Arab Adults Research Articles

Prevalence of Neutropenia in a Cohort of Adult Population in Qatar: Relation to Other Hematological Parameters and Anthropometric Data

Abstract: Neutropenia, defined as an absolute neutrophil count (ANC) below 1.5 × 109/L, encompasses a wide range of diagnoses, from normal variants to life-threatening acquired and congenital disorders. The prevalence of neutropenia and associated hematological parameters in Arab males and females coming for blood donation was not studied before in Qatar. Neutropenia, usually defined as an absolute neutrophil count (ANC) below 1.5 × 109/L (1500/mm3), encompasses a wide range of diagnoses, from normal variants to life-threatening acquired and congenital disorders. The functional consequences depend largely, but not exclusively, on the severity of neutropenia. ANC of 1.0-1.5 × 109/L does not impair host defence but may warrant investigation of the underlying cause. However, ANC of 0.5-1.0 × 109/L may slightly increase the risk of infections, but only if other arms of the immune system are impaired. ANC of 0.2-0.5 × 109/L is associated with an increased risk of infections in most patients. ANC of 0.2 × 109/L or less (often referred to as "agranulocytosis") carries a risk of severe, life-threatening infections with susceptibility to opportunistic organisms. Healthy Caucasian and Asian populations generally have ANCs of 1.5 to 7.0 × 109/L. Persons of African descent, however, may have lower normal neutrophil counts, with ANC <1.5 × 109/L occurring in about 4.5% of black participants in one U.S. survey. It was once thought that neutrophil levels fluctuate cyclically in the normal person, but best evidence now indicates that levels fluctuate considerably but do not normally cycle in a mathematically regular fashion. Aim and Objective: To provide baseline information regarding the prevalence and spectrum of neutropenia in random large samples (n = 600) of non-prospective Arab blood donors. Materials and Methods: Complete blood count (CBC) of all non-prospective blood donors (n =600) was performed in 600 Arab healthy Adults (Age > 18 years to < 65 years) using automated analyzer for evaluation of white and red blood cell indices. Haemoglobin concentration was determined using the Coulter LH 750, Advia 2120/120 or Sysmex XE 5000/2100 cell counter. Results: The prevalence of Neutropenia ( ANC) below 1.5 × 109/L ) in 600 non-prospective adult Arab blood donors (200 females and 400 males, age >18 y : <65 y)) was 10.7%. The prevalence in females was 32 % and in males was 6 %. ANC below 1 × 109/L was detected in 10 % of Arab females and 1.8 % of Arab males. Neutropenia was significantly higher in healthy adult Arab females compared with males. In females, the neutropenic group group had significantly lower Hb level and higher RDW, and lower total WBC and lymphocyte counts (p <0.001) compared to the group with ANC > 1.5 × 109/L. In males, the neutropenic group had significantly lower Hb level and hematocrit value, and lower total WBC, lymphocyte, and basophil counts (p <0.001) compared to the group with ANC > 1.5 × 109/L. Significant correlations were found between the ANC and Hb (r = 0.33, p < 0.05) and ANC and total WBC (r = 0.45, P < 0.01). Conclusion: The prevalence of neutropenia is considerably high in Arab adult females compared to other ethnic groups and it is significantly higher in females compared to males. Besides the genetic constitution for Arabs , the lower Hb and high RDW in females with neutropenia suggested that iron deficiency is factor in the production of this neutropenia. Key words: Prevalence, Neutropenia, Anemia, Adults, Arabs, ANC. Disclosures No relevant conflicts of interest to declare.

Hematological Indices Reference Intervals for Healthy Arab Population in Qatar: Effect of Age, Gender, Geographic Location and ABO Blood Group

