Bacterial dysbiosis in newly diagnosed treatment naïve pediatric ulcerative colitis in Saudi Arabia.

BACKGROUND: The role of microbiota in the pathogenesis of ulcerative colitis (UC) has been increasingly recognized. However, most of the reports are from Western populations. In Middle Eastern countries, including Saudi Arabia, little is known about the role of microbiota. Therefore, our aim was to describe the bacterial microbiota profile and signature in pediatric UC in Saudi Arabia. METHODS: Twenty children with UC and 20 healthy controls enrolled in the study gave stool samples. Twenty rectal mucosal samples were taken from UC and 20 from non-UC controls. Inclusion criteria included newly diagnosed and untreated children and lack of antibiotic exposure for at least 6 months before stool collection was required for children with UC and controls. Bacterial deoxyribonucleic acid was extracted and sequenced using shotgun metagenomic analysis. Statistical analysis included Shannon alpha diversity metrics, Bray-Curtis dissimilarity, DESeq2, and biomarker discovery. RESULTS: The demographic characteristics were similar in children with UC and controls. There was a significant reduction in alpha diversity (P = 0.037) and beta diversity in samples from children with UC (P = 0.001). Many taxa were identified with log2 abundance analysis, revealing 110 and 102 species significantly depleted and enriched in UC, respectively. Eleven bacterial species' signatures were identified. CONCLUSIONS: In Saudi Arabian children with UC, we demonstrate a dysbiosis similar to reports from Western populations, possibly related to changes of lifestyle. Microbial signature discovery in this report is an important contribution to research, leading to the development of adjunctive non-invasive diagnostic options in unusual cases of UC.

Prevalence and socioeconomic correlates of growth impairment among Saudi children and adolescents.

Background: Saudi Arabia has witnessed economic prosperity leading to changes in diet and lifestyle. Concurrent with these changes, the prevalence rates of overweight and obesity are rising. No recent data exist on the trends and pattern of growth impairment among Saudi children. We aimed to provide the most recent estimate of the prevalence of thinness and short stature among healthy school-aged children in Riyadh, Saudi Arabia, and to investigate the effect of parental socioeconomic status (SES) on growth impairment. Methods: A cross-sectional study was conducted in 2015 among schoolchildren in Riyadh. A sample of 7931 children (67% girls) aged 6-16 years was randomly selected. Body mass index (BMI) z-score <-2 SD and height z-score <-2 SD, for age and sex, using the WHO reference 2007, defined thinness and short stature, respectively. To assess the impact of SES on growth, we categorized SES into 4 levels by incorporating 4 main indicators: parents' educational level, family income, type of residence, and parents' jobs. Results: The prevalence of short stature was 15%, and the prevalence of thinness was 3.5%. Stratification of the thinness prevalence rate according to gender indicated that boys were significantly thinner than girls (4.7% versus 2.8%, P = 0.048). Short stature was significantly higher among children in the lower SES classes than among their counterparts in the higher SES classes. Parents of thin children were more likely to be less educated, have less income, live in apartments, and have a lower SES than parents of overweight and obese children. Conclusions: The rate of thinness among Saudi children is low, similar to that in developed countries, and is significantly correlated with SES.

Tricho-hepato-enteric syndrome: Retrospective multicenter experience in Saudi Arabia.

Background: Trichohepatoenteric syndrome (THES) is a very rare disorder that is characterized by intractable congenital diarrhea, woolly hair, intrauterine growth restriction, facial dysmorphism, and short stature. Our knowledge of THES is limited due to the small number of reported cases. Methods: Thirty patients diagnosed with THES, all molecularly confirmed by whole exome sequencing (WES) to have biallelic variants in TTC37 or SKIV2L, were included in the study. Clinical, biochemical, and nutritional phenotypes and outcome data were collected from all participants. Results: The median age of THES patients was 3.7 years (0.9-23 years). Diarrhea and malnutrition were the most common clinical features (100%). Other common features included hair abnormalities (96%), skin hyperpigmentation (87%), facial dysmorphic abnormalities (73%), psychomotor retardation (57%), and hepatic abnormalities (30%). Twenty-five patients required parenteral nutrition (83%) with a mean duration of 13.34 months, and nearly half were eventually weaned off. Parenteral nutrition was associated with a poor prognosis. The vast majority of cases (89.6%) had biallelic variants in SKIV2L, with biallelic variants in TTC37 accounting for the remaining cases. A total of seven variants were identified in TTC37 (n = 3) and SKIV2L (n = 4). The underlying genotype influenced some phenotypic aspects, especially liver involvement, which was more common in TTC37-related THES. Conclusion: Our data helps define the natural history of THES and provide clinical management guidelines.

