Overweight and Obesity in the Eastern Mediterranean Region
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- Abstract OBJECTIVE
- Abstract BACKGROUND
- OBJECTIVE
- Abstract OBJECTIVES
- Knowledge, Attitude and Practice Regarding Obesity among Patients, at Aga Khan University Hospital, Karachi.
- Ethnic Differences and Determinants of Diabetes and Central Obesity among South Asians of Pakistan.
- Abstract AIMS
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PARTICIPANTS: Of the original sample of 644 children aged 7-11, 511
children were tracked and measurements were obtained from 434 children three years after baseline.
with four sessions of focused education promoting a healthy diet and discouraging the consumption of carbonated drinks.
and waist circumference. Body mass index (BMI) converted to z scores (SD scores) and to centile values with growth reference curves. Waist circumference was also converted to z scores (SD scores). RESULTS: At three years after baseline the age and sex specific BMI z scores (SD scores) had increased in the control group by 0.10 (SD 0.53) but decreased in the intervention group by -0.01 (SD 0.58), with a mean difference of 0.10 (95% confidence interval -0.00 to 0.21, P=0.06). The prevalence of overweight increased in both the intervention and control group at three years and the significant difference between the groups seen at 12 months was no longer evident. The BMI increased in the control group by 2.14 (SD 1.64) and the interven on group by 1.88 (SD 1.71), with mean difference of 0.26 (-0.07 to 0.58, P= 0.12). The waist circumference increased in both groups a er three years with a mean difference of 0.09 (- 0.06 to 0.26, P=0.25).
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CONCLUSIONS: These longitudinal results show that after a simple year long intervention the difference in prevalence of overweight in children seen at 12 months was not sustained at three years.
J Pak Med Assoc. 2007 May;57(5):235-9. Frequency of The Metabolic Syndrome in Adult Type 2 Diabetics Presenting to Pakistan Institute of Medical Sciences. Mohsin A, Zafar J, Nisar YB, Imran SM, Zaheer K, Khizar B, Qazi RA. Department of General Medicine, The Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad. Abstract OBJECTIVE: To determine the frequency of metabolic syndrome in both genders, in a limited adult type 2 diabe c popula on presen ng to Pakistan Institute of Medical Sciences, Islamabad.
teaching hospital. During the six months of study period, 106 adult type 2 diabetics were examined and evaluated for the presence of metabolic syndrome according to the ATP-III criteria. Asian standards for the waist circumference were used.
whom 95% were females. Abdominal obesity was present in 91% females and 86% males. Low HDL levels were present in all females and 83% males. Seventy eight percent females and 63% males had elevated levels of triglycerides. Hypertension was present in 68% and 73% females and males respectively. CONCLUSION: This study showed a very high prevalence of the metabolic syndrome in type2 diabe c popula on. Females were more affected than males in all respects.
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Crit Rev Food Sci Nutr. 2007;47(4):389-96. Guar Gum: A Miracle Therapy for Hypercholesterolemia, Hyperglycemia and Obesity. Butt MS, Shahzadi N, Sharif MK, Nasir M. Institute of Food Science and Technology, University of Agriculture, Faisalabad 38040, Pakistan. Abstract The number of hypercholesterolemic and hyperglycemic people is increasing rapidly in the world. The prevention against these health problems is related to a complex management of conventional and non- conventional risk factors. The inclusion of dietary fiber in the diet is the right approach to reduce these risks. Cholesterol and glucose lowering effects are most often associated with gelling, mucilaginous, and viscous fibers such as guar gum, an edible thickening agent. It has widespread applications in the food industry due to its ability to hydrate without heating. The demand for guar gum is still growing rapidly because in addition to its indispensable role in lowering serum cholesterol and glucose levels, it is also considered helpful in weight loss programs. The main thrust of therapeutic and medicinal properties lies in the soluble dietary fiber content of guar gum to improve the serum biochemical profile of human and non-human primates, reducing total serum cholesterol, triglycerides, increasing the high density lipoprotein cholesterol level, and the management of glycemic indices and obesity. Among the various intervention strategies, diet diversification is the right approach to overcome these problems. Composite flours containing wheat and legumes have proven practical uses and are being utilized in many parts of the world to improve the nutritional and functional properties of flour. The main focus of this manuscript is to review the available information on various aspects of guar gum with special reference to its effectiveness in reducing the cardiovascular disease risk, diabetes and weight loss programs.