Introduction: The majority of physicians' medical judgments are based on clinical information supported by laboratory reports . The availability of a reference interval for different lab values facilitates the process of interpretation . Complete blood count (CBC), testing is one of the most frequently performed hematology test in any clinical setting. Analysis of CBC by hematology analyzers is an indispensable means in the evaluation of many acute and chronic disorders including traumatic, infectious, immunological, and hematological diseases. Establishment of a normal reference interval is essential for accurate clarification of the disease diagnosis as well as for follow up. CBC techniques have improved significantly, and the accurate automated methods have now substituted manual methods. In addition, various novel blood cell parameters have been developed alongside to aid in diagnosis and management of several blood disorders . However significant differences exist in the reference intervals based on age, gender, ethnicity, genetic differences, environmental factors, and geographical location.. Dietary habits and occupational exposures are factors that have been shown to affect reference interval . Therefore, there is a requirement for each country to establish its own reference intervals. Country-specific reference intervals for CBC of adult peripheral blood have been established in many countries around the world; however, there have been no specific comprehensive studies in Arab population in Qatar based on age, gender, geographic location and ABO blood groups. To the best of our knowledge, this is the first study in Qatar that investigated CBC reference intervals in relation to age, gender, and blood grouping which can now be used as a reference when evaluating patient samples in Qatar. Methods: Venous blood specimens were collected from 720 healthy randomly selected individuals aged 18 to 69 years from 2018 to 2019 and analyzed by Sysmex NX-10 and NX -20 automated hematology analyzers. Results were statistically analyzed and compared by gender, age, and ABO blood group. Arab adults were divided into African Arabs (Egypt, Libya, Tunisia, Morocco) and Asian Arabs (Syria, Lebanon, Jordon, Palestine, Qatar). The lower and upper reference limits of the hematology reference intervals were established at the -2 SD and +2SD respectively. Results: Reference intervals were calculated for all the hematology parameters which included red blood cell, white blood cell and differential count, and platelet parameters. Arab males had significantly higher Hb, Hct, RDW, ANC, lymphocytes and monocyte counts compared to adult females. Asian-Arab males had significantly higher Hb concentration and higher WBC, lymphocytes and eosinophil counts compared to African- Arab males. Asian Arab young males had significantly higher Hb level and lymphocyte count and lower monocytes counts compared old males. African Arab young males had significantly higher lymphocyte and lower monocytes counts compared to old males. Asian- Arab young females had higher WBC, ANC counts compared to old Asian Arab females. No statistical difference in the studied hematological parameters was detected among the three groups with different ABO subgroups Conclusions: Data from this study established specific reference intervals which could be considered for general use in the Arab world. The differences in hematology reference intervals in respect to age, sex and geographical location highlights the necessity to establish reference intervals for venous blood parameters among the healthy population in each country or at least in each region. Disclosures No relevant conflicts of interest to declare.

Level of Self-efficacy, Psychological Peace, and Death Anxiety Among A Sample Of Arab adults - A Comparative Study

Level of Self-efficacy, Psychological Peace, and Death Anxiety Among A Sample Of Arab adults - A Comparative Study

Reliability and validity of Arabic version of revised general nutrition knowledge questionnaire on university students.

The current study evaluated the reliability and validity of the Arabic version of the revised general nutrition knowledge questionnaire (GNKQ-R) for adults. The eighty-eight-item English GNKQ-R was adapted into an eighty-six-item Arabic version. Four validation studies were conducted for internal (n 805) and external (n 106) reliability, construct validity between participants with (n 84) and without (n 88) nutrition background, convergent validity for associations between nutrition knowledge and demographic characteristics (n 750) and responsiveness to online nutrition information (n 55). United Arab Emirates University in United Arab Emirates and Hashemite University in Jordan. Undergraduate students aged 18 years and above, enrolled in any programme at the two universities, were recruited. Overall, internal reliability (Cronbach's α = 0·91) and external reliability (P = 0·350; intra-class correlation coefficient = 0·84) were high. Significantly higher GNKQ-R scores of students with (66·0 (10·6)) v. without (38·0 (10·7), P < 0·001; d = 2·6) nutrition background indicated high construct validity. Significantly higher GNKQ-R scores among females v. males, older and senior students v. younger and junior students and students in health discipline v. non-health discipline reflected good convergent validity. Significant differences in GNKQ-R scores with nutrition information (time 1 = 37·8 (10·5) and time 2 = 47·7 (9·1), P < 0·001; d = 1·0) indicated high responsiveness to nutrition intervention. The Arabic GNKQ-R showed high reliability and validity in the young adult Arab population. Besides the reliability of the overall questionnaire, each section demonstrated adequate reliability. Further studies are warranted to establish the generalisability and applicability of the Arabic GNKQ-R in older adults and in different middle-eastern Arab countries.

Vitamin D level and its relation to muscle and fat mass in adult male Arabs.

