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Diabetes Care, ( Middle East Edition )Volume 12, Number 2, Spring 2015
LOCAL ARTICLES
(these local articles do not appear in the US version)
105
4th Annual Middle East Congress on Clinical Nutrition
March 5-7, 2015
Ajman, United Arab Emirates
Abstracts
OR-1
Use of bone mineral densitometry following Aluminum chelation in children on long term parenteral nutrition. Ali Ibrahim
Al Mehaidib, Haifaa Alawadhi, Wajeeh Aldkhail King Faisal
Specialist Hospital& Research Center, Riyadh, Saudi Arabia
Introduction:Patients on long term total parenteral nutrition
(TPN) are at risk of Aluminum (Al) toxicity, a condition that
was first demonstrated in patients on hemodialysis. Al toxicity
may induce osteomalacia, encephalopathy and anemia.
Aim: To study the value of bone densitometry following aluminum chelation using Desferrioxamine in children receiving
long term TPN.
Methods: The files of all children on long term TPN at king
Faisal Specialist Hospital & Research Center, Riyadh, Saudi
Arabia, were reviewed. Long term TPN was defined as being
on TPN for > 3 weeks duration.
The hospital pharmacy prepared all the TPN solutions from
premade components that were purchased from external manufacturer. Only patients who had a bone mineral densitometry
(BMD) examination were included. The Z score of the lumbar
spine was used as a marker of the level of bone mineral density.
A measurement of the level of calcium, magnesium, phosphorus, and vitamin D were done .
Results:We had a total of 8 patients on cyclic TPN . Their diagnosis were: microvillus inclusion disease (3 ), tufting enteropathy
(2 ), syndromic diarrhea (1 ), severe combined immunodeficiency (1 ), short gut syndrome (1 ).Only five patients had
BMD examination. The other 3 were excluded. The mean age
of was 108 months ( 6 to 13 years ) with a mean TPN duration of 21 months. A mean Al level of 1.61 micro-mol/L (<0.4
micromol/L) . Measurement of bone disease markers showed
a mean of 2.25 mmol/l, 0.80 mmol/l, 1.48 mmol/l and 44.6
nmol/l for calcium, magnesium, phosphorus and vitamin D
respectively.The mean Z-score of the lumbar bone of the included patients was -2.2. Only 1 patient had a high Al level
(Al = 4.39 micro-mol/L, Al = 0.157 micro-mol/L/Kg) and received Desferrioxamine at a dose of 4.2 mg/kg then 1 year later
it was increased to 10.7 mg/kg. His BMD pre chelation showed
a Z-score (of the lumber spine) = -4.2, while the post chelation
BMD showed a Z-score = -3.2
Conclusion: To our knowledge ,this is the first report of the response to Desferrioxamine therapy using BMD. The improvement in the z-score of our patient supports the use of BMD as
a routine method of evaluating such patients. However, a larger
study is needed.
OR-2
Fruit and vegetable consumption among adults in Saudi Arabia, 2013 Charbel El Bcheraoui, Marwa Tuffaha, Mohammed
Basulaiman, Farah Daoud, Abdullah A. Al Rabeeah, Alih.
Mokdad Institute for Health Metrics and Evaluation, Univeristy of Washington USA
Background: Dietary risks were the leading risk factor for
death worldwide in 2010. However, current national estimates on
fruit and vegetable consumption in the Kingdom of Saudi Arabia
(KSA) are nonexistent. We conducted a large household survey
to inform the Saudi Ministry of Health (MOH) on a major modifiable risk factor: daily consumption of fruits and vegetables.
Methods: The Saudi Health Interview Survey is a national multistage survey of individuals aged 15 years or older. It includes
questions on socio-demographic characteristics, tobacco consumption, diet, physical activity, health care utilization, different
health-related behaviors, and self-reported chronic conditions.
We used a backward elimination multivariate logistic regression model to measure association between the Centers for
Disease Control and Prevention (CDC) recommended daily
consumption of fruits and vegetables and different factors.
Results: Between April and June 2013, a total of 10,735 participants completed the survey. Overall, 2.6% of Saudis aged 15
years or older met the CDC guidelines for daily consumption
of fruits and vegetables. The likelihood of meeting the CDC
guidelines increased with age; among women; persons who
graduated from elementary or high school or had a higher education; residents of Makkah, Al Sharqia, Ha’il, or Jizan; those
who consumed at least two servings of meat or chicken per day;
those who visited a health care facility for a routine medical
exam within the last three years; and those who have been diagnosed with hypertension.
Conclusion: We have showed that KSA is in dire need of improving the diet of its population. Our findings call for urgent
research to understand the reasons for low fruit and vegetable
consumption, focusing on price or preference in order to develop
and implement culturally and country-relevant solutions to increase the consumption of fruits and vegetables.
OR-3
Competitive tool for the development of School Nutrition Policies: Old Concepts, New Insights, New Questions “Evidence
from Lebanon”Sima Hamadeh, Haigazian University, Lebanon
Background: Lebanon has been experiencing a nutritional
transition in food choices during the past years. Hence, youth
lifestyles have been affected and are at increased risk of obesity.
Schools have a major role in ameliorating youth’s lifestyle and
food patterns.
Objective: To explore the determinants of deploying an eventual national nutrition policy at Lebanese schools by studying
the perceptions of keys stakeholders.
Methodology: An exhaustive integrated conceptual framework
was proposed to explore stakeholders and youth perceptions
toward school nutrition policy implementation from different
perspectives where various levels of action (individual, community, organizational variables)
Setting: Social Marketing suggests targeting schools and communities. The target population of this study consist of 32 multidisciplinary stakeholders active in Lebanese communities,
and 35 adults (directors, food services managers, parents, and
teachers) and 48 youth (ages 10-14) from 8 schools (private/
public, urban/rural)
Data collection: Directed and semi-structured individual interviews were conducted with participants. Focus groups were
conducted with teachers and parents.
Analysis strategy: Data have been submitted to a thematic
qualitative analysis. Major findings were synthesized per respondent group to identify similarities or differences in their
perspectives according to the school profile.
Results: This study suggested necessary steps to success school
nutrition policy deployment and its sustainability. The identified determinants help the stakeholders, the decision-and policy- makers in their promotion and communication practices
during planning, developing, implementing and evaluating a
national school nutrition policy.
OR-4
Validity of prediction equations for the assessment of REE in
sample of Saudi males Ali M Almajwal. Mahmoud M Abulmeaty, Mohamed F Elsadek College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
Objective: To assess the validity of predictive equations by the
measurement of resting energy expenditure (REE) in a sample
of Saudi males using the Quark RMR as a reference.
Methods: Forty five Saudi male subjects (mean±SD, age
21.79±3.65 years, body mass index (BMI), 28.25±2.79 kg/m2)
were recruited. REE was measured with the Quark RMR and
calculated using 10 prediction equations. Accuracy was defined
as prediction within ± 10% of the measured REE by Quark
RMR. Differences > ± 250 kcal were considered clinically unacceptable as determined by the limits of agreement from the
Bland-Altman analysis. Mean differences using paired t test,
bias, percent of bias, accurate estimation, underestimation and
overestimation were also calculated for each tool.
Results: Data analysis showed that all equations were highly
correlated with the measured REE by Quark RMR. Paired t
test indicated that Schofield, WHO and Harris-Benedict equations were the most accurate equations in the study sample.
The mean numerical bias and the mean percentage bias estimates for Schofield (wt), Schofield (wt & ht), WHO (wt) and
Harris-Benedict were 8.1±264 kcal (underestimation: 23.8%),
15.6±263 kcal (underestimation: 26.2%), 2.4±265 kcal (underestimation: 23.8%) and 19.4±271 kcal (underestimation:
23.8%), respectively. The accuracy of the predictions were
54.8%, 52.4%, 54.8% and 52.4, respectively. The errors across
all equations were clinically unacceptable and were more than
250 kcal maximum stated a priori.
Conclusion: Bland-Altman analysis showed that there is poor
agreement between the REE measured by Quark RMR compared to predictive equations.
Acknowledgement:This project was supported by NSTIP strategic technologies programs, number (11 MED 1966-02) in the
Kingdom of Saudi Arabia.
