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Total dietary fiber (TDF), insoluble dietary fiber (IDF) and soluble dietary fiber (SDF) contents of 37 composite dishes commonly consumed in the State of Kuwait were determined by the AOAC enzymatic--gravimetric method of Prosky et al. Levels (g/100  g) of SDF ranged over 0.3--0.5 in fish-based dishes, 0.3--2.6 in meat-based dishes, 0.1--1.4 in rice dishes, 3.2--4.6 in vegetable dishes, 0.3--0.7 in soup dishes, 0 in dairy dishes, 0.7--0.8 in sandwiches, and 0.1--5.0 in sweet dishes. IDF levels ranged over 1.1--1.8 in fish-based, 0.9--3.2 in meat-based, 0.6--2.7 in rice, 2.1--4.0 in vegetables, 0.6--3.4 in soup, 0 in dairy, 0.2--0.3 in sandwiches, and 0.2-11.6 in sweets. TDF values ranged over 1.4--2.3 in fish-based, 1.2--3.7 in meat-based, 0.3--4.1 in rice, 3.2-4.6 in vegetables, 0.9--3.8 in soup, 0 in dairy, 0.7--0.8 in sandwiches and 0.3--15.4 in sweets. This work attempts to provide new data on TDF, IDF and SDF of selected commonly consumed Kuwaiti composite dishes. [ABSTRACT FROM AUTHOR]

Infantile-onset multisystem neurologic, endocrine, and pancreatic disease (IMNEPD) is a rare autosomal recessive multisystemic disease with a prevalence of < 1/1 000 000. The wide spectrum of symptoms and associated diseases makes the diagnosis of this disease particularly challenging. Here, we report a 12-year-old Bahraini male who presented with the core clinical features of IMNEPD including intellectual disability, global developmental delay, sensorineural hearing loss, endocrine dysfunction, and exocrine pancreatic insufficiency. The diagnosis was confirmed by genetic testing using whole exome sequencing. This is the first reported case of IMNEPD from Bahrain and was found to have a novel homozygous peptidyl-tRNA hydrolase 2 (PTRH2) gene mutation (NM&#95;001015509.2: c.370del p.(Glu124Lysfs*4)). Moreover, we conducted an extensive literature review with an emphasis on the variable clinical spectrum and genotypes of previously reported patients in comparison to our case., (Copyright © 2023, Oman Medical Journal.)

This systematic review aims to identify and characterize existing national sugar reduction initiatives and strategies in the Eastern Mediterranean Region. For this purpose, a systematic review of published and grey literature was performed. A comprehensive list of search terms in the title/abstract/keyword fields was used to cover the four following concepts (1) sugar, (2) reduction OR intake, (3) policy and (4) EMR countries. A total of 162 peer-reviewed documents were identified, until the 2nd of August 2022. The key characteristics of the identified national strategies/initiatives included the average sugar intake of each country's population; sugar levels in food products/beverages; implementation strategies (taxation; elimination of subsidies; marketing regulation; reformulation; consumer education; labeling; interventions in public institution settings), as well as monitoring and evaluation of program impact. Twenty-one countries (95%) implemented at least one type of sugar reduction initiatives, the most common of which was consumer education (71%). The implemented fiscal policies included sugar subsidies' elimination (fourteen countries; 67%) and taxation (thirteen countries 62%). Thirteen countries (62%) have implemented interventions in public institution settings, compared to twelve and ten countries that implemented food product reformulation and marketing regulation initiatives, respectively. Food labeling was the least implemented sugar reduction initiative (nine countries). Monitoring activities were conducted by four countries only and impact evaluations were identified in only Iran and Kingdom of Saudi Arabia (KSA). Further action is needed to ensure that countries of the region strengthen their regulatory capacities and compliance monitoring of sugar reduction policy actions.

