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Introduction: Obesity and tobacco, including waterpipe smoking, are associated with diminished emotional well-being. Although concurrent obesity and waterpipe smoking consumption have been reported, the combined effect of these lifestyle components on emotional well-being is unknown. Therefore, the current study compared the positive and negative emotions in adults with waterpipe dependency and obesity. Methods: The study was cross-sectional (n = 691) and conducted between July 2022 and February 2023 using a convenient sampling procedure. Waterpipe dependency was measured using the Lebanese Waterpipe Dependency Scale, whereas obesity was estimated using the calculated body mass index (BMI). The Positive and Negative Affect Schedule (PANAS) was used to obtain emotions. BMI-stratified one-way ANCOVA was used for statistical analysis. Results: Revealed a main effect of waterpipe dependency among the overly obese individuals for both positive and negative PANAS scores (P < 0.05). Post hoc analysis showed lower positive PANAS scores in the heavy versus the none, mild, and moderate waterpipe dependency groups (P < 0.05). In addition, a greater negative PANAS score in the heavy versus none and mild groups (P < 0.01) and in the moderate versus mild (P < 0.05) dependency group. Finally, the BMI-stratified one-way ANCOVA revealed no main effect of waterpipe dependency among the rest of the BMI groups (P > 0.05). Conclusion: The results suggest that dependency on waterpipe smoking was associated with lower positive emotions and greater negative emotions, especially among overly obese individuals. Programs to restrain waterpipe and manage obesity are needed, especially when both are concurrently present.

Summary: Background: The objective of this study is to investigate the trends of exposure and burden attributable to the four main metabolic risk factors, including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body-mass index (BMI), and high low-density lipoproteins cholesterol (LDL) in North Africa and the Middle East from 1990 to 2019. Methods: The data were retrieved from Global Burden of Disease Study 2019. Summary exposure value (SEV) was used for risk factor exposure. Burden attributable to each risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life-years (DALYs). Findings: While age-standardized death rate (ASDR) attributable to high-LDL and high-SBP decreased by 26.5% (18.6–35.2) and 23.4% (15.9–31.5) over 1990–2019, respectively, high-BMI with 5.1% (−9.0–25.9) and high-FPG with 21.4% (7.0–37.4) change, grew in ASDR. Moreover, age-standardized DALY rate attributed to high-LDL and high-SBP declined by 30.2% (20.9–39.0) and 25.2% (16.8–33.9), respectively. The attributable age-standardized DALY rate of high-BMI with 8.3% (−6.5–28.8) and high-FPG with 27.0% (14.3–40.8) increase, had a growing trend. Age-standardized SEVs of high-FPG, high-BMI, high-SBP, and high-LDL increased by 92.4% (82.8–103.3), 76.0% (58.9–99.3), 10.4% (3.8–18.0), and 5.5% (4.3–7.1), respectively. Interpretation: The burden attributed to high-SBP and high-LDL decreased during the 1990–2019 period in the region, while the attributable burden of high-FPG and high-BMI increased. Alarmingly, exposure to all four risk factors increased in the past three decades. There has been significant heterogeneity among the countries in the region regarding the trends of exposure and attributable burden. Urgent action is required at the individual, community, and national levels in terms of introducing effective strategies for prevention and treatment that account for local and socioeconomic factors. Funding: Bill & Melinda Gates Foundation.

Objectives: Atrial fibrillation (AF) is a common heart disease associated with cardiac dysfunction. Adiponectin is an abundant protein produced by adipocytes that regulates metabolism and inflammation in the body. Studies have reported a link between AF and circulatory adipokines. The objective of the study is to investigate the associations between adiponectin serum level and the ADIPOQ rs1501299 (276G/T) SNP with AF. Methods: The study included a total of 112 AF cases and 112 matched healthy controls. Serum adiponectin was analyzed using an ELISA assay. Genotyping of rs1501299 was performed using PCR-RFLP technique. Results: The results showed that the level of adiponectin in the serum was significantly higher (P 0.05). Conclusion: The results confirmed the relationship between blood adiponectin and AF. However, the polymorphism of the ADIPOQ rs1501299 gene may not be associated with AF in the population studied.