Key words: validity, Quark RMR, predictive equations, Saudi
Arabia
OR-5
Vitamin D Status and Its Relationship with Metabolic Markers
in Persons with Obesity and Type 2 Diabetes in the UAE: A
Cross-Sectional Study Amena Sadiya, Consultant Nutritonist &
Team Leader Lifestyle Clinic Rashid Center for Diabetes and
Research, Ministry of Health UAE
Aim: To report vitamin D status and its impact on metabolic
parameters in people in the United Arab Emirates with obesity
and type 2 diabetes (T2D).
Methodology: This cross-sectional study included 309 individuals with obesity and T2D who were randomly
selected based on study criteria. Serum concentrations of
25-hydroxy vitamin D (s-25(OH)D), calcium, phosphorus,
parathyroid hormone, alkaline phosphatase, glycemic profile,
and cardiometabolic parameters were assessed in fasting blood
samples, and anthropometric measurements were recorded.
Results: Vitamin D deficiency (s-25(OH)D < 50 nmol/L)was
observed in 83.2% of the participants, with a mean s-25(OH)
Dof 33.8 } 20.3 nmol/L. Serum25(OH)D correlated negatively
(𝑃 < 0.01)with body mass index, fatmass, waist circumference,
parathyroid hormone, alkaline phosphatase, triglycerides, LDLcholesterol, and apolipoprotein B and positively (𝑃 < 0.01) with
age and calcium concentration. Waist circumference was the
main predictor of s-25(OH)D status. There was no significant as-
sociation between serum 25(OH)D and glycemic profile.
Conclusion: There is an overwhelming prevalence of vitamin
D deficiency in our sample of the Emirati population with obesity and T2D. Association of s-25(OH)D with body mass index,
waist circumference, fat mass, markers of calcium homeostasis
and cardiometabolic parameters suggests a role of vitamin D
in the development of cardiometabolic disease-related process.
P-1
The Adherence to Evidence-Based Guidelines of Enteral Nutrition in the Critically Ill in Jordan
Mahmoud Al Kalaldeh, Zarqa University, Amman, Jordan
Objectives: To assess the effect of enteral nutrition evidencebased guidelines on nutritional outcomes for critically ill, mechanically ventilated patients.
Methods: A prospective observational study started with introductory sessions about recent ASPEN guidelines of enteral nutrition
for ICU nurses. Nurse-centered guidelines were implemented at
four intensive care units in Jordan. Before and after the program,
five-days of bedside observation were carried out and included patient’s outcomes of nutritional adequacy and complications.
Results: Unequal distributed sample of 192 patients (80 control
& 112 intervention) was involved. Observation revealed that
head-of-bed elevation and frequency of using continuous feeding infusion were increased after the guidelines. Considering a
range of assessment tools, nurses were more frequently using
assessment measures after implementing the guidelines. In addition, the incidences of pulmonary aspiration, diarrhoea, and high
gastric aspirates reduced significantly. While attaining caloric
intake increased significantly after the guidelines (5% vs. 20.5%,
p<0.001), length of enteral nutrition and mechanical ventilation
along with higher gastric residues and APACHE score were factors decreased the likelihood of nutritional adequacy.
Conclusion: The value of using the evidence-base guidelines
for expediting nutritional goals was prominent. Adopting unified guidelines for enteral nutrition enhanced nursing adherence
to evidence base, decrease the incidence of complications, and
promote successful nutrition.
P-2
Association of major dietary patterns with cardio-metabolic
risk factors in type 2 diabetic patients
Mahdieh Akhoundan, Zhaleh Shadman, Nooshin Poorsoltan,
Bagher Larijani, Mostafa Qorbani, Mohsen Khoshniat Nikoo,
Endocrinology and Metabolism Clinical Science Institute, Tehran University of Medical Sciences, Tehran, Iran
Objective: Role of dietary modifications on the treatment and
management of diabetes and complications was shown by
many researchers. This study was designed to examine the association of major dietary patterns with diabetes related cardiometabolic risk factors in Iranian diabetes.
Methods and materials: Cross-sectional study. Dietary data
were obtained by a validated food frequency questionnaire.
Blood samples were collected after 12 h fasting for glycemic
and lipid profiles. Information on the general characteristics,
anthropometric, blood pressure measurements and physical activity level was collected. Type 2 diabetic patients who were
followed for at least two years by the Diabetes and Metabolic
disease Clinic of Tehran University of Medical Sciences were
included in this study. 525 type2diabetic subjects with mean
age 55 ± 10 y, recruited in this study.
Results: Three major dietary patterns retained through principal
component analysis:Western like (high in sweets, fast foods,
carbonated drinks, red meat, mayonnaise, nuts, refined grains,
potato and visceral meat), Asian like (high in vegetables, low
fat dairy, fish, poultry and egg), and Traditional like (high in
high fat dairy, oils, whole grains, vegetables and fruits). Western like dietary pattern was positively associated with fasting
serum glucose, total cholesterol and low density lipoprotein
cholesterol. After extensive adjustment for potential confounders, the association of serum total cholesterol and Western like
dietary pattern remained significant.
Conclusions: Results of this study indicated that modifications in dietary pattern, especially in those who have a Western dietary pattern, may be effective in preventing or delaying
diabetes-associated cardio metabolic complications.
P-3
¬EFFECT OF GARLIC (Allium sativum) AND CORIANDER
(Coriandrum sativum) ON LIPID PROFILE OF CARDIOVASCULAR PATIENTS
Falak Zeb. Mahpara Safdar, Saleem Khan, Mumtaz Muhammad, Sahib Alam, Hira Shakoor, The University of Agriculture,
Department of Human Nutrition, University Campus, Peshawar, Pakistan
Background: Hyperlipidemia has been counted in the major
causes of cardiovascular diseases (CVDs). Medically as well
as nutritionally, garlic and coriander have been used safely in
reducing the risk factors of CVDs. This study was to evaluate
the effect of garlic, coriander and their mixture on lipid profile
of CVDs patients.
Materials and method: A clinical trial was conducted on diagnosed CVD patients with hyperlipidemia (total cholesterol
106
(these local articles do not appear in the US version)
>220 mg/dl between the age of 40-80 years) to assess the effect
of garlic and coriander powder capsules on lipid profile. The total patients (n=28) were recruited from out-patient department
of Hayatabad Medical Complex Peshawar and divided into four
groups, each group has 7 individuals. G¬1 received garlic only,
G2 received coriander only, G3 received garlic and coriander
mixture and G4 was placebo, 2 g/day for 40 days. In the start
of intervention, after 20, 40 and at 60th day (last 20 days was
follow up period) lipid profile was investigated.
Results: The result indicated that in G1, a significant (p<0.05)
decrease in TC and LDL while significant (p<0.05) increase in
HDL was observed. TGL and VLDL were non-significantly
decreased. In G2, TC and LDL were significantly (p<0.05) decreased, TGL and VLDL were non-significantly decreased while
HDL was non-significantly increased. In G3, there was a significant (p<0.05) decrease in TC, TGL, LDL and VLDL while
HDL was significantly (p<0.05) increased. All the doses, when
compared with placebo group, there was a significant increase in
TC and LDL while a significant (p<0.05) decrease in TGL and
VLDL and a non-significant increase in HDL were observed.
Conclusion: It is concluded that 2 g/day garlic alone and coriander alone for 40 days decreased TC and LDL significantly
(p<0.05) while TGL and VLDL non-significantly. There was a
significant (p<0.05) increase in HDL level by using garlic alone
while a non-significant increase for coriander alone dose. Garlic and coriander mixture showed significant (p<0.05) decrease
in TC, TGL, LDL and VLDL while significant (p<0.05) increase in HDL in cardiovascular patients with hyperlipidemia.
We suggest that 2g/day garlic, coriander and the mixture of both
is an effective remedy for improving the lipid profile of CVD
patients and may be used along with their routine medication
to minimize the disorder. Anyhow more clinical trials may be
conducted on these products with different doses and durations
to explore further about their efficacy and therapeutic use.
