An alarmingly high and increasing prevalence of obesity in Jordan / 한국역학회지

OBJECTIVES@#The aim of this study was to determine the prevalence of obesity in Jordan, to assess related trends, and to determine associated factors and comorbidities. @*METHODS@#A multipurpose national household survey of Jordanian adults was conducted over a 4-month period in 2017. Data were collected using a structured validated questionnaire. Anthropometric measurements including waist circumference (WC; measured midway between the iliac crest and the lower rib margin), body mass index (BMI), hip circumference, waist-to-hip ratio, and waist-to-height ratio were obtained to categorize participants with regard to overweight and obesity. @*RESULTS@#This study included 4,056 persons (1,193 men and 2,863 women) aged 18 years to 90 years (mean±standard deviation, 43.8±14.2 years). According to the International Diabetes Federation WC criteria, the age-standardized prevalence of obesity was 60.4% among men and 75.6% among women, while approximately three-quarters of men and women were overweight or obese as defined by BMI. The age-adjusted odds of obesity in 2017 were approximately twice those in 2009 in men (odds ratio [OR], 1.98) and women (OR, 1.96). In the multivariate analysis, age, region of residence, and marital status were significantly associated with obesity in both genders. Obesity was significantly associated with increased odds of diabetes mellitus, hypertension, elevated triglycerides, and low high-density lipoprotein cholesterol after adjusting for age. @*CONCLUSIONS@#The rate of obesity in Jordan is high and increasing, and obesity is associated with other metabolic abnormalities. Well-defined programs to control and prevent obesity, as well as intersectoral action, are urgently required to reverse current trends.

An alarmingly high and increasing prevalence of obesity in Jordan / 한국역학회지

OBJECTIVES@#The aim of this study was to determine the prevalence of obesity in Jordan, to assess related trends, and to determine associated factors and comorbidities. @*METHODS@#A multipurpose national household survey of Jordanian adults was conducted over a 4-month period in 2017. Data were collected using a structured validated questionnaire. Anthropometric measurements including waist circumference (WC; measured midway between the iliac crest and the lower rib margin), body mass index (BMI), hip circumference, waist-to-hip ratio, and waist-to-height ratio were obtained to categorize participants with regard to overweight and obesity. @*RESULTS@#This study included 4,056 persons (1,193 men and 2,863 women) aged 18 years to 90 years (mean±standard deviation, 43.8±14.2 years). According to the International Diabetes Federation WC criteria, the age-standardized prevalence of obesity was 60.4% among men and 75.6% among women, while approximately three-quarters of men and women were overweight or obese as defined by BMI. The age-adjusted odds of obesity in 2017 were approximately twice those in 2009 in men (odds ratio [OR], 1.98) and women (OR, 1.96). In the multivariate analysis, age, region of residence, and marital status were significantly associated with obesity in both genders. Obesity was significantly associated with increased odds of diabetes mellitus, hypertension, elevated triglycerides, and low high-density lipoprotein cholesterol after adjusting for age. @*CONCLUSIONS@#The rate of obesity in Jordan is high and increasing, and obesity is associated with other metabolic abnormalities. Well-defined programs to control and prevent obesity, as well as intersectoral action, are urgently required to reverse current trends.

prevalence and determinants of anaemia in Jordan

Background: Anaemia is a global public health problem particularly in low- and middle-income countries and may be associated with serious health consequences. Limited studies, if any, have examined the prevalence and risk factors of anaemia in Jordan at the national level.

Aims: This study aimed to assess the prevalence of anaemia in Jordan for both sexes at the national level and to identify high-risk population subgroups.

Methods: A national population-based household sample was selected from the 12 governorates of Jordan in 2017. A total of 1125 males and 2797 females aged between 18 and 90 years were included. The prevalence of anaemia, overall and among subgroups of the population was estimated using Hb level as per WHO definition.

Results: Results showed prevalence of anaemia to be 4.9% in males, 19.3% in non-pregnant females, and 27.4% in pregnant females. The age standardized prevalence rates were 4.9% in males and 19.3% in females. The age standardized prevalence rates were 4.9% in males and 19.3% in females. Anaemia was predominantly mild (males: 81%, non-pregnant females: 57%, and pregnant females: 65.2%). Sex, age, region, marital status, and education were significantly associated with anaemia. Iron deficiency anaemia (IDA) accounted for 68% of anaemic females and 38% of anaemic males.