Objective: This study aimed to evaluate dietary habits (DH) and eating behaviors (EB) among adults during confinement induced by COVID-19 in Jordan. Method: In this cross-sectional study, an online survey designed to assess the change in DH and EB during April and May 2020 was distributed using various social media platforms. Results: The survey was completed by a total of 1844 adult (18–72 years) participants from the public in Jordan. The results indicated an increase (42.5–61.8%) in most of the DH and EB examined in the current study in the majority of participants. Among these changes, they have increased (p

Background Validated outcome measures are essential for assessment and treatment of children with disabilities. The Children’s Hand-use Experience Questionnaire (CHEQ) was developed and validated for use in Western countries for children with unilateral hand dysfunction. This study aimed to perform a cross-cultural adaptation and investigate reliability for the Arabic CHEQ. Methods Translation and cross-cultural adaptation were performed in four phases: (i) forward-translation and reconciliation with feedback from parents and typically developing children from Jordan ( n = 14); (ii) backward-translation and review; (iii) cognitive debriefing with parents and/or their children with unilateral hand dysfunction ( n = 17); and (iv) review and proofreading. In the psychometric analyses, 161 children from Jordan (mean age [SD] 10y 8 m [5y 8 m]; 88 males) participated. Internal consistency was evaluated with Cronbach’s alpha. Test-retest reliability was evaluated in 39 children with intraclass correlation coefficient (ICC) and weighted kappa (κ). Results Synonyms of four words were added to accommodate for different Arabic dialects. On average, 93% of children with unilateral hand dysfunction and their parents understood the CHEQ items. One response alternative, ‘ Get help ’, to the opening question was unclear for 70% of the respondents and need further explanation. Two items about using a knife and fork were difficult to comprehend and culturally irrelevant. High internal consistency was demonstrated (Cronbach’s alphas 0.94- 0.97) and moderate to excellent ICC (0.77–0.93). For 18 individual items, κ indicated poor to good agreement (κ between 0.28 and 0.66). Conclusions After the suggested minor adjustments, the Arabic CHEQ will be comprehensible, culturally relevant and reliable for assessing children with unilateral hand dysfunction in Jordan.

Introduction Ferritin has been implicated in body physiology and pathology. Smoking cigarettes (Cg) alters ferritin metabolism. Waterpipe (Wp) smoking has recently reemerged as a global epidemic and is linked to the most devastating diseases. However, the effect of smoking Wp on ferritin is not known. Therefore, the current study compared plasma ferritin in adolescents smoking Cg, Wp, both (CgWp) versus never smoked. Material and methods Self-reported smoking status and plasma ferritin levels were obtained from 849 boys (n = 470) and girls (n = 379) in the 7th–10th grade (age range = 13–17 years). Results The ANCOVA revealed a main effect for gender (p < 0.000) and smoking status (p 0.9). Post-hoc analysis showed greater plasma ferritin in the adolescents smoking Wp (p < 0.03) and CgWp (p < 0.004) versus never smoked. Gender-stratified ANCOVA showed a main effect for smoking status in the boys (p < 0.02) and girls (p < 0.03). Additional comparisons among the boys showed greater plasma ferritin in the Wp (p < 0.006) and CgWp (p 0.5) between Wp and CgWp smoking. Another subgroup comparison showed greater plasma ferritin in the girls smoking Cg (p < 0.02) and CgWp (p 0.3) between Cg and CgWp smoking. Conclusions The results indicate that ferritin is elevated in adolescent smokers, particularly the boys smoking Wp and CgWp and in the girls smoking Cg and CgWp.

COVID-19 pandemic is associated with negative impacts on mental health. The study investigated mental health measures that include depression, stress, and anxiety, and their correlation with gender and age among Jordanians in the COVID-19 era. This investigation adopted a quantitative, cross-sectional, and descriptive design and included 1587 subjects recruited through a convenient sampling approach. Jordanians (≥18 years old) were recruited in the study. The total DASS score of the whole sample was 32.7 ± 0.67. The DASS scale showed significantly high scores for stress, anxiety, and depression in the groups that perceived a moderate-high probability of infection with COVID-19 (P

Background: Coronavirus disease (COVID19) is an ongoing pandemic, which forced governments across the globe to implement confinement measures to limit the spread of the disease. These measures have impacted the daily life and psychological status of people. However, no studies have examined the relationship between changes in psychological status with reading habits during the COVID19 pandemic. Objectives: The study aims at examining the relationship between changes in reading habits and negative emotional states. Method: The psychological status was measured using the Depression, Anxiety, Stress Scales (DASS). In addition, the participants reported changes in four types of reading experiences during COVID19 confinement. These reading types are specialized, general knowledge, story/novels, and religious material. An internet-based survey was used to collect the data among adults. Results: A total of 1711 individuals participated in the study. About 60.0%, 55.1%, 60.5% and 61.0% reported participating in scientific, religious, general, and novel reading, respectively. Additionally, the ANOVA revealed differences (p

