. RESULTS: The mean of BMI was of 16,63 +/- 2,58 Kg/m2 among boys and 17.36 +/- 3.52 Kg/m in girls. The BMI increased with age and more precociously in girls (10 years) that in boys (13-14 years). The mean+2SD of the BMI approached the 95th percen le. It is no ced that our 85th percen le and 95th percen le as well in the girls and in boys were lower than the same percentiles of the children of other countries (NHANES I, IOTF) and that our 97th percen le is higher than that of the French according to tables of Roland Cachera. By conside ring the NHANES I and 651
the IOTF, the prevalence of obesity were rather weak (<5%) but high according to the tables of Roland Cachera (3 to 11%). CONCLUSION: The prevalence of obesity was low in 1996 according to references' of the NHANES I and IOTF but high according to tables' of Roland Cachera. Prevention of obesity by a healthy way of life remains the most effective means in the long and undoubtedly less expensive realizing programs of regular monitoring.
Blood Press. 2008;17(5-6):278-83. The -2548G/A LEP Polymorphism Is Associated with Blood Pressure in Tunisian Obese Patients. Ben Ali S, Kallel A, Ftouhi B, Sediri Y, Feki M, Slimane H, Jemaa R, Kaabachi N. Research Laboratory LAB-SM-01, Biochemistry Department, Rabta Hospital, Tunis, Tunisia. Abstract OBJECTIVE: To examine the association of a common -2548G/A (rs7799039) promoter variant of the human leptin gene (LEP) with obesity or body mass index (BMI) and its associated phenotypes such as blood pressure variability and the prevalence of hypertension in a sample of the Tunisian population. DESIGN AND METHODS: Two hundred and twenty-nine obese patients were screened and compared with 251 normal weight subjects. The - 2548G/A LEP polymorphism was analysed by PCR-RFLP procedure.
polymorphism and obesity or BMI. However, in obese patients subjects with AA genotype had significantly higher systolic (p = 0.003) and diastolic (p = 0.002) blood pressure compared with those with GA or GG genotypes. Stratified analysis by gender revealed that male patients but not female homozygous for -2548A allele exhibited significantly increased systolic (p = 0.01) and diastolic (p<0.001) blood pressure than did carriers of -2548G allele. Multiple linear regression analysis revealed that AA genotype significantly affect systolic and diastolic blood pressure in obese men. Additionally, significant association between AA genotype and higher prevalence of hypertension was found in male pa ents (p = 0.03).
polymorphism is associated with blood pressure in obese male patients. 652
Tunis Med. 2008 Jul;86(7):649-52. Prevalence of Obesity and Overweight in Tunisia on 2001. Kamoun M, Hajem S, Imen S, Achour N, Slimane H. Diabetology-Endocrinology Department, La Rabta Hospital, Tunis, Tunisia.
the last decades. AIM: Evaluation of the prevalence of obesity and overweight in Tunisia. METHODS: Prospective epidemiological survey concerning a representative sample of Tunisian Popula on realised on 2001 by the Tunisian Na onal Health Public Institut. Medical visit and anthropometric measurements were performed by medical investigators at subject's home. Statistical analysis using SAS program were performed. WHO body mass index criteria were used to define overweight and obesity. Population investigated included 8576 adults and adolescents 15 years or older, 4232 men and 4344 women. RESULTS: Prevalence of obesity is 12.2% (6.1% in men, 18.3% in women, p<0.001). Prevalences of obesity grade I, II, and III are respec vely 8.7%, 2.9% and 0.7%. Prevalence of overweight is 21.8% (8.9% in men, 12.8% in women, p<0.001). Prevalences of obesity and overweight are respec vely in rural districts 8.6% and 10.2%, in urban districts 14.8% and 23.6% (p<0.001). Tunisian eastern areas are more affected by obesity and overweight than western areas but there isn't a north-south gradient.
in Tunisia became quite similar to the prevalence in European countries, but concerned especially women and eastern areas, more industrialised and more urbanised than the western ones. Preventive strategies should be rapidly implemented in Tunisia to stop the growing of this health public problem.
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Blood Press. 2008;17(5-6):278-83. The -2548G/A LEP Polymorphism Is Associated with Blood Pressure in Tunisian Obese Patients. Ben Ali S, Kallel A, Ftouhi B, Sediri Y, Feki M, Slimane H, Jemaa R, Kaabachi N. Research Laboratory LAB-SM-01, Biochemistry Department, Rabta Hospital, Tunis, Tunisia. Abstract OBJECTIVE: To examine the association of a common -2548G/A (rs7799039) promoter variant of the human leptin gene (LEP) with obesity or body mass index (BMI) and its associated phenotypes such as blood pressure variability and the prevalence of hypertension in a sample of the Tunisian population. DESIGN AND METHODS: Two hundred and twenty-nine obese patients were screened and compared with 251 normal weight subjects. The - 2548G/A LEP polymorphism was analysed by PCR-RFLP procedure.
polymorphism and obesity or BMI. However, in obese patients subjects with AA genotype had significantly higher systolic (p = 0.003) and diastolic (p = 0.002) blood pressure compared with those with GA or GG genotypes. Stratified analysis by gender revealed that male patients but not female homozygous for -2548A allele exhibited significantly increased systolic (p = 0.01) and diastolic (p<0.001) blood pressure than did carriers of -2548G allele. Multiple linear regression analysis revealed that AA genotype significantly affect systolic and diastolic blood pressure in obese men. Additionally, significant association between AA genotype and higher prevalence of hypertension was found in male pa ents (p = 0.03).
polymorphism is associated with blood pressure in obese male patients.
