Status of nutrition care process implementation in hospitals in Jeddah, Saudi Arabia.

BACKGROUND AND AIMS: The Nutrition Care Process (NCP) and Nutrition Care Process Terminology (NCPT) are currently implemented by dietetics practitioners worldwide, with various advantages, including ensuring consistency and clarity of dietetics-related healthcare records and the possibility to collect and analyse patient outcomes; however, how Saudi dietitians experience the implementation process is poorly understood. The aim of this study was to explore the experiences of Saudi dietitians of NCP implementation in hospitals in Jeddah. METHODS: In this quantitative, cross-sectional study, 56 dietitians were recruited from six principal hospitals in Jeddah. A questionnaire was used to collect data on the characteristics of the dietitians and hospital-related clinical nutrition care performance, the perception and opinions of dietitians towards the NCP, and the status of NCP implementation. RESULTS: Almost all dietitians (98%) were aware of the NCP; however, only 27% had received NCP training. Most dietitians (73%) reported that their department currently follows the NCP, while only 26% reported using the standardized NCP, including International Classification of Functioning, Disability & Health - Dietetics (ICF-D)-WHO and International Dietetic & Nutrition Terminology (IDNT) - USA, with 63% following the hospital's own NCP. Reported reasons for hospitals not following the NCP included insufficient dietitians, lack of experience, or conflict with the hospital's nutrition care system. A majority of dietitians reported no perceived barriers to applying the NCP; however, 23% reported NCP documentation as a challenge. CONCLUSIONS: The majority of dietitians are aware of the NCP and feel confident to practice; however, the NCP model is not currently implemented in Jeddah hospitals as standard. On-going education, a training program, and an implementation plan should be prioritised.

Efficacy of different modes of vitamin D supplementation strategies in Saudi adolescents.

Vitamin D deficiency is rampant in the Middle East, even in children and adolescents. This study was designed to investigate the effects of different vitamin D repletion strategies commonly used on serum vitamin D levels of Saudi adolescents. STUDY DESIGN: A 6-month multi-center, controlled, clinical study, involving 34 schools in the central region of Riyadh, Saudi Arabia. Different strategies of vitamin D supplementation were tested (200 ml fortified milk of different brands or vitamin D tablet (1,000IU). Anthropometrics were taken and fasting blood samples withdrawn at baseline and after intervention for the quantification of serum glucose, lipid profile and 25(OH) vitamin D. A significant increase in 25(OH)D level was observed in subjects supplemented with vitamin D tablet, milk brand 2 and milk brand 4, whereas subjects supplied with fortified milk brands 1 and 3 respectively, exhibited a significant decrease in 25(OH)D levels. Analysis of covariance showed that after adjusting for baseline 25(OH)D, age, gender and BMI, the mean 25(OH)D levels of children who were taking vitamin D tablet (9.1 ±â€¯0.8 nmol/l) and milk brand 4 were significantly higher (7.3 ±â€¯1.1 nmol/l) than children taking milk brand 2 (1.6 ±â€¯1.0 nmol/l). Subjects supplied with milk brands 1 and 2 exhibited a significant increase in total cholesterol level, while it dropped significantly in subjects taking milk brand 3, while no changes were observed in other groups. Different strategies in vitamin D supplementation used in this clinical study elicited varying degrees of improvement in serum 25(OH)D level. The observed outcomes were dependent on the strategy and gender in the Saudi adolescent population, with oral tablet supplementation being favored in boys.

Vitamin D status correction in Saudi Arabia: an experts' consensus under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases (ESCEO).

BACKGROUND: Vitamin D deficiency is common in the Middle East and in Saudi Arabia, in particular. While several international recommendations on the management of vitamin D deficiency have been documented and practiced globally, these recommendations should be adapted to the conditions of the Middle Eastern region. To address this challenge, the Prince Mutaib Chair for Biomarkers of Osteoporosis (PMCO) in King Saud University (KSU), Riyadh, KSA, together with local experts and in cooperation with the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), organized a panel that formulated unified recommendations in the diagnosis and treatment of vitamin D deficiency in the region. METHODS: The selection of local and international experts commenced during the 2nd International Vitamin D Symposium conducted in Riyadh, Saudi Arabia, last January 20--21, 2016. Reviews of the most recent literature were done, and face-to-face meetings were conducted for revisions and final recommendations. RESULTS: Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided. RESULTS: Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided. CONCLUSION: Vitamin D supplementation/correction is advised in all persons whose serum 25(OH)D falls below 50 nmol/l (20 ng/ml), and achieving a target of 75 nmol/l (30 ng/ml) is particularly suited for frail, osteoporotic, and older patients. Conducting well-designed clinical trials in the region that will address economic implications and investigations on the treatment persistence and compliance to vitamin D treatment in the region are encouraged.