Conclusions: The prevalence of anaemia in Jordan is lower than previously reported by WHO and the majority of anaemia was mild. Iron deficiency anaemia was the the most common type of anaemia, particularly in females. Flour fortification with iron and folic acid could have accounted for the decline of anaemia in Jordan

Congenital bilateral anorchia: a study of 5 cases in Jordan

We report the clinical and hormonal findings in 5 cases of bilateral anorchism. Five male patients aged 3-5 years presented with suspected cryptorchidism. Physical examination, hormonal, imaging, chromosomal, and molecular analyses of these cases were performed. Ultrasonography of the pelvis and magnetic resonance of the abdomen were performed and failed to show any true testicular tissue or showed only atrophied suspicious testicular tissue. Chromosomal analysis revealed a normal male karyotype and molecular analysis did not reveal mutations or polymorphisms in the SRY gene. The basal FSH and LH levels were increased, and there were increase in response to gonadotropin-releasing hormone test, testosterone levels failed to increase after hCG administration. Lastly, surgical exploration confirmed the absence of testicular structure in three of them. Diagnostically, the very low anti Mullerian hormone level combined with the lack of testosterone response to hCG are the hormonal hallmarks of bilateral congenital anorchia

Vitamin D status in type 2 diabetic and pre-diabetic patients

To assess the serum vitamin D level in type 2 diabetic and pre-diabetic patients. A Cross-Sectional Study. National Center for Diabetes Endocrinology and Genetics [NCDEG], Jordan. All type 2 DM and pre-diabetes patients were eligible for inclusion in this study. The study was conducted from 1 October 2011 to 31 January 2012. The total sample size was 1,181 patients. Six hundred eighty-one patients had type 2 diabetes and 500 had pre-diabetes. Medical records and direct interview by the investigator or his colleagues were the sources of data. Three thousand seven subjects aged 13 years and above were selected as a control group from the data of the National Study of Vitamin D and B12, which was conducted in Jordan in 2009. The mean age was 53 [ +/- 10] years. Seven hundred fifty-eight [64.2%] were females, 681 [57.7%] were type 2 diabetic and 500 [42.3%] were pre-diabetic. Low serum vitamin D level [vitamin D and B12, which was conducted in Jordan in 2009. The mean age was 53 [ +/- 10] years. Seven hundred fifty-eight [64.2%] were females, 681 [57.7%] were type 2 diabetic and 500 [42.3%] were pre-diabetic. Low serum vitamin D level [vitamin D level were lack of sun exposure and milk consumption. Low serum vitamin D level is highly prevalent among type 2 diabetes and pre-diabetes subjects. The two most important risk factors for low serum vitamin D level were lack of sun exposure and low milk consumption

Maternal and fetal outcomes in diabetic pregnant women

To assess maternal and fetal outcomes in Jordanian women with known Diabetes Mellitus or Gestational Diabetes. A retrospective medical record review was conducted on 234 pregnant women who were followed at the National Center for Diabetes Endocrinology and Genetics and Gynecological Department in Jordan University Hospital between 2004 and 2009. A total of 148 subjects had Gestational Diabetes Mellitus and 86 had known diabetes mellitus [Type 1 = 28, Type 2 = 58]. Caesarean section was more frequent in Gestational Diabetes Mellitus subjects than in Diabetes Mellitus group [47.3% vs. 44.2%]. The frequency of pre-term delivery tends to be higher in Diabetes Mellitus group than Gestational Diabetes Mellitus group [9.3% vs. 8.1%]. Abortion was more common in Diabetes Mellitus group than Gestational Diabetes Mellitus group [11.6% vs.4%]. Macrosomia, hypoglycemia, hypocalcaemia, polycythemia and congenital malformation were more common in Diabetes Mellitus group than Gestational Diabetes Mellitus group. The results showed that Diabetes Mellitus group witnessed more abortion and pre-term delivery compared to Gestational Diabetes Mellitus groups. The caesarean section was higher in Gestational Diabetes Mellitus compared to Diabetes Mellitus group. Gestational Diabetes Mellitus group had better fetal outcome than the Diabetes Mellitus group, indicating that Diabetes Mellitus [type 1, type 2] in pregnancy is a serious condition.

