Prevalence and Correlates of Diabetes Mellitus Among Adult Obese Saudis in Al-Jouf Region

Transcription

1 Wold Jounal of Public Health 2017; 2(2): doi: /j.wjph Pevalence and Coelates of Diabetes Mellitus Among Adult Obese Saudis in Al-Jouf Region Mohamed Yahya Saeedi 1, Ahmed Jameel Almadani 1, Abdelgadie Ibahim Jamo 1, *, Fayez G. Aluwailly 4, Ashaf Bashi Albaaka 3, Ahmed K. Ibahim 2, Kassim A. Kassim 1 1 Geneal Diectoate fo Contol of Genetic and Chonic Diseases, Ministy of Health, Riyadh, Saudi Aabia 2 Public Health & Community Medicine Depatment, Faculty of Medicine, Assiut Univesity, Asyut, Egypt 3 Community Medicine, Geneal Diectoate fo Public Health, Al Jouf Region, Kingdom of Saudi Aabia 4 Community Medicine, Geneal Diectoate fo Planning & Taining, Al Jouf Region, Kingdom of Saudi Aabia addess: * Coesponding autho To cite this aticle: Mohamed Yahya Saeedi, Ahmed Jameel Almadani, Abdelgadie Ibahim Jamo, Fayez G. Aluwailly, Ashaf Bashi Albaaka, Ahmed K. Ibahim, Kassim A. Kassim. Pevalence and Coelates of Diabetes Mellitus Among Adult Obese Saudis in Al-Jouf Region. Wold Jounal of Public Health. Vol. 2, No. 2, 2017, pp doi: /j.wjph Received: Januay 24, 2017; Accepted: Mach 22, 2017; Published: Apil 12, 2017 Abstact: Backgound: Saudi Health Infomation Suvey epoted that diabetes affects 13.2% of the population while 16.3% ae bodeline, also obesity affects 28.7% of the population. Diabetes has a majo impact on health and quality of life. wheeas, ealy contol of type 2 diabetes also educes the isk of motality. Aim: we aimed to exploe the pevalence and the most impotant deteminants of diabetes among a sample of Saudi obese adults and discove the eliability and validity of the CANRISK scale. Methods: A coss-sectional study of 390 obese, adult Saudis attending the 9 th Olive Festival in Al-Jouf egion, KSA using CANRISK questionnaie and blood suga testing was caied out. Results: Thee was statistically significant association between diabetes and paticipants age (p<0.001) and insignificant association fo gende, maital status, educational level, monthly income, smoking and healthy habits (p>0.05). The isk of having diabetes was inceased 3.7 times fo the olde age goup (64-74 yeas) in compaison to the younge goup with a steady isk incease with advanced age (AOR=3.7, 95% CI ). The isk of having pe-diabetes o diabetes was high in 72%, modeate in 22.5% and low in only 5.5% of the studied sample. Conclusion: Pevention stategies need to addess the diffeential isks fo diabetes among the expected high-isk goups and conside them as tagets fo clinical and public health action. Keywods: Pevalence, Diabetes, Validity, Canisk 1. Intoduction Diabetes and obesity ae majo causes of mobidity and motality both ae costly in both health-elated and economic tems [1] [2]. The woldwide pevalence of diabetes and obesity has been doubled between 1980 and WHO estimated that, globally, 422 million adults aged ove 18 yeas wee living with diabetes and ove 600 million wee obese [3-5]. Woldwide, the numbe of people with diabetes has substantially inceased fom 108 million in 1980 to cuent numbes that ae aound fou times highe [3, 4]. Diabetes pevalence was coelated with the global ubanization: a tend towad sedentay lifestyles and poo diet [6-9]. The Kingdom of Saudi Aabia (KSA) has witnessed a demogaphic shift ove the last 20 yeas, accompanied by behavioual changes such as an incease in caloic, fat, and cabohydate intake with a eduction in physical activity [10]. In 2015; Thee wee 3.4 million cases of diabetes in Saudi Aabia and moe than 35.4 million people in the Middle East and Noth Afica (MENA) Region; by 2040 this will ise to 72.1 million [11]. Saudi Health Infomation Suvey epoted that diabetes affects 13.2% (14.8% males, 11.7% females) of the population and 16.3% ae bodeline (17.0% males, 15.5% females), while obesity affects 28.7% of the population (24.1% males, 33.5% females) [12]. Diabetes has a majo impact on health and quality of life and is a wosening poblem in both the developed and the developing wold due to the complications it geneates, such