Mental health is strongly affected by physical (PA) and sedentary (SA) activity. In the current study, the relationships of PA and sedentary activity (SA) with mental status amid confinement caused by COVID-19 were examined. The study is self-reporting, survey-based, and cross-sectional in design. The study was conducted in Jordan and included 1744 participants (≥18 years old). The participants' mental status was obtained using the Depression-Anxiety-Stress Scale (DASS). The results showed involvement in both PA and SA during COVID-19-induced confinement. The involvement includes walking (77.2%), running (70.3%), cycling (84.9%), swimming (83.1%), sports (82.9%), weightlifting (86.4%), watching TV (79.4%), using electronics (86.3%), and logging to social media (85.1%). Lower DASS scores were associated (p 0.05) with cycling and swimming PA. Additionally, DASS scores (p 0.05) with electronics and social media use during confinement. In conclusion, individuals who experienced higher levels of stress, anxiety, and depression were more likely to turn to more PA and less SA. These findings are important and suggest that individuals during confinement find PA a useful strategy to mitigate the negative mental effects of the pandemic.

Sleep can significantly modulate the immune response to infectious agents. In the current study, changes in sleep quality during COVID-19-induced confinement among adults were investigated. This was a cross-sectional survey study of the public using social media. Participants (n = 1846) were recruited in the study, of which >92% reported a variety of confinement procedures such as self-quarantine, physical distancing, banning of public events, school closure, and lockdown. Majority of the participants (53–59%) reported an increase in most of the sleep parameters except a decrease (49.1%) in daytime sleep. Age was associated with changes in sleeping disturbances during COVID-19 confinement (p < 0.001). Young participants were more likely to experience sleeping disturbance than older ones (p < 0.05). In addition, gender (p < 0.001) is an independent predictor of nighttime sleeping. Being a male is associated with a “decrease” and being a female is associated with an “increase” in nighttime sleeping hours (p < 0.05). Moreover, change in daytime sleeping was related to age, gender, and job type (p < 0.05). In conclusion, changes in sleep quality during COVID-19-induced confinement were reported. Intervention programs and strategies are warranted to further improve sleep during the current and future disease-induced confinement.

Abstract The beneficial effects of exercise training on memory formation are well documented. However, the memory enhancement profile following the time‐course of exercise training remains unknown. In this investigation, changes in the spatial hippocampal memory following a time‐course of swimming exercise training were examined. Young adult Wistar rats were tested for both short‐term and long‐term memories using the radial arm water maize (RAWM) paradigm following 0, 1, 7, 14, and 28 days of swimming exercise training (60 min per day, 5 days/week)s. The mean total errors on RAWM during the learning phase and memory testing remained the same (p > 0.5) after 1 day of swimming exercise. On the other hand, swimming exercise‐induced significant enhancement to the learning phase and memory formation after 7 days of training (p 0.5). Similarly, short‐ and long‐term memories improved after 7 days (p 0.05). The time course of improvement of learning and both short‐ and long‐term memories after swimming exercise were evident after 7 days and plateaued thereafter. Results of the current study could form the base for future utilization of exercises to enhance cognitive function in healthy individuals.

Tobacco and hypertension can increase the risk of cardiovascular diseases. However, the long-term effect of smoking, particularly waterpipe, on blood pressure (BP) is uncertain. Therefore, the current study compared heart rate (HR), systolic (SBP), diastolic (DBP), mean arterial pressure (MAP), pulse pressures (PP), and rate pressure product (RPP) in waterpipe versus never smokers. Self-reported questionnaire and automatic oscillatory device were used to obtain smoking status and BP measures, respectively, in 250 women and 261 men aged 20–85 years. Of these, 277 were waterpipe smokers (144 men and 133 women). The 2*2 (smoking status*gender) ANCOVA showed greater (P

Abstract Waterpipe (Wp) tobacco smoking is widely spreading, especially among adolescents. It has also been associated with organ damage and disease risk resulting from oxidative stress. However, no studies have examined the effect of smoking Wp on oxidative stress among adolescents. In the current study, we evaluated serum levels of oxidative stress biomarkers and activities of antioxidant enzymes between adolescents smoking cigarette (Cg only), Wp only, both (CgWp) versus never. The results showed higher GSSG levels in the Cg only, Wp only, and CgWp versus the none group. Similarly, the activity of GPx was greater in the Cg only versus the Wp only and CgWp. The activity of catalase was higher in the Wp only/CgWp groups versus none. No main effect of smoking on GSH, or GSH/GSSH, SOD, or TBARS was detected. In conclusion, Wp smoking among adolescents is associated with induction of stress oxidative to a similar extend of Cg smoking. Interventions and studies for smoking cessation and harm reduction that target Wp smoking among adolescents are needed.

