Regional variation in prevalence of overweight and obesity in Saudi children and adolescents

There are limited data on regional variation of overweight and obesity in the Kingdom of Saudi Arabia. Therefore, the aim of this report is to explore the magnitude of these variation in order to focus preventive programs to regional needs. Community-based multistage random sample of representative cohort from each region. the study sample was cross-sectional, representative of healthy children and adolescents from 2 to 17 years of age. Body mass index [BMI] was calculated according to the formula [weight/height[2]. The 2000 center for disease control reference was used for the calculation of prevalence of overweight and obesity defined as the proportion of children and adolescents whose BMI for age was above 85[th] and 95[th] percentiles respectively, for Northern, Southwestern and Central regions of the Kingdom. Chi-square test was used to assess the difference in prevalence between regions and a P value of <0.05 was considered significant. The sample size was 3525,3413 and 4174 from 2-17 years of age in the Central, Southwestern and Northern regions respectively. The overall prevalence of overweight was 21%, 13.4% and 20.1%, that of obesity was 9.3%, 6% and 9.1% in the Central, Southwestern and Northern regions respectively indicating a significantly-lower prevalence in the Southwestern compared to other regions [P<0.0001]. This report revealed significant regional variations important to consider in planning preventive and therapeutic programs tailored to the needs of each region

Prevalence of short stature in Saudi children and adolescents

Data on stature in Saudi children and adolescents are limited. The objective of this report was to establish the national prevalence of short stature in Saudi children and adolescents. Community-based, cross-sectional study conducted over 2 years [2004, 2005] The national data set of the Saudi reference was used to calculate the stature for age for children and adolescents 5 to 18 years of age. Using the 2007 World Health Organization [WHO] reference, the prevalence of moderate and severe short stature was defined as the proportion of children whose standard deviation score for stature for age was less than -2 and -3, respectively. In addition, the 2000 Center for Disease Control [CDC] and the older 1978 National Center for Health Statistics [NCHS]TWHO references were used for comparison. Using the 2007 WHO reference, sample size in the Saudi reference was 19372 healthy children and adolescents 5 to 1 7 years of age, with 50.8% being boys. The overall prevalence of moderate and severe short stature in boys was 11.3% and 1.8%, respectively; and in girls, 10.5% and 1.2%, respectively. The prevalence of moderate short stature was 12.1%, 11% and 11.3% in boys and 10.9%, 11.3% and 10.5% in girls when the 1978 WHO, the 2000 CDC and the 2007 WHO references were used, respectively. The national prevalence of short stature in Saudi children and adolescents is intermediate compared with the international level. Improvement in the socioeconomic and health status of children and adolescents should lead to a reduction in the prevalence of short stature

Effects of education of the head of the household on the prevalence of malnutrition in children

To explore the effect of the educational level of the head of household on the prevalence of malnutrition in Saudi children. The study was conducted over 2 years in 2004 and 2005 in all regions of the Kingdom of Saudi Arabia [KSA]. The design consisted of a stratified multistage probability random sampling of the population of the KSA. The educational level of the heads of the household, and measurements of weight and height of the children were obtained during house visits. Nutritional indicators in the form of weight for age, height for age, and weight for height for children below 5 years of age were determined, and the prevalence of each indicator below -2 standard deviations [SD] was calculated for each level of education. The sample size was 7390 in the weight for age, 7275 height for age, and 7335 for weight for height. The prevalence of underweight [weight for age below -2 SD] increased from 7.4% for the university level to 15.2% in the children of illiterate heads of household. Similar patterns were found for the prevalence of stunting [height for age below -2 SD] and wasting [weight for height below -2 SD]. This study demonstrates that the higher the education level of the heads of the household, the lower the prevalence of malnutrition in their children, suggesting that completing at least 9-12 years of education [intermediate and secondary school] is needed for better improvement in the nutritional status of the children