Low levels of vitamin D have been linked with increased adiposity and diminished muscle strength. Whether it is also related to fat deposition in muscle tissues is not studied well. This study explored the associations between circulating 25-hydroxyvitamin D (25(OH)D) and fat deposition in muscle tissues of adult Arab males. A total 465 adult Saudi males were included in this cross-sectional study. Anthropometrics, body composition and muscle strength were assessed. Serum 25(OH)D was determined and quantified enzymatically. They were grouped according to vitamin D status: deficient (25(OH)D < 50 nmol/l) N = 325 (69.9%) and sufficient (25(OH)D > 50 nmol/l)140 (30.1%). Mean level of lean/height2, lean-arm-legs and lean-arms-legs/height2 were significantly higher in 25(OH)D deficient participants (p-values 0.03; 0.05 and 0.01 respectively). Thigh strength was significantly higher in 25(OH)D sufficient participants than their deficient counterparts (p = 0.02). In all participants, a significant correlation between 25(OH)D was observed with age and thigh-strength (p-values < 0.05), while a significant inverse correlation between 25(OH)D and lean/height2, lean-arms-legs, lean-arms-legs/height2, fat (%) region, fat arms, fat legs, fat trunk, lean legs were noted. In conclusion, low circulating 25(OH)D is associated with enhanced fat infiltration in muscle tissues of adult Arab males.

Awareness and Knowledge Regarding the Consumption of Dietary Fiber and Its Relation to Self-Reported Health Status in an Adult Arab Population: A Cross-Sectional Study.

The objective of this study was to examine the awareness, knowledge, and habits regarding dietary fiber intake and to analyze its relationship with self-reported health status among Saudi adults. A survey-based study using face-to-face interview was designed, and 1363 apparently healthy adult Saudi males and females participated. Most participants were females (81.2%), aged 25 and above (87.2%), and were educated at least up to the secondary level of education (80.8%). The majority of the participants were aware of the role of fiber-rich foods in health conditions such as obesity (70.5%), cardiovascular diseases (68.9%), and regulation of blood sugar (68.9%), with females significantly having higher nutrition knowledge than males. A disconnect in translating this nutrition knowledge was observed particularly in food choices when eating out, where preferences for white bread (84.4%), fried potatoes (69.9%) and peeled fruits (60.6%) were significantly higher than preferences for cooked vegetables (29.6%) and brown bread (18.1%). The most common reason for this disconnect was due to perception that foods rich in dietary fibers were expensive (72.1%), have less health benefits (56.5%), were not readily available (51.6%), and participants’ disliking of the taste (52.8%). Participants in the highest quartile (Q4) for dietary fiber consumption reported a lower prevalence of constipation (odds ratio, 95% confidence interval of 0.40, 0.28–0.57, p < 0.01), high cholesterol (0.43, 0.27–0.68, p < 0.01) and obesity (0.67, 0.44–0.98, p = 0.03) than participants in the lowest quartile (Q1). Dietary fiber intake appears to be protective against constipation, high cholesterol and obesity in Saudi adults. However, a disparity observed between knowledge and attitude towards intake of dietary fibers could limit its health benefits. Further studies including adolescents should be conducted to impart knowledge on the emotional, cognitive and sensory factors related to food choices in order to minimize the gap between nutrition knowledge and the consumption of healthy high-fiber diets.

Predictive Equations Based on Body Composition for Resting Energy Expenditure Estimation in Adults with Obesity.

An accurate estimation of Resting Energy Expenditure (REE) in patients with obesity is crucial. Therefore, our aim was to assess the validity of REE predictive equations based on body composition variables in treatment-seeking Arab adults with obesity. Body composition and REE were measured by Tanita BC-418 bioimpedance and Vmax Encore 229 IC, respectively, and predictive equations based on fat mass and fat-free mass were used in REE estimations among 87 adults of both genders, in the Outpatient Clinic in the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). The mean differences between the measured and estimated REE values were calculated to assess the accuracy, and the Bland-Altman method was used to assess the level of agreement. Ten predictive equations were included. In males, all the predictive equations gave significantly different estimates of REE when compared to that measured by IC. On the other hand, in females, the mean difference between the REE value estimated by Huang and Horie-Waitzberg equations and that measured using IC was not significant, and the agreement was confirmed using Bland-Altman plots. Huang and Horie-Waitzberg equations are suggested for accurate REE estimation in females; however, new validated REE estimation equations for males in this population are still needed.

