Psychological Wellbeing of Diabetic Individuals, Prediabetics, and Non-diabetics: A Population-Based Study in Saudi Arabia.

Background: The increased burden of diabetes affects the quality of life, including psychosocial problems. The study aims to compare the psychological well-being of individuals who are prediabetic, diabetic, or non-diabetic. Methods: A cross-sectional exploratory study was conducted from January to June 2016 (n = 1,019) in Al Kharj, Saudi Arabia. After consent and questionnaires were filled out, trained staff took blood samples followed by anthropometry. Chi-squared tests, one-way ANOVA, and multiple linear regression analyses were conducted to examine the association between diabetes classes defined by HbA1c cut-off levels set by the American Diabetes Association (three categories), individual items, and total score in general health questionnaire (GHQ). An ROC curve was plotted for the total GHQ-12 score against HbA1c. Findings: The mean GHQ score for psychological distress was significantly higher (F = 6.569, P = 0.038) in the diabetics (mean = 14.7) and the prediabetics (12.4) than in the non-diabetics (10.71). Four out of six positive GHQ items and three out of six negative GHQ items significantly differed among the three classes of diabetes. The adjusted multivariate analysis revealed that people with diabetes were most likely to report psychological distress compared to non-diabetics (unstandardized beta = 2.414; P = 0.037). The AUC examining the relationship between HBA1c and GHQ scores showed a moderate but statistically insignificant sensitivity/specificity of 0.643 (P = 0.23). Conclusion: This study demonstrates that psychological wellbeing is substantially poorer among diabetic or prediabetic individuals than non-diabetic individuals. Future longitudinal studies are required to examine a plausible causal relationship between diabetes/prediabetes and psychological distress.

Combined' Neck/Back Pain and Psychological Distress/Morbidity Among the Saudi Population: A Cross-Sectional Study.

Background: Psychological distress/morbidity is amongst the primary reason for the cause of pain at multiple sites, its progression, and recovery. Though still not very clear if physical pain in the neck or the back may predict psychological morbidities or not. Thus, we investigated the association between combined neck or back pain and psychological distress/morbidity. Methods: A cross-sectional study was conducted in Al-Kharj, Saudi Arabia, including 1,003 individuals. The questionnaire comprised of General Health Questionnaire-12 (GHQ-12) and some questions about neck and back pain. Data analysis was done using statistical software SPSS version 26.0. Results: The results of the multivariate analysis revealed a significant positive association between neck/back pain status and total GHQ score (unstandardized Beta = 2.442, P ≤ 0.0001). Having neck/back pain had almost a 2.5 times greater risk of psychological distress/morbidity. Further, females were more likely to have a higher risk of psychological distress/morbidity (unstandardized Beta = 1.334, P = 0.007) than males while adjusting for sociodemographic and clinical characteristics. Conclusion: The combination of neck and back pain was significantly associated with the Saudi population's psychological problems. Therefore, the Saudi government needs to devise high-risk strategies and allocate adequate resources to the cause so that at-risk people can be shielded from the adverse complications arising from this condition in the long run.

Association between prehypertension and psychological distress among adults in Saudi Arabia: A population-based survey.

BACKGROUND: Prehypertension is a precursor to hypertension status. Psychological distress has been identified earlier among hypertensives; however, there is little evidence for the presumptive relationship between prehypertension and psychological distress. OBJECTIVE: The study aimed to assess the psychological wellbeing of the Al-Kharj, Saudi Arabia population, using the General Health Questionnaire (GHQ-12) and correlating it with prehypertensive patients in the same population. METHODS: A cross-sectional analysis of the population of Al-Kharj, Saudi Arabia, was carried out between January and June of 2016. With an 85 percent response rate, a total of 1016 participants participated in the study. A multiple linear regression analysis was performed to assess the relationship between prehypertension and psychological distress. RESULTS: The findings of the adjusted analysis demonstrated that, on average prehypertensive patients were more distressed psychologically than non-hypertensive patients (unstandardized Beta regression coefficient = 3.600; P-value 0.025). Similarly, on average women were found to be more psychologically distressed than men (unstandardized Beta = 1.511, P-value 0.002). Civil workers and unemployed individuals were more psychologically distressed than employed individuals (unstandardized Beta = 1.326, P-value 0.041) while adjusting for the sociodemographic and other variables such as BMI, diabetes status, cholesterol, and smoking status. CONCLUSION: The current study shows that as compared to normotensive patients, self-rated mental wellbeing and psychological wellbeing are all considerably poorer among prehypertensive patients. To prevent individuals from having negative psychological outcomes and their long-term complications, the Government of Saudi Arabia needs to concentrate on prehypertensive, female, and unemployed individuals. Well-designed longitudinal studies, primarily in Saudi Arabia, are needed in the future to research the cause and impact of poor mental health and prehypertension.