High intakes of trans fatty acids (TFA), particularly industrially-produced TFA, are implicated in the etiology of cardiovascular diseases, which represent the leading cause of mortality in the Eastern Mediterranean Region (EMR). This systematic review aims to document existing national TFA reduction strategies in the EMR, providing an overview of initiatives that are implemented by countries of the region, and tracking progress toward the elimination of industrially-produced TFA. A systematic review of published and gray literature was conducted using a predefined search strategy. A total of 136 peer-reviewed articles, gray literature documents, websites and references from country contacts were obtained, up until 2 August 2021. Randomized-control trials, case-control studies, and studies targeting unhealthy population groups were excluded. Only articles published after 1995, in English, Arabic or French, were included. Key characteristics of strategies were extracted and classified according to a pre-developed framework, which includes TFA intake assessment; determination of TFA levels in foods; strategic approach; implementation strategies (TFA bans/limits; consumer education, labeling, interventions in public institution settings, taxation), as well as monitoring and evaluation of program impact. Thirteen out of the 22 countries of the EMR (59%) have estimated TFA intake levels, 9 have determined TFA levels in foods (41%), and 14 (63.6%) have national TFA reduction initiatives. These initiatives were mainly led by governments, or by national multi-sectoral committees. The most common TFA reduction initiatives were based on TFA limits or bans (14/14 countries), with a mandatory approach being adopted by 8 countries (Bahrain, Iran, Jordan, KSA, Kuwait, Morocco, Oman and Palestine). Complementary approaches were implemented in several countries, including consumer education (10/14), food labeling (9/14) and interventions in specific settings (7/14). Monitoring activities were conducted by few countries (5/14), and impact evaluations were identified in only Iran and the UAE. The robustness of the studies, in terms of methodology and quality of assessment, as well as the lack of sufficient data in the EMR, remain a limitation that needs to be highlighted. Further action is needed to initiate TFA reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluation of ongoing programs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Al-Jawaldeh, Taktouk, Chatila, Naalbandian, Abdollahi, Ajlan, Al Hamad, Alkhalaf, Almamary, Alobaid, Alyafei, Azizi, Baqadir, Barham, Binsunaid, El Ammari, El Ati, Hoteit, Massad, Nejad and Nasreddine.)

Background: The conduction delay and block that compose the critical isthmus of macroreentrant ventricular tachycardia (VT) is partly "functional" in that they only occur at faster cycle lengths. Close-coupled pacing stresses the myocardium's conduction capacity and may reveal late potentials (LPs) and fractionation. Interest has emerged in targeting this functional substrate., Objective: The purpose of this study was to assess the feasibility and efficacy of a functional substrate VT ablation strategy., Methods: Patients with scar-related VT undergoing their first ablation were recruited. A closely coupled extrastimulus (ventricular effective refractory period + 30 ms) was delivered at the right ventricular apex while mapping with a high-density catheter. Sites of functional impaired conduction exhibited increased electrogram duration due to LPs/fractionation. The time to last deflection was annotated on an electroanatomic map, readily identifying ablation targets., Results: A total of 40 patients were recruited (34 [85%] ischemic). Median procedure duration was 330 minutes (interquartile range [IQR] 300-369), and ablation time was 49.4 minutes (IQR 33.8-48.3). Median functional substrate area was 41.9 cm 2 (IQR 22.1-73.9). It was similarly distributed across bipolar voltage zones. Noninducibility was achieved in 34 of 40 patients (85%). Median follow-up was 711 days (IQR 255.5-972.8), during which 35 of 39 patients (89.7%) did not have VT recurrence, and 3 of 39 (7.5%) died. Antiarrhythmic drugs were continued in 53.8% (21/39)., Conclusion: Functional substrate ablation resulted in high rates of noninducibility and freedom from VT. Mapping times were increased considerably. Our findings add to the encouraging trend reported by related techniques. Randomized multicenter trials are warranted to assess this next phase of VT ablation., (Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Objective: The beneficial role of breast-feeding for maternal and child health is now well established. Its possible role in helping to prevent diabetes and obesity in children in later life means that more attention must be given to understanding how patterns of infant feeding are changing. The present study describes breast-feeding profiles and associated factors in Kuwait. Design/Setting/Subjects Interviews with 1484 recent mothers were undertaken at immunisation clinics across Kuwait. Descriptive analysis and binary logistic regression of results were performed., Results: Rates of breast-feeding initiation in Kuwait were high (98·1 %) but by the time of discharge from hospital, only 36·5 % of mothers were fully breast-feeding, 37·0 % were partially breast-feeding and 26·5 % were already fully formula-feeding. Multiple social and health reasons were given for weaning the child, with 87·6 % of mothers who had stopped breast-feeding completely doing so within 3 months postpartum. Nationality (P<0·001), employment status 6 months prior to delivery (P<0·001), mode of delivery (P=0·01), sex of the child (P=0·026) and breast-feeding information given by nurses (P=0·026) were all found to be significantly associated with breast-feeding. Few women (5·6 %) got information on infant nutrition and feeding from nursing staff, but those who did were 2·54 times more likely to be still breast-feeding at discharge from hospital. Over 70 % of mothers had enjoyed breast-feeding and 74 % said they would be very likely to breast-feed again., Conclusions: In Kuwait where the prevalence of both obesity and type 2 diabetes is growing rapidly, the public health role of breast-feeding must be recognised and acted upon more than it has in the past.