Vitamin D deficiency and biochemical variations among urban Saudi adolescent girls according to season.

OBJECTIVES: To determine seasonal variations in the vitamin D status of Saudi adolescent girls in Riyadh, Kingdom of Saudi Arabia (KSA) and its effect in biochemical and clinical characteristics.  METHODS: In this prospective study, a total of 2000 Saudi females aged 12-18 years from different schools in Riyadh, KSA participated and submitted a generalized questionnaire with clinical information. Fasting blood samples were obtained in 1618 subjects for the winter season (December to February) and only 499 subjects returned to submit fasting blood samples for the summer season (June-August). Circulating serum 25(OH)D, parathyroid hormone (PTH), and other biomarkers of bone remodeling were measured during both seasons.  RESULTS: Vitamin D deficiency (serum 25(OH)D  less than 25 nmol/L) was significantly higher during summer than winter (63.5% versus 40.8%; p less than 0.001). Mean serum PTH was also significantly higher during summer than winter (p less than 0.01). In all subjects, serum PTH showed a significant inverse association with 25(OH)D at levels below 40 nmol/L (r=-0.21; p less than 0.001). The prevalence of subjects having clinical and metabolic manifestations suggestive of osteomalacia was 2.13% (N=33 out of 1548). CONCLUSION: Seasonal variations in the vitamin D status of Saudi adolescent females significantly modifies biochemical parameters as response to vitamin D status change. In the meantime, heightened public health awareness should be given to populations at higher risk for vitamin D deficiency.

Sun exposure, skin color and vitamin D status in Arab children and adults.

Accumulating evidence suggests an increased prevalence of vitamin D deficiency in the Middle East and North African countries. Sunlight has long been recognized as a major provider of vitamin D and lighter skin color has been associated with better vitamin D status. In this context, we aimed to determine whether 25-hydroxyvitamin D[25-(OH)D] concentrations are related to skin color, sun exposure and gender among healthy Saudi children and adults. A total of 808 Saudi children (age=14.6±0.04years) and 561 (age=31.4±0.3years) adults of both genders were included in this study. Levels of sun exposure and skin color were determined using a standard questionnaire. Anthropometry and plasma 25-(OH)D concentrations were analyzed. On the basis of duration of sun exposure (<20min vs. >20min), a significantly lower concentration of 25-(OH)D (40.9±1.2 vs. 35.5±1.8nmol/l; p<0.019) was demonstrated in dark-skinned boys with exposure time less than 20min than those exposed longer than 20min. We were unable to show an effect of sunlight exposure or skin color on vitamin D status of children or adults, except in dark-skinned boys who had lower 25(OH)D concentrations associated with limited sun exposure.

Effects of 12-month, 2000IU/day vitamin D supplementation on treatment naïve and vitamin D deficient Saudi type 2 diabetic patients.

OBJECTIVES: To determine whether 12-month, 2000IU/day vitamin D supplementation cardiometabolically improves treatment naïve type 2 diabetes mellitus (T2DM) Saudi patients with vitamin D deficiency.  METHODS: This 12-month interventional study was conducted at primary health centers in 5 different residential areas in Riyadh, Saudi Arabia between January 2013 and January 2014. Forty-five Saudi  T2DM  patients were enrolled. Baseline anthropometrics, glycemic, and lipid profiles were measured and repeated after 6 and 12 months. All subjects were provided with 2000IU vitamin D supplements for one year.   RESULTS: Vitamin D deficiency at baseline was 46.7%, 31.8% after 6 months, and 35.6% after 12 months, indicating an overall improvement in the vitamin D status in the entire cohort. Insulin and homeostatic model assessment-insulin resistance (HOMA-IR) after 12 months were significantly lower than a 6 months (p less than 0.05), but comparable to baseline values. Mean levels of triglycerides increased overtime from baseline (1.9±0.01 mmol/l) to 12 months (2.1±0.2 mmol). This modest increase in serum triglycerides was parallel to the insignificant decrease in circulating high-density lipoprotein -cholesterol levels.  CONCLUSION: Twelve-month vitamin D supplementation of 2000IU per day in a cohort of treatment naïve Saudi patients with T2DM resulted in improvement of several cardiometabolic parameters including systolic blood pressure, insulin, and HOMA-IR. Further studies that include a placebo group are suggested to reinforce findings.

Vitamin D status in Saudi school children based on knowledge.