The association between overweight/obesity and psychological distress: A population based cross-sectional study in Saudi Arabia.

OBJECTIVES: The objective of this study was to compare the association between mental well-being between obese (classes 1 and 2), over-weight and non-obese population-based individuals. METHODS: A population-based cross-sectional study was conducted in Al-Kharj, Saudi Arabia. A total of 1019 Saudi nationals aged ≥ 18 years participated in the survey. BMI scores were used to categorize participants into three groups: Obese, overweighted and non-obese/non-overweight. Mental well-being was evaluated by using the validated Arabic version of the General Health Questionnaire version 12 (GHQ-12). RESULTS: We used total GHQ score (Mean=12; SD=5.23) to compare mental well-being between the four BMI class categories. The overall one-way ANOVA model was statistically significant (F = 7.018, d = 6, P < 0.001). In multivariate analysis, after adjusting for sociodemographic variables, diabetes and smoking statuses we found that higher psychological distress (as evident by a higher total GHQ score) was associated with higher BMI. The unstandardized Beta regression coefficient = 2.627; P = 0.034). Females were more likely to have higher psychological distress than males (unstandardized Beta = 1.466, P = 0.003). Job status whether being unemployed or 'civilian' (civil worker) was significantly associated with higher psychological distress (unstandardized Beta = 1.405, P = 0.041). Being diabetic has a 1.6 times higher risk of psychological distress (unstandardized Beta = 1.604, P = 0.027). CONCLUSION: The study highlights the public health implications of psychological distress amongst individuals with overweight and obesity in Saudi Arabia. Future longitudinal studies should explore the temporality of this relationship.

The Prevalence of Headache and Associated Factors in Al-Kharj, Saudi Arabia: A Cross-Sectional Study.

Background: Only few studies have investigated the prevalence and risk factors of headaches among the Saudi population. The study aimed to estimate the prevalence of headache and to explore its associated risk factors Al-Kharj, Saudi Arabia. Methods: The multistage sampling technique was used to enroll 1200 population-based participants who were asked to complete a self-administered questionnaire about headaches, demographics, and several other parameters such as smoking status and different chronic and psychological illnesses. The chi-square test and multivariate logistic regression analysis were used to test the association. Results: The overall prevalence of headaches in this study was 3%. The multiple logistic regression analysis showed that females were more likely to have headaches than males (odds ratio (OR) 0.735, 95% confidence interval (CI) = 0.612-1.341; P=0.024). Being a current smoker was also significantly associated with higher "odds" of having headache (OR = 1.319, 95% CI = 0.932-2.462; P=0.037). Participants who were overweight had a significantly higher risk of headache (OR = 1.631, 95% CI = 1.48-1.854; P=0.037). Nonmarried people were significantly more likely to have headache pain, compared to married individuals (OR = 0.875, 95% CI = 0.646-2.317; P=0.047). Conclusion: The prevalence of headaches was 3%, and four significant associated factors were identified: females, nonmarried, smoking, and overweight. The temporality of the relationship between these factors and headache cannot be confirmed in this cross-sectional study; so future longitudinal studies are needed to confirm these potential causal relationships.

Psychological predictors of chronic pain in Al Kharj region, Saudi Arabia.

