Nutrition transition in the United Arab Emirates.

BACKGROUND/OBJECTIVES: The United Arab Emirates has undergone remarkable economic and social transformations over the past few decades. We present findings on the prevalence of overweight and obesity, dietary and activity patterns among Emiratis in 2009/10, and explore associated urbanization and wealth factors. SUBJECTS/METHODS: A cross-sectional study was conducted in 628 randomly selected households in all seven emirates. Sociodemographics, 24-h dietary recalls, physical activity and anthropometric data were collected from adult females (≥ 19 years), adolescents (11-18 years) and children (6-10 years) in each family via in-person interviews using validated questionnaires. RESULTS: In 2009/10, 65% of adult women, 28% of male adolescents and 40% of female adolescents, 25% of male children and 41% of female children were overweight or obese. 43% of girls and 38% of boys (6-10 years) consumed more calories than their estimated energy requirements. Snacking represents a major source of Emirati caloric intake (>20%) of total calories. In addition, caloric beverages account for 8-14% of total calories. Meanwhile, physical activity levels are low, especially among females Emiratis and those living in urban areas. CONCLUSIONS: These trends represent the potential risk for severe cardiometabolic problems in the United Arab Emirates. The significant gender differentials among children and adolescents are driven by diet and activity differences. More attention should be paid to educate the public on nutrition (for example, limit the consumption of sugared sodas, fruit drinks and whole milk, promote water and low-fat/skim milk consumption instead) and encourage physical activity from a young age, especially among females. Built environments and social support for improved lifestyle choices by individuals are needed.

Variants in the gene encoding aldose reductase (AKR1B1) and diabetic nephropathy in American Indians.

AIMS: The aldose reductase gene (AKR1B1) is a strong candidate for diabetic nephropathy, and the T allele at rs759853 and the Z-2 allele at an [AC]n microsatellite are associated with diabetic kidney disease in some populations. As AKR1B1 is located on 7q35, where we have previously reported linkage to diabetic nephropathy in Pima Indians, this study examined the association of AKR1B1 variants with diabetic nephropathy in this population. METHODS: AKR1B1 variants were identified by sequencing and genotyped using allelic discrimination and pyrosequencing. Genotype distributions were compared between 107 cases with diabetic end-stage renal disease and 108 control subjects with diabetes for > or = 10 years and no evidence of nephropathy, and between 141 individuals with nephropathy and 416 individuals without heavy proteinuria in a family study of 257 sibships. RESULTS: We identified 11 AKR1B1 single nucleotide polymorphisms (SNPs) and the [AC]n microsatellite polymorphism. Three SNPs were rare and two were in 100% genotypic concordance; thus, eight polymorphisms were genotyped. No variant was associated with diabetic kidney disease in the case-control or family-based study. For example, the T allele at rs759853 had an allele frequency of 0.165 in cases and 0.171 in control subjects (OR = 0.96, 95% CI, 0.57-1.59, P = 0.86); in the family study its frequency was 0.140 and 0.169 in affected and unaffected individuals, respectively (OR = 0.90, 95% CI, 0.53-1.54 P = 0.71). Corresponding values for the Z-2 allele at the [AC]n microsatellite were OR = 1.09 (95% CI 0.72-1.66, P = 0.67) and OR = 1.25 (95% CI 0.81-1.95, P = 0.31) in the case-control and family studies, respectively. CONCLUSIONS: Common AKR1B1 polymorphisms are unlikely to be major determinants of diabetic nephropathy in this population.

Ecological associations between asthma prevalence and potential exposure to farming.

Farming and exposure to livestock have been proposed as protective against the development of asthma in children. An ecological study was conducted to examine the support for these relationships in the USA. County-specific aggregate measures were used to examine the relationship between the prevalence of asthma and wheeze in 7th and 8th grade school children (aged 12-14 yrs) and selected measures of potential exposure to farming in the state of North Carolina. Binomial regression models were fitted to quantify these relationships, with adjustments for parental smoking, socioeconomic status, sex and race. Regression coefficients were reported for an increment of one interquartile range (IQR) in each indicator of exposure. The prevalence of asthma showed decreasing trends for most indicators of farm exposure. Regression results suggested that the largest decreases in asthma prevalence were associated with the number of farms (-5.0% per IQR increment), acreage of hay (-7.2% per IQR increment) and beef cattle (-7.8% per IQR increment). The pattern of results was similar for wheezing. In conclusion, the findings of this study are consistent with the hypothesis that certain farm exposures are protective against childhood asthma. Further research with individual-level data is needed to identify the specific protective exposures.

Health consequences associated with frequent wheezing in adolescents without asthma diagnosis.

Using questions from the International Study of Asthma and Allergies in Childhood, this study evaluated the association between undiagnosed frequent wheezing and health consequences in adolescents. The North Carolina School Asthma Survey provided self-reported questionnaire data on respiratory health from 122,829 children aged 12-14 yrs. The frequency of health consequences were compared among undiagnosed frequent wheezers, diagnosed asthmatics, and children with no wheezing symptoms or diagnosed asthma. The odds of wheezing-related sleep disturbances, limited activities, and missed school were higher among undiagnosed frequent wheezers, relative to diagnosed asthmatics. The frequency of emergency room visits and hospitalisations did not differ substantially between the undiagnosed wheezing and diagnosed asthma groups, though the undiagnosed group was less likely to have visited a physician for wheezing in the past year. Children with frequent wheezing symptoms but no asthma diagnosis experience substantial illness-related morbidity similar to that of diagnosed asthmatics. Undiagnosed frequent wheezers require more recognition from primary care physicians and need active disease management to reduce health consequences.