2 Wold Jounal of Public Health 2017; 2(2): as; heat disease, kidney disease, eye damage, neuopathy and many othes [13, 14]. Consequently, people with diabetes tend to live an aveage of 5 to 10 yeas less than those without diabetes. Ealy detection of type 2 diabetes and pediabetes leads to ealie contol of blood glucose which is cucial fo peventing these complications. Ealy contol of type 2 diabetes also educes the isk of motality and comobidity as evidenced by the United Kingdom Pospective Diabetes Study (UKPDS) [15] CANRISK can help aise the public s awaeness of thei isk fo diabetes to pevent o manage the disease. CANRISK is a questionnaie that helps to identify the pe-diabetes o type 2 diabetes. It is mainly fo adults between the ages of 45 and 74 yeas, but may also be used fo younge goups in high-isk populations [16]. Completing the questionnaie gives patients an oveall CANRISK scoe that shows thei isk of having pe-diabetes o diabetes. CANRISK was adapted fom a simila questionnaie that is being used in Finland as pat of its national diabetes pevention pogam (FINDRISC). The Public Health Agency of Canada (PHAC) convened a goup of clinical and academic expets to modify the questionnaie so it would moe accuately eflect known diabetes isk factos applicable to Canadians, such as the addition of new questions on ethnicity, education and gestational diabetes [16] The aim of the pesent study was to evaluate the pevalence of diabeties among the studied goup, to investigate the deteminants of the disease among the studied cohot and to the validity of the sceening scale. 2. Method 2.1. Design and Pocedues The study was a coss-sectional suvey of obese (BMI 25), adult (age 40 yeas) Saudis attending the Cown Health Pogam Exhibition at the 9 th Olive Festival in Al- Jouf egion, KSA. The study was caied out duing the peiod fom 10/2015 to 2/2016. A convenience sampling technique was applied ecuiting eligible candidates fo the study and using a self-administeed questionnaie fo data collection. Sample size calculation was caied out accoding to the WHO guidelines fo desciptive study designs (1), povided that the pevalence of diabetes among Al-Jouf population was 24% accoding to Saudi national Suvey [12], with 95% confidence level, an eo of 0.05 and 90% powe of calculation. The esulted minimum sample was 292. Paticipants wee asked to fill the study questionnaie afte a bief intoduction about the eseach aim, concept, methods, and benefits. A goup of tained medical pesonnel helped in the data collection pocedue. Paticipants wee asked to fill in each question to ovecome missing data. The questionnaie was anonymous, infomed consent was obtained and confidentiality was assued. Fo the blood sample, each applicant was asked to sign a witten consent afte full explanation of the aims, isks, and benefits Measue A. Socio-demogaphic data questions included; age, sex, maital status, occupation, and educational level. B. The Canadian Diabetes Risk Questionnaie (CANRISK) [15]; it is a stuctued questionnaie composed of 12 questions that help in identifying the isk of pe-diabetes o type 2 diabetes. It is mainly fo adults between the ages of 40 and 74 yeas, but may also be used fo younge goups in high-isk populations. Completing the questionnaie gives patients an oveall CANRISK scoe that shows thei isk of having pe-diabetes o diabetes. CANRISK was adapted fom a simila questionnaie that is being used in Finland as pat of its national diabetes pevention pogam (FINDRISC). The Public Health Agency of Canada (PHAC) convened a goup of clinical and academic expets to modify the questionnaie so it would moe accuately eflect known diabetes isk factos applicable to Canadians, such as the addition of new questions on ethnicity, education, and gestational diabetes. In a ecent Canadian pee-eviewed study involving ove 6000 blood-tested adults, CANRISK scoes wee validated against diagnostic gold standad blood tests used in assessing diabetes isk in Canada s multi-ethnic population 3. CANRISK scoes can be easily intepeted by summing up point scoes fo each of the 12 questions then compaing the esults with theshold scoes fo each of the 3 isk categoies; a) Low < 21; the isk of having pe-diabetes o type 2 diabetes is faily low, though it always pays to maintain a healthy lifestyle b) Modeate: 21 32; based on the identified isk factos, the isk of having pe-diabetes o type 2 diabetes is modeate. Should consult a health cae pactitione about the isk of developing diabetes c) High > 32; based on the identified isk factos, the isk of having pe-diabetes o type 2 diabetes is high. Must consult a health cae pactitione to discuss getting blood suga tested. The scoe can also be conveted to estimate