Regional disparity in prevalence of malnutrition in Saudi children

To evaluate the regional difference in the prevalence of malnutrition in Saudi children. Data for this study were collected over 2 years [2004 and 2005]. A cross-sectional representative sample of the Saudi population of healthy children below 5 years of age was used to calculate the prevalence of malnutrition. The study was carried out in the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. Body measurements of the weight, length, and height were performed according to standard recommendations. Standard deviation scores were determined using the Lambda, Mu, and Sigma [LMS] statistical methodology. The 1978 NCHS/WHO growth reference was used for the calculation of prevalence of underweight, wasting, and stunting defined as the proportion of children whose weight for age, weight for height, and height for age was below minus standard deviation [-2 SD] for Northern, Southwestern, and Central regions of the Kingdom of Saudi Arabia. Chi-square test was used to assess the difference in prevalence between regions, and a p<0.05 was considered significant. The sample size of children <5 years of age in Central region was 5067, Southwestern 2285, and Northern 2933. The prevalence of underweight was 4%, 19.7% and 5.5%, that of wasting was 6.5%, 16.7% and 6.5% and of stunting was 6.4%, 13.2% and 6.4% in the Central, Southwestern, and Northern regions indicating a significantly-higher prevalence in Southwestern compared to other regions [p<0.001]. This report revealed a high prevalence of significant nutritional indicators in the Southwestern regions than in other regions. This finding indicates that this region should be given priority for further studies to identify causes, and to design health promotion programs

Prevalence of overweight and obesity in Saudi children and adolescents

There is limited information on overweight and obesity in Saudi children and adolescents. The objective of this study was to establish the national prevalence of overweight and obesity in Saudi children and adolescents. The 2005 Saudi reference data set was used to calculate the body mass index [BMI] for children aged 5 to 18 years. Using the 2007 WHO reference, the prevalence of overweight, obesity and severe obesity were defined as the proportion of children with a BMI standard deviation score more than +1, +2 and +3, respectively. The 2000 CDC reference was also used for comparison. There were 19317 healthy children and adolescents from 5 to 18 years of age, 50.8% of whom were boys. The overall prevalence of overweight, obesity and severe obesity in all age groups was 23.1%, 9.3% and 2%, respectively. A significantly lower prevalence of overweight [23.8 vs 20.4; P<.001] and obesity [9.5 vs 5.7; P<.001] was found when the CDC reference was used. This report establishes baseline national prevalence rates for overweight, obesity and severe obesity in Saudi children and adolescents, indicating intermediate levels between developing and industrialized countries. Measures should be implemented to prevent further increases in the numbers of overweight school-age children and adolescents and the associated health hazards

Prevalence of malnutrition in Saudi children: a community-based study

There is no published information on the prevalence of malnutrition in Saudi Arabia. The objective of this study was to establish the prevalence data. The prevalence of nutritional indicators in the form of underweight, stunting, and wasting in a national sample of children younger than 5 years of age was calculated using the new WHO standards as reference. Calculations were performed using the corresponding WHO software. The prevalence of moderate and severe underweight, wasting and stunting, was defined as the proportion of children whose weight for age, weight for height, and height for age were below-2 and-3 standard deviation scores, respectively. The number of children younger than 5 years of age was 15 516 and 50.5% were boys. The prevalence of moderate and severe underweight was 6.9% and 1.3%, respectively. The prevalence of moderate and severe wasting was 9.8% and 2.9%, respectively. Finally, the prevalence of moderate and severe stunting was 10.9% and 2.8%, respectively. The prevalence was lower in girls for all indicators. Comparison of the prevalence of nutritional indicators in selected countries demonstrates large disparity with an intermediate position for Saudi Arabia. This report establishes the national prevalence of malnutrition among Saudi children. Compared to data from other countries, these prevalence rates are still higher than other countries with less economic resources, indicating that more efforts are needed to improve the nutritional status of children

Body mass index in Saudi Arabian children and adolescents: a national reference and comparison with international standards