P-4
Outcomes of campaigns for Palestine refugees with diabetes
mellitus attending UNRWA health centers–Jordan
Nada Mufid Abu Kishk, Akihiro Seita, Yousef Shahin, Maartje
van den Berg, Akihiro Seita, Yousef Shahin, Maartje van den
Berg, Jordan
Background: United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) is the main healthcare provider for Palestine refugees in Jordan, Lebanon, Syria,
the West Bank and Gaza Strip. Among the UNRWA population
the prevalence of Diabetes Mellitus type II (DMII) is 11%. Of
these patients, 64% are obese and 26% overweight. UNRWA
conducted a DM campaign, “Life is Sweeter with Less Sugar”
to increase healthy lifestyle awareness and improve health care
management of DM among Palestine refugees.
Method: 1300 Patients with DMI or DMII for ≥1 year, and who
were willing to participate, were randomly selected from 30
health centers (HCs) in Jordan, Gaza, Lebanon and West Bank.
HCs conducted weekly group educational, healthy cooking,
and exercise sessions for six months. Anthropometric measurements, 2hours postprandial glucose tests (2hrPPGT), cholesterol, and blood pressure were collected at the beginning and end.
Multiple logistic regression analysis was performed to assess
the effect of sessions.
Findings:1174 (951 females, 223 males) completed the campaign, with an average of 83.7% attendance of sessions conducted; patients were diagnosed with DMII (36.1%), DMII &
hypertension (59.3%), or DMI (4.6%).
Of all patients, 33% lost ≤3% of their weight, and 16% lost
≥5%. Significant reduction was seen in patients with high-risk
waist circumference (WC), p<0.001. Also, Body Mass Index
(BMI) and waist-height ratio reduced in both sex (p<0.001).
Significant improvements were seen in 2hrPPGT and cholesterol. A significant effect of number of education and cooking
sessions was seen on weight reduction, BMI, and 2hrPPGT.
Exercise sessions showed an effect on BMI and cholesterol
reduction.
Interpretation: This campaign focusing on healthy life style
awareness by using a variety of sessions, improved anthropometric measurements and blood sugar in Palestine refugees with DM.
Such campaigns need to be sustained and expanded to other HCs.
P-5
Dietitians fighting obesity in Greek municipalities: Results from
the Nutrition-Health Alliance (NutriHeAl) program
Maria Hassapidou, THEMISTOKLIS TZOTZAS, IOANNIS
PAGKALOS, KONSTANTINOS TZIOMALOS, KONSTANTINA
PAPADIMITRIOU, Department of Nutrition and Dietetics, Alexander Technological Institution of Thessaloniki, Greece
In the last decades, there is a rapid increase of obesity prevalence in Greece, with an associated increase of cardiometabolic
(CM)) diseases. The NutriHeAl program is a nutrition intervention program in 50 Greek municipalities. It is financed through
the National Strategic Resource Framework (ESPA). We present
here preliminary results for 3681 patients from a total of 8000
estimated to finally participate in the study. From these 62.4%
had obesity, 17% type 2 DM, 48.8% hyperlipidemia, 40.5% hypertension and 12% cardiovascular disease (CVD).All subjects
were randomized into 2 groups and followed by regular visits for
6 months. The intervention group received a personalised Mediterranean healthy diet by dietitians , whereas the control group
did not receive any dietary counselling. Measurements that were
carried out: BMI, Body Weight (BW), %Body Fat (%BF) by BIA,
waist circumference(W), serum lipids (TC,TG,LDL-C,HDL-C),
Fasting plasma glucose (FPG), HBA1c, Systolic (SBP) and Diastolic (DBP) blood pressure, depending on the disease.BMI
was reduced for all the obese patients in the intervention group
from 33,1±6.4 to 32.0±6,3 kg/m2 and% BF from 39.7± 8.0 to
38.4±8.0 .HBA1c was reduced for the type 2 DM patients from
7.3± 3.8% to 6.8±3.5%, and LDL-C from 129.6±35.0 mg/dl to
120.9±35.0mg/dl for the patients with hyperlipidemia. In controls,
metabolic parameters remained unchanged or worsened. Preliminary data from this nutrition intervention study suggest that a well
balanced Mediterranean-type diet is able to reduce several metabolic risk factors in Greek patients with CM diseases.
LOCAL ARTICLES
Diabetes Care, ( Middle East Edition )Volume 12, Number 2, Spring 2015
P-6
Food Choices, Physical Activity and Prevention of Cardiovascular Diseases in a Young Adult Albanians
Angela Andreoli, Ilir Topi, Ermira Paja, Cleonice Renzetti,
Aldo Baldi, Fabian Cenko System Medicine “Tor Vergata” University, Rome, Italy and University UCNSBC, Tirane, Albania
Albania is a Country that is living a transitional economical
realty from the rural life to a more developed and westernized
state. This transition is seen also in the change of lifestyles.
The aim of the study was to evaluate food intake and physical
activity of Young Adult Albanians and verify the risk for the
development of cardiovascular diseases.
Subjects and Methods: In 120 Young Adult Albanians aged 1827 (65 males, 55 females) Body Composition by Bioelectrical
analyses (BIA), Blood Pressure, anthropometry and circumferences, and food intake and physical activity questionnaires
were measured. The Body Mass Index (BMI) was calculated.
Results: Subjects were divided on the basis of the BMI in normal weight, overweight and obese and by gender. The results
found that males tend to be more overweight and obese than
women. There was a significant difference in the blood pressure
depending on the fat mass, and waist and hips Circumferences.
Obese subjects had an higher blood pressure, practiced less
physical activity and their food habits were less correct. 11%
of the subjects eat 2 times a day, 80% do 2-4 times a day, and
e 3% eat more than 4 times a day. Only the 31% of the ubjects
take breakfast. There was an Inverse trend between fat mass and
weekly hours of physical activity.
Conclusions: Also in the Albanian population a lower BMI is
not associated with a lower fat mass, That can result higher in
measurements using a BIA. The Albanian population is moving from a rural socio-economical reality to a more westernized
way-to-live that can also be seen in the= Nutritional habits of a
Young Adult Population with an increasing risk for overweight/
obesity and Cardiovascular diseases.
P-7
Behavioral Lifestyle Intervention Study (BLIS) in subjects with
type 2 diabetes in UAE: A randomized controlled trial in real
life setting
Sarah Qassim Abdi, Amena Sadiya, Samia Ali, Shiby Varghese
and Salah Abusnana Rashid Center for Diabetes and Research,
Ministry of Health, Ajman, UAE
Purpose: The primary purpose of this study was to develop a
behavioral lifestyle intervention and evaluate its effectiveness
in improving the glycemic control in patients with type 2 diabetes in real life setting. This is because ambiguity still exists
on the effectiveness of lifestyle interventions in routine clinical
practice despite of the efficacy of large randomized controlled
trials, suggesting the need for more research in this area.
Methods: BLIS was a translational randomized controlled trial
with two parallel arms. Patients (n=35) were randomly assigned
to intervention or control group. All patients in the intervention
group had gone through a six months behavioral lifestyle program composed of 8 sessions; 4 individual consultations and 4
telephonic calls. The cognitive behavior theory (CBT) was the
underpinning theory for the lifestyle intervention; hence CBT
behavioral strategies like self monitoring and goal setting were
used to improve compliance to healthy lifestyle practices. The
trial primary outcome was HbA1c. Secondary outcomes included weight, body mass index (BMI), body composition analysis,
lipid profile, blood pressure, carbohydrates intake in grams,
minutes of moderate physical exercise and were assessed using
one-way Anova at significance level of p<0.05.
Results:At 6 months, the HbA1c of patients (n=18) in the intervention group had reduced significantly (-1.56 ± 1.81, p<0.05)
while no significant change (p>0.05) observed in the control
group. Similarly, both carbohydrates intake from the cereal
group and the total carbohydrates intake in grams reduced significantly (p<0.05) in the intervention group by 32.92 ± 54.34
and 20.94 ± 56.73, respectively. No significant change was observed in the other secondary outcomes (p >0.05).
Conclusion: BLIS was effective in improving the glycemic
control in patients with type 2 diabetes in routine clinical practice. More randomized controlled trials with larger sample size
are needed to identify the key behavioral strategy that improves
the compliance to lifestyle modification in real life. Also future research might need to evaluate effectiveness of lifestyle
programs focused on weight management in clinical practice.