Prevalence and consequences of asthma and wheezing in African-American and White adolescents.

PURPOSE: To describe the functional consequences of health care utilization for wheezing symptoms and diagnosed asthma in a multiracial school-based population. METHODS: Wheezing symptoms and physician-diagnosed asthma were measured in 2059 eighth graders with the International Study of Asthma and Allergies in Children video questionnaire. The sample site population was 40% African-American, 53% White, and 49% girls. Thirty-two percent of the children were on the free school lunch program. Adolescents self-reported their wheezing symptoms and physician diagnosis in response to the video wheezing scenes. They also answered questions on activity limitations, school attendance, and sleep disturbances owing to their wheezing symptoms. Multiple logistic regression was used to calculate odds ratios and adjust for potential confounders. RESULTS: Nine percent of the adolescents reported physician-diagnosed asthma with current symptoms and 27% reported current wheezing with no diagnosis of asthma. Physician-diagnosed asthmatics and wheezers were 2.6 (95% confidence interval [CI] 1.9, 3.6) and 1.8 (95% CI 1.4, 2.2) times more likely, respectively, to miss school days because of wheezing symptoms than asymptomatic adolescents. Diagnosed asthmatics were 7.8 (95% CI 5.5, 11.2) times and wheezers 4.7 (95% CI 3.5, 6.1) times more likely to have sleep disturbances than asymptomatic adolescents. Diagnosed asthmatics were 49 (95% CI 30.0, 79.8) times and wheezers 4.8 (95% CI 3.0, 7.5) times as likely to report a clinic visit for wheezing than asymptomatic adolescents. African-Americans had similar prevalence of wheezing, compared with Whites, although African-Americans were 1.4 (95% CI 1.1, 1.9) times as likely to have physician-diagnosed asthma. Girls were twice as likely to report physician-diagnosed asthma and wheezing symptoms as were boys. CONCLUSIONS: Adolescents with wheezing experienced functional consequences comparable to those of adolescents with physician-diagnosed asthma. Although wheezers may have less severe asthma than diagnosed asthmatics, the functional consequences of wheezing are likely to impair school performance and limit activity.

Area-level characteristics and smoking in women.

OBJECTIVES: This study examined whether area-level characteristics are associated with individual smoking behavior among women. METHODS: Analyses included 648 women enrolled as control patients in the Carolina Breast Cancer Study (1993-1996). Smoking and covariate information was obtained from interviews. Area-level characteristics included census block-group education level, poverty, unemployment, car-home ownership, crowding, and, for 431 women, city-level crime rates. RESULTS: In multivariate logistic regression models, no area characteristics were clearly associated with a history of smoking. Among those who had ever smoked, continued smoking was associated with living in low-education areas (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.0, 2.9), high-unemployment areas (OR = 1.7, 95% CI = 1.0, 2.8), and high-crime areas (OR = 1.6, 95% CI = 0.8, 3.2). CONCLUSIONS: The present findings are consistent with a growing literature suggesting that area-level social and economic disadvantage influences individual smoking behavior.

Statewide adolescent asthma surveillance.

We assessed the prevalence of diagnosed asthma, wheezing, healthcare utilization, and environmental triggers in children ages 13-14 years, and evaluated the feasibility of statewide asthma surveillance in North Carolina. A cross-sectional study (N = 1,596) was conducted using the International Survey for Asthma and Allergies in Childhood (ISAAC) questionnaire. Ten percent reported current diagnosed asthma. Nineteen percent reported wheezing symptoms with no diagnosis of asthma. Children with frequent wheezing were more likely to be poor, African-American, and female. Thirty percent of diagnosed asthmatics made 1 or more emergency room visits in the last year. Undiagnosed asthmatics were unmedicated. These results highlight the magnitude of the asthma epidemic in early adolescence, and illustrate that statewide surveillance using ISAAC is feasible.

Asthma inhaler use and barriers in a population-based sample of African-American and white adolescents.

BACKGROUND: There is little information on inhaler medication and barriers to use among a population-based sample of adolescents and whether possible variations in asthma treatment by ethnic group exist. OBJECTIVE: We describe the prevalence of inhaler use and identify barriers for proper use of asthma medication in a population-based sample of adolescents of which 34% are African-American. METHODS: A cross-sectional survey using the ISAAC (International Survey of Asthma and Allergies in Children) questionnaire was conducted in a school population-based sample (n = 2056) of 13 to 14-year-old eight grade students in the Charlotte-Mecklenburg, North Carolina public school system. Questions were asked about symptom prevalence, asthma diagnosis, inhaler use, and barriers to care. RESULTS: Fourteen percent of the children (296/2056) reported using an inhaler in the last 12 months with no differences among African-American children and white children. Twenty-six percent of inhaler users were not allowed to carry their medication on their person while at school. Girls were more likely to be allowed to carry their inhalers at school and diagnosed asthmatic girls had a higher prevalence of wheezing in the last year (47%) compared with diagnosed asthmatic boys (35%). Smoking prevalence was higher in inhaler users (26%) compared to the study population (19%). CONCLUSIONS: Inhaler use is high in this population. Adolescents using inhalers need to reduce their smoking levels. Schools need to reevaluate their policies on the use of inhalers at school.