Prevalence of low testosterone levels in men with type 2 diabetes mellitus: a cross-sectional study

A high prevalence of low serum testosterone [LST] in men with type 2 diabetes have been reported worldwide. The aim of this study was to determine the prevalence and associated factors of LST in men with type 2 diabetes. This was a cross-sectional study, conducted among 1,089 men [aged 30-70 years] with type 2 diabetes who consecutively attended a major diabetes center in Amman, Jordan, between August 2008 and February 2009. The patients' demographic characteristics were collected using a prestructured questionnaire. Duration of diabetes, smoking habits, presence of retinopathy, neuropathy, and nephropathy were collected from the medical records. All participants were asked to complete the Androgen Deficiency in Ageing Male [ADAM] questionnaire. Venous blood sample was collected to test for total testosterone [TT], free testosterone [FT], sex hormone binding globulin [SHBG], follicle-stimulating hormone [FSH], luteinizing hormone [LH], prolactin [PRL], serum lipids, and glycosylated hemoglobin [HbA1c]. LST was defined as TT <3 ng/ml. Overall, 36.5% of patients with diabetes had TT level <3 ng/ml and 29% had symptoms of androgen deficiency. Of those with serum testosterone level <3 ng/ml, 80.2% had symptoms of androgen deficiency, 16.9% had primary hypogonadism [HG], and 83.1% had secondary HG. Univariate analysis showed a significant relationship between age, income, education, body mass index [BMI], smoking, duration of diabetes, diabetic nephropathy, diabetic neuropathy, and HbA1c. Multivariate logistic regression analysis indicated age, income, BMI, and diabetic neuropathy as the independent risk factors of LST. The prevalence of LST among men with type 2 diabetes is high. Age, income, BMI, and diabetic neuropathy were found to be the independent risk factors for LST

Relationship between 25-hydroxyvitamin D and metabolic syndrome among Jordanian adults

Evidence of the association between 25-hydroxyvitamin D (25(OH)D) and metabolic syndrome (MeS) remains uncertain and incongruent. This study aimed to determine the association between 25(OH)D and MeS among Jordanian adults. A complex multistage sampling technique was used to select a national population-based household sample. The present report deals exclusively with adults aged > 18 years who had complete information on all components of MeS (n = 3,234). A structured questionnaire was used to collect all relevant information. Anthropometric, clinical, and laboratory measurements were obtained. MeS was defined according to the International Diabetes Federation (IDF) definition. Of the total, 42.0% had MeS and 31.7% had 25(OH)D < 30 ng/ml. In a stratified analysis, the prevalence of MeS did not differ significantly between subjects with low and normal 25(OH)D levels for men and women in all age groups. In the multivariate analysis, the odds of MeS were not significantly different between subjects with low and normal 25(OH)D levels (OR = 0.85, 95% CI: 0.70, 1.05, P-value = 0.133). The association between 25(OH)D and MeS remained non-significant when 25(OH)D was analyzed as a continuous variable (OR = 1.004, 95% CI; 1.000, 1.008, P = 0.057) and when analyzed based on quartiles. None of the individual components of MeS were significantly associated with 25(OH)D level. This study does not provide evidence to support the association between 25(OH)D level and MeS or its individual components. Prospective studies are necessary to better determine the roles of 25(OH)D levels in the etiology of MeS.

Prevalence of elevated hepatic transaminases among Jordanian patients with type 2 diabetes mellitus

Since the extent of elevation of liver transaminases in type 2 diabetics in Jordan and most of the Middle East is unknown, we estimated the prevalence of elevated liver transaminase levels among patients with type 2 diabetes and determined associated risk factors. This study was performed on 1014 consecutive type 2 diabetic outpatients who attended the National Center for Diabetes, Endocrinology and Genetics in Amman, Jordan. The patients' age ranged between 26-85 years with a mean age of 56.8 [+9.8]. Three- hundred and fifty three [54.5%] were males with a median age of 58 years [ranging between 26-82 years], and four hundred and sixty one [45.5%] were females with a median age of 57 years [ranging between 28-85 years]. Body mass index, waist circumference, lipid profile, and hepatic transaminase levels were recorded. Ultraonography was performed in those with elevated alanine transaminase levels. Overall, the prevalence of elevated alanine transaminase [ALT] level was 10.4% [n=105] with the gender-wise prevalence being 12.8% [n=71] in men and 7.4% [n=34] in women. The prevalence of elevated aspartate transaminase [AST] levels was 5.4% [n=56] with the gender-wise prevalence being 5.6% [n=31] in men and 5.4% [n=25] in women. Only 4.5% [n=44] showed elevated levels of both ALT and AST. Male gender [OR=2.35, Cl: 1.5-3.8] and high waist circumference [OR=1.9, Cl: 1.2-3.2] were associated with increased risk of elevated ALT levels. Younger patients had a higher tendency to have elevated ALT compared to those over 65 years [OR=12.4 for patients aged 25-45years, and OR=5.8 for those who were 45-65 years old]. Non-insulin use was associated with a high odds ratio for elevated ALT levels [OR=1.7, Cl: 1.1 -2.9]. Elevated ALT and AST levels are found in 10.4% and 5.4% of our type 2 diabetic patients respectively. Male gender, younger age, higher waist circumference; as an indicator of central obesity, as well as non insulin use are independent predictors of elevated liver transaminase levels