Aims: Brain derived neurotrophic factor (BDNF) is essential for cognitive function. It is also found in non-neuronal tissues with various regulatory actions, including metabolic. Physical fitness (PF) is associated with improved synthesis and secretion of BDNF and reduced obesity. However, the importance of PF for the relationship of BDNF with obesity has not been investigated. This study aims at examining the relationship of PF with BDNF and obesity in 174 young (age = 25.30 ± 9.2 years) healthy adults. Main methods: Serum BDNF was evaluated using ELISA while obesity was determined using body weight (BW), BMI, and waist circumference (WC). Six minute walk distance (6MWD) test was used to estimate PF. Key findings: Serum BDNF was greater (p = 0.000) in the participants with high (Hi6MWD) versus low (Lw6MWD) PF group. Additionally, 6MWD explained 6.8% of serum BDNF. Obesity measures were greater (p < 0.05) in the participants with low versus high BDNF. In regression analyses, serum BDNF explained 4.7% of BW (p = 0.004), 3.8% of BMI (p = 0.011), and 6.2% of WC (p = 0.001). However, when the participants were divided into Hi6MWD and Lw6MWD, BDNF explained 8.2% of BW (p = 0.009), 6.0% of BMI (p = 0.03), and 7.0% of WC (p = 0.013), only in the Hi6MWD, but not in the Lw6MWD (p > 0.05) groups. Significance: The finding confirms the relationship of BDNF with obesity. Additionally, it further suggests the importance of PF level to this relationship among young adults. Future studies are needed to confirm these findings.

Teachers play a vital role in facilitating research in schools. However, teachers' views of informed consent/assent for children participation in research in the Middle East have not been investigated. In this study, focus group interviews were conducted to understand high-school teachers' perspectives toward adolescent assents and consents. The teachers indicated that parent consent is important and should be coupled with sufficient information about the research study. The teachers added that assent is most important for children above 13 years old. Conversely, the teachers believed that parent approval is only important for invasive (such as research involves blood withdrawal) but not simple procedures. Most importantly, for procedures that are considered simple, part of the teachers do not acknowledge the significance of parental approval, such as body weight, or beneficial, such as new treatment. The results indicate that some of the teachers’ views were consistent with proper conduction of pediatric research. However, other views were worrisome and might warrant further studies and actions. Risks related need to be assessed and policies needs to be developed in order to ensure the proper conduction of pediatric research.

Introduction The relationship between waterpipe smoking and eating habits among adolescents has not been investigated, thus the aim of the current study was to compare eating habits among adolescent cigarette-only, waterpipe-only, dual smokers versus non-smokers. We hypothesize that adolescent smokers practice unhealthy eating habits with worse habits among waterpipe smokers and dual smokers. Methods Using a descriptive, cross-sectional design, self-reporting patterns of waterpipe, cigarette smoking and eating habits were collected from a random representative sample of 1720 boys and girls in grades 7–10 in Northern Jordan. Results A total of 6.9%, 23.2% and 26.2% reported cigarette-only, waterpipe-only, and dual smoking, respectively. After controlling for gender, family income and education level of the mother and father, subsequent post hoc ANCOVA analyses revealed the following: mean (±SD) weekly breakfast consumption was greater in non-smokers (3.9±2.4) than waterpipe-only smokers (3.5±2.5, p=0.040) and dual smokers (3.2±2.5, p

The effect of homocysteine on cardiovascular diseases is still equivocal, especially in rheumatoid arthritis patients. In this investigation, the association between homocysteine with blood flow and vascular resistance in rheumatoid arthritis was examined. Serum levels of homocysteine were determined in thirty-one rheumatoid arthritis patients and nineteen apparently healthy subjects using ELISA. Additionally, strain-gauge plethysmography was used to determine both forearm blood flow and vascular function at rest and after occlusion. Forearm occlusion blood flow (patients: 21.9 ± 6.55 versus control: 25.5 ± 6.10ml/100mL/min) was lower (p < 0.05) while occlusion vascular resistance (patients: 4.77 ± 2.08 versus controls 3.05 ± 0.96U) was greater (p < 0.01) in rheumatoid arthritis than in the controls. Level of serum homocysteine was similar (p = 0.803) in rheumatoid arthritis group and healthy group. In addition, level of serum homocysteine was correlated with resting blood flow (r = −0.41; p < 0.02) and resting vascular resistance (r = 0.31, p < 0.05) in the patients group. The study confirms altered vascular function in rheumatoid arthritis. Uniquely, the results show that homocysteine was related to resting, but not postischemia, vascular measures. These relationships indicate that homocysteine might impact the vasculature in rheumatoid arthritis.