the pobability of cuent dysglycemia by using a fomula descibed in Robinson, et al., 2011, Validating the CANRISK pognostic model fo assessing diabetes isk in Canada s multi-ethnic population [3]. A. Clinical Data included smoking status, weight in kilogam, height in mete, body mass index (BMI = weight in kg/(height in m) 2 ), waist cicumfeence in cm and blood pessue measuement. B. Laboatoy Data i. Glycated haemoglobin (HbA1C) test indicates the aveage blood suga level fo the past two to thee months. It measues the pecentage of blood suga attached to haemoglobin (the oxygen-caying potein in ed blood cells). The highe the blood suga levels, the moe suga will be attached with haemoglobin. An A1C level of 6.5% on two sepaate tests indicates diabetes. An A1C between 5.7 and 6.4% indicates pe-

3 83 Mohamed Yahya Saeedi et al.: Pevalence and Coelates of Diabetes Mellitus Among Adult Obese Saudis in Al-Jouf Region diabetes. Below 5.7% is consideed nomal. False A1C test esults could be due to pegnancy o having an uncommon fom of haemoglobin. ii. Random blood suga test. A blood sample will be taken at a andom time. Regadless of the time of the last meal, a andom blood suga level of 200 milligams pe decilite (mg/dl) 11.1 millimoles pe lite (mmol/l) suggests diabetes Statistical Analysis Data wee analyzed using SPSS vesion 21 softwae. To pepae the data fo analysis, basic statistics wee calculated (fequencies, coss-tabulation, and histogam). Fequency tables wee examined to exploe missing data, eos in the data and data consistency. Missing data in the main vaiables (IAS and PHQ) wee teated by eplacing the missing value with median values. Age and sex wee added as a pioi vaiables. Basic univaiate analyses (chi-squae and t-test) wee conducted to test the associations between A1C esults and the exposue vaiables. An initial multivaiate logistic egession model was built containing a pioi vaiables (age and sex) plus the associated vaiables fom the univaiate sceening analyses to epot the adjusted odds atio (AOR). Likelihood Ratio Test (LHR) and Confidence Intevals (CIs) wee calculated to assess the significance. The final model fitting was caied out in thee stages; 1st; a pioi vaiables and the significant vaiables in the initial model wee included, 2nd; all non-significant vaiables fom the initial model wee included in the final model one at a time to test fo thei effect on the model, 3d; to adjust fo the effects of the othe factos (non-significant vaiables fom the univaiate analysis), these factos wee simultaneously incopoated into the model and the likelihood atio test was used to test fo model obustness. Additionally, possible effect modification by sex was examined by testing fo inteactions between sex and each of the pedicto vaiables individually (p 0.05). Fo eliability and validity of the CANRISK; Coelation analysis was used to test the association between vaiables (Speaman s ank coelation). Item analysis was pefomed, Conbach αs and Inta-Class Coelation Coefficient (ICC) wee calculated fo total PDI and fo sepaate items. A significant p- value was consideed when it is less than o equal to the HbA1C test. Table 1. Socio-demogaphic chaacteistics of Diabetic Adult Obese Saudis in Al-Jouf Region, Vaiable Total no. = 390 (%) Age Goup in yeas < Gende Male Female Maital Status Not Maied Maied Educational Level Some High School o less High School Diploma College o Univesity Degee Occupation* Not Woking Woking Monthly Income (SR) 10, > 10, Missing Smoking Status Non-smoke Smoke Ex-smoke Physical Activity No Yes Eating Fuits & Vegetables No Yes *Not woking (unemployed, housewife, student and etied), woking (Govenmental, pivate & othes) 3. Results The cuent study included 390 paticipants attending the Cown Health Pogam Exhibition at the 9th Olive Festival in Al-Jouf egion, KSA in The paticipants' age anged fom 40 to 74 yeas. About thee quates wee males whee the majoity of them (90%) wee maied. Most of the espondents (65%) wee non-smokes. Also, about 60% wee employed and 36% had univesity degee. Moeove, about 37% had monthly income > 10,000 SR. Regading healthy habits; only 11% wee physically active and 18% wee eating vegetables and fuits egulaly. The demogaphic data of these patients ae shown in Table 1 & Figue 1. In this study, 159 paticipants (41%) wee found to be Diabetics accoding Figue 1. Age Distibution of Diabetic Cases among the studied cohot.