BACKGROUND: Psychological distress is one of the major determinants for the experience progression, and recovery of chronic pain. However, it is unclear whether physical pain in specific body sites could be predictive of psychological illness. In this study, we aim to investigate the link between chronic pain in specific anatomical sites and psychological distress represented in the General Health Questionnaire-12 (GHQ-12 items). METHODS: A population-based cross-sectional study was conducted in Al Kharj region of Saudi Arabia. We included 1003 participants. Data were collected using the GHQ-12, and a subjective report on eight anatomical pain sites. Data analysis used statistical software SPSS version 26.0 for Windows statistical package. RESULTS: Chronic musculoskeletal pain in the neck and head regions was significantly associated with higher psychological distress. Other sites (back, lower limb, chest, abdominal and upper limb pain) were not associated with psychological distress. In multiple regression analysis, chronic 'general' pain was significantly associated with higher psychological distress (unstandardized Beta regression coefficient = 2.568; P < 0.0001). The patients with younger age were more likely to develop negative psychological disorders (unstandardized Beta = - 3.137; P = 0.038). Females were more likely to have higher psychological distress than males (unstandardized Beta = 2.464, P = 0.003). Single (not-married) people have a higher risk of psychological distress than married people (unstandardized Beta = 2.518, P = 0.025). Also, job type/status whether being unemployed (not working) or 'civilian' (civil servant/worker) was positively and significantly associated with an increased probability of psychological distress (unstandardized Beta = 1.436, P = 0.019). CONCLUSION: Chronic 'general' pain was significantly associated with negative psychological disorders. The government of Saudi Arabia needs to focus on patients with chronic 'general' pain, females, young and unmarried individuals as potentially 'high-risk' population subgroups for adverse psychological disorders, and subsequent long-term complications.

The prevalence of hypercholesterolemia and associated risk factors in Al-Kharj population, Saudi Arabia: a cross-sectional survey.

BACKGROUND: Hypercholesterolemia (HC) is an important precursor to many cardiovascular, cerebrovascular, and peripheral vascular diseases. A report conducted by the American Heart Association showed the prevalence of HC to be 11.9%, with around 28.5 million adults age ≥ 20 years having high cholesterol levels. This study aimed to evaluate the prevalence of HC and its associated risk factors among the general population of Al-Kharj, Saudi Arabia. METHOD: A cross-sectional study was conducted on the general population of Al-Kharj, Saudi Arabia in 2016. The representative sample consisted of 1019 individuals, who all participated on a voluntary basis. The statistical analysis was performed using SPSS version 25. RESULTS: The results of this study showed the prevalence of HC in the sample to be 12.5%. There was a significant moderate positive association between increasing age and the prevalence of HC (r = 0.240, P < 0.0001). Males had a significantly higher prevalence of HC (56.7%) compared to their female counterparts (43.3%) (X2 = 23.093, P ≤ 0.0001). BMI was positively and significantly associated with high cholesterol status. Participants in the overweight category had a significantly higher risk of HC (OR = 1.727; 95% CI = 1.58-1.914; P = 0.046). The non-obese (< 25 kg/m2) participants had an inverse significant association with the risk of hypercholesterolemia. (OR = 0.411; 95% CI = 0.216-0.783; P = 0.007). CONCLUSION: In this population-based study, the predominant risk factors of HC in Al-Kharj region were being of a Saudi nationality, male, having obesity, being unemployed, and being a civilian worker. There is a clear need for future screening studies of HC, as most previous studies have reported contradictory prevalence data (because they were conducted in different regions of KSA). Furthermore, well-designed prospective cohort studies are needed in the future to assess how the association between lifestyle behavioural factors such as dietary intake patterns and levels of physical activity may affect the relative risk of HC status.

The relationship between chronic pain, prehypertension, and hypertension. A population-based cross-sectional survey in Al-Kharj, Saudi Arabia.