P-8
Trans-Fatty Acid Content in Edible Oils: Iran’s Experience
Payam Peymani, Health Policy Research Center, Shiraz University of Medical Sciences Morteza Banakar and Omid Kamrani
(School of Dentistry, Shiraz University of Medical Sciences, International Branch, Shiraz, Iran) Kamran Lankarani, Hassan
Joulaie, Rasoul Dinarvand, Hedayat Hosseini, Saba Afifi Iran
Health policy makers are encouraged and designed a national
plan and agenda in order to reduce the level and amount of
TFAs in oil industry. The program’s framework comprised
three main aspects: Campaigning on Public education with an
emphasis on increase in knowledge and attitude of the public
regarding adverse health effects of TFA, negotiation of Ministry of Health and Medical Education (MOHME) representatives with food and oil processing companies and setting regulations on restricting the amount of TFAs from >20% to less
than 10% and establishment of a national committee including
experts of MOHME and representatives of major food industries to coordinate all policy makings on food production at
national and local levels. Four years after implementation of
the policy on limiting the amount of TFA in edible oil to 10%,
a dramatic decline was observed in TFA content of edible oils
in Iran from 28.8% in 2001 to 5.62% in 2006. Recently publish papers shown the mean of total TFA was 0.45% ranging
from (0.11% - 1.61%) for liquid frying oils and 2.92% ranging
from (0.46% - 5.40%) for solid oils. The highest content of total
saturated fatty acid (SFA) was detected in solid oils with average of 32.07. TFA and SFA(Saturated Fatty Acid) intake can
be decreased by proper education, voluntary reduction of TFA
content by oil industries and labeling of TFA and SFA composition of each production along with legislations on TFA and SFA
reduction in edible oil (legislation to ban these fats).
P-9
Arabic Food Diet
Ayman Mohamed Wajdi Natsheh UAE
Introduction: Understanding proper food intake by all public
has become a necessity, in order to reduce malnutrition related
illnesses in the Arab countries, which have been on the forefront of the highest world ratios for non communicable diseases
(NCDs), mainly for obesity and diabetes.
Purpose: Eliminating existing barriers of understanding, and
implementing proper nutrition by the general public in the Arab
World, by taking into account the peculiarity of the Arabic cuisines and the Arabic food consumption habits.
Methods: Communicating the nutritional recommendations using
familiar terms each individual can understand, such as the main
dish and its supplements, which compose the food table, and how
to get a practically balanced meal from a diverse food table.
Results: Eating food is a human behavior, and not calculations
of calories and portions. Adjusting the right mindset of the individual to eat balanced food, as a proper behavior, could be
done by organizing the information of food and nutrition, and
answering related questions prior to make a decision on eating foods, which could be considered key to successful implementation, illustrated in The Three Pyramids and the Sphinx
drawings.
Significance:New approach to reduce the rate of nutrition-related NCDs in the Arab countries, such as obesity and diabetes,
by offering an easier and practical approach for understanding
and implementing proper nutrition to the general public, which
is science – based and culture - oriented. (Copyright © 2015.)
P-10
Practical Home Diet
Ayman Mohamed Wajdi Natsheh UAE
Introduction: Reduction of Non Communicable Diseases
(NCDs) has become a priority in the Arab World, especially
obesity and diabetes, such that finding a successful way, for
implementing proper food intake by all public has become a
necessity to avoid them.
Purpose: Providing a practical approach to be implemented at
home, in order to simplify implementation of proper nutrition
to the Arab population, since eating a diverse and a balanced
plate every day and at every meal is not easy to implement for
the general public.
Methods: Considering the foods currently consumed by the
public as a constant, and categorizing them into four categories
based on their balance, whilst improving people’s diet by amending the quantity and the frequency of the categorized foods.
Results: Immediate improvement to the current diets, as people can continue eating the same food they are used to, using
the same recipes and cooking methods. This matter does not let
them being deprived from their traditional beloved foods, and
does not impose them to eat uncommon foods.
Significance:- This approach offers a practical home diet plan,
which is friendlier to the public, because it is culture – oriented,
since Arabic culture is family centered. This is science – based,
and can significantly contribute in reduction of the nutritionrelated NCDs in the Arab countries. (Copyright © 2012 - 2015.)
P-11
Assessment of nutritional status by the use of Malnutrition Universal Screening Tool (MUST) and the Skeletal Muscle Index
(SMI): a comparative study
Vasileios Alivizatos, Fotis Kadjianis, Pavlos Athanasopoulos,
Mairi Panagidi, Nikos Mainas, Department of Surgery, Nutrition and Intestinal Failure Unit, “St. Andreas” General Hospital, Patra, Greece
Aim. MUST is considered as an easy screening tool to detect patients at risk of malnutrition, whereas recent studies show that SMI
may be correlated with the nutritional status. The aim of this study
was to evaluate if MUST score is correlated with SMI values.
Methods. Some consecutive surgical patients having recent
CT scans routinely acquired from health records were prospectively underwent to assessment of their risk of malnutrition by
MUST; also, their regional CT images were analyzed at the
level of the 3rd lumbar vertebra and the SMI was calculated
using a commercially available software. Those with unintentional weight loss and SMI values < 52.4 cm2 of muscle mass /
m2 height (men) and < 38.5 (women) were classified as having
malnutrition. The correlation coefficient was used to evaluate if
MUST score was correlated with SMI values.
Results. Out of 13 patients enrolled in the study, 2 had MUST
score zero and normal SMI values; all the rest had MUST score
ranged from 1 to 4, unintentional weight loss and SMI values below normal (39.1+-11 for men, 28.3+-4.5 for women).
Analysis of these data show a moderate negative correlation
between the two methods (R=-0.585, p<0.05).
Conclusion. MUST score > 0 accompanied by unintentional
weight loss is always associated with low SMI values and,
consequently, with malnutrition. In clinical practice, it means
MUST represents a simple and reliable method to assess the nutritional status, without the need to further assessment by more
comprehensive and expensive methods.
P-12
Association of Hypertriglyceridemic Waist Phenotype with Liver Enzymes and Cardiometabolic Risk Factors in Adolescents
Silva Hovsepian, Roya Kelishadi, Fahimeh Jamshidi, Mostafa
Qorbani, candidate,child growth and development research
center,Isfahan University of Medical Sciences,Isfahan, Iran
This study aims to investigate the performance of metabolic syndrome (MetS) and the hypertriglyceridemic-waist (HW) phenotype in determining the cardiometabolic risk factors and elevated
liver enzymes in a national sample of pediatric population.
Methods: This nationwide study was conducted in the framework of the third survey of Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable Disease
Diabetes Care, ( Middle East Edition )Volume 12, Number 2, Spring 2015
(CASPIAN-III) study. Students, aged 10-18 years, were recruited from 27 provincial counties in Iran. The prevalence of
cardiometabolic risk factors was compared in students with and
without HW and Mets. The association of HW with different
cardiometabolic risk factors was determined.
Results: Mean age of studied population was 14.73±2.41.
Prevalence of HW and MetS was 3.3%and 4%, respectively.
69 (71.1%) of participants with HW had MetS. Mean of BMI
,systolic and diastolic blood pressure, cholesterol and ALT was
significantly higher in participants with HW than those without,
similar to those with and without MetS(P<0.05).There was significant association between HW and increased level of cholesterol, low HDL-C, obesity, and elevated ALT(P<0.05).
Conclusions: The findings of current study serve as complementary evidence of previous studies, which have been mainly
conducted among adults, and suggest that HW phenotype is
associated with cardiometabolic risk factors especially with
elevated alanine amiotransaminase and hypercholesterolemia.
We propose that in primary care settings and in large epidemiological studies, measurement of all components of MetS can
be replaced by studying HW as a screening tool for identifying
children at high risk for cardiometabolic disorders.
Key words: Hypertriglyceridemic waist, metabolic syndrome, adolescent, alanine aminotransaminase, aspartate aminotransaminase
PO-1
The Prevalence Of Celiac Disease In Patients Fulfilling Rome
III Criteria For Irritable Bowel Syndrome
Wesam A. Ibrahim, Saied A. Shalaby, Moataz M. Saied, George
Magdy Hanna
Internal medicine Department- Faculty of Medicine- Ain Shams
University- Cairo, Egypt.