Because there are no reference standards for body mass index [BMI] in Saudi children, we established BMI reference percentiles for normal Saudi Arabian children and adolescents and compared them with international standards. Data from a stratified mutltistage probability sample were collected from the 13 health regions in Saudi Arabia, as part of a nationwide health profile survey of Saudi Arabian children and adolescents conducted to establish normal physical growth references. Selected households were visited by a trained team. Weight and length/height were measured and recorded following the WHO recommended procedures using the same equipment, which were subjected to both calibration and intra/interobserver variations. Survey of 11 874 eligible households yielded 35 275 full-term and healthy children and adolescents who were subjected to anthropometric measurements. Four BMI curves were produced, from birth to 36 months and 2 to 19 years for girls and boys. The 3[rd], 5[th], 10[th], 25[th], 50[th], 75[th], 85[th], 90[th], 95[th], and 97[th] percentiles were produced and compared with the WHO and CDC BMI charts. In the higher percentiles, the Saudi children differed from Western counterparts, indicating that Saudi children have equal or higher BMIs. The BMI curves reflect statistically representative BMI values for Saudi Arabian children and adolescents

Age related reference ranges of heart rate for Saudi children and adolescents

To evaluate the resting heart rate to define reference values for healthy Saudi children and adolescents. To establish representative heart rate [HR] reference values for Saudi Arabian children and adolescents, a sample of children, and adolescents was selected by multi-stage probability sampling of the Saudi population from birth to 20 years of age. The selected sample represents Saudi children from the whole country. Data were collected by a house-to-house survey of all selected households in all the 13 regions in the country. A total of 10,458 Saudi children were included in the study. The HR was measured by oscillometric-automated devices. Upper and lower reference values of the HR in boys and girls were calculated as mean +/- 2 SD. The study is cross-sectional, community based, and conducted over 2 years [2004-2005]. Data management and analysis were performed in the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. Determination of the HR values in a sample representing healthy Saudi children and adolescents from birth to 20 years of age. The present study provides age-specific reference values for heart rate [HR] of Saudi children and adolescents based on a large study sample. The use of these standards should aid the identification of children with abnormal HR

Blood pressure standards for Saudi children and adolescents

Blood pressure levels may vary in children because of genetic, ethnic and socioeconomic factors. To date, there have been no large national studies in Saudi Arabia on blood pressure in children.Therefore, we sought to establish representative blood pressure reference centiles for Saudi Arabian children and adolescents. We selected a sample of children and adolescents aged from birth to 18 years by multi-stage probability sampling of the Saudi population. The selected sample represented Saudi children from the whole country. Data were collected through a house-to-house survey of all selected households in all 13 regions in the country. Data were analyzed to study the distribution pattern of systolic [SBP] and diastolic blood pressure [DBP] and to develop reference values. The 90th percentile of SBP and DBP values for each age were compared with values from a Turkish and an American study. A total of 16 226 Saudi children and adolescents from birth to 18 years were studied. Blood pressure rose steadily with age in both boys and girls. The average annual increase in SBP was 1.66 mm Hg for boys and 1.44 mm Hg for girls. The average annual increase in DBP was 0.83 mm Hg for boys and 0.77 mm Hg for girls. DBP rose sharply in boys at the age of 18 years. Values for the 90th percentile of both SBP and DBP varied in Saudi children from their Turkish and American counterparts for all age groups. Blood pressure values in this study differed from those from other studies in developing countries and in the United States, indicating that comparison across studies is difficult and from that every population should use their own normal standards to define measured blood pressure levels in children

Consanguinity and major genetic disorders in Saudi children: a community-based cross-sectional study

There is a high rate of consanguinity in Saudi Arabia; however, information on its relationship with genetic disorders is limited. The objective of this cross-sectional study was to explore the role of consanguinity in genetic disorders. The study sample was determined by a multistage probability random sampling procedure. Consanguinity status was obtained during household visits. Primary care physicians performed a history and physical examination of all children and adolescents younger than 19 years, and all cases of genetic diseases were recorded. The chi-square test was used to compare proportions. During the two-year study period [2004-2005], 11 554 of 11 874 [97%] mothers answered the question on consanguinity, and 6470 of 11 554 [56%] were consanguineous. There was no significant association between first-cousin consanguinity and Down syndrome [P=.55]. Similarly, there was no significant association with either sickle cell disease [P=.97] or glucose-6-phosphate dehydrogenase deficiency [P=.67] for first-cous-in consanguinity. A borderline statistical significance was found for major congenital malformations [P=.05]. However, the most significant association with first-cousin consanguinity was congenital heart disease [CHD] [P=.01]. Finally, no significant association was found for type 1 diabetes mellitus [P=.92]. For all types of con-sanguinity, similar trends of association were found, with a definite statistically significant association only with CHD [P=.003]. The data suggest a significant role of parental consanguinity in CHD. However, a relationship between consanguinity and other genetic diseases could not be established. The effect of consanguinity on genetic diseases is not uniform and this should be taken into consideration in genetic counseling