Overweight and obesity among Saudi children and adolescents: Where do we stand today?

BACKGROUND/AIM: To provide the most recent estimate of childhood obesity and determine the trend in childhood obesity in Riyadh city over the past two decades, by comparing our results with previous studies that published data comparable to our study in terms of geography, sample age (6-16 years), and use of World Health Organization (WHO) cut-offs to define obesity. PATIENTS AND METHODS: A cross-sectional study was conducted in 2015 among school children in Riyadh city. A sample of 7930 children (67% girls) aged 6-16 years were randomly selected. Body mass index for age and gender above +1 and below +2 standard deviation scores (SDS) defined overweight (SDS, z-scores) and >+2 SD scores defined obesity. RESULTS: The overall prevalence of overweight and obesity was 13.4% (14.2% for girls and 12% for boys; P= 0.02) and 18.2% (18% for girls and 18.4% for boys; P = 0.73), respectively. When compared with the WHO-based national prevalence rate of obesity reported in 2004 (≈9.3%), the obesity rate has doubled over a 10-year period. There was a significantly higher prevalence of obesity in adolescents (>11 years) than in children (20.2% vs 15.7%; P < 0.01). Overweight and obesity increased significantly with higher levels of socioeconomic status. Obese children were at 1.5 and 2 times risk of developing gas bloating and vomiting than non-obese children. CONCLUSION: The prevalence of overweight and obesity has risen alarmingly among Saudi children and adolescents over the past decade and should make a strong case to initiate and monitor effective implementation of obesity prevention measures.

Mass Screening for Celiac Disease Among School-aged Children: Toward Exploring Celiac Iceberg in Saudi Arabia.

OBJECTIVES: We conducted this mass screening study to determine the prevalence of celiac disease (CD) and characterize the celiac iceberg among Saudi pediatric population in Riyadh, the capital city of Saudi Arabia. METHODS: During the study period (January 2014-June 2016), we have conducted a cross-sectional, mass screening, immunoglobulin A-tissue transglutaminase (TTG-IgA)-based study on 7930 Saudi students from primary and intermediate schools in Riyadh. Students with positive TTG-IgA (>20 U/L) were called in the hospital to undergo a repeat of TTG-IgA; in those with borderline positive TTG-IgA (20-60 U/L), IgA-endomyseal antibody (EMA-IgA) test was performed. Children with TTG-IgA >60 U/L and children with borderline positive TTG-IgA and positive EMA-IgA were advised to undergo upper endoscopy and intestinal biopsies. RESULTS: We identified 221 students with positive TTG-IgA (2.8%). CD was diagnosed in 119 cases (1.5%, 1:67 Saudi children) (mean age 11.5 ±â€Š2.62 years; girls 81 [68%]). Another 51 children had persistently borderline positive TTG-IgA but negative EMA (0.64%) and the remaining 51 had transiently positive TTG-IgA. We have identified 3 clinical patterns in the screening-identified cases with CD: a silent form (37%), a mild symptomatic form characterized by gastrointestinal symptoms in presence of normal growth or overweight/obesity (48%), and gastrointestinal symptoms associated with impaired growth in 15%. CONCLUSIONS: Our study provided evidence of a high prevalence of CD among Saudi children (1.5%), a rate that is at least twice the average prevalence rate in Europe and North America.