The clinical presentation of celiac disease can vary from a classical malabsorption syndrome to more subtle atypical gastrointestinal manifestations (similar to irritable bowel syndrome);
with abdominal cramping, intestinal gas, distention and bloating; chronic diarrhea or constipation (or both) or extra intestinal
presentation. Anti-tissue transgluatmainase is a highly sensitive
and specific test for diagnosis of celiac disease.
Aim: To study the prevalence of Celiac disease (CD) in Egyptian patients with clinically diagnosed irritable bowel syndrome
(according to ROME III criteria) (with predominant diarrhea).
Patients and Methods: This study was conducted on 50 patients clinically diagnosed irritable bowel syndrome (fulfilling ROME III criteria with predominant diarrhea).All studied
patients were subjected to complete history taking, thorough
clinical examination, laboratory investigations with measurement of Anti-tissue transglutaminase antibody (tTG), abdominal ultrasonography and diagnostic upper GIT endoscopy for
all patients with positive Anti-Tissue Transglutaminase antibody with 4 to 8 biopsies taken from the second part of the
duodenum. Results: There was (4) patients (8%) (3 females and
1 male) had high levels of anti-tissue transglutaminase with
high possibility of celiac disease and for confirmation of the
diagnosis, upper gastrointestinal endoscopy with 4 to 8 biopsies
taken from the second part of the duodenum was done for all serological positive patients, their biopsies were compatible with
the histopathological criteria of celiac disease. The comparison
between IBS patients with tTG positive and IBS patients with
tTG negative revealed highly significant difference as regard
serum levels of tTG with high levels in tTG positive patients,
also show highly significant difference as regard haemoglobin
level with significant reduction in tTG positive patients. There
were highly statistically significant inverse correlation between
tTG and both total serum protein and serum albumin.
Conclusion: There are symptoms overlap between celiac disease and irritable bowel syndrome which make diagnosis of
celiac disease missed or misdiagnosed as irritable bowel syndrome. To avoid misdiagnosing of celiac disease in patients
who have symptoms similar to IBS with predominant diarrhea;
it is recommended to add serum anti tissue transglutaminase
antibody test as initial screening test during their investigations.
PO-2
Role of Anise in Prophylaxis in Influenza like Symptoms
Wesam A. Ibrahim, Sayed M. Shalaby, Rawia A. Alfiky, Remon
N. Yakovos Internal Medicine, Faculty of Medicine, Ain shams
University, Cairo, Egypt
Influenza, commonly referred to as the flu, is an infectious diseasecaused by RNA viruses of the family Orthomyxoviridae (the
influenza viruses). Anise is one of the common beverages in Egypt
during winter season specific. Known to all Egyptian there is relation between common cold and Anise drinking. Shikimic acid can
be separated from Chinese anise. Shikimic acid is used for synthesis for potent antiflu drug tamiflu. Tamiflu is part of a new class of
medicines called neuraminidase inhibitors.
Aim: to evaluate the effect of drinking anise in protection of
influenza symptoms.
Patients and methods: This study was carried out on 80 healthy
students in a school. The study was conducted from January till
the end of March of 2010, to coincide with normal cold and
flu season on 2 equal groups, group A: 40 healthy who supplied with 250 ml of boiled anise every 2 hours to drink during
the attendance hours in school, as 3 times daily this continued
through the whole 3 months, and group B: 40 healthy studied as
controls. Both groups were age and sex-matched
Results: revealed statistically significant difference between
the 2 groups as regard positive flu symptoms. The percentage
of students with positive flu symptoms in group A (study group)
was 35% while students in group B (control group) showed
higher incidence of flu symptoms with a percentage of 60%.
This was statistically significant (P<0.05).The analysis of the
symptoms showed significant decrease in the incidence of having running nose, sneezing, headache and cough, and it showed
highly significant decrease of fever and sore throat.
Conclusion: The study showed that drinking 2-3 cups of anise
daily affects the incidence of influenza symptoms significantly,
and that there is significant reduction of incidence of rhinnorhea, sore throat, cough, fever and headache.
LOCAL ARTICLES
PO-3
A quantitative study examining the degree of compliance to the
Saudi policy and IOM standards in boys’ public high schools in
Riyadh, Saudi Arabia
Khalid Aldubayan, Mary Murimi, King Saud University KSA
Aims: This study evaluated the Saudi school nutrition policy;
investigated the implementation of the Saudi policy; and assessed the nutritional content of foods offered in schools using
IOM school nutrition standards.
Methods: A total of 76 boys’ public high schools were randomly
visited from four areas in Riyadh (19 schools north, 19 schools
south, 19 schools east, and 19 schools west). The sample size power was analyzed. In each school, principals and canteen managers
were interviewed. Validated questionnaires, an observational note,
and a food checklist were used. The Saudi policy was used in scoring schools implementation, and the IOM standards were used in
assessing the nutritional content of foods offered in schools.
Results: The alignment scores were measured using the Saudi
policy and IOM standards in 4 categories: 1 indicates 0-25%,
2 indicates 25-50%, 3 indicates 50-75%, and 4 indicates 75100%. For the Saudi policy, 44.7% (34) of the schools scored
in category 2, 50% (38) of the schools scored in category 3,
and 5.3% (4) of the schools scored in category 4. For the IOM
standards, 96.1% (73) of the schools scored in category 1, and
3.9% (3) of the schools scored in category 2. There is no significant correlation between the schools’ alignment scores and
the demographic variables. Conclusion: The results indicate the
high requirement of developing the nutritional content of the
Saudi policy based on the IOM standards. The results also indicate the moderate implementation of the Saudi policy and weak
inspection by the Saudi Ministry of Education.
PO-4
Effect of Olive oil on the Biochemical profile and Histoarchitectural changes in liver and aorta caused by high-fat diet
Farooq Ahmed Wani, Shaik Rahiman, A. Z. El- Bahrawy
Department of Pathology, College of Medicine, Aljouf University, Saudi Arabia Department of Biochemistry, College of
Medicine, Aljouf University, Saudi Arabia Department of Biology, College of Science, Aljouf University, Saudi Arabia
Olive oil has been gaining ever-increasing renown as a part of
Mediterranean diet and as a source of unsaturated fatty acids.
Furthermore, it has several beneficial therapeutic effects on
human health. Aim: The present study was aimed to evaluate the biochemical and histopathological effects of olive oil
on the liver and aorta of mice fed with high fat diet. Methodology: Experimental Swiss albino mice were divided into 4
groups of 10 mice each. Group –I (Control group) received
normal saline only and Group –II received high fat diet(HFD)
. Group-III (positive Control)has been feed normal diet with
10% of olive oil per Kg body weight. Group-IV mice were allowed to feed High fat diet and treated with 10% olive oil per
Kg body weight. After 16 weeks of feeding, 12 hrs after last
feeding, blood samples were taken for biochemical profile (Lipid and liver enzymes) and mice were sacrificed by cervical
decapitation and selected tissues obtained and prepared for histopathological study. Results: Our study revealed that olive oil
has a significant corrective effect on the biochemical profile of
Group–IV animals when results were compared to High fat diet
fed group (Group-II). The histopathological study of the liver
architecture of HFD group revealed abnormal radiation pattern
of hepatocytes, presence of foam cells and inflammatory cell
infiltration. The aorta of HFD group mice showed straightening
of tunica intimae with deposition of lipid in tunica media. The
changes in the liver and aorta were lessened in Group IV mice
treated with 10% olive oil. Conclusion: Our results revealed
that olive oil has potential beneficial effects on body organs
such as liver and aorta in experimental animals; furthermore,
it has shown an ameliorating effect on lipid profile and liver
enzymes. We conclude that olive oil usage can help in prevention of the metabolic diseases such as obesity as well as have a
potential impact in controlling them.