Objectives: We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR)., Methods: The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs)., Results: For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries., Conclusions: This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost-YLLs) and nonfatal outcomes (years lived with disability-YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25-49 age group, with a peak in the 35-39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of diseases in the region., Competing Interests: We would like to declare the following commercial affiliations: Dr. Anwar Rafay is employed by Contech International health consultants. Syed Danish Ali is employed by SIR Consultants. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

The aim of this pilot study was to assess body composition and total energy expenditure (TEE) in 35 obese 7-9 years old Kuwaiti children (18 girls and 17 boys). Total body water (TBW) and TEE were assessed by doubly-labeled water technique. TBW was derived from the intercept of the elimination rate of deuterium and TEE from the difference in elimination rates of 18 O and deuterium. TBW was used to estimate fat-free mass (FFM), using hydration factors for different ages and gender. Fat mass (FM) was calculated as the difference between body weight and FFM. Body weight was not statistically different but TBW was significantly higher ( p = 0.018) in boys (44.9% ± 3.3%) than girls (42.4% ± 3.0%), while girls had significantly higher estimated FM (45.2 ± 3.9 weight % versus 41.6% ± 4.3%; p = 0.014). TEE was significantly higher in boys (2395 ± 349 kcal/day) compared with girls (1978 ± 169 kcal/day); p = 0.001. Estimated physical activity level (PAL) was significantly higher in boys; 1.61 ± 0.167 versus 1.51 ± 0.870; p = 0.034. Our results provide the first dataset of TEE in 7-9 years old obese Kuwaiti children and highlight important gender differences to be considered during the development of school based interventions targeted to combat childhood obesity., Competing Interests: The authors declare no conflict of interest. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Background: The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013., Methods: GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically., Findings: The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60-80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred., Interpretation: Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts., Funding: Bill & Melinda Gates Foundation., (Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.)

The objective of this study was to assess the prevalence of anemia and iron deficiency (ID) of a nationally representative sample of the Kuwait population. We also determined if anemia differed by socioeconomic status or by RBC folate and vitamins A and B12 levels. The subjects who were made up of 1830 males and females between the ages of 2 months to 86 years, were divided into the following age groups (0-5, 5-11, 12-14, 15-19, 20-49, ≥50 years). Results showed that the prevalence of anemia was 3% in adult males and 17% in females. The prevalence of ID varied according to age between 4% (≥50 years) and 21% (5-11 years) and 9% (12-14 years) and 23% (15-19 years), respectively, in males and females. The prevalence of anemia and ID was higher in females compared to males. Adults with normal ferritin level, but with low RBC folate and vitamins A and B12 levels had higher prevalence of anemia than those with normal RBC folate and vitamins A and B12 levels. This first nationally representative nutrition and health survey in Kuwait indicated that anemia and ID are prevalent and ID contributes significantly to anemia prevalence.

Objective: The 2H dilution technique is the reference method to estimate total body water for body composition assessment. The aims of the present study were to establish the total body water technique at the Kuwait Institute for Scientific Research and assess body composition of Kuwaiti children., Design: The isotope ratio mass spectrometer was calibrated with defined international reference water standards. A non-random sampling approach was used to recruit a convenience sample of Kuwaiti children. A dose of 2H2O, 1-3 g, was consumed after an overnight fast and 2H enrichment in baseline and post-dose urine samples was measured. Total body water was calculated and used to estimate fat-free mass. Fat mass was estimated as body weight minus fat-free mass., Setting: The total body water study was implemented in primary schools., Subjects: Seventy-five boys and eighty-three girls (7-9 years)., Results: Measurements of the isotope ratio mass spectrometer were confirmed to be accurate and precise. Children were classified as normal weight, overweight or obese according to the WHO based on BMI-for-age Z-scores. Normal-weight and overweight girls had significantly higher percentage body fat (median (range): 32·4 % (24·7-39·3 %) and 38·3 % (29·3-44·2 %), respectively) compared with boys (median (range): 26·5 % (14·2-37·1 %) and 34·6 % (29·9-40·2 %), respectively). No gender difference was found in obese children (median 46·5 % v. 45·6 %)., Conclusions: The establishment of a state-of-the-art stable isotope laboratory for assessment of body composition provides an opportunity to explore a wide range of applications to better understand the relationship between body size, body composition and risk of developing non-communicable diseases in Kuwait.