4 Wold Jounal of Public Health 2017; 2(2): Table 2 showed the univaiate isk factos associations with diabetes. Thee was statistically significant association between diabetes and paticipants age (p<0.001); i.e. the olde the paticipant, the highe the pevalence of diabetes. Also, highe pecentages of diabetes wee epoted fo unemployed paticipants. On the othe hand, insignificant association was noticed fo gende, maital status, educational level, monthly income, smoking and healthy habits (p>0.05). Moeove, about two-thids of diabetics wee obese (p<0.05) and 70% of them have abnomal waist cicumfeence (p<0.05). Also, the mean systolic and diastolic blood pessue wee highe among obese compaed with nonobese espondents (p<0.01 & =0.05, espectively). Respecting the paticipants' histoy; we found that about 45% of diabetics had histoy of hypetension (p<0.01) and about two-thids had histoy of high blood glucose and family histoy of diabetes (p<0.001) (Table 2). Vaiables Age Goup in yeas Table 2. Univaiate analysis of Risk Factos. Non-diabetic (n=231) Diabetic (n=159) < (70.2%) 36 (29.8%) (65.7%) 49 (34.3%) (45.3%) 47 (54.7%) (32.5%) 27 (67.5%) Gende Male 179 (60.9%) 115 (39.1%) Female 52 (54.2%) 44 (45.8%) Maital Status Not Maied 20 (8.7%) 22 (13.8%) Maied 211 (91.3%) 137 (86.2%) Educational Level Some High School o less 125 (54.1%) 97 (61.0%) High School Diploma 15 (6.5%) 13 (8.2%) College o Univesity Degee 91 (39.4%) 49 (30.8%) Occupation* Not Woking 149 (64.5%) 82 (52.2%) Woking 82 (35.5%) 76 (47.8%) Monthly Income (SR) 10, (57.9%) 93 (62.8%) > 10, (42.1%) 55 (37.2%) Smoking Status Non-smoke 153 (66.2%) 101 (63.5%) Smoke 52 (22.5%) 40 (25.2%) Ex-smoke 26 (11.3%) 18 (11.3%) Physical Activity No 209 (90.5%) 140 (88.1%) Yes 22 (9.5%) 19 (11.9%) Eating Fuits & Vegetables No 191 (82.7%) 129 (81.1%) Yes 40 (17.3%) 30 (18.9%) P-value < 0.001* = 0.148* = 0.074* = 0.067* = 0.010* = 0.200* = 0.269* = 0.273* = 0.396* *Chi-squae analysis was used to compae the diffeence in popotions Vaiables BMI Table 2. Continued. Non-diabetic (n=231) Diabetic (n=159) Nomal 30 (13.0%) 10 (6.3%) Ove-weight 77 (33.3%) 50 (31.4%) Obese 124 (53.7%) 99 (62.3%) Waist Cicumfeence Nomal 93 (40.3%) 48 (30.2%) Abnomal 138 (59.7%) 111 (69.8%) Systolic Blood Pessue Mean ± SD ± ± 18.1 Median (Range) (85-190) 82.5 (55-178) Diastolic Blood Pessue Mean ± SD 82.7 ± ± 14.9 Median (Range) 82 (35.5%) 76 (47.8%) Histoy of Hypetension No 167 (72.3%) 88 (55.3%) Yes 64 (27.7%) 71 (44.7%) Histoy of High Glucose Level No 191 (82.7%) 38 (23.9%) Yes 40 (17.3%) 121 (76.1%) Family Histoy No 104 (45.0%) 43 (27.0%) Yes 127 (55.0%) 116 (73.0%) P-value < 0.028* = 0.027* = 0.004** = 0.050** = 0.001* < 0.001* < 0.001* *Chi-squae analysis was used to compae the diffeence in popotions **Student t-test was used to compae the mean diffeence between the two goups Table 3 illustated the adjusted OR fo the most common isk factos associated with diabetes. The final logistic egession model contained seven pedictos fo diabetes in the studied cohot which