Association of ANGPTL8 (Betatrophin) Gene Variants with Components of Metabolic Syndrome in Arab Adults

Angiopoietin-like protein 8 (ANGPTL8) has a role in lipid metabolism, beta-cell proliferation and diabetes progression, however, the association between different variants in the ANGPTL8 gene and metabolic syndrome (MetS) components has not been studied widely especially in Arab ethnic groups. In this study, the associations of ANGPTL8 variants on MetS risk in Saudi Arab adults were investigated. A total of 905 unrelated Saudi adults (580 healthy controls and 325 MetS) were included. MetS was screened based on the International Diabetes Federation (IDF) criteria. The genotype and allele frequency distribution of rs737337 (T/C) and rs2278426 (C/T) polymorphism in ANGPTL8 gene was studied. Participants with MetS were significantly older, had higher BMI, and rs737337 polymorphism frequency was significantly lower than in control. Furthermore, the TC + CC genotype and C allele of rs737337 (T/C) was associated with decreased risk of hypercholesterolemia and hyperglycemia [odds ratio (OR) 0.61, 95%CI 0.40–0.93, p = 0.016 and OR 0.58, 0.39–0.86, p = 0.007 respectively for hypercholesterolemia; and OR 0.66, 0.45–0.97, p = 0.032 and OR 0.65, 0.46–0.93; p = 0.016 respectively for hyperglycemia]. Similarly, CT, CT + TT genotype and T allele of rs2278426 (C/T) were associated with decreased risk of hyperglycemia (p < 0.05). In conclusion, the study suggests that the gene variants in SNPs rs 737337 (T/C) and rs 2278426 (C/T) are associated with lower risk of hypercholesterolemia and hyperglycemia. These findings supplement the growing literature supporting the role of ANGPTL8 in lipid and glucose metabolism.

Reversal of Prediabetes in Saudi Adults: Results from an 18 Month Lifestyle Intervention.

Aim: This 18 month intervention study aims to determine the efficacy of a lifestyle modification program on prediabetes reversal among Saudi adults. Methods: An 18 month randomized, multicenter trial was conducted among Saudis with prediabetes aged 25–60 recruited from King Salman Hospital and primary care centers in Riyadh, Saudi Arabia. A total of 180 consenting individuals were randomized (1:1) to receive either intensive lifestyle intervention (ILIG) or guidance (control group, CG). ILIG was provided with a personalized lifestyle counseling by nutritionists every 3 months to improve diet and exercise behaviors. CG was given booklets containing information on prediabetes and its prevention. Data from lifestyle assessments and laboratory measurements were analyzed at baseline and every 6 months. The primary outcome was the reversal rate of prediabetes. Results: 158 participants were analyzed (CG:85, ILIG:73) at the 12 month follow-up and 28 participants (CG:11 and ILIG:17) completed the entire 18 month study. Post-intervention, the cumulative incidence of prediabetes reversal in the ILIG was 38 participants (52.1%) which was significantly higher than CG with 26 participants (30.6%) (p = 0.02). Conclusion: A tailored lifestyle intervention is effective in reversing prediabetes, at least for a year, among Arab adults with prediabetes. The challenge of sustaining interest in adopting lifestyle changes for a longer duration should be addressed in this population.

Gut microbiome of native Arab Kuwaitis

BackgroundThe human gut microbiome has an important role in health and disease. There is extensive geographical variation in the composition of the gut microbiome, however, little is known about the gut microbiome composition of people from the Arabian Peninsula. In this study, we describe the gut microbiome of Arab Kuwaitis. The gut microbiome of 25 native adult Arab Kuwaitis was characterised using 16S rRNA gene sequencing of the V3–V4 regions. Sequencing data were analysed using DADA2. Phylogeny analysis was performed using amplicon sequence variants (ASVs) assigned to the Bacteroides genus and 16S rRNA sequences of Bacteroides type strains to understand the relationships among Bacteroides ASVs.ResultsAbout 63% of participants were overweight/obese reflecting normal Kuwaiti population. Firmicutes and Bacteroidetes were the dominant phyla detected in the gut microbiome (representing 48% and 46% of total sequencing reads respectively). At the genus level, Bacteroides was the most abundant genus in 22 of 25 participants. A total of 223 ASVs were assigned to the Bacteroides genus, eleven of which were present in 50% or more of study participants, reflecting a high diversity of this genus. Phylogenetic analysis revealed that the Bacteroides dorei/vulgatus group was the most abundant phylogenetic group (representing 11.91% of all sequence reads) and was detected in all 25 individuals.ConclusionsBacteroides was the most abundant genus in the gut microbiome of native Arab Kuwaiti adults, with Bacteroides dorei/vulgatus forming the predominant phylogenetic group. The microbiome composition would also have been influenced by the nutritional status of participants.