Objectives: To describe nutrient intakes and prevalence of overweight and obesity in a nationally representative sample of Kuwaitis and to compare intakes with reference values., Design: Cross-sectional, multistage stratified, cluster sample. Settings National nutrition survey covering all geographical areas of the country., Subjects: Kuwaitis (n 1704) between 3 and 86 years of age., Results: Obesity was more prevalent among women than men (50 % and 70 % for females aged 19-50 years and ≥51 years, respectively, v. 29 % and 42 % for their male counterparts). Boys were more obese than girls, with the highest obesity rate among those aged 9-13 years (37 % and 24 % of males and females, respectively). Energy intake was higher than the estimated energy requirements for almost half of Kuwaiti children and one-third of adults. The Estimated Average Requirement was exceeded by 78-100 % of the recommendation for protein and carbohydrates. More than two-thirds of males aged ≥4 years exceeded the Tolerable Upper Intake Level for Na. Conversely, less than 20 % of Kuwaitis, regardless of age, consumed 100 % or more of the Estimated Average Requirement for vitamin D, vitamin E, Ca, n-3 and n-6 fatty acids. Less than 20 % of children met the recommended level for fibre., Conclusions: Nutrition transition among Kuwaitis was demonstrated by the increased prevalence of obesity and overweight, increased intakes of energy and macronutrients and decreased intakes of fibre and micronutrients. Interventions to increase awareness about healthy foods combined with modifications in subsidy policies are clearly warranted to increase consumption of low-energy, nutrient-dense foods.

The socio-economic development which followed the discovery of oil resources brought about considerable changes in the food habits and lifestyle of the Kuwaiti population. Excessive caloric intake and decreased energy expenditure due to a sedentary lifestyle have led to a rapid increase in obesity, diabetes and other non-communicable chronic diseases in the population. In this paper, we examine the prevalence of the Metabolic Syndrome (MetS) among Kuwaiti adults (≥20 years) using data from the first national nutrition survey conducted between July 2008 and November 2009. The prevalence of MetS was 37.7% in females and 34.2% in males by NCEP criteria, whereas the values were 40.1% in females and 41.7% in males according to IDF criteria. Prevalence of MetS increased with age and was higher in females than males. The high prevalence of the MetS in Kuwaiti adults warrants urgent public health measures to prevent morbidity and mortality due to cardiovascular complications in the future.

Objective: Abdominal obesity is a major risk factor for chronic diseases. Yet there are no waist circumference (WC) cut-offs for children in the Arabian Gulf. We developed smoothed WC percentiles for 5-19-year-old Kuwaiti children and adolescents, which could be used in clinical and public health practice. We also examined the percentages of children who had WC ≥ 90th percentile, a value commonly associated with an elevated risk of CVD., Design: This is a cross-sectional study that was conducted by the Kuwait National Nutrition Surveillance System., Setting: Data were collected from representative primary-, intermediate- and secondary-school children as part of the yearly nutrition and health monitoring. Least mean square regression was used to develop smoothed WC curves., Subjects: A total of 9593 healthy 5.0-18.9-year-old children of both sexes were studied from all areas of Kuwait. Age, gender, residency, education level, weight, height and WC were collected for all participants., Results: We developed the first smoothed WC curves for Kuwaiti children. Male children had higher WC than female children. WC increased with age in both genders, but larger percentages of male children had WC ≥ 90th percentile. Male children aged >10 years have higher WC percentiles than do female children at the 50th, 75th, 90th and 97th percentiles., Conclusions: Male children (especially those aged >10 years) are at higher risk than female children. Few health-care professionals routinely measure WC. WC measurement should be promoted as an important tool in paediatric primary care practice. The use of these age- and gender-specific percentiles can impact public health recommendations for Kuwaiti and other Arab children from the Gulf.

Objective: To ascertain abdominal obesity prevalence (waist circumference, WC) in adolescents and to develop smoothed WC percentile charts for Kuwaiti adolescents for public health use., Subjects and Methods: A cross-sectional study of 4,219 healthy Kuwaiti male and female secondary school students between the ages of 11-19 years was examined. Adolescents were drawn from all geographical regions of the country, as part of the Kuwait Nutrition Surveillance Program (KNSP). The KNSP consists of yearly data collections of variables, including weights, heights, and WCs and several sociodemographic variables. LMS regression was used to develop smoothed WC percentile curves. The final percentile curves presented are the result of smoothing three age-specific curves, termed lambda (L), mu (M), and sigma (S) for each gender., Results: Between 5.9 and 12.8% of females and 8.0-30.3% males had WC values > or = 90th percentile. Moreover, the mean WC of males was consistently higher than those of females at each age and the percent of adolescents who exceed the 90th percentile increased with age in males, but not in females., Conclusion: Mean WC was higher in males than in females at every age. In most cases, two to three times greater percentages of males, compared to females, equaled or exceeded the 90th percentile, a value frequently associated with higher cardiovascular risk. These results indicate the urgent need to reduce abdominal obesity, an important indicator of the metabolic syndrome, in Kuwaiti adolescents., (Copyright 2010 S. Karger AG, Basel.)