ae; age, BMI, waist cicumfeence, systolic blood pessue, histoy of high glucose level, family histoy and monthly income using the Likelihood Ratio Test (LRT) (P < 0.05). The isk of having diabetes was inceased 3.7 times fo the olde age goup (64-74 yeas) in compaison to the younge goup with a steady isk incease with advanced age (AOR=3.7, 95% CI ). BMI and waist cicumfeence inceased the isk of diabetes. Obese paticipants wee about five times moe liable to have diabetes (AOR=4.95, 95% CI ). Moeove, those with abnomal waist cicumfeence wee about two times moe likely to have diabetes (AOR=2.2, 95% CI ). Systolic hypetension also had an impact on diabetes as those with high systolic blood pessue wee 2% moe liable to have diabetes (AOR=1.02, 95% CI ). As egads paticipants' histoy; those with positive histoy of high glucose level wee moe likely to have diabetes (AOR=1.2, 95% CI ) and those with family histoy of diabetes wee 45% moe likely to have the disease (AOR=1.45, 95% CI ). Finally, highe monthly income (>10,000 SR) inceased the isk of diabetes by 80% (AOR=1.8, 95% CI ). Based on the isk factos identified in the CANRISK questionnaie, the isk of having pe-diabetes o diabetes was high in 72% of the studied sample, modeate in 22.5% and low in only 5.5% (Figue 2).

5 85 Mohamed Yahya Saeedi et al.: Pevalence and Coelates of Diabetes Mellitus Among Adult Obese Saudis in Al-Jouf Region Vaiables Initial Model* Table 3. Adjusted OR of Risk Factos of PPD. Final Model** Adjusted OR 95% CI LRT P-value Adjusted OR 95% CI LRT P-value Age Goup in yeas < = = Gende Male 1 = Female Occupation Not Woking 1 Woking = BMI Nomal 1 1 = Ove-weight = Obese Waist Cicumfeence Nomal 1 = = Abnomal Systolic Blood Pessue = = Diastolic Blood Pessue = 403 Vaiables Initial Model* Table 3. Continue. Final Model** Adjusted OR 95% CI LRT P-value Adjusted OR 95% CI LRT P-value Histoy of Hypetension No 1 = Yes Histoy of High Glucose Level No 1 < < Yes Family Histoy No 1 = = Yes Monthly Income (SR) 10,000 1 = = > 10, *The Initial model included the Significant Socio-demogaphic vaiables and clinical vaiables ** In the final mode (age, BMI, WC, systolic blood pessue, histoy of high glucose level and family histoy of diabetes) then the Likelihood Ratio Test (LRT) fo adding the non-significant vaiables to the final model was pefomed (monthly income) The popeties and distibution of the CANARISK scale wee descibed in table 4 and figue 3. CANARISK anged fom 10 to 69 with the mean equals 41.2 (SD= 12.8), 95% Confidence Inteval fo Mean ( ). The spead of scoes was nomally distibuted (skewness = 0.07 and kutosis = -0.06) (i.e. the cuve of distibution is not shifted to left o ight sides). The scale eliability was modeate (Conbach's α was 0.52 and ICC was 0.6). The discimination value which is the ability to disciminate between vaiables, that is an impotant indicato fo validity, measued by Feguson δ equals 0.61 (nomally, Feguson δ moe than 0.5 is valid). Figue 2. Distibution of the studied cohot accoding to the CANARISK scoes.