Background: Chronic pain and hypertension are highly prevalent in both developing and developed countries. Although they may appear to be two separate phenomena, several studies in developed countries have found them associated at the population level. Studies in developing countries are scarce and association between pain with prehypertension are rarely explored. The objective of this study was to explore the potential association between prehypertension, hypertension, and chronic pain in a Saudi population.Methods: A cross-sectional general population-based study was conducted on a random sample of employees and university students over a period of 6 months from January 2016 to June 2016 in Al Kharj, Saudi Arabia. A total of 1200 general population adults (aged 18 years and above) were invited to participate in the study.Results: With a response rate of 85.9%, 1031 individuals were included in the final analysis. Among the general population of Al-Kharj, statistically significant association was found between age and chronic pain [Odds ratio (OR) = 1.764 [95% C.I. = 1.391-1.927], P < 0.0001] and between hypertension and chronic pain [(OR) = 1.039 [95% C.I. = 1.018-1.060], P < 0.0001], respectively. The association between prehypertension and chronic pain was not statistically significant [(OR) = 1.211 [95% C.I. = 0.879-1.668, P = 0.243].Conclusion: Results of this survey suggests a statistically significant relationship between hypertension (but not prehypertension) and chronic pain. The temporality of the relationship between hypertension and chronic needs to be explored in future longitudinal studies.

Association between Chronic Pain and Diabetes/Prediabetes: A Population-Based Cross-Sectional Survey in Saudi Arabia.

Background: Diabetes is a debilitating chronic health condition that is associated with certain pain syndromes. The present study sought to evaluate chronic pain and its association with diabetes mellitus at a population level. Methods: A population-based cross-sectional questionnaire survey study was conducted in Al-Kharj, Saudi Arabia, from January 2016 to June 2016. Participants from both private and governmental institutions were selected following a multistage sampling technique and using a cluster sampling method. Anthropometric measurements were taken, including body weight, height, body mass index (BMI) and waist circumference. A blood sample was also drawn from each respondent for fasting blood sugar, HbA1c, and fasting lipid profile. A P value of less than 0.05 indicated statistical significance. Results: A total of 1003 subjects were included for final analysis. Compared to prediabetic and nondiabetic individuals, diabetic subjects had a higher prevalence of lower limb pain (11.1%), back pain (8.9%), abdominal pain (6.7%), and neck pain (4.4%) (X 2 = 27.792, P = 0.015). In a multiple logistic regression model, after adjusting for age, gender, education level, cholesterol, and smoking status, diabetic/prediabetic patients had a significantly higher prevalence of chronic pain ((OR) = 1.931 (95% CI = 1.536-2.362), P = 0.037). Increased age was also significantly associated with chronic pain ((OR) = 1.032 (95% CI = 1.010-1.054, P = 0.004). Conclusion: Results of this study found a significant association between diabetes and prediabetes and chronic pain symptoms. Prospective studies are needed to explore temporality of such association.

Prevalence of hypertension and prehypertension and its associated cardioembolic risk factors; a population based cross-sectional study in Alkharj, Saudi Arabia.

BACKGROUND: Hypertension and prehypertension pose significant public-health and clinical challenges for both economically developed and developing nations. Prevalence of these conditions are frequently underreported because of its often-silent nature. Population-based studies that explore the occurrence and correlates of these conditions are scarce in Saudi Arabia. This study aimed at estimating the prevalence and associated factors of hypertension and prehypertension on a representative sample of males and females living in Al-Kharj town in Saudi Arabia. METHODS: Cross-sectional analysis was performed from January 2016 until June 2016 by recruiting a representative sample (n = 1019; aged 18 to 67 years) of the Al Kharj population. All participants completed a self-administered questionnaire, followed by a physical examination and blood test. Statistical analysis was carried out using SPSS version 24.0 for Windows. RESULTS: The prevalence of prehypertension was 66.1, 48.1 and 54.9% in male, female and all subjects, respectively. The prevalence of hypertension was 6.0, 4.2 and 4.9% in male, female and all subjects, respectively. Being overweight was associated with the highest risk of hypertension (OR = 4.98 [95% C.I. = 1.98-12.52], P = 0.001). People who were classified as class I obese had 3.5 times the risk of hypertension compared with the non-obese group (OR = 3.49 [95% C.I. = 1.42-8.63], P = 0.007). Risk of pre-hypertension was significantly lower in females (OR = 0.48 [95% C.I. = 0.32-0.71]) and tends to increase with obesity status. Gender-specific analyses found that males in the lowest education attainment level had a significantly increased risk of pre-hypertension (OR = 6.56 [95% C.I. = 1.27-33.85], P = 0.003). CONCLUSION: This population-based study in Saudi Arabia shows that hypertension and prehypertension are common conditions particularly among males. Overweight and obesity was associated with both conditions. In addition, lower education attainment was a significantly associated factor among males. Future prospective studies are needed to confirm the etiological nature of such associations.