BACKGROUND: The prevalence of vitamin D deficiency in the kingdom of Saudi Arabia is rising unexpectedly in every age group. Apart from several risk factors, the lack of awareness is posing a serious threat for low vitamin D levels in children as well. The aim of our study was to compare the knowledge and status of vitamin D in Saudi school children. METHODS: Saudi students, 1188 boys (15.1 ± 2.2 years) and 1038 girls (15.1 ± 2.0 years), were recruited and a pre-designed questionnaire with regards to knowledge about vitamin D was administered. Blood samples were collected and serum 25hydroxyvitamin D (25(OH)D was measured. RESULTS: A significantly higher percentage of boys answered correctly than girls regarding knowledge questions as sun exposure (p = 0.002, and 0.011), breastfeeding (p < 0.001) and diseases (p < 0.001). The percentage of girls was significantly higher who thought that fruits and vegetables are not rich sources of vitamin D (24.7% girls vs. 15.4% boys; p < 0.001and 29.6% girls vs. 20.9% boys p < 0.001), respectively. Boys had a higher prevalence and frequency of sun exposure than girls (p < 0.001 for both). Girls showed a significantly higher percentage of sunscreen use and full covering during sun exposure (p = 0.001 for both).Vitamin D deficiency was significantly higher in girls than boys (47.0% versus 19.4.0%; p < 0.001). Vitamin D status in boys was significantly higher than girls (p < 0.001). In girls, those who answered correctly about vitamin D related disease (p = 0.03) and sources (p = 0.015), demonstrated significantly higher vitamin D levels. CONCLUSIONS: The awareness of vitamin D and sunlight in children needs to be improved by provision of trained physicians and school teachers. Creating more areas where girls can uncover freely during routine works and outdoor activities will help increase their vitamin D levels.

Pistagremic acid, a glucosidase inhibitor from Pistacia integerrima.

Pistacia integerrima Stewart in traditionally used as folk remedy for various pathological conditions including diabetes. In order to identify the bioactive compound responsible for its folk use in diabetes, a phytochemical and biological study was conducted. Pistagremic acid (PA) was isolated from the dried galls extract of P. integerrima. Strong α-glucosidase inhibitory potential of PA was predicted using its molecular docking simulations against yeast α-glucosidase as a therapeutic target. Significant experimental α-glucosidase inhibitory activity of PA confirmed the computational predictions. PA showed potent enzyme inhibitory activity both against yeast (IC(50): 89.12±0.12µM) and rat intestinal (IC(50): 62.47±0.09µM) α-glucosidases. Interestingly, acarbose was found to be more than 12 times more potent an inhibitor against mammalian (rat intestinal) enzyme (having IC(50) value 62.47±0.09µM), as compared to the microbial (yeast) enzyme (with IC(50) value 780.21µM). Molecular binding mode was explored via molecular docking simulations, which revealed hydrogen bonding interactions between PA and important amino acid residues (Asp60, Arg69 and Asp 70 (3.11Å)), surrounding the catalytic site of the α-glucosidase. These interactions could be mainly responsible for their role in potent inhibitory activity of PA. PA has a strong potential to be further investigated as a new lead compound for better management of diabetes.

Daily intake of selenium and concentrations in blood of residents of Riyadh City, Saudi Arabia.

Concentrations of selenium (Se) in food from local markets of Riyadh, Kingdom of Saudi Arabia (KSA) were measured and daily intake calculated based on information from a questionnaire of foods eaten by healthy Saudis. The daily intake of Se was then compared to concentrations of Se in blood serum. Primary sources of Se in the diet of Saudis were as follows: meat and meat products (31%), egg (20.4%), cereals and cereal products (16%), legumes (8.7%), fruits (6.8%), milk and dairy products (2.0%), beverages (2%), sweets (1.8%), pickles (0.2%), and oil (0.02%). Daily intake of Se, estimated to be 93 µg Se/person/day, was slightly greater than that calculated from the Food and Agriculture Organization (FAO) food balance sheet for KSA, which was approximately 90 µg Se/person/day. The daily intake of Se by Saudis in Riyadh was greater than that of Australians or Dutch but less that of Canadians and Americans. There was a statistically significant correlation (R = +0.38, P < 0.05) between daily intake of Se and concentrations of Se in blood serum of Saudis in Riyadh. The mean concentration of Se in serum was 1.0 × 10(2) ± 30.5 µg Se/l. Taken together, the results suggest that the average Se intake and Se serum concentrations are within the known limits and recommendations, making it unlikely that Saudis are on average at risk of deficiency or toxicity.

Hepatoprotective effects of vitamin E/selenium against malathion-induced injuries on the antioxidant status and apoptosis-related gene expression in rats.

