1. 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

2. Where West and East Meet N Engl J Med 2010;363:1198-1198

4. White male Black male White female Black female

6. 6

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

8. 1. Kuwait 21.1% 2. Lebanon 20.2% 3. Qatar 20.2% 4. Saudi Arabia 20.0% 5. Bahrain 19.9 6. UAE 19.2 Global 8.3% IDF Atlas 2011

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

12. Sugar & Salt Two White Poisons 98% 1995 2011 95% 2011 91% MenWomen 6 Cups of Salted Tea Per Day On Average Shah et al. J Hum Hypertension, 2001;(15)107-111

13. 13 Malaysia Oil Rich High Towers and Famous

14. DDCs’ Partnership for NCDs Prevention Population-based Samples 2010-2012 14 Al Ain, UAEMalaysia Pakistan Children 1000Children 500 Children 1000 Adults 623 Adults 2000 Mpuntain villages

15. 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 1630 1000 Fasting Blood Samples

16. Sample & Sampling of Parents, Al Ain, Abu Dhabi, UAE Study Adolescents 1630 16 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

17. 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

19. Training Session for Nurses

21. Measuring Blood Pressure with Omron Automated BP Monitor

22. 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

23. 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

24. 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)

25. 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

26. 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

28. Distribution of study adolescents by gender 28

29. Type of school attended by study participants 29

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

31. Do you walk to school? 31

32. Fast food/food in restaurants 32

33. Soft-drink consumption 33

34. Nutritional status in Adults by country 34

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

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

37. 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

43. Prevalence of Metabolic Syndrome in YouPLoS ONE 2013;8(2): e56159 th Aged 12-18 Years by Nutritional Status (1018), Al Ain, 2010

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

45. 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]

46. Prevalence of depression on Beck Depression Inventory-II 46

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

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

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

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

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

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

53. 50 th European Pediatric Research, Hamburg, Germany, October 9-12, 2009

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

55. European International Pediatric Conference, Istanbul, April, 2013 55

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

57. 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)

58. 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)

59. 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)

60. Addressing Disease at Early Phase Risk Level

61. Prevention and control of NCDs for a Healthy Tomorrow