6 Wold Jounal of Public Health 2017; 2(2): Paamete Table 4. Statistical Popeties of the CANARISK scale. Statistic Mean % Confidence Inteval fo Mean % Timmed Mean Median Range 59 (10 69) Std. Deviation 12.8 Inte-quatile Range 17 Skewness 0.07 Kutosis Reliability (Conbach α) ICC Discimination (Feguson δ Delta-) Numbe (N=390) Age Sex BMI WC Histoy of High Glucose Level Histoy of Hypetension *Coelation is significant at the 0.05 level (2-tailed). CANARISK Scoe 0.71 * (< 0.001) 0.23 ** (=0.026) 0.46 * (< 0.001) 0.69 * (< 0.001) 0.81 * (< 0.001) 0.55 * (< 0.001) Table 6 and Figue 4 showed the CANARISK scoe discimination among study sample. ROC cuve was dawn by a nonpaametic method using SPSS softwae (AUC = 0.803, 95% confidence inteval: , p < 0.001). This cuve and the coesponding AUC showed that CANARISK scale as a sceening tool fo diabetes mellitus has pedictive ability to disciminate diabetic patients fom nomal subjects. Table 7. CANARISK scoe discimination among study sample. CANARISK Scoe P-value 95% CI + AUC* SE** Diabetics < *AUC = Aea unde the Cuve **SE = Standad Eo +CI = Confidence Inteval Figue 3. Distibution of the CANARISK scale among the studied sample. Table 5 demonstated the constuct validity of the CANARISK scale was measued by Speaman s coelation. Thee was stong positive coelation between CANARISK scale scoes and age, HbA1C, WC and histoy of high glucose level (coelation coefficient = 0.71, 0.62, 0.69 and 0.81 espectively; p<0.001). Moeove, modeate positive coelations wee epoted with RBS, BMI and Histoy of hypetension (coelation coefficient = 0.52, 0.46 and 0.55 espectively; p<0.001). Thee was significant weak positive coelation between CANARISK scale scoes and gende (coefficient = 0.23 espectively; p=0.026). Table 5. Speaman s coelation between CANARISK scoe, RBS, HBA1C, Socio-demogaphics and Clinical Data. Numbe (N=390) RBS HBA1C CANARISK Scoe 0.52 * (< 0.001) 0.62 * (< 0.001) 4. Discussion ***Null hypothesis: tue aea = 0.5 Figue 4. ROC fo CANARISK scale. Diabetes is on the ise woldwide; accoding to the latest

7 87 Mohamed Yahya Saeedi et al.: Pevalence and Coelates of Diabetes Mellitus Among Adult Obese Saudis in Al-Jouf Region epot fom the Intenational Diabetes Fedeation, the global pevalence will ise fom 8.3% in 2013 to 11.1% in 2033 and the numbe of people affected by the disease will incease by 57% fom 382 to almost 600 million [17]. As demonstated in the cuent study, diabetes pevalence among obese adults was 41% while Al-Saleem et al [18] epoted that diabetes was epoted among 20% of obese compaed to 10% among individuals with nomal weight in study conducted in 230 PHCCs in Asee egion. Also, the Health Suvey fo England (HSE) data fom shows that 12.4% of people aged 18 yeas and ove with obesity have diagnosed diabetes, five times that of people of a healthy weight. [19]. That can be explained by the close association between obesity and type 2 diabetes and the seveity of type 2 diabetes ae closely linked with body mass index (BMI) [20]. Thee ae a seven times geate isk of diabetes in obese people compaed to those of healthy weight, with a theefold incease in isk fo oveweight people also the body fat distibution can incease the isk of diabetes, the pecise mechanism of association emains unclea [21]. So, any adult individual with oveweight/obesity should be sceened fo diabetes as is a pat of metabolic syndome is common among Saudi adults as epoted by Al-Nozha et al [22]. Thee was a statistically significant association between diabetes and paticipants age. Thee is a clea association between inceasing age and geate diabetes pevalence. These findings ae in ageement with many studies which showed a stong association inceasing age and diabetes pevalence [1, 18, 19, 23] Insignificant association was noticed