(these local articles do not appear in the US version)
107
Children with Diabetes in Schools (KIDS project) IDF, Belgium Hanan Gawesh, David Chaney, Maeva Germe, International Diabetes Federation
Objectives: Approximately 79,000 children are diagnosed with
diabetes annually worldwide. Schools play an important role in
protecting the rights of school children with diabetes; however for
many of these children lack of knowledge within schools around
diabetes can lead to isolation, stigma and discrimination. IDF, ISPAD and Sanofi Diabetes launched the KiDS project in 2013, aiming to foster a supportive school environment that creates a better
understanding of diabetes and support children with this condition.
Methods: The project was piloted in India and Brazil. A technical advisory committee of international diabetes experts was established to develop a global diabetes information pack (GDIP).
Results: The GDIP was culturally adapted to India and Brazil needs. It is divided in two sections: one focused on T1DM
offering guidelines for the management of children with diabetes at school and a sample diabetes management plan; second focused on healthy lifestyle to prevent T2DM. The GDIP
is tailored for use by school staff, parents, parents of children
with diabetes and children. It is available online (IDF website)
in 8 languages (including Arabic) free of charge. 2937 persons
downloaded the pack worldwide.
Conclusions: Alongside the GDIP, early results following the
first trainings are encouraging. Trainings in Brazil are expected
to reach 15,000 students. In New Delhi, the Ministry of health
has committed to training 30-40,000 teachers with KiDS material. The KiDS project will be evaluated in both countries in
2015 with results being discussed at the World Diabetes Congress Vancouver. http://www.idf.org/education/kids
OR-3
Periodontal therapy as an adjunctive modality for HbA1c reduction in type 2 diabetic patients.
Chalini Sundar Shanmugham, Sundar Ramalingam, V. Mohan
BDS, MPH.Elite Medical and Surgical Center, Saudi Arabia
Aims: The aim of this study was to evaluate the role of non surgical periodontal therapy (dental scaling/curettage of gums to
remove inflammation) in reducing HbA1c levels among type 2
diabetes mellitus (T2DM) patients with good glycemic control.
Methods: Study sample comprised a subset of patients identified through secondary analysis of patient records from Madras
Diabetes Research Foundation (MDRF), Chennai, India. Inclusion criteria were patients (age 35-55 years) diagnosed with
T2DM before 1 year, oral hypoglycaemic therapy, recent (within 1-month) HbA1c level≤7.0, self reported treatment compliance (diet, medication and exercise) and presence of mild to
moderate periodontitis based on dental examination. Following
ethical approval and consent patients underwent non-surgical
periodontal therapy to treat periodontitis. HbA1c levels were
repeated 6-months after periodontal therapy. Means of the two
HbA1c readings were compared using paired samples T-test
with 95% significance level (p<0.05).
Results: A total of 266T2DM patients fulfilling the inclusion
criteria were identified with a mean HbA1c of 8.44±1.87. All
patients underwent non-surgical periodontal therapy. 131patients (49.25%) had good glycemic control (HbA1c≤7.0) and
their mean HbA1c readings before and after periodontal therapy were 6.92±0.66 and 6.66±0.88 respectively. Paired T-test
revealed significant difference between pre- and post-treatment
HbA1c values (t=4.44,df=130,p<0.001).
Conclusion: Within the limitations of this study non-surgical
periodontal therapy in T2DM patients with mild to moderate
periodontitis helps in reducing HbA1c levels 6-months postperiodontal treatment.
We implemented telemedicine to evaluate health indicators in
type 2 diabetes patients treated by video consultations or by the
standard outpatient treatment regime, and studied the effect of
two different treatment models in T2DM in a randomized trial.
40 patients with T2DM allocated from October 2011 until July
2012 were randomized either by treatment at home by telemedicine with video conferences or the usual standard outpatient
treatment with regular visit at the clinic over six months. A
TandBerg E20 videotelephone was, delivered and serviced by
the telephone company, TDC, Denmark.
The reductions in the two treatments resulted in significant differences in the clinical variables HbA1c (-15 vs. -11 %), mean
blood glucose (-18 vs. -13 %), and cholesterol (-7 vs. -6 %),
given as changes in percent of telemedicine vs. standard; respectively. In LDL (-4 vs. -6 %), weight (-1 vs. 2 %), diastolic
diurnal blood pressure (-1 vs. -7 %), and systolic diurnal blood
pressure (0 vs. -1 %) no differences were seen between the
groups. Nine consultations missed in the standard outpatient
group, and none in the telemedicine group.
Telemedicine is a safe and effective option in treatment of
T2DM with better outcome in blood glucose, diurnal blood
pressure and cholesterol after six months treatment.
OR-4
Evaluating Diabetic out Patient Education Services at the Primary Care Clinics Ahmed Albarrak, Rafiuddin Mohammed2,
Nora Al Rowaibe’ah3, Huda Al Anbar3 1Professor of Health
Informatics, College of Medicine, King Saud University, Vice
Rector for Quality, Planning and Development, Saudi Electronic University, Riyadh, Saudi Arabia
2Faculty, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia 3Medical Students, College of Medicine, King Saud University, Riyadh, Saudi Arabia
Objectives: diabetes management is a combination of self management integrated health care providers support in addition
to healthcare settings in the primary care clinics. The present
study was to evaluate diabetic patients knowledge and selfefficacy in the primary care clinics settings.
Method: A cross sectional study at primary care clinics, King
Khalid University Hospitals, Riyadh, Saudi Arabia. The participants were selected through random sampling. The study
questionnaire consisting of 24 questions and nine self-efficacy,
modified from previous validated survey questionnaires. In the
self-efficacy questionnaire, scale from one to ten was used to
rate based on the participants confidence. The diabetes management indicator used in this study was the glycohemoglobin
(Hba1c) value derived from patients’ medical records. SPSS
software was used for data analysis.
Results: A total of 116 patients (males 37 (31.9%); females 79
(68.1%)) with mean age (57.4 ± 1.1) were surveyed. Majority
of participants 69.8% were taking pills whereas 18.1 were on
insulin. A positive correlation was found between years since
diagnosis and Hba1c (p=0.046). The mean knowledge was
slightly higher in males than females with no significance. A
positive correlation found between knowledge and self-reported rate of understanding of diabetics and its treatment. In addition, a significant correlation (p=0.003) was found between
self-efficacy and knowledge.
Conclusion: Diabetic patients had superficial knowledge on
diabetics. Few common areas such as compliances, exercise,
meal practice and food sources need reinforcement. Finally,
more research should be focus on diabetic educational programs development and evaluations.
Keywords: Diabetes, Patient Education, Primary care clinics,
Knowledge
OR-2
P-1
19th Pan Arab Conference on Diabetes
March 24-27, 2015
Le Meridien Cairo Airport, Cairo, Egypt
OR-1
Telemedicine is superior compared with standard care in type
2 diabetes mellitus. A randomizedcontrolled project in an outpatient clinic. Ole Winther Rasmussen MD1, Ph.D, Finn Friis
Lauszus2 MD, Ph.D. and Medical Deparment1, Kolding Hospital, SLB, and Gynecological Department2, Herning Hospital,
Denmark.
108
(these local articles do not appear in the US version)
IGF-1 in preeclampsia and preterm delivery in women with
type 1 diabetes mellitus
Finn F Lauszus, Jens Fuglsang, Ole W Rasmussen, Denmark
Aim: No data on IGF-1 and either preterm or preeclampsia have
been reported so far in diabetic pregnancies. We evaluated consecutive measurements of IGF-1 for preeclampsia and preterm
delivery in type 1 diabetes mellitus.
Setting: In an outpatient university clinic 97 pregnant women were
consecutively recruited for evaluation of indicators for deterioration of diabetes status and adverse perinatal outcome. At every visit
a blood sample for measurement of IGF-1 was drawn.
Results: IGF-1 levels from week 14 to 32 was consistently
lower in women who delivered preterm compared with women
whose delivered after gestational week 36; the increase in 2nd
and 3rd trimester was steeper in those delivering at term than
in women delivering preterm (p=0.032). IGF-1 in preeclampsia
did not show the same relation in diabetic women (p=0.74).The
above testing were repeated without the women with macroalbuminuria (n=7). Similar testing results were found with IGF-1
and preterm delivery (p=0.03) and preeclampsia (p=0.71) in
normo- and microalbuminuric women (n=90). However, the
lowest tertile of birth weight ratio (0.8-1.2) was associated with
lower IGF-1 from week 14 to 32 (p=0.047, adjusted for preterm
delivery and preeclampsia).