The factor structure of the general health questionnaire (GHQ12) in Saudi Arabia.

BACKGROUND: The General Health Questionnaire-12 (GHQ-12) is one of the most unique and extensively used self-report instruments for evaluating psychological disorders and strains. However, the factor structure of GHQ-12 has not been fully explored. The current study aims to assess the factorial structure of GHQ-12 in a large cross-sectional data-set extracted from Al Kharj central region of Saudi Arabia. METHODS: Population based cross sectional data was extracted from January 2016 to June 2016 from Al Kharj population recruiting 1019 respondents aged 18 and above. Exploratory factor analysis (EFA) was applied together with multiple regression analysis to extract and retain factors. Mean GHQ-12 score for demographic and health-related traits were used for assessing this association. Statistical analysis was carried out using STATA version 12.1. RESULTS: Three factors, including social dysfunction, anxiety, and loss of confidence were extracted from the factor structure. 55% of the overall variance was obtained through these factors. Total score of GHQ-12 ranged from 0 to 32 with a mean score of 12. CONCLUSION: Investigation of the factor structure of GHQ-12 demonstrated that GHQ-12 is a good measure for evaluating the general health of Saudi population. Future studies based on a larger sample size of non-clinical respondents will be useful to evaluate the practical effectiveness of GHQ-12 factors.

Prevalence of overweight and obesity based on the body mass index; a cross-sectional study in Alkharj, Saudi Arabia.

BACKGROUND: Obesity and overweight are accompanied with several different chronic diseases. Overweight and obesity can be measured by using body mass index (BMI) and is also used widely as an index of relative adiposity among any population. The aim of the study is to evaluate the prevalence of overweight and obesity among general population in Al-Kharj, Saudi Arabia. METHODS: Cross-sectional analysis was undertaken from a representative sample (N = 1019) of the Al Kharj population. Anthropometric measurements including the waist circumference (in centimeters), height (in meters), and weight (in kilograms) of the subjects were undertaken by means of standard apparatus. SPSS 24.0 was utilized for statistical analysis of the data. RESULTS: Majority of respondents in this study were overweight and obese (54.3%) compared with 45.7% being non-obese. A linear positive association of increasing BMI with older age groups was present in males and females. Men had larger waist circumference, weight and height measures as compared with their female counterparts. Regression analysis showed increasing age, being married and high serum cholesterol to be the significant predictors of overweight and obesity while gender, education level, job status, and having diabetes were not. CONCLUSIONS: The obesity-overweight prevalence in the Saudi population is high mainly across both genders. However, the associated factors are potentially preventable and modifiable. The regional barriers to lifestyle modifications and interventions to encourage active lifestyles, especially among adolescents to limit the occurrence of obesity and ultimately promote health and wellbeing, are warranted. Furthermore, prospective studies are needed in future to confirm the aetiological nature of such associations.

The Use of an Adapted Health IT Usability Evaluation Model (Health-ITUEM) for Evaluating Consumer Reported Ratings of Diabetes mHealth Applications: Implications for Diabetes Care and Management.

