Childhood Obesity from high mountains of Pakistan to the Plains of United Arab Emirate: its role in NCDs Syed M Shah, MBBS, MPH, PhD Associate Professor Institute of Public Health, FMHS, UAE University 1

Where West and East Meet N Engl J Med 2010;363:

White male Black male White female Black female

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UAE DDCs’ Partnership for NCDs Prevention UAE University Intermediary between Developed & Developing Countries Countries UNC Harvard McGill

1. Kuwait 21.1% 2. Lebanon 20.2% 3. Qatar 20.2% 4. Saudi Arabia 20.0% 5. Bahrain UAE 19.2 Global 8.3% IDF Atlas 2011

Naked Mountain or Nanga Parbat 26,660 feet 9 th Highest

Sugar & Salt Two White Poisons 98% % % MenWomen 6 Cups of Salted Tea Per Day On Average Shah et al. J Hum Hypertension, 2001;(15)

13 Malaysia Oil Rich High Towers and Famous

DDCs’ Partnership for NCDs Prevention Population-based Samples Al Ain, UAEMalaysia Pakistan Children 1000Children 500 Children 1000 Adults 623 Adults 2000 Mpuntain villages

Sampling Frame and Sample for the Study in Al Ain, Abu Dhabi 15 Total schools in Al Ain N=142 8 School 4 Private 4 Public 4 Girls 4 boys Random sample Fasting Blood Samples

Sample & Sampling of Parents, Al Ain, Abu Dhabi, UAE Study Adolescents Parents Provided Contact Phone number of home To participate 1039 N= 316, non-working number N= 11 Moved out of Al Ain N=90 Refused to participate N= 622 participated after overnight fasting

Sample and Sampling in High Mountain Population, Gilgit Baltistan Ghizar District 18 villages 1000 Housholds Proportionate to size of households 2000 adults aged ≥18 years 17

Training Session for Nurses

Measuring Blood Pressure with Omron Automated BP Monitor

Methods WHO “STEPS Methodology”, for the measurement of NCD risk factors at the country level Questionnaire for children developed based on Project HeartBeat (Darwin Labarthe), McGill adolescents Health Project (Gilles Paradis) International Physical Activity Questionnaire (IPAQ-short version) 22

Methods Blood Pressure (BP) measured with calibrated automated device (Omron HEM-705c) Hypertension was defined as an average BP ≥140/90 mmHg and/or if the participant was undertaking treatment of previously diagnosed hypertension 23

Methods Age- and gender-specific means, SDs, and percentile values of systolic BP (SBP) and diastolic BP (DBP). Overweight as BMI≥85 th and <95 th Obesity as BMI ≥95 th percentile according to 2000 CDC growth charts. International Obesity Task Force (IOTF) sex-age- specific BMI cut-offs (Cole et al)

Methods The prevalence of “high normal” and “elevated BP was determined by comparing the subjects’ SBP and DBP with the age-, gender-, and height-specific 90 th and 95 th percentile reference values from the US National High Blood Pressure Education Program using CDC growth chart reference percentiles for height. 25

Fat deposition starts at 2 years of age Foam Cells Fatty Streak Intermediate LesionAtheroma Fibrous Plaque Complicated Lesion/ Rupture Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 104). From First Decade From Third Decade From Fourth Decade

Distribution of study adolescents by gender 28

Type of school attended by study participants 29

How many hours you spend in a day on average, watching TV, playing Video gams? 30

Do you walk to school? 31

Fast food/food in restaurants 32

Soft-drink consumption 33

Nutritional status in Adults by country 34

Prevalence of Overweight and obesity in youth aged 12 to 18 years 35

Overweight and Obesity in Al AIN, Youth age 12-18

Overweight and obesity among Youth, 12 to 18 (Cole et al 2000) Canada CCHS Survey, US NHANES Emirati UAE Stood Tall When Compared With Fellow Westerners

Prevalence of Metabolic Syndrome in YouPLoS ONE 2013;8(2): e56159 th Aged Years by Nutritional Status (1018), Al Ain, 2010

Prevalence of Vitamin D deficiency in Emirati youth % BMC Public Health 2013, 13:33

Plasma Lipid level in Adolescents Age 12 to 18 Years (n=1000), Al Ain, UAE Tot-C [ ˂170, 170-˂200, ≥200 mg/dL], LDL-C [˂110, 110-˂130 mg/dL] HDL-C [ ˂40, 40-45, ˃45 mg/dL], TG [˂90, 90-˂130, ≥130 mg/dL]

Prevalence of depression on Beck Depression Inventory-II 46

Depression (%) by Self-esteem Scores on the Rosenberg Self-Esteem Scale 47

Proportion (%) of adolescents aged 12 to 18 years reported cigarette smoking 48

Proportion (%) of adolescents aged 12 to 18 years reported exposure to 2 nd hand tobacco 49

Figure 2. Proportion (%) with hypertension (BP≥140/90) by nutritional status (normal, overweight, Obese) 50 Overall 18.0% Our Environment Our Health

Prevalence of Pre-diabetes and Diabetes among adults (n=623), Al Ain, UAE 51

“The chains of habit are too light to be felt until they are too heavy to be broken” 52

50 th European Pediatric Research, Hamburg, Germany, October 9-12, 2009

54 Students Presented 4 Papers in the World Heart Federation Conference, Dubai, UAE, April 2012

European International Pediatric Conference, Istanbul, April,

56 Dr. Darwin Labarthe, Director, Division for Heart Disease & Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, USA

DDC Partners UAE University FMHS [Syed Shah, Tar-Ching Aw, Jawad Hashim, Fatma Al Maskari, Nicho Nagelkerkee] Faculty of Food & Agriculture (& Ayesha Al Dhaheri & Habiba Ali ) Humanities and Social Sciences (Shadi Martin)

Developing Countries Partners Aga Khan University, Department of Community Health Sciences (Rozi, M. Kadir) University of Malaya, Centre for Population Health (Nabilla Al-Sadat et al)

Partners & Advisors Prevention Harvard Medical School, Internal Medicine (Dr. James Meigs) University of North Carolina, Obesity Centre, USA. (Barry Popkin) McGill University, Canada (Gilles Paradis) University of Saskatchewan (Bruce Reeder)

Addressing Disease at Early Phase Risk Level

Prevention and control of NCDs for a Healthy Tomorrow