Insulin- like growth factors I- II

IGF-1 that is generated in the liver is the anabolic effector and linear growth promoting hormone of the pituitary Growth Hormone [GH]. In the tissues, IGFs are important regulators of cell survival, growth, metabolism and differentiated functions. Prospective studies suggest that individuals with circulating levels of Insulin- like Growth Factor 1 [IGF-1] at the high end of the normal range are exposed to increased risk for several common cancers. This has led to the development of novel IGF- I receptor targeting therapies which have impressive antineoplastic activity in experimental system. This review article will focus on the biology of IGF-1 and its role in health and malignant states

Coronary heart disease and post menopausal hormone replacement therapy - revisited

Until recently hormone replacement therapy [HRT] was recommended as a secondary prevention treatment for coronary heart disease [CHD] in post menopausal women. This recommendation was based on observational studies, showing some beneficial effects that were possibly due to enrollment bias, where users had a better CHD profile. Randomized controlled trials were needed to provide objective data on this issue. Now we have the results of three randomized trials addressing the relation of HRT and CHD in post menopausal women, two of them are secondary prevention and one is a primary prevention trial. In this review, analysis of the three studies will be provided and the recommendations will be presented

Glucoregulation of prolactin secretion

In order to assess the influence of glucose on prolactin secretion and differences in prolactin responses between diabetic and normal subjects, we studied a total of 18 normal and 13 stable insulin-dependent diabetic subjects. All were males and within 10% of ideal body weight. Seven of the normal subjects underwent standard insulin-induced hypoglycemia, with a significant [P < 0.01] prolactin response to this stimulus. Six each of the normal and diabetic groups underwent five hour oral glucose tolerance tests. No change in prolactin levels was noted in the diabetic group, but the normal group had a suppression in prolactin levels significantly below baseline [P < 0.001] and significantly different from the diabetic group [P < 0.01]. Seven of the normal and eight of the diabetic group received L-Dopa, 500 mg orally, with a resultant significant suppression of prolactin in each group [P< 0.01], while no difference was noted between the groups. These results suggest that hypoglycemia stimulates prolactin release and hyperglycemia inhibits prolactin release in normal subjects, while the latter response is absent in the diabetic. L-Dopa-induced suppression obtained in both the normal and diabetic group, suggests that this presumed hypothalamic derived prolactin suppressing mechanism is intact in the diabetic. Possible mechanisms for the absent glucose suppression of prolactin in diabetics are discussed. The effects of gestation and suckling on prolactin secretion, as well as the lactogenic properties of prolactin, are well established in the human[1,2]. In addition, an osmoregulatory function of prolactin exists in lower animals[3], and recent reports have suggested that changes in plasma osmolarity modulate prolactin secretion in man[4] and prolactin has been shown to alter water and electrolyte metabolism in man[5]. A glucoregulatory function for prolactin has not been explored, and the effect of glucose on prolactin secretion is not clear. Furthermore, the dynamics of prolactin secretion in diabetics has not been investigated. It is the purpose of this communication to report a series of studies designed to assess the effect of glucose on prolactin secretion and to compare prolactin responses in normal and diabetic subjects

Treatment of insulin resistance with monocomponent insulin

The case is presented of a 45-year-old diabetic female with insulin resistance. In spite of the administration of more than 1,000 units of lente insulin in addition to corticosteroids, the patient's blood sugar reached 1,000 mg%. The use of 200 units of monocomponent insulin initially, and 100 units later, was enough to control her blood sugar. The use of monocomponent insulin is suggested for the therapy of insulin resistance. Since diabetics have been treated with insulin their mortality has decreased remarkably. However, insulin therapy has brought with it some new aspects of morbidity which were not originally related to the disease but rather to insulin therapy itself[1]. Besides the known hypoglycemic action of the hormone, local and systematic allergic manifestations were reported from the early years of its use. Lipodystrophy was later added as another side effect. Insulin resistance was subsequently reported and immunogenic processes were implicated. It was demonstrated that antibodies were produced and specific types could be correlated with distinct and sometimes difficult clinical situations such as resistance and allergy[2]. This was especially true when the purification of beef and pork insulin was very crude. With recent advances in purification, highly purified insulin has become available to aid in the treatment of diabetics who develop these potentially dangerous complications. This paper reports on a case of insulin resistance that was treated with monocomponent insulin as an alternative to the conventional preparations