Aim: To investigate the level of diabetes knowledge in a population with type 2 diabetes (T2D) and a high prevalence of illiteracy, to identify the main gaps in the knowledge and to study the determinants of the knowledge score., Methods: This cross-sectional survey involved 24 diabetes clinics and Kuwaiti adults with T2D (n=5114), and used the Michigan Diabetes Knowledge Test., Results: The participants' mean age (+/-S.D.) was 55.6+/-10.4 years; 68.2% were women, 45.0% were illiterate, 52.2% reported a family income equivalent to 1200 to 2400 euros per month and only 28.6% performed glucose monitoring. Mean+/-S.D. HbA(1c) was 8.76+/-2.3%. Their mean score for the total knowledge test was 58.9%. Knowledge deficits were apparent in the questions related to diet and self-care. Participants who were older, and with lower educational levels, limited family income, negative family history of diabetes or were smokers had significantly lower knowledge scores. The scores were also lower in those who had shorter disease duration and fewer complications, were taking insulin, had less frequent insulin injections, performed less glucose monitoring and had lower HbA(1c) levels. Education, family income, glucose monitoring and presence of complications were independent determinants of the knowledge score., Conclusion: Knowledge of diabetes in a T2D population with a high prevalence of illiteracy was poor. Limited family income and lack of self-care are other predictors of knowledge deficits. Efforts need to be focused on educational programmes with strategies to assist T2D patients of limited education and income to manage their disease more effectively.

International comparisons of adolescent overweight and obesity are hampered by the lack of a single agreed measurement reference. We compared 3 BMI-for-age references on samples of adolescent girls from Egypt, Kuwait and Lebanon. Overweight and obesity was highest in Kuwait and lowest in Lebanon. Performance of the 3 standards differed only slightly although one was particularly applicable in country-to-country comparisons.

Over an 8-year period (January 1996 to December 2003), a total of 171 patients below the age of 15 years were diagnosed with chronic renal failure. The mean incidence rate of CRF in Kuwaiti children was found to be 38.2 per million children per year, with a peak incidence of 55 per million children per year. While the mean age at diagnosis was 33+/-12 months (range: 1 month to 15 years), the male:female ratio was 2.7:1. Etiological factors for chronic renal failure included congenital urological malformation (61.9%), chronic glomerulopathies (5.2%), hereditary nephropathies (21%), multi-system disease (0.5%), chronic pyelonephritis (without VUR) (4.6%), tumors (0.6%), ischemic renal disease (1.1%) and unknown etiology (1.7%). Thirty percent of patients reached end-stage renal disease within a mean of 18 months following diagnosis. The overall mortality before reaching ESRD was reported to be 4%. Kuwait has one of the highest incidence and prevalence rates of CRF in children. It is likely that genetic and hereditary factors are the cause of these high rates.

Background: The Food Frequency Questionnaire (FFQ) is one of the most commonly used tools in epidemiologic studies to assess long-term nutritional exposure. The purpose of this study is to describe the development of a culture specific FFQ for Arab populations in the United Arab Emirates (UAE) and Kuwait., Methods: We interviewed samples of Arab populations over 18 years old in UAE and Kuwait assessing their dietary intakes using 24-hour dietary recall. Based on the most commonly reported foods and portion sizes, we constructed a food list with the units of measurement. The food list was converted to a Semi-Quantitative Food Frequency Questionnaire (SFFQ) format following the basic pattern of SFFQ using usual reported portions. The long SFFQ was field-tested, shortened and developed into the final SFFQ. To estimate nutrients from mixed dishes we collected recipes of those mixed dishes that were commonly eaten, and estimated their nutritional content by using nutrient values of the ingredients that took into account method of preparation from the US Department of Agriculture's Food Composition Database., Results: The SFFQs consist of 153 and 152 items for UAE and Kuwait, respectively. The participants reported average intakes over the past year. On average the participants reported eating 3.4 servings/d of fruits and 3.1 servings/d of vegetables in UAE versus 2.8 servings/d of fruits and 3.2 servings/d of vegetables in Kuwait. Participants reported eating cereals 4.8 times/d in UAE and 5.3 times/d in Kuwait. The mean intake of dairy products was 2.2/d in UAE and 3.4 among Kuwaiti., Conclusion: We have developed SFFQs to measure diet in UAE and Kuwait that will serve the needs of public health researchers and clinicians and are currently validating those instruments.