Conclusion:We found low IGF-1 levels associated with preterm delivery. Similarly, we confirm that low birth weight ratio
is associated with low IGF-1 levels in normo- and microalbuminuric women.
P-2
Hypoglycaemic and Histopathological Evaluation of Tinospora
cardifolia on Normal and Alloxan- induced Dibetic Rats
Hayat M Mukhtar, Wadhan P, Natural Product Research Laboratory, Department of Pharmacognosy, SBS Polytechnic and
Pharmacy College, Patti, Amritsar- 143416, Punjab, India
Herbal drugs are prescribed widely as hypoglycemic agents
even when their biologically active compounds are unknown,
because of their effectiveness, less side effects and relatively
low cost. One such plant expected to have hypoglycemic activity is Tinospora cardifolia (Menispermaceae). Aqueous extract
of stem was studied for hypoglycemic activity in normal glucose loaded and alloxanised albino rats of either sex, weighing
180-200g. Blood samples were collected from tip of tail just
prior to 1 and 3 hours after extract administration. During subacute treatment, the administration of extract/drug was continued for 14 days, once daily. Blood samples were collected from
tip of the tail just prior to and on days 7 and 14 of the extract/
drug administration. Serum was separated and blood glucose
levels were measured immediately by glucose oxidase method.
Animals received extrcat/drug orally at two doses of 250 and
500 mg/kg. In alloxan-induced diabetic rats and normal glucose
loaded rats (OGTT) aqueous extract showed statistically highly
significant (P<0.001) and considerable fall in blood glucose
levels. Histopathological slides of pancreas indicated that hematoxylin and eosin sections of pancreas at a dose of 250 mg/
kg treated diabetic rats, showed round or ovoid nuclei islet cells
at the periphery. However, the pancreas at a dose level of 500
mg/kg treated diabetic rat showed islet cells with normal architecture. The same results were interpreted from hepatocytes.
The present investigation thus justifies use of Tinospora cardifolia in traditional system of medicine as an anti diabetic drug.
P-3
Diabetes screening and a survey about lifestyle and awareness
of diabetes in Indonesian women
Moyo Ri, Shinichi Okamura, Emiko Shibayama, Dwi Nurviyandari Kusuma Wati, Wenny Savitri, Wiwin Wiarsih, Suwarno, Atsushi Kuwabara
Takasaki University of Health and Welfare Japan, Universitas
Indonesia Indonesia, STIKES. A Yani Indonesia
This research aims to establish adequate health guidance for
Indonesian women through a diabetes screening to detect early
risk factors for developing diabetes in life style and awareness
about diabetes.Participants were collected from women aged
eighteen and older in Depok and Yogyakarta. A questionnaire
surveyed background information, lifestyle, awareness about
diabetes, and medical examinations. This research was approved by the Ethics Committees of Takasaki University of
Health and Welfare and the University of Indonesia. Statistics
analyses were done using SPSS for Windows version 21.0 software. The number of the enrolled participants was 207: 122
from Depok (45.1 ± 12.8 years old) and 85 from Yogyakarta
(41.2 ± 11.5 years old). The percentage of housewives was
84.5% in Depok and 55.3% in Yogyakarta; fasting blood sugar,
87.9 ± 29.0 mg/dl and 94.2 ± 25.3 mg/dl; Body Mass Index,
25.9 ± 4.7 and 23.9 ± 3.9; systolic blood pressure, 147.0 ± 29.7
mmHg and 140.2 ± 25.8 mmHg; pre-diabetes (fasting blood
sugar: 100-125 mg/dl), 4.1% and 29.4%; diabetes (fasting
blood sugar: >= 126 mg/dl), 5.7% and 4.7%. Daily activities
of “do not exercise in daily life” and “have sedentary life style”
were significantly higher in Depok (p <0.05); on the other hand,
eating habits of “eat sweet food”, “drink sweet beverage”, and
“put sugar into tea” were significantly higher in Yogyakarta (p
<0.05). There was no significant difference between those two
districts for the awareness of diabetes. Participants in both areas
had respective problems in lifestyle. Health guidance to correct
lifestyle and be aware of diabetes is necessary for reducing diabetics and pre-diabetics
P-4
Prolactin receptor mRNA expression in experimental diabetic
nephropathy: Relationship with urinary albumin excretion*
Bahaa Mohammed Al-Trad,2, Ibraheem M. Ashankyty3
1College of Medicine, University of Hail, Hail, Saudi Arabia
2Departments of Biological Sciences, Yarmouk University, Irbid, Jordan
3College of Applied Medical Sciences, University of Hail,
Hail, Saudi Arabia
Background: The complex molecular mechanisms involved in
the pathogenesis and progression of diabetic nephropathy (DN)
LOCAL ARTICLES
Diabetes Care, ( Middle East Edition )Volume 12, Number 2, Spring 2015
are not completely known. Disturbances of prolactin, peptide
hormone produced by the pituitary gland, secretion occur in
both the chronic renal failure and in diabetes mellitus. So far,
the role that prolactin play in the pathology of DN progression
is still unclear. Therefore, the present study was intended to examine whether the renal mRNA expression of prolactin receptor (PRL-R) is altered in experimental diabetes, and how such
changes related to the development of albuminuria.
Methods: Adult female wistar rats were divided into two groups
(n=6/group): control (non-diabetic, ND) and diabetic (D).Diabetes was induced by a single dose injection of 55 mg/ kg streptozotocin.After ten weeks, renal mRNA expressions of both
short and long forms of PRL-R were evaluated by real-time
polymerase chain reaction.
Results: Diabetes was associated with increases in urinary
albumin excretion (UAE; mean± SEM; ND, 1.3±0.26; D,
5.8±1.6 mg/day; P<0.01), kidney weight/body weight ratio
(ND, 0.61±0.02; D, 0.97±0.08; P<0.01), serum prolactin (ND,
24.5±3.81; D, 57.5±4.27 ng/ml; P<0.01) and the mRNA expression of both long (ND, 1.15±0.27; D, 4.11±0.92; P<0.05) and
short (ND, 1.10±0.23; D, 4.61±0.73; P<0.05) forms of PRL-R.
Furthermore, UAE was significantly and positively correlated
with serum prolactin levels (r = 0.54, P < 0.05) and with mRNA
expressions of both short and long forms of PRL-R (r = 0.80, P
< 0.05; r = 0.68, P < 0.05, respectively).
Conclusion: These results provide evidence, for the first time,
that the development of experimental diabetic kidney disease
is associated with increases in the renal expression of PRL-R,
suggesting a potential role for prolactin in the development and
progression of renal injury secondary to diabetes mellitus.
*This work was financially supported by King Abdulaziz City
for Science and Technology (KACST) under research no (MS-34/44).
P-5
Relationship Between Periodontitis and Obesity in Controlled
Type-2 Diabetic Patients.
Sundar Ramalingam Munusamy Ramalingam, V. Mohan , Chalini Sundar Shanmugham, Sundar
BDS, MPH., Elite Medical and Surgical Center, Saudi Arabia
Aim: The aim of this study was to determine the relationship
between periodontal inflammation and obesity among patients
with controlled type-2 diabetes mellitus(T2DM.
Methods: Following ethical approval and consent adult(35-55
years) T2DM patients at Madras Diabetes Research
Foundation(MDRF), Chennai, India with HbA1c(p<0.05).
Results: A total of 218patients(144males,74females,mean age–
47.3±6.5) participated in the study. The mean BMI and HbA1c
were 25.04±4.26 and 5.84±0.74 respectively, and 63patients
had clinical periodontitis. Bivariate analysis revealed significant association between periodontitis and BMI in addition to
age, gender, smoking habits and OHI. Mean BMI of patients
with and without periodontitis were 26.18±4.21 and 24.58±4.19
respectively. Binary logistic regression adjusted for the confounding effect of age, gender, smoking and OHI revealed an
increased odds of obesity with periodontitis (OR=1.096,95%
C.I.-1.010-1.190,P=0.028)
Conclusion: Based on the results of this study, there is significant relationship between BMI and periodontitis among controlled T2DM patients.