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Diabetes Obes Metab. 2007 Nov;9(6):859-68. Waist Circumference Cut-Off Points for Identification of Abdominal Obesity among the Tunisian Adult Population. Bouguerra R, Alberti H, Smida H, Salem LB, Rayana CB, El Atti J, Achour A, Gaigi S, Slama CB, Zouari B, Alberti KG. Institut National de Nutrition, Tunis, Tunisia. Abstract AIMS: Waist circumference (WC) is a convenient measure of abdominal adipose tissue. It itself is a cardiovascular disease (CVD) and diabetes-risk factor and is strongly linked to other CVD risk factors. There are, however, ethnic differences in the relationship of WC to the other risk factors. The aim of this study was to determine the optimal cut-off points of WC and body mass index (BMI) at which cardiovascular risk factors can be identified with maximum sensitivity and specificity in a representative sample of the Tunisian adult population and to investigate any correlation between WC and BMI.
cross-sectional population-based survey, conducted in 1996 on a large na onally representa ve sample, which included 3435 adults (1244 men and 2191 women) of 20 years or older. WC, BMI, blood pressure and fas ng blood measurements (plasma glucose, total cholesterol, triglycerides) were recorded. Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut-off values of WC and BMI to identify with maximum sensitivity and specificity the detection of high blood pressure, hyperglycaemia, high blood cholesterol and hypertriglyceridaemia.
and 85 cm in women for the op mum detec on of high blood pressure, diabetes and dyslipidaemia. The optimum BMI cut-off points for predicting cardiovascular risk factors were 24 kg/m(2) in men and 27 kg/m(2) in women. The cut-off points recommended for the Caucasian population differ from those appropriate for the Tunisian population. The data show a continuous increase in odds ratios of each cardiovascular risk factor, with increasing level of WC and BMI. WC exceeding 85 cm in men and 79 cm in women correctly iden fied subjects with a BMI of >/=25 kg/m(2), sensi vity of >90% and specificity of >83%. 655
CONCLUSIONS: Based on the ROC analysis, we suggest a WC of 85 cm for both men and women as appropriate cut-off points to identify central obesity for the purposes of CVD and diabetes-risk detection among Tunisians. WCs of 85 cm in men and 79 cm in women were the most sensi ve and specific to iden fy most subjects with a BMI >/=25 kg/m(2).
Tunis Med. 2006 Nov;84(11):714-6. Frequency and Risk Factors of Obesity in Tunisian Adolescent. Blouza-Chabchoub S, Rached-Amrouche C, Jamoussi-Kammoun H, Bouchaa N. Service ORL & Chirurgie Cervico-Faciale, Tunisie. Abstract The aim of the study was to determine the prevalence and the risk factors of obesity in Tunisian adolescent. METHODS: This prospective study included 1050 adolescents (aged 13 to 17 years) from two high schools according to the socioeconomic status. The aim was to evaluate the prevalence and the main risk factors of obesity in this studied group. The weight and height of every adolescent were measured and the Body Mass Index (BMI) was calculated for each of them. Using this criteria and referring to the curves of this Index for the age established by the National Health and Nutrition Examination Survey (NHANES) we found 49 obese adolescents. We evaluated the spontaneous food intake for each of them during three days. The results showed that the frequency of obesity is 5.1% without significant difference between the two schools. The highest obesity frequency is no ced at age 13 and 14 years in the two sexes. The obesity frequency is significantly more important in males of the high socioeconomic status. Family history of obesity was no ced in 51% of obese adolescents. Most of them (96%) had abnormal alimentary behavior. 52% of them had an excess of caloric intake and 82% an excess of lipid without significant difference between the two schools.
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Diabetes Metab. 2006 Jun;32(3):215-21. Prevalence of Metabolic Abnormalities in the Tunisian Adults: A Population Based Study. Bouguerra R, Ben Salem L, Alberti H, Ben Rayana C, El Atti J, Blouza S, Gaigi S, Achour A, Ben Slama C, Zouari B. National Institut of Nutrition, Tunis, Tunisia. radhia.bouguerra@rns.tn Abstract AIMS: To estimate the prevalence of individual metabolic abnormalities and the cluster of metabolic abnormalities in a representative sample of the Tunisian adult population and to identify their relationship with gender, age and residency. The definition used is an adaptation of the NCEP ATP III defini on, using total cholesterol>or=5.2 mmol/l instead of HDL- cholesterol. MATERIALS AND METHODS: We used a sample of the Tunisian National Nutrition Survey (TNNS), a cross-sec onal health survey conducted in 1996, to es mate the nutri onal status of the popula on. The TNNS included 2 927 adults aged 20 years or older who had measurements of height, body weight, waist circumference, blood pressure, fasting plasma glucose, total cholesterol and triglycerides. The cluster of metabolic abnormalities was defined as the presence of three or more metabolic abnormalities.
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