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CMAJ. 2006 Oct 24;175(9):1071-7. Prevalence of Overweight and Obesity and Their Association with Hypertension and Diabetes Mellitus in an Indo-Asian Population. Jafar TH, Chaturvedi N, Pappas G. Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. tazeen.jafar@aku.edu Abstract BACKGROUND: The associations of body mass index (BMI) and chronic disease may differ between Indo-Asian and Western populations. We used Indo-Asian-specific definitions of overweight and obesity to determine the prevalence of these problems in Pakistan and studied the sensitivity and specificity of BMI cutoff values for an association with hypertension and diabetes mellitus. METHODS: We analyzed data for 8972 people aged 15 years or more from the Na onal Health Survey of Pakistan (1990-1994). People considered overweight or obese were those with a BMI of 23 kg/m2 or greater, and those considered obese as having a BMI of 27 kg/m2 or greater. We built multivariable models and performed logistic regression analysis.
general Pakistani population, was 25.0% (95% confidence interval [CI] 21.8%-28.2%). The prevalence of obesity was 10.3% (95% CI 7.0%-13.2%). The factors independently and significantly associated with overweight and obesity included greater age, being female, urban residence, being literate, and having a high (v. low) economic status and a high (v. low) intake of meat. With receiver operating characteristic curves, we found that the use of even lower BMI cutoff values (21.2 and 22.1 kg/m2 for men and 21.2 and 22.9 kg/m2 for women) than those recommended for an Indo-Asian population yielded the optimal areas under the curve for an association with hypertension and diabetes, respectively.
classified as overweight or obese with the use of Indo-Asian-specific BMI cutoff values. Optimal identification of those at risk of hypertension and diabetes and healthy targets may require the use of even lower BMI cutoff values than those already proposed for an Indo-Asian population.
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J Pak Med Assoc. 2006 Sep;56(9):391-4. Comparison of Adiponectin, Leptin and Blood Lipid Levels in Normal and Obese Postmenopausal Women. Jaleel F, Jaleel A, Rahman MA, Alam E. Department of Biochemistry, Ziauddin Medical University, Karachi.
normal and obese postmenopausal women and to compare them. METHODS: Eighty postmenopausal women were selected which included 40 normal controls and 40 obese women matched for age and height. Adiponectin and leptin levels were determined by ELISA. Triglycerides, cholesterol, LDL cholesterol and HDL cholesterol were determined by standard kit methods using Clinicon 4010.
significantly (P < 0.001) in obese women compared to controls. Similarly triglycerides, cholesterol and LDL cholesterol were increased significantly (P
HDL cholesterol was observed in both groups. Significant correlation of leptin with lipid profile was observed when both groups were combined.
increased significantly in obese women compared to controls. Significant correlation exists between leptin and lipid profile in combined group.
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J Pak Med Assoc. 2006 Jun;56(6):264-7. Anthropometric Indices of Middle Socio-Economic Class School Children in Karachi Compared with NCHS Standards-A Pilot Study. Aziz S, Puri DA, Hossain KZ, Hussain F, Naqvi SA, Rizvi SA. Department of Paediatrics, Sindh Institute of Urology, Civil Hospital, Karachi. Abstract OBJECTIVE: To measure height and weight of school going children (2-18 years of age) in Karachi. By means of these parameters we were able to document where the Pakistani paediatric population plot on NCHS growth centile charts. METHODS: A population based cross-sectional study (in government and private schools, Karachi), in which height and weight were taken using standardized techniques. Two thousand two hundred forty five healthy school-going children 2 to 16 years of age (calculated from date of birth); sex, height and weight were documented. After the survey was completed, height and weight of the children were plotted on NCHS centiles curves. RESULTS: P5, P25 and P50 cen les for height and weight of the Pakistani girls and boys was much below that of NCHS. However, P95 for boys and girls weight and height did not differ markedly in the Pakistani and NCHS centiles. CONCLUSION: Height and weight of these children is below the NCHS cen le for height and weight. Children plo ng near the P95 NCHS, indicates that obesity may be a serious concern in our population. However, further studies are required for support. This pilot study indicates the need for development of centile charts for Pakistani paediatric population.