P-6
Xylitol improves in vivo anti-oxidative status in normal and a
type 2 diabetes model of rats
Md. Shahidul Islam and Chika Chukwuma *
Biomedical Research Laboratory, Department of Biochemistry,
School of Life Sciences, University of KwaZulu-Natal (Westville
Campus), Durban 4000, South Africa
Background and aim: Xylitol is widely used as a sugar substitute in many oral and healthcare products targeting to overweight, obese and diabetic patients. Apart from the recently
reported anti-diabetic effects of xylitol, the in vitro hydroxyl
radical scavenging activity of xylitol has also been reported in
some recent study. However, the effects of xylitol in in vivo
anti-oxidative status are still unknown either in normal or diabetic condition. The present study was conducted to examine
the effects of xylitol on in vivo anti-oxidative status in normal
and a type 2 diabetes model of rats.
Materials and Methods: Six-week-old male Sprague-Dawley
rats were randomly divided into 4 groups of 7 animals, namely
Normal Control (NC), Normal Xylitol (NXYL), Diabetic Control (DBC) and Diabetic Xylitol (DXYL). The animals in NC and
NXYL group were supplied with normal drinking water when
the animals in DBC and DXYL groups were supplied with 10%
xylitol solution ad libitum for a 5-week experimental period.
Results: At the end of the experiment, the lipid peroxidation
(MDA concentrations) was significantly decreased and antioxidant enzyme (catalase, SOD, GR and GPx) activity and glutathione concentration were significantly increased in the most
of the samples amongst serum, liver, kidney, heart and pancreas
of xylitol-fed group compared to their corresponding controls.
Conclusion: The data of this study suggest that xylitol has potential anti-oxidative effects which may be partly involved in
its anti-diabetic effects.
Acknowledgement: This work was supported by a grant for
young and women researchers from National Research Foundation (NRF), South Africa.
PO-1
Type1 diabetes and bone turnover among children and adolescents
Mona Karem Amin, Amina Mohammed Abdelwahab, Sonia Gamal Elsharkawy, Fadia Mostafa Attia Suez Canal University
Background: Diabetes has its burden on bone turnover among
children and adolescents. Little is known about the relationship
between both.
Objective:To determine the relationship between type 1 diabetes and bone turnover among children and adolescents.
Design:Cross-sectional descriptive study. Settings:Pediatrics
department, Suez Canal University Hospital, Ismailia, Egypt
Participants: 39 type 1 diabetic patients, between 6 and 18
years, and 39 matched healthy control.
Measurements:Glycosylated hemoglobin (HbA1c), Alkaline
phosphatase (ALP), Pyridinoline crosslinks (PYD).
Results:Only one third of the patients had high levels of ALP.
The PYD level was significantly higher among diabetic patients
(p <0.001). Values of PYD/creatinine among type 1 diabetic
participants (12.64±4.31 nmol/mmol) were +3 SD away from
the mean of the control group (2.90±1.50 nmol/mmol). There
was no statistically significant correlation between ALP and
HbA1c among diabetic participants. There was no statistically
significant correlation between PYD/creatinine and HbA1c
among diabetic participants. There was no significant correlation between ALP and PYD/creatinine ratio.
Conclusion:Type 1 diabetes is significantly associated with
higher bone catabolism indicated by the higher bone markers
of PYD levels without coupling bone formation. Bone turnover (formation - resorption) is not related to glycemic control.
Diabetes and bone resorption could be co-morbid conditions
stemming from a common pathological route.
PO-2
Manganese Porphyrin Protects Neonatal Pig Islets against
Oxidative Stress and Enhances their Function in Diabetic Mice
Awrad Nasralla, Jon Piganelli, Ray Rajotte, King Fahad Specialist Hospital and Research Center
Widespread application of islet transplantation is still limited
to selected patients due to the shortage of human donors. Pig
islets are being considered as an alternative source of human
islets due to several reasons including the similarity of insulin structure between human and pig. This provides unlimited
source of islets that could be used for more patients with type 1
diabetes. However,significant numbers of islets are lost during
isolation and transplantation procedures due to oxidative stress.
Synthetic antioxidants such as catalytic antioxidant specifically manganese (III) tetrakis (N-ethylpyridium-2-yl) porphyrin (MnP) was shown to protect islet from oxidative stress. In
this study, we speculate that pre-treatment of neonatal pig islets
with the manganese porphyrin (MnP) will protect neonatal pig
islets against oxidative stress and enhance their function after
transplantation into diabetic mice.
Methods: neonatal pig islets were cultured with 0, 34 or 68 µM
MnP overnight at 37o C, 95 % air, 5 % CO2. Islet viability was
also determined using a two-color fluorescence assay. Further, untreated and MnP-treated islets were incubated with 1mM hydrogen peroxide (H2O2) for 2 hours, then visualized under the fluorescence microscope. Streptozotocin induced diabetic NSG mice
were transplanted with neonatal pig islets pre-treated with 0, 34 or
68 µM MnP. Blood glucose levels of these mice were monitored
once a week. When mice achieved normoglycemia, they were
subjected to an intraperitoneal glucose tolerance test (IPGTT).
At the end of the study, we performed survival nephrectomy and
sections of the islet graft were stained for insulin and glucagon.
Results: we found that pre-treatment with MnP is not toxic to
islets. We observed that majority of untreated islets incubated
with H2O2 were destroyed in contrast to MnP-treated islets
where many intact islets were seen. NSG mice that received
islets pre-treated with 34 µM MnP achieved normoglycemia
earlier (P= 0.02), had significantly lower average blood glucose
level (P= 0.02), and showed better glycemic control (P=NS)
during an IPGTT compared to other groups. Photomicrographs
of islet grafts from the three experimental groups showed
strong immunoreactivity to insulin and glucagon.
Conclusion: the use of MnP prior to transplantation could protect
neonatal pig islets from oxidative stress and improve their function
PO-3
Real-world incidence of hypoglycaemia in Saudi Arabia: results from the Hypoglycaemia Assessment Tool study
Najim Abdulwahid, Farag Gendy, Faisal Abdalla Hashim,
Waleed Abdelfattah, Ashraf Shaaban Mahfouz
*Prince Salman Hospital, Saudi Arabia
1 Dr Sulaiman Al Habib Medical Centre, Saudi Arabia
2 Almana General Hospital, Saudi Arabia
3 Novo Nordisk Gulf, Saudi Arabia
4 Ghassan Naguib Pharoun, Saudi Arabia
Objective: To investigate the incidence of hypoglycaemia and
the associated predictive factors among insulin-treated people
with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) in clinical practice in Saudi Arabia in the noninterventional Hypoglycaemia Assessment Tool study.
Methods: T1DM or T2DM patients, aged ≥18 years and treated
with insulin for >12 months, completed self-assessment questionnaires that recorded demographic and treatment information and hypoglycaemia in the preceding 6 months and the 4
weeks after baseline. The association between predictive factors and hypoglycaemia was examined using a multivariate
regression model fully adjusted for all variables.
Results: Of the 329 T1DM and 1438 T2DM completers, 68.9%
and 50.2%, respectively, experienced at least 1 hypoglycaemic
event in the 4 weeks before baseline and 51.6% and 34.7%,
respectively, experienced hypoglycaemia in the 4 weeks after
baseline. The pre-baseline incidence rate of any hypoglycaemia
was 29.2 and 15.7 events per patient-year for T1DM and T2DM
patients, respectively, and 23.4 and 12.4 events per patient-year,
respectively, post-baseline. The rate of severe hypoglycaemia 6
months before baseline was 3.7 and 2.0 events per patient-year,
for T1DM and T2DM patients, respectively, and 6.4 and 2.3
events per patient-year, respectively, post-baseline. Hypoglycaemia rate did not differ based on diabetes type, gender, type
of insulin or hypoglycaemia unawareness; however, a statistically significant difference in the rate of any hypoglycaemia
was noted by reporting period (after baseline versus before
baseline, p<0.001).
Conclusion: Hypoglycaemia is common among insulin-treated
diabetic patients in Saudi Arabia, necessitating improved diabetes management and patient education that could be a positive
factor in creating hypoglycaemia awareness.