The present study is undertaken to evaluate the protective effect of vitamin E (α-tocopherol) and selenium (Se) against malathion (MTN)-induced oxidative stress and hepatic injuries in experimental rats. Male rats were randomly divided into eight groups comprised of 10 rats each. The 1(st) group served as a negative control (C(N)), whereas the 2(nd) was supplemented with a combination of α-tocopherol (100 mg kg(-1) body weight, b.w.)/Se (0.1 mg kg(-1) bw). The 3(rd), 4(th) and 5(th) groups were respectively administered with increasing doses of MTN equivalent to (1/50 )LD(50) (M(1/50)), (1/25) LD(50) (M(1/25)) and (1/10) LD(50) (M(1/10)), respectively. The 6(th), 7(th) and 8(th) groups were administered the same doses of MTN as in the 3(rd), 4(th) and 5(th) groups with a concomitant supplementation with α-tocopherol/Se. Subchronic exposure of rats to MTN for 45 days resulted in statistical dose-dependent decrease in acetylcholinestrase (AChE) activity, increase in oxidative stress marker lipid peroxidation (LPO) and reduction in reduced glutathione (GSH) level. Moreover, the levels of glutathione persoxidase (GPx), superoxide dismutase (SOD) and catalase (CAT) were significantly decline in response to MTN exposure in a dose-dependent fashion. Furthermore, histopathological studies of liver in the rats which received MTN exhibited, moderate to severe degenerative and necrotic changes in the hepatocytes. Notably, the administration of α-tocopherol/Se protected the liver of rats exposed to MTN as evidenced by the appearance of normal histological structures, significant attenuation of the decline in all antioxidant enzymes tested (i.e. GPx, SOD and CAT), significant recovery in the GSH level and statistical reduction in LPO, as compared to the experimental rat. The effect of α-tocopherol/Se supplementation on transcriptional activity of three key stress and apoptosis-related genes (i.e., Tp53, CASP3 and CASP9), in response to MTN exposure in rats, was investigated. Results revealed a significant concentration-dependent up-regulation in the level of expression for the three genes examined, in response to MTN exposure, compared with the control. Interestingly, the supplementation of MTN-treated rats with α-tocopherol/Se modulates the observed significant dose-dependent up-regulation in the level of expression for three selected genes, indicative of an interfering role in the signaling transduction process of MTN-mediated poisoning. Taken together, these data suggest that the administration of α-tocopherol/Se may partially protect against MTN-induced hepatic oxidative stress and injuries.

Effects of dietary flavonoids intake in saudi patients with coronary heart disease.

OBJECTIVES: The aim of the study was to assess the dietary intake of flavonoids and their effect on serum lipid levels in Saudi patients with coronary heart disease (CHD). METHODOLOGY: A cross-sectional study with a sample of 50 CHD patients and 50 controls. A 24-hour recall method was used to collect data on the dietary intake of macronutrients, flavonoids, and antioxidant vitamins. A food frequency questionnaire (FFQ) was used to collect data on habitual consumption during the year preceding the interview. Baseline data collection included medical history, anthropometric measurements, physical activity, and smoking status. RESULTS: CHD patients showed significantly less intake of fruits and vegetables compared to the controls. Serum lipids including total cholesterol (TC), triglycerides (TG), and low density lipoproteins (LDL) were found to be significantly higher in CHD patients than in the controls. The main sources of flavonoids in a typical Saudi diet are tea, fruits (apples), vegetables (onions), and chocolate. The intake of flavonoids and antioxidant vitamins was significantly lower in CHD patients compared to the controls. A negative correlation between the dietary intake of different flavonoids and serum LDL was observed in CHD patients. Significant correlation was found between the intake of flavonol and waist to hip ratio CONCLUSIONS: The findings of the study support a potential protective effect of dietary flavonoids in relation to CHD. The study showed that consuming more Flavonoids may have positive effect on lowering blood lipids.

Mothers' practices during pregnancy, lactation and care of their children in Riyadh, Saudi Arabia.

OBJECTIVE: To study mothers' practices during pregnancy, lactation and care during the first 2 years. METHODS: A cross section study was carried out in 5 Primary Health Care Centres (PHCC) in Riyadh, Kingdom of Saudi Arabia. Two hundred and fifty women (50 from each PHCC) who have children less than 2-years of age who visited the selected PHCCs during the study period were selected by systematic random sampling. Data was collected via a questionnaire which contained sociodemographic characteristics of the mother and their children and mothers' practices during pregnancy, lactation and the care of their children. RESULTS: Approximately 73% of the mothers breast fed their children initially but only 37.6% are currently breast feeding their children. The majority of the mothers started breast feeding during 1-8 hours after delivery, 63% added supplementary foods to their children at 4-8 months. The majority of mothers visited antenatal clinics during pregnancy, vaccinated their children and followed up their children in well baby clinics. Half of the mothers are currently using contraceptives and 19% are consuming less food during pregnancy. The mothers' educational level was the most important factor associated with mothers' practices. CONCLUSION: Some mothers' practices during pregnancy, lactation and child care needs corrective intervention.