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J Pak Med Assoc. 2006 Jun;56(6):267-72. High Rates of Obesity and Cardiovascular Disease Risk Factors in Lower Middle Class Community in Pakistan: The Metroville Health Study. Dennis B, Aziz K, She L, Faruqui AM, Davis CE, Manolio TA, Burke GL, Aziz S. Department of Biostatistics, University of North Carolina, Chapel Hill, USA.
index, waist circumference and waist/ hip ratio, correlate obesity measures to coronary heart disease risk factors in comparison to Pakistan National Survey (PNS). METHODS: The Metroville Health Study (MHS) was an urban risk factor reduction intervention study in Metroville Karachi. Base line data was used which was not a random sample. Demographic data including serum cholesterol, glucose, haemoglobin, and blood pressure were collected. RESULTS: In MHS high cholesterol was 16% and 24% in men and women respectively, and 25% had hypertension. Self-reported diabetes was 8%, over-weight/obesity 34% and 49% for men and women, compared to 16% and 25% for PNS, while high risk waist-hip ra o (WHR) was present in 41% and 72% of men and women respec vely. Under-weight in Metroville men was 12% and 9% in women, compared to 26% and 27% in PNS. The anthropometry variables were significantly correlated with each other while weight was significantly correlated with TC and waist circumference (WC). CONCLUSION: Obesity was alarmingly prevalent in urban Metroville in comparison to PNS. Cardio Vascular Disease (CVD) risk factors were prevalent in Metroville and TC and WC were significantly correlated with obesity measures. For prevention of increasing CVD in urban communities, targeted programs of intervention are required.
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J Pak Med Assoc. 2006 Feb;56(2):50-3. Obesity Related Complica ons in 100 Obese Subjects and Their Age Matched Controls. Khurram M, Paracha SJ, Khar HT, Hasan Z. Department of Medicine, DHQ Hospital, Rawalpindi Medical College, Rawalpindi.
50-59 years. METHODS: A case control study was conducted at Medical Unit of District Headquarters Hospital, Rawalpindi for 6 months. Hundred obese subjects in the age range 50-59 years and their age matched non-obese 100 controls were included consecutively from general population. Obese subjects had body mass index (BMI) >30Kg/m2. Controls had BMI of 18.5-22.9Kg/m2 and normal waist hip ratio. Obesity related complications i.e., hypertension, diabetes mellitus, ischemic heart disease, stroke, hyperlipidemia, gall stones, varicose veins, psychological problems, sleep related problems, and degenerative arthritis, were sought in all subjects. Waist hip ratio was noted as measure of central distribution of body fat in obese subjects. RESULTS: Of the 200 subjects, 59% (n=118) were female and 41% (n=82) male. Of the obese subjects 74% and 44% of non-obese controls were female. Mean age of obese subjects and their controls was 54.4 +/- 3.22 and 54.57 +/- 3.54 years respectively. Central obesity was noted in 84% of obese subjects. Hyperlipidemia (87%), hypertension (71%), diabetes mellitus (65%), gallstones (57%), ischaemic heart disease (49%), osteoarthri s (46%), and sleep disorders (35%) were significant (p<0.05) obesity related complications. CONCLUSION: Hyperlipidemia, hypertension, diabetes mellitus, gallstones, ischaemic heart disease, osteoarthritis and sleep disorders are common obesity related complica ons in subjects of age range 50-59 years.
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Pak J Pharm Sci. 2006 Jan;19(1):62-5.
Oxidative Stress. Khan NI, Naz L, Yasmeen G. Department of Physiology, University of Karachi, Karachi-75270, Pakistan. nazish_iqbal_khan@yahoo.com Abstract The role of obesity in diabetes mellitus, hyperlipidemia, colon cancer, sudden death and other cardiovascular diseases has confirmed in many recent research studies. In present study, it is hypothesized that obesity can serve as an independent risk factor for the decreased activities of cytoprotective antioxidants in humans and for the associated systemic oxida ve stress. 150 age matched, female subjects with no history of smoking or biochemical evidence of diabetes mellitus, hypertension, hyperlipidemia, renal or liver disease or cancer were included in the study and were divided into different grades of obesity according to their body mass index (BMI). Hemoglobin and erythrocyte glutathione (GSH) concentrations were measured for each subject. The study suggests that increase BMI was found to be associated with a significant decrease in erythrocyte glutathione concentration. From these observations it is concluded that obesity even in the absence of smoking, diabetes mellitus, hyperlipidemia, renal or liver diseases can decrease the activities of body's protective antioxidants, and can enhance the systemic oxidative stress and should therefore receive the same attention as obesity with complications.