prevalence of sickle cell disease in Saudi children and adolescents. A community-based survey

To determine the prevalence and regional distribution of sickle cell disease in Saudi children. A sample size of 45,682 children and adolescents from newborn to 19 years of age was selected by multistage random probability sampling of the Saudi households from each of the 13 regions of the country. The study is cross-sectional, community based, and conducted over 2 years from 2004 to 2005. Data, including history and clinical examination were collected with house-to-house survey of all selected households. Data management and analysis was carried out at King Saud University, Riyadh, Saudi Arabia. Sickle cell disease was detected in 108 of 45,682 children and adolescents with a prevalence of 24 per 10,000. The regional distribution of sickle cell disease showed eastern region dominance with a prevalence of 145 per 10,000, followed by the southern region with a prevalence of 24 per 10,000, western region 12 per 10,000, and central region with 6 per 10,000. No cases were found in the northern regions. The male to female ratio was approximately 1:1. The results of this national wide community-based survey show a high prevalence of sickle cell disease in the community and the disease is more common in eastern and southern regions of the country. National or regional newborn screening programs for sickle cell disease using hematological tests should be planed. This study shows that the population at risk has an uneven geographical distribution. For this reason, selective rather than universal neonatal screening is likely to be more appropriate in the country

Prevalence of type 1 diabetes mellitus in Saudi Arabian children and adolescents

To determine the prevalence of type 1 diabetes mellitus among 0-19 years old Saudi children and adolescents. A nationwide Saudi Arabian project was conducted in the years 2001-2007 with the objective of establishing national growth charts, and defining the prevalence of some chronic childhood diseases such as diabetes mellitus. The 14,000 households were randomly selected based on a recent population statistic. The questionnaire used included demographic data and evidence of diabetes mellitus. The prevalence was estimated and expressed per 100,000. Breakdown of this figure per age and region was carried out. In the 11,874 out of the 14,000 84.9% selected households, 45,682 children and adolescents were surveyed. Fifty children and adolescents were identified to have type 1 diabetes mellitus with a prevalence rate of 109.5 per 100,000. The male to female ratio was almost equal [26 males and 24 females]. The distribution of prevalence of type 1 diabetes mellitus by region shows that the highest was 162 in the central region, and the lowest was 48 in the eastern region. Children and adolescents were also grouped by age into 5-6 [prevalence 100], 7-12 [prevalence 109], 13-16 [prevalence 243], and 17-18 [prevalence 150]. We conclude that the prevalence of type 1 diabetes mellitus in Saudi Arabian children and adolescents is 109.5 per 100,000

Comparison of the 2005 growth charts for Saudi children and adolescents to the 2000 CDC growth charts

The 2000 CDC growth charts for the United States, a revision of the National Center for Health Statistics/World Health Organization [NCHS/WHO] growth charts, were released in 2002 to replace the NCHS/WHO charts. We evaluated the differences between the CDC growth charts and the Saudi 2005 reference to determine the implications of using the 2000 CDC growth charts in Saudi children and adollescents. The Saudi reference was based on a cross-sectional representative sample of the Saudi population of healthy children and adolescents from birth to 19 years of age. Measurements of the length/ stature, weight and head circumference were performed according to expert recommendations. The CDC charts from birth to 20 years were based on a cross-sectional representative national sample from five sources collected between 1963 and 1994. The data from the CDC study including the 3rd, 5th, 50th, 95th, and 97th percentiles were plotted against the corresponding percentiles on the Saudi charts for the weight for age, height for age, weight for height for children from 0 to 36 months and weight for age, stature for age and body mass index for children 2 to 19 years of age. There were major differences between the two growth charts. The main findings were the upward shift of the lower percentiles of the CDC curves and the overlap or downward shift of the upper percentiles, especially for weight, weight for height, and BMI. The use of the 2000 CDC growth charts for Saudi children and adolescents increases the prevalence of undernutrition, stunting, and wasting, potentially leading to unnecessary referrals, investigations and parrental anxiety. The increased prevalence of overweight and obesity is alarming and needs further investigation