BACKGROUND: The aim of this paper is to present a usability analysis of the consumer ratings of key diabetes mHealth applications using an adapted Health IT Usability Evaluation Model (Health-ITUEM). METHODS: A qualitative content analysis method was used to analyze publicly available consumer reported data posted on the Android Market and Google Play for four leading diabetes mHealth applications. Health-ITUEM concepts including information needs, flexibility/customizability, learnability, performance speed, and competency guided the categorization and analysis of the data. Health impact was an additional category that was included in the study. A total of 405 consumers' ratings collected from January 9, 2014 to February 17, 2014 were included in the study. RESULTS: Overall, the consumers' ratings of the leading diabetes mHealth applications for both usability and health impacts were positive. The performance speed of the mHealth application and the information needs of the consumers were the primary usability factors impacting the use of the diabetes mHealth applications. There was also evidence on the positive health impacts of such applications. CONCLUSIONS: Consumers are more likely to use diabetes related mHealth applications that perform well and meet their information needs. Furthermore, there is preliminary evidence that diabetes mHealth applications can have positive impact on the health of patients.

A review of the cardiometabolic risk experience among Canadian Métis populations.

Cardiometabolic risk is a growing concern in Western society in which rates of cardiovascular disease, diabetes, and obesity are on the rise. Aboriginal populations currently experience unequal burdens of these chronic conditions. However, limited information regarding the experience of cardiometabolic risk among Métis populations is available. This review sought to evaluate the cardiometabolic risk experience among Métis populations in Canada. Canada's Métis population currently experiences greater burdens of chronic conditions including metabolic syndrome, diabetes, obesity, and cardiovascular disease than that of the non-Aboriginal population. Métis populations also experience poorer life expectancy, education, and employment attainments, and reduced access to health care services compared with non-Aboriginal populations. Interventions addressing the deficiencies in sociodemographic, lifestyle, and social determinants among the Métis population might help combat rising experiences of chronic diseases faced by these people. Though the burden of chronic conditions, sociodemographic, lifestyle challenges, and social determinants of health among Métis populations are generally less than that of First Nations populations, Métis people experience these health challenges and influencing factors are generally more similar to that of First Nations than non-Aboriginal peoples. Subsequently, Métis populations need to be included in plans and strategies to reduce chronic conditions among Aboriginal populations. In conclusion, Métis populations experience greater burden of cardiometabolic risk and its components than the general Canadian population.

Men's health in northern British Columbia: analysis and reporting of early intervention screening program data related to cardiovascular health.

Type 2 diabetes (T2D) is a well-established risk factor for cardiovascular disease (CVD). Higher rates of T2D are attributable to unhealthy lifestyle factors and a number of clinical and metabolic risk factors. There is paucity of research which investigated the association of lifestyle risk factors and metabolic markers amongst adult men in northern British Columbia (BC). Using a face-to-face screening questionnaire, we assessed the relationships between age, body mass index (BMI), and a number of CVD risk factors in a convenience sample of 123 eligible men recruited from communities across northern BC in February of 2011. In regards to the metabolic risk factors measured through screening blood tests (lipid profiles; blood glucose) responses to the questionnaire were dichotomized into high and low risk categories. These dichotomized variables were subsequently used to determine if significant associations existed with each of the age category variable and a standard BMI categorical variable. There were significant linear relationships between the categorical BMI variable and a number of metabolic risk factors, as well as smoking history. Older age (40+ years) was associated with higher BMI status (overweight/obese). Our findings provide compelling evidence that northern BC men possess a number of clinical, metabolic, and lifestyle risk factors associated with high CV risk. Future studies should examine other sociodemographic variables including occupation status, education attainment, and ethnicity, and other psychosocial determinants which include knowledge, attitudes, and perceptions (KAP) related to T2D and CV risk profile in adult men working and living in northern BC, Canada.

The relationship of body mass index to outcomes after percutaneous coronary intervention.