Effects of A 12-Month Intensive Lifestyle Monitoring Program in Predominantly Overweight/Obese Arab Adults with Prediabetes.

This 12-month, randomized, controlled lifestyle intervention study was aimed at assessing the effectiveness of a lifestyle intervention in terms of (1) the reduction of at least 5% of body weight compared to baseline and (2) the percentage of participants in which fasting blood glucose (FBG) normalizes (<5.6 mmol/L) post-intervention, in predominantly overweight/obese Saudi adults with impaired fasting glucose. A total of 300 Saudi adults with prediabetes at baseline (FBG 5.6–6.9 mmol/L) were enrolled to receive either general advice (GA) or a rigorous, self-monitored, lifestyle modification program (intervention group, IG) for 12 months, focused on food choices, physical activity, and weight loss. Anthropometric and biochemical estimations were analyzed at baseline, 6, and 12 months. At baseline, 136/150 in the GA group (90.7%) and 127/150 in the IG group (84.7%) were either overweight or obese. A total of 14% (n = 21) of the subjects in the IG arm discontinued, compared to 8% (n = 12) in the GA arm. Data from completers (92% (n = 138) and 86% (n= 129) participants in GA and IG arms, respectively) were considered for the final analysis. Post-intervention, 37.2% (n = 48) of participants in the IG group had ≥5% weight reduction, as compared to 12.3% (n = 17) in the GA group (p < 0.01). Similarly, the percentage of participants who normalized their FBG post-intervention was 46.5% (n = 60) in the IG group compared to 21.7% (n = 30) in the GA group (p < 0.01). A 12-month Diabetes Prevention Program (DPP)-styled intensive lifestyle program translated effectively in decreasing weight and improving fasting glucose compared to the GA group in predominantly overweight/obese Saudi adults with prediabetes, suggesting that in the case of guided intervention programs, people are willing to participate and possibly change a sedentary lifestyle.

Vitamin D Supplementation Is Associated with Increased Glutathione Peroxidase-1 Levels in Arab Adults with Prediabetes.

Vitamin D supplementation may be used to lower oxidative stress. This interventional study aimed to investigate the effects of vitamin D supplementation on glutathione peroxidase 1 (GPx1) levels and other parameters in Arab adults with prediabetes. A total of 203 Saudi adults with prediabetes and vitamin D deficiency [intervention group, N = 146 (53 males and 93 females); control group, N = 57 (25 males and 32 females)] were included in this non-randomized, six-month intervention study. The intervention group received 50,000 international units (IU) cholecalciferol tablets once a week for two months, then twice a month for the next two months, followed by 1000 IU daily for the last two months. The control group received no supplementation. Serum 25(OH)D, lipid profile, glucose, C-reactive protein (CRP) and GPx1 were measured at baseline and after six months. Post-intervention, GPx1 concentrations increased significantly in the intervention group [17.3 (11.5–59.0) vs 26.7 (11.4–59.9) p < 0.01] while no changes were observed in the control group (p = 0.15). This significant increase in 25(OH)D and GPx1 levels persisted after adjusting for age and BMI. Stratification according to sex revealed that this favourable increase in GPx1 was true only for males (p = 0.002). In all groups, baseline GPx1 was inversely correlated with low density lipoprotein (LDL)-cholesterol (r = −0.26, p < 0.01) and body mass index (BMI) (r = −0.20, p < 0.05), while positively correlated with age (r = 0.18, p < 0.05) and systolic blood pressure (r = 0.19, p < 0.05). In conclusion, vitamin D supplementation favourably enhanced GPx1 levels in adult Arabs with prediabetes, particularly in males.

Diagnostic Values of Uric Acid and Pro-Inflammatory Cytokines for Renal Failure in Arab Adults