fo smoking and healthy habits but U.S. Depatment of Health and Human Sevices [24] epoted that the isk of developing type 2 diabetes is 30-40% highe fo egula smokes than fo nonsmokes and that thee is a positive dose-esponse elationship between the numbe of cigaettes smoked and the isk of developing diabetes [18, 25]. The meta-analysis of Willi C. et al [26] included moe than 3.9 million paticipants and 140,813 cases of diabetes, with the numbe of paticipants in these studies anging fom 241 to 2,540,753. Follow-up anged fom yeas, with a median of 10 yeas. Concluded active smokes had an inceased isk of developing type 2 diabetes compaed with non-smokes, with a pooled RR of 1.37 (95% CI, ). BMI and waist cicumfeence inceased the isk of diabetes, obese paticipants wee about five times moe liable to have diabetes (AOR=4.95, 95% CI ), these findings ae in ageement with many studies which showed associations between inceasing levels of BMI, deceasing levels of physical activity and unhealthy diet on the development of type 2 diabetes [27, 28]. Also, Guh DPet al [29] noted the stongest association between oveweight defined by body mass index (BMI) and the incidence of type II diabetes in females (RR = 3.92 (95% CI: )). Statistically, significant associations with obesity wee found with the incidence of type II diabetes. CANRISK is a statistically valid tool that may pove to be suitable fo assessing diabetes isk in Canada s multi-ethnic population [30]. In cuent study and based on the isk factos identified in the CANRISK questionnaie, the isk of having pe-diabetes o diabetes was high in 72% of the studied sample, modeate in 22.5% and low in only 5.5% which is diffe fom data published by Chip P Rowan et al [31] in 2014 and shows that the oveall isk scoe, 30.2% of paticipants fell into the Small isk categoy, 33.1% into the Modeate isk categoy 16.5% into the High isk categoy, 15.4% into the Vey High isk categoy, and 4.8% into the Exteme isk categoy. 4.8% into the Exteme isk categoy that can be explained by that, ou taget goup was obese. 5. Conclusion Pevention and teatment need to addess the diffeential isks fo diabetes among the expected high-isk goups and conside them as tagets fo clinical and public health action. Such knowledge could lead to ealy detection povides inceased awaeness and the oppotunity to individuals allowing them to make impotant lifestyle changes as quickly as possible with the goal of peventing, o delaying, the pogession towads type 2 diabetes and the known associated complications. Refeences [1] Mokdad, A. H., et al., Pevalence of obesity, diabetes, and obesity-elated health isk factos, JAMA, (1): p [2] Kaczoowski, J., C. Robinson, and K. Neenbeg, Development of the CANRISK questionnaie to sceen fo pediabetes and undiagnosed type 2 diabetes. Canadian Jounal of Diabetes (4): p. 5. [3] Collaboation, N. C. D. R. F., Effects of diabetes definition on global suveillance of diabetes pevalence and diagnosis: a pooled analysis of 96 population-based studies with 331,288 paticipants. Lancet Diabetes Endocinol, (8): p [4] WHO, Global epot on diabetes [5] WHO, W. H. o., Obesity and oveweight, Fact sheet, Januay [6] Amuna, P. and F. B. Zoto, Epidemiological and nutition tansition in developing counties: impact on human health and development. Poc Nut Soc, (1): p [7] Consultation, W. F. E., Diet, nutition and the pevention of chonic diseases p [8] Key, T. J., et al., The effect of diet on isk of cance. Lancet, (9336): p [9] Stampfe, M. J., et al., Pimay pevention of coonay heat disease in women though diet and lifestyle. N Engl J Med, (1): p [10] Al-Hazzaa, H. M., et al., Physical activity, sedentay behavios and dietay habits among Saudi adolescents elative to age, gende and egion. Int J Behav Nut Phys Act, : p. 140.