Childhood obesity: referred cases to a tertiary health center in riyad, Saudi Arabia

To show the pattern of etiology of childhood obesity referred to our endocrinology clinic between December 1989 and December 1994. Subject and All the children referred to our clinic at the above stipulated dates were studied. This is a retrospective medical records review of these patients. The patient's height and weight were measured by trained staff of the clinic. The Quetelet index also known as Body Mass Index [BMI] was calculated as weight [kg]/ height [m]2 for each patient. Laboratory data as well as results of clinical investigations were also obtained from the records of the patients. 52 patients with ages ranging between 2 years and 16 years [median 8 years] were studied. Male: female ratio was 1:1.35 [67.3%] of the patients were Saudis while 17 [32.7%] were non-Saudis. The etiology of obesity among the series were nutritional 46 [88.5%], Prader-Willi Syndrome 3 [5.8%], Laurence-Moon-Biedl Syndrome that the majority of the patients had simple nutritional obesity

Criteria for diagnosis of growth hormone deficiency: does it exist?

Exploration of the criteria for diagnosing hormone deficiency used by physicians practicing in SaudiArabia. A questionnaire addressing the issue of criteria for diagnosing growth hormone deficiency was distributed to 104 physicians practicing in Saudi Arabia who were attending a course in endocrinology. Analysis of the data received from 48 physicians was carried out. Only one criteria from 10 clinical and biochemical criteria was chosen by 2 [4%], 2 by 9 [19%], 3 by 8 [17%], 4 by 15 [31%], 5 by 9 [19%], 6 by 2 [4%] and 7 by 3 [6%] physicians. The majority, 31 [65%] chose subnormal growth velocity as an important criteria. Twenty-four [50%] chose the subnormal physiological growth hormone values taken during sleep or after vigorous exercise, 26 [54%] chose the 2 provocative pharmacological tests, and 18 [37.5%] and 9 [19%] chose one and 3 pharmacological tests. Subnormal random single growth hormone measurement was chosen by 8 [17%] physicians. Low somatomedin C [IgFl] and subnormal IgFl binding proteins were the choice of 18 [37.5%] and 4 [8%]. Favorable biochemical response to growth hormone was the choice of 16 [33%]. When the choices were combined only 3 [6%] physicians took the most likely correct combination choice ie subnormal growth velocity, delayed bone age coupled with subnormal growth hormone values taken during sleep or exercise, and 2 provocative pharmacological tests. Definite diagnostic criteria for growth hormone deficiency is lacking in this country. A nationwide criteria, and subsequent central control of growth hormone is required

Sex reassignment: a challenging problem-current medical and Islamic guide lines

Sexual ambiguity is a complex and often confusing medical problem. In addition to the life-threatening adrenal crises which may accompany some forms, ambiguity of the genitalia may lead to incorrect sex assignment by parents and/or health personnel. Children who present to medical attention beyond the neonatal period constitute a challenging problem due to the grave consequences of this condition. Thirty cases in whom sex reassignment was indicated were seen at King Khalid University Hospital, Riyadh, over a 10-year period. Of these, 27 [90%] were genetic females [20 were 21- and seven were 11-hydroxylase deficient] and three [10%] were genetic males [two partial androgen insensitive and one 5 alpha-reductase deficient]. All genetic males who were incorrectly assigned as females accepted reassignment. But 9 out of 27 [33%] of the genetic females who were incorrectly assigned as males refused reassignment. Preference for male sex assignment, delayed diagnosis and sociocultural circumstances seem to be the contributing factors for refusal. A national consensus about this important issue strengthened by the existing religious recommendations is demanded