The detection of risk factors and the early diagnosis of renal failure are vital for the success of preventive therapeutic interventions. This study aimed to determine the potential association between uric acid (UA) levels and pro-inflammatory markers in patients undergoing hemodialysis (HD). Moreover, their possible role in premature diagnosis of renal injury (RI) was also evaluated. 50 HD patients and 24 healthy volunteers were included. Uricase-PAP test was used to measure UA. Tumor necrosis factor (TNF-α), interleukin6 (IL-6), and C-reactive protein (CRP) were measured by multiplex ELISA assay. The usefulness of UA and Pro-inflammatory markers for timely detection of renal damage was measured using the receiver operating characteristic (ROC) curve. Patients had significantly higher plasma concentrations of UA, TNF-α, IL-6, and CRP relative to volunteers. A positive correlation was found in HD patients between UA and TNF-α, and CRP, but there was no significant correlation between UA and the inflammatory markers in healthy controls. The area under the ROC curve for serum CRA was smaller than that for UA, demonstrating that UA may serve as a superior biomarker for early detection of renal injury in comparison to TNF- α. Nevertheless, serum CRP was found to be greater than both TNF-α and IL-6, the latter of which had a non-significant area under the ROC curve. Taken together, serum UA, CRP, and TNF-α—but not IL-6—are potentially early indicators for the diagnosis of RI. Moreover, serum UA is significantly elevated in HD patients and positively associated with inflammatory markers.

Translation and validation of the Arabic version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ).

OBJECTIVES:To develop and test the validity and reliability of an Arabic version of the psychosocial impact of dental aesthetics questionnaire (PIDAQ).MATERIALS AND METHODS:The original English version was translated into Arabic, back-translated, pre-tested, and cross-culturally adapted before being administered to 205 individuals aged between 18–30 years from Medina, Saudi Arabia. Cronbach's alpha coefficient was used to test internal consistency, and the intraclass correlation coefficient (ICC) was used to assess test–retest reliability. Construct validity was assessed using factor analysis, and convergent validity was tested by comparing PIDAQ scores to the aesthetic components of the Dental Aesthetic Index (DAI) and Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC), while discriminant validity was assessed by comparing PIDAQ scores to participants' self-evaluation of orthodontic treatment need. Gender and age differences in the PIDAQ score were assessed.RESULTS:Cronbach's alpha coefficient was 0.940, corrected item-total correlation coefficients were between 0.509 and 0.719, and the ICC was 0.937. Principal component factor analysis extracted three domains, and factor loading ranged from 0.563 to 0.843. Total PIDAQ score and subscale scores had significant correlations with the DAI and IOTN-AC. The questionnaire discriminated well between participants who had a perceived need for orthodontic treatment and those with no perceived need. There were no significant age or gender differences in participants' PIDAQ scores.CONCLUSIONS:The Arabic version of the PIDAQ had excellent psychometric properties with sufficient reliability and validity to be used for the assessment of the orthodontic-related quality of life in young Arab adults.

Improvements in Glycemic, Micronutrient, and Mineral Indices in Arab Adults with Pre-Diabetes Post-Lifestyle Modification Program.

The present study aimed to investigate the changes in dietary patterns of adult Saudis with prediabetes who underwent a six-month lifestyle modification program. A total of 160 Saudis with prediabetes (baseline fasting glucose 5.6–6.9 mmol/L), aged 20–60 years, were enrolled in one of the two arms: A one-time general advice about lifestyle modification (GA group) at orientation or a well-structured and monitored nutrition and lifestyle counseling for six months (guidance group). Fasting blood samples and a dietary recall for daily intakes of macro/micronutrients using a validated computerized food database “ESHA—the Food Processor Nutrition Analysis program” were collected pre- and post-intervention. Compliance to reference daily intake (RDI) was also calculated at both time points. At baseline, overall, severe deficiencies in the majority of micronutrient intakes were observed. Post intervention, clinically significant improvements in the glycemic indices (fasting glucose and insulin resistance) were seen over time in the guidance group. Also, significant improvements in dietary habits and physical activity levels were more apparent in the guidance group than the GA group, particularly in the daily intakes of total carbohydrate (46.9% compliance post vs. 20.3% at baseline); dietary fiber (21.9% vs. 3.1%); and some micronutrients like vitamin B6 (21.3% vs. 6.7%), vitamin B12 (45.3% vs. 28%), vitamin C (21.9% vs. 7.8%), riboflavin (40% vs. 10.7%), niacin (41.3% vs. 14.7%), magnesium (18.8% vs. 4.7%), iron (54.7% vs. 34.4%), and copper (37.3% vs. 13.3%). The study highlights the effects of a six-month lifestyle modification program in improving dietary micronutrient intakes of Saudis with prediabetes. Since micronutrient intake was observed to be low, fortification of these micronutrients in the Saudi diet is recommended.