OBJECTIVES: To evaluate the effect of body mass index (BMI) on in-hospital outcomes in patients undergoing percutaneous coronary intervention (PCI) at a tertiary care hospital center in Ontario, Canada. BACKGROUND: Obesity is present in a large population of patients undergoing revascularization with PCI. METHODS: Retrospective analysis of 4,631 patients aged 62.0 +/- 12 years, stratified by BMI into five groups: nonobese (<25 kg/m2); overweight (25-29.9 kg/m2); class I obese (30-34.9 kg/m2); class II obese (35-39.9 kg/m2); and class III obese (> or =40 kg/m2). RESULTS: A BMI >25 kg/m2 was present in 79% of patients, and 35% were obese (BMI > or =30 kg/m2). Obese patients, particularly the class III obese, were significantly younger and had higher prevalence of diabetes, hypertension, and dyslipidemia (P < 0.0001). After adjustment for several covariates, lower BMI was independently associated with higher risk of major bleeding requiring transfusion (adjusted odds ratio [OR]= 1.40, 95% confidence interval [CI] 1.04-1.88, P = 0.025), and femoral hematoma (adjusted OR = 1.14, 95% CI 1.05-1.25, P = 0.003) in lean (<20 kg/m2) and normal BMI (20-24.9 kg/m2) patients. Obesity was not associated with death, myocardial infarction, repeat PCI, coronary artery bypass grafting, or major adverse cardiac event. CONCLUSIONS: Obesity is not associated with increased risk of adverse postprocedural in-hospital outcomes. These findings, however, do not discount the need for sustained efforts in secondary prevention of obesity and its consequences.

Mediterranean dietary components and body mass index in adults: the peel nutrition and heart health survey.

Diet is a lifestyle factor that contributes to the risk of overweight/obesity and cardiovascular disease. The objective of this study was to examine the hypothesis that a Mediterranean-type dietary pattern (M) is associated with healthy body weights in a large suburban municipality in Ontario. A random cross-sectional sample of 759 adults, 18 to 65 years of age, participated in a telephone survey, which included questions on the frequency of consumption of 60 food categories. Principal components analysis showed that food categories aggregated into six low-order dietary factors and two high-order dietary patterns. The M pattern reflected higher consumption of fruits and vegetables, olive oil and garlic, and fish and shellfish. The non-M pattern reflected high fat/nutrient poor, meats and poultry, and foods high in added sugars. The M-score was inversely related to body mass index (BMI) (p = 0.027). After adjustment for gender, education, income and marital status, a higher M-score predicted a lower BMI in the 40 to 49 year age group. Heart health promotion strategies aimed at preventing adult obesity should emphasize components of a Mediterranean-type diet pattern.

Metabolic profile and exercise capacity outcomes: their relationship to overweight and obesity in a Canadian cardiac rehabilitation setting.

PURPOSE: Obesity remains a significant health problem for cardiac rehabilitation patients. The purpose of this study was to examine the relation of overweight and obesity to cardiovascular risk factors in patients, and to compare the change in cardiovascular risk factor profiles in patients with coronary artery disease undergoing cardiac rehabilitation at a tertiary care hospital center in Ontario, Canada. METHODS: Retrospective analysis of cross-sectional data for 3542 patients, ages 63 +/- 11 years, stratified by body mass index (BMI), was performed. RESULTS: The findings showed that 81% of the patients had a BMI exceeding 25 kg/m(2), and that 35% of the patients were obese (BMI > or =30 kg/m(2)). After adjustment for age, sex, smoking, hypertension, diabetes, and peak power output, BMI was a significant independent predictor of a higher total cholesterol level, higher fasting blood glucose and triglyceride levels, and lower levels of high-density lipoprotein cholesterol. The Adult Treatment Panel III criteria were used to examine the prevalence of the metabolic syndrome for each BMI group. At baseline, 77% of the obese males in classes 2 and 3 had three or more risk factors for the metabolic syndrome, as compared with 68% of the obese females in classes 2 and 3. After 24 weeks of intervention, the outcome data for 1353 patients showed that despite no change in body weight, all the BMI groups demonstrated significant improvements in metabolic profiles and peak exercise capacity. CONCLUSIONS: Cardiac rehabilitation results in significant improvement in the cardiovascular risk profile at all levels of BMI, independently of weight loss. Future studies should examine whether targeting weight loss in cardiac rehabilitation further improves outcomes and the overall cardiovascular risk profile.