Waterpipe (Wp) use is associated with most devastating diseases and particularly popular among adolescents. Vascular endothelium growth factor (VEGF) is essential for generating new vessels. The effect of smoking tobacco on VEGF is controversial and unknown among adolescents. Therefore, the current study compared serum VEGF in adolescents smoking cigarettes (Cg) only (9.3%), Wp only (19.6%), and dual (Wp and Cg) (36.4%) versus nonsmokers (34.6%) in adolescents. A self-reported questionnaire and enzyme-linked immunosorbent assay (ELISA) were used to obtain smoking status and serum VEGF, respectively, in 475 (age: 14.6 ± 1.0 years) boys (n = 263) and girls (n = 212) from Irbid, Jordan. The analysis showed that smoking status (R2 = 0.021; p = 0.001) and gender (R2 = 0.035; p = 0.000) can predict VEGF. Furthermore, 2-way-ANCOVA revealed that VEGF was lower in the dual cohort versus the Cg (33.4%; p = 0.04) and nonsmoker (29.6%; p = 0.003) cohorts; VEGF in smokers, was lower (33.6%; p = 0.04) in the Wp versus nonsmokers in the boys but not the girls. These results are unique and suggest that smoking lowers VEGF, which might adversely affect vascular growth and function. This is alarming given that adolescents are still in the development stage and smoking, particularly Wp, is popular among them. Therefore, interventions targeting smoking among schoolchildren are urgently needed to avoid the negative effects of smoking, especially on vascular health.

Exercise testing is associated with barriers prevent using cardiovascular (CV) endurance (CVE) measure frequently. A recent nonexercise model (NM) is alleged to estimate CVE without exercise. This study examined CVE relationships, using the NM model, with measures of obesity, physical fitness (PF), blood glucose and lipid, and circulation in 188 asymptomatic young (18–40 years) adults. Estimated CVE correlated favorably with measures of PF (r=0.4-0.5) including handgrip strength, distance in 6 munities walking test, and shoulder press, and leg extension strengths, obesity (r=0.2-0.7) including % body fat, body water content, fat mass, muscle mass, BMI, waist and hip circumferences and waist/hip ratio, and circulation (r=0.2-0.3) including blood pressures, blood flow, vascular resistance, and blood (r=0.2-0.5) profile including glucose, total cholesterol, LDL-C, HDL-C, and triglycerides. Additionally, differences (P

Objective. To examine the relationship of handgrip strength with forearm blood flow (BF) and vascular resistance (VR) in rheumatoid arthritis (RA) patients. Methods. Forearm BF at rest (RBF) and after upper arm occlusion (RHBF), and handgrip strength were examined in 78 individuals (RA=42 and controls (CT)=36). Subsequently, VR at rest (RVR) and after occlusion (RHVR) were calculated. Results. The patients’ RBF (P=0.02) and RHBF (P=0.0001) were less, whereas RVR (P=0.002) and RHVR (P=0.0001) were greater as compared to the CTs. Similarly, handgrip strength was lower in the RAs (P=0.0001). Finally, handgrip strength was directly associated with RBF (r=0.43; P=0.0001), and RHBF (r=0.5; P=0.0001), and inversely related to RVR (r=-0.3; P=0.009) and RHVR (r=-0.3; P=0.007). Conclusion. The present study uniquely identifies an association between regional measures of forearm blood flow and handgrip strength in patients and healthy control. In addition, this study confirms the presence of vascular and muscle dysfunction in patients with rheumatoid arthritis, as evidenced by lower forearm blood flow indices, at rest and following occlusion, and lower handgrip strength as compared to healthy individuals.

BackgroundVarious aspects of lifestyle seem to change during confinement, particularly during the COVID-19 pandemic. The current study examines confinement's effects on tobacco smoking habits (SH).MethodsA survey was distributed among adults living in Jordan (age >18 years) of both genders during April-May of 2020, of which 1925 responded to the survey.ResultsThe prevalence of smoking was 33.3%, 46.1%, and 21.1% for cigarettes (Cg), waterpipe (Wp), and E-cigarettes (ECg), respectively. Among the smokers, 38.5-45.8% reported a "no-change," while 32.1-41.7% reported a "decrease" in SH during confinement. On the other hand, 18.0-22.1% reported an "increase" in the SH. However, concerning the factors that might affect SH, the results showed that age, gender, income, and job sector contribute to the observed changes.ConclusionsChanges in the SH during COVID-19 have been reported in about 50% of participants who smoke tobacco, with a more reported decrease than increase in use. Studies and interventions are needed to confirm further and understand the current results and discourage smoking during the COVID-19 pandemic.

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.

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.