WE CAN’T AVOID IT. IT’S THERE! AGEISM EXPERIENCED BY DIVERSE CULTURAL GROUPS IN OTTAWA, CANADA

Introduction: Discrimination based on age is pervasive across Canada. Little is known about the experiences of ageism among diverse cultural groups. The purpose of this pilot study was to explore the perceptions of ageism among culturally diverse older adults in Ottawa, Canada. Methods: Three focus groups were conducted with Chinese, Arab, and Indian older adults in Ottawa in June 2016. An 8-item protocol was developed to guide the discussions. Qualitative data were analyzed using open, axial, and selective coding. Results: Twenty-five culturally diverse older adults (9 Chinese, 6 Arab, and 10 Indian) participated in the focus groups. All described personal positive and negative examples of discrimination based on their age without being familiar with the term “ageism”. Several described their experiences with the intersection of age, race, and gender, although these interpretations varied by cultural group. Ageism in the media was also easily recognized. Participants recommended using specific content, communication channels, and organizations to counteract ageism. Discussion: This pilot study helped to illustrate that ageism is a societal problem that requires a societal solution. As Canada’s population becomes older and more diverse, important efforts are needed to raise awareness of ageism.

Development and Efficacy of an Electronic, Culturally Adapted Lifestyle Counseling Tool for Improving Diabetes-Related Dietary Knowledge: Randomized Controlled Trial Among Ethnic Minority Adults With Type 2 Diabetes Mellitus.

BackgroundEthnic minority populations exhibit disproportionately high rates of type 2 diabetes mellitus (T2DM). Electronic health tools have the potential to facilitate the cultural adaptation and tailoring of T2DM education to improve the knowledge and management of diabetes mellitus (DM).ObjectiveThis study aimed (1) to develop an adaptable Interactive Lifestyle Assessment, Counseling, and Education (I-ACE) software to support dietitian-delivered lifestyle counseling among low-socioeconomic status (SES) ethnic minority patients with T2DM and (2) to evaluate its effect on DM-related dietary knowledge and management compared with standard lifestyle advice (SLA) in a randomized controlled trial (RCT).MethodsThe I-ACE software, developed in consultation with clinical dieticians, incorporates evidence-based dietary and physical activity (PA) recommendations and educational materials. The features and behavioral change techniques include quantitative lifestyle (dietary intake and PA) assessment and simulation, individually tailored education and recommendations, motivational interviewing, and goal setting. For the unblinded pilot RCT, 50 overweight or obese Arab adults (aged 40-62 years) with poorly controlled T2DM were recruited from primary care clinics and randomly assigned to receive 4 in-person, dietician-delivered counseling sessions over 6 months using either (1) the I-ACE tool (experimental arm) or (2) the SLA methods (comparison arm). All outcome assessments were face-to-face. DM-related dietary knowledge (primary outcome) was measured at baseline, 3, 6, and 12 months. Lifestyle and other parameters were measured before, during, and after the intervention. Multiple linear regression and repeated measures linear mixed models were used to compare the changes in study outcomes and explore time trends in between-group and within-group changes.ResultsA total of 25 participants were enrolled in each arm, of whom 24 and 21 completed the final assessment of the primary outcome in the I-ACE and SLA arms, respectively. DM-related lifestyle knowledge increased more rapidly in the I-ACE arm than in the SLA arm (P value for study arm×time interaction=.02). Within the I-ACE arm, the mean (SE) differences in added sugar and dietary fiber intakes from baseline to 12 months were −2.6% (SE 1.0%) of total energy (P=.03) and 2.7 (SE 0.0) g/1000 kcal (P=.003), respectively. The odds of engaging in any leisure PA at 12 months tended to be higher in the I-ACE arm versus SLA arm, but did not reach statistical significance (odds ratio 2.8; 95% CI 0.7-11.6; P=.16). Both arms exhibited significant reductions in HbA1c (P value for change over time <.001).ConclusionsThe use of the I-ACE software in a 6-month, 4-session dietician-delivered lifestyle counseling intervention improved the efficiency of lifestyle education, compared with SLA, among low-SES, ethnic minority patients with T2DM. This pilot trial provides justification for conducting a large-scale trial to evaluate its effectiveness and applicability in routine clinical care among ethnically diverse populations.Trial RegistrationClinicalTrials.gov NCT01858506; https://clinicaltrials.gov/ct2/show/NCT01858506.