J Ayub Med Coll Abbottabad. 2004 Jul-Sep;16(3):32-4. Knowledge, Attitude and Practice Regarding Obesity among Patients, at Aga Khan University Hospital, Karachi. Qidwai W, Azam SI. Family Medicine Department, Aga khan University Hospital, Karachi, Pakistan. waris@akunet.org Abstract BACKGROUND: Obesity is a major public health problem and responsible for significant morbidity and mortality among our patients. It is important to study the knowledge, attitude and practices with regard to obesity among patients, in order to devise interventional strategies. 455
METHODS: Patients visiting the out-patient clinics of Aga Khan University Hospital, Karachi, were included in the study. The interview was questionnaire-based and recorded the demographic profile of the patients and questions relevant to the objective of the study. The ethical requirements for the study were met. SPSS computer software was used for data management. A hundred patients were surveyed. RESULTS: Women (55%) were more than men (45%), under 39 years (73%), married (55%), with graduate or more educa on (65%), in private service (44%) and housewives (19%). A substan al number of respondents (75%) understood the meaning of obesity and considered it a major health problem (90%). More respondents felt the need to reduce weight (52%), despite the fact that lesser number considered themselves to be overweight or obese (34%). A majority of the respondents did exercise (59%) but a minority did it more than five mes a week (17%) and more than 30 minutes on each occasion (31%). A substan al propor on of the respondents stated their preference for oily food (34%), sweets (34%), fried food (40%), red meat (21%), fast food (37%), bu er, cheese and cream (31%).
CONCLUSIONS: We have found a significant level of understanding about obesity among our patients. Physical exercise and dietary measures to control body weight are lacking despite the desire to have appropriate body weight. There is a need and we strongly recommend patient education programs to control obesity.
Diabet Med. 2004 Jul;21(7):716-23. Ethnic Differences and Determinants of Diabetes and Central Obesity among South Asians of Pakistan. Jafar TH, Levey AS, White FM, Gul A, Jessani S, Khan AQ, Jafary FH, Schmid CH, Chaturvedi N. Clinical Epidemiology Unit, Department of Community Health Sciences, The Aga Khan University, PO Box 3500,
Stadium Road, Karachi, Pakistan. tazeen.jafar@aku.edu Abstract AIMS: To study the within ethnic subgroup variations in diabetes and central obesity among South Asians. METHODS: Data from 9442 individuals age > or = 15 years from the Na onal Health Survey of Pakistan (NHSP) (1990-1994) were analysed. 456
Diabetes was defined as non-fas ng blood glucose > or =7.8 mmol/l, or known history of diabetes. Central obesity was measured at the waist circumference. Distinct ethnic subgroups Muhajir, Punjabi, Sindhi, Pashtun, and Baluchi were defined by mother tongue. RESULTS: The age-standardized prevalence of diabetes varied among ethnic subgroups (P = 0.002), being highest among the Muhajirs (men 5.7%, women 7.9%), then Punjabis (men 4.6%, women 7.2%), Sindhis (men 5.1%, women 4.8%), Pashtuns (men 3.0%, women 3.8%), and lowest among the Baluchis (men 2.9%, women 2.6%). While diabetes was more prevalent in urban vs. rural dwellers [odds ra o (OR) 1.50, 95% confidence interval (CI) 1.24, 1.82], this difference was no longer significant a er adjus ng for central obesity (OR 1.15, 95% CI 0.95, 1.42). However, the ethnic differences persisted after adjusting for major sociodemographic risk factors (unadjusted OR for Pashtun vs. Punjabi 0.59, 95% CI 0.42, 0.84, adjusted OR 0.54, 95% CI 0.37, 0.78). Ethnic varia on was also observed in central obesity, which varied with gender, and did not necessarily track with ethnic differences in diabetes.
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