BDS, MSc, MSPH, MHPE, FFPH, ScD. Associate Prof. of Epidemiology and Biostatistics. Associate Prof. Medical Education

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1 Yusuf Al-Gau Gau d BDS, MSc, MSPH, MHPE, FFPH, ScD Associate Prof. of Epidemiology and Biostatistics Associate Prof. Medical Education Jordan University of Science & Technology

2 Alarming high prevalence rates of diabetes and metabolic syndrome in Arab countries: Data from Jordan This is the first generation where children may die before their parents. Paul Zimmet

3 Outline Definition of Metabolic Syndrome Obesity, Diabetes, Metabolic Syndrome and Cardiovascular Diseases es Prevalence of Metabolic Syndrome and Diabetes among adults Prevalence of Metabolic Syndrome among children and adolescents Prevention of Metabolic Syndrome Strategic directions and actions

4 Cluster or Constellation ATP III/IDF Atherogenic Dyslipidemia Elevated Blood Pressure Elevated Plasma Glucose Prothrombotic State Proinflammatory State ADA/EASD Atherogenic Dyslipidemia Elevated Blood Pressure Prediabetes Prothrombotic State Proinflammatory State

5 The Metabolic Syndrome (ATP III) Any 3 OF 5 Risk Factor Abdominal Obesity Men Women Triglycerides HDL-Cholesterol Men Women Criterion Waist Circumference >102 cm (>40 in) >88 cm (>35 in) 150 mg/dl <40 mg/dl <50 mg/dl Blood Pressure 130/ 130/ 85 mm Hg Fasting Glucose 110 mg/dl

6 IDF (2005) Waist circumference : ethnicity specific* for Europids: Male > 94 cm Female > 80 cm plus any two of the following Raised triglycerides Reduced HDL cholesterol Raised fasting plasma glucose Raised blood pressure

7 BMI Distribution Shifts K density BMI Likely causes: Changes in lifestyle including: Sedentary lifestyle and lack of physical activity Abundance of food, inappropriate eating habits, and obesity. Population aging BMI (Kg/m 2 )

8 BMI and Cardiovascular Disease Mortality Relative Risk of Death < Men Women Lean Overweight Obese Body Mass Index Calle et al. N Engl J Med 1999;341:1097.

9 Cardiovascular Diseases Mortality increases with the increased number of Metabolic Syndrome components Hazard ratio No risk factors 1-2 risk factors MeS MeS+Diabetes Risk factors

10 Prevalence of MeS in the region Jordan 36 Turkey 33 Qatar 28 Country Arab Americans Oman Saudi Arabia Palestine Prevalence of Metabolic Syndrome

11 Prevalence of Diabetes in Arab Countries Bahrain 25 UAE 20 Syria 20 Sudan 19 SAA 18 Jordan 17 Egypt 16 Qatar 16 Country Tunisia Libya Lebanon Omman 12 Iraq 10 Yemen 9 Morroco 8 Palastin Prevalence of diabetes

12 Metabolic syndrome in Jordan

13 Metabolic syndrome among Jordan Adults

14

15 Metabolic syndrome and its components among Jordanian children and adolescents

16 Percentage Boys (n=183) Girls (n=162) Total (N=345) Boys (n=52) Girls (n=115) Total (N=167) 10-<16 year 16 year Age/sex

17 Prevalence of Childhood Obesity in the Region (9-18 yrs) Country % Overweight % Obesity Jordan 17 9 Oman Syria Sudan 12 8

18 Overweight and obesity Prevalence (%) % Overweight Obesity 14% % % 15.5 Male Female Male Female 8.2 Children Adolescents gender

19 2,131 children aged 6 and 12 year Overweight 20% Obesity 6%

20 Predictors of obesity among Jordanian children

21 Individual metabolic abnormalities in children Girls Boys Prevalence Abdominal obesity High Triglycerides level Low HDL cholesterol High Blood pressure

22 Individual metabolic abnormalities in adolescents Girls Boys Prevalence Abdominal obesity High Triglycerides level Low HDL cholesterol High Blood pressure

23 Clustering of metabolic abnormalities according to body mass index Normal Overweight Obesity Percentage (%) and 18 years Number of metabolic abnormalities

24 Prevention of MeS You need to make sensible changes to your lifestyle. Exercise. Start slowly: Exercising on most days of the week for minutes. Eat a healthy diet with lots of fruits and vegetables and go easy on the saturated fats, trans fat, cholesterol, and salt. Lose weight if you're overweight. Quit smoking if you smoke -- now. Schedule regular checkups with your doctor to check your blood pressure, cholesterol, and blood sugar.

25 Strategic directions and actions Strengthening of surveillance of these diseases and their risk factors Advocacy and communications: Health is a fundamental human right Obtain political and community support Policy development, legislation, and regulation: Governments are responsible for the development of healthy public policies and ensure action across all sectors concerned

26 Strategic directions and actions Health promotion and population-based prevention Target the population as a whole as well as high risk individuals Community-based interventions Strengthening and reorientation of health systems Human resources: education, training, motivation, incentives, etc Shift toward more prevention Improvement of disease prevention and management

27 WHO strategy on diet and physical activity The overall goal of the global strategy on diet, physical activity and health (WHA57.17, 2004) is to Promote and protect health by guiding the development of an enabling environment for sustainable actions at individual, family, community, national and global levels, that when taken together, will lead to reduced disease and death rates related to unhealthy diet and physical inactivity

28

29 Thank you

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