Romantic relationship and psychological wellbeing: the experiences of young individuals with visual impairment

Purpose The sense of vision plays a dominant role in entering a romantic partnership. However, the romantic experiences of individuals with visual impairment have received scant research attention. The study aimed to describe the lived romantic experiences of young adults with visual impairment from various cultural backgrounds and to understand the implications of these experiences on their psychological wellbeing. Method The study was conducted in the Israeli multicultural society. We conducted in-depth semi-structured interviews with 24 Jewish and Arab adults (aged 18-40 years) with visual impairment about their romantic experiences and the meanings they attribute to these experiences. We used an inductive thematic analysis. Results Singlehood seemed to be a distressing situation for the Muslim female participants compared to the Jewish participants. Having a romantic partner contributed to the participants' self-acceptance and psychological well-being, especially for Muslim individuals. Conclusions The findings demonstrate the intersection of lifelong disability, gender, and culture in the context of romantic relationships. The findings also highlight the need to support the romantic opportunities and experiences of young individuals with visual impairment, especially those from Arab society. IMPLICATIONS FOR REHABILITATION Young adults with visual impairment often face physical and social barriers in entering and maintaining a romantic relationship. Having a romantic partner contributes to the self-acceptance and psychological wellbeing of young adults with visual impairment. Rehabilitation practitioners should take into consideration personal and environmental factors, such as gender and cultural background, when providing support in a romantic and intimate relationship, for individuals with lifelong disabilities. Rehabilitation practitioners should also engage family members, especially from religious families, to support their relatives with visual impairment in developing a romantic relationship.

Metabolic Syndrome in Arab Adults with Low Bone Mineral Density.

There are discrepancies in the reports on the association of metabolic syndrome (MetS) and its components with bone mineral density (BMD) and hence more population-based studies on this subject are needed. In this context, this observational study was aimed to investigate the association between T-scores of BMD at lumbar L1–L4 and full MetS and its individual components. A total of 1587 participants (84.7% females), >35 years and with risk factors associated with bone loss were recruited from February 2013 to August 2016. BMD was done at L1–L4 using dual-energy X-ray absorptiometry (DXA). T-Scores were calculated. Fasting blood samples and anthropometrics were done at recruitment. Fasting lipid profile and glucose were measured. Screening for full MetS and its components was done according to the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. Logistic regression analysis revealed that the odds of having full MetS increased significantly from the lowest T-score tertile to the highest one in both sexes (OR, odd ratio (95% CI, confidence interval) of tertile 2 and 3 at 1.49 (0.8 to 2.8) and 2.46 (1.3 to 4.7), p = 0.02 in males and 1.35 (1.0 to 1.7) and 1.45 (1.1 to1.9), p < 0.01 in females). The odds remained significant even after adjustments with age, body mass index (BMI), and other risk factors associated with bone loss. Among the components of MetS, only central obesity showed a significant positive association with T-score. The study suggests a significant positive association of T-score (spine) with full MetS irrespective of sex, and among the components of MetS this positive association was seen specifically with central obesity.

Bone metabolism markers are associated with neck circumference in adult Arab women.

Body fat distribution is associated with decreased bone resorption and neck circumference (NC), a surrogate measure for upper body fat, has never been tested as a marker that can reflect bone turnover. This is the first study aimed to analyze the associations between NC and several bone biomarkers among adult Saudi women. This cross-sectional study included a total of 265 middle-aged Saudi women [86 non-obese (mean age 52.7 ± 8.1; mean BMI 26.9 ± 2.3) and 179 obese (mean age 50.6 ± 7.5; mean BMI 35.7 ± 4.5)] recruited from primary care centers in Riyadh, Saudi Arabia. Anthropometrics included BMI, NC, waist and hip circumferences, total body fat percentage (%), and blood pressure. Biochemical parameters included glucose and lipid profile which were measured routinely. Serum levels of 25(OH) D, parathyroid hormone, RANKl, sclerostin, C-terminal telopeptide of collagen I (CTX-I), Dkk1, IL1β, osteoprotegerin, osteopontin, and osteocalcin were measured using commercially available assays. In all groups, NC was inversely associated with PTH (R = - 0.22; p < 0.05) and positively associated with osteoprotegerin (R = 0.20; p < 0.05) even after adjustments for age and BMI. Using all anthropometric indices as independent variables showed that only NC explained the variance perceived in CTX-I (p= 0.049). In the non-obese, waist-hip ratio (WHR) was significantly associated with sclerostin (R = 0.40; p < 0.05) and body fat was significantly associated with osteopontin (R = 0.42; p < 0.05). NC is modestly but significantly associated with bone biomarkers, particularly the bone resorption markers, among adult Arab women. The present findings highlight the importance of NC as measure of upper body subcutaneous fat in influencing bone biomarker expression in adult females.