8 Wold Jounal of Public Health 2017; 2(2): [11] Fedeation, I. D., IDF DIABETES ATLAS, ed. S. Edition [12] Aabia, M. o. H. K. o. S. Saudi Health Infomation Suvey 2013; Available fom: ey2013.pdf. [13] Albeti, K. G. and P. Z. Zimmet, Definition, diagnosis and classification of diabetes mellitus and its complications. Pat 1: diagnosis and classification of diabetes mellitus povisional epot of a WHO consultation. Diabet Med, (7): p [14] Ceiello, A., Oxidative stess and diabetes-associated complications. Endoc Pact, Suppl 1: p [15] Association, A. D., Implications of the United Kingdom Pospective Diabetes Study. Diabetes Cae (1). [16] Canada., P. H. A. o. CANRISK: the Canadian diabetes isk questionnaie use guide fo phamacists [17] Andesson, T., et al., Pevalence and incidence of diabetes in Stockholm County PLoS One, (8): p. e [18] Safa A Al-Saleem, A. M. A., Yahia M Al-Khaldi, Obesity among patients attending pimay cae centes, Asee Region, Saudi Aabia. Saudi Jounal of Obesity (2): p. 4. [19] Gatineau M, H. C., Holman N, Outhwaite H, Oldidge L, Chistie A, Ells L., Adult obesity and type 2 diabetes, S. M. Di Swanston, PHE Edito. 2014, Oxfod: Public Health England, [20] Abdullah, A., et al., The magnitude of association between oveweight and obesity and the isk of diabetes: a metaanalysis of pospective cohot studies. Diabetes Res Clin Pact, (3): p [21] Eckel, R. H., et al., Obesity and type 2 diabetes: what can be unified and what needs to be individualized? Diabetes Cae, (6): p [22] Al-Nozha, M., et al., Metabolic syndome in Saudi Aabia. Saudi Med J, (12): p netwok., N. c. i. i., Diabetes Pevalence Model fo Local Authoities and CCGs. Seconday National cadiovascula intelligence intelligence netwok. Diabetes Pevalence Model fo Local Authoities and CCGs. [23] Sevices., U. S. D. o. H. a. H., The Health Consequences of Smoking 50 Yeas of Pogess. A Repot of the Sugeon Geneal Executive Summay. Atlanta: Depatment of Health and Human Sevices, Centes fo Disease Contol and Pevention, National Cente fo Chonic Disease Pevention and Health Pomotion, Office on Smoking and Health, [24] Robets K, C. N., Hancock C, Hay Rutte, Social and economic inequalities in diet and physical activity. Oxfod: Public Health England Obesity Knowledge and Intelligence, [25] Willi, C., et al., Active smoking and the isk of type 2 diabetes: a systematic eview and meta-analysis. JAMA, (22): p [26] InteAct, C., et al., Physical activity educes the isk of incident type 2 diabetes in geneal and in abdominally lean and obese men and women: the EPIC-InteAct Study. Diabetologia, (7): p [27] Jeon, C. Y., et al., Physical activity of modeate intensity and isk of type 2 diabetes: a systematic eview. Diabetes Cae, (3): p [28] Guh, D. P., et al., The incidence of co-mobidities elated to obesity and oveweight: a systematic eview and metaanalysis. BMC Public Health, : p. 88. [29] Janusz Kaczoowski, C. R., Kaa Neenbeg, Development of the CANRISK questionnaie to sceen fo pediabetes and undiagnosed type 2 diabetes. CANADIAN JOURNAL OF DIABETES (4): p [30] Rowan, C. P., et al., Identifying pesons at isk fo developing type 2 diabetes in a concentated population of high isk ethnicities in Canada using a isk assessment questionnaie and point-of-cae capillay blood HbA1c measuement. BMC Public Health, : p. 929.