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Vitamin D deficiency is rampant in the Middle East, even in children and adolescents. This study was designed to investigate the effects of different vitamin D repletion strategies commonly used on serum vitamin D levels of Saudi adolescents. Study design: A 6-month multi-center, controlled, clinical study, involving 34 schools in the central region of Riyadh, Saudi Arabia. Different strategies of vitamin D supplementation were tested (200 ml fortified milk of different brands or vitamin D tablet (1,000IU). Anthropometrics were taken and fasting blood samples withdrawn at baseline and after intervention for the quantification of serum glucose, lipid profile and 25(OH) vitamin D. A significant increase in 25(OH)D level was observed in subjects supplemented with vitamin D tablet, milk brand 2 and milk brand 4, whereas subjects supplied with fortified milk brands 1 and 3 respectively, exhibited a significant decrease in 25(OH)D levels. Analysis of covariance showed that after adjusting for baseline 25(OH)D, age, gender and BMI, the mean 25(OH)D levels of children who were taking vitamin D tablet (9.1 ± 0.8 nmol/l) and milk brand 4 were significantly higher (7.3 ± 1.1 nmol/l) than children taking milk brand 2 (1.6 ± 1.0 nmol/l). Subjects supplied with milk brands 1 and 2 exhibited a significant increase in total cholesterol level, while it dropped significantly in subjects taking milk brand 3, while no changes were observed in other groups. Different strategies in vitamin D supplementation used in this clinical study elicited varying degrees of improvement in serum 25(OH)D level. The observed outcomes were dependent on the strategy and gender in the Saudi adolescent population, with oral tablet supplementation being favored in boys.

Summary Background and aims The Nutrition Care Process (NCP) and Nutrition Care Process Terminology (NCPT) are currently implemented by dietetics practitioners worldwide, with various advantages, including ensuring consistency and clarity of dietetics-related healthcare records and the possibility to collect and analyse patient outcomes; however, how Saudi dietitians experience the implementation process is poorly understood. The aim of this study was to explore the experiences of Saudi dietitians of NCP implementation in hospitals in Jeddah. Methods In this quantitative, cross-sectional study, 56 dietitians were recruited from six principal hospitals in Jeddah. A questionnaire was used to collect data on the characteristics of the dietitians and hospital-related clinical nutrition care performance, the perception and opinions of dietitians towards the NCP, and the status of NCP implementation. Results Almost all dietitians (98%) were aware of the NCP; however, only 27% had received NCP training. Most dietitians (73%) reported that their department currently follows the NCP, while only 26% reported using the standardized NCP, including International Classification of Functioning, Disability & Health – Dietetics (ICF-D)-WHO and International Dietetic & Nutrition Terminology (IDNT) – USA, with 63% following the hospital's own NCP. Reported reasons for hospitals not following the NCP included insufficient dietitians, lack of experience, or conflict with the hospital's nutrition care system. A majority of dietitians reported no perceived barriers to applying the NCP; however, 23% reported NCP documentation as a challenge. Conclusions The majority of dietitians are aware of the NCP and feel confident to practice; however, the NCP model is not currently implemented in Jeddah hospitals as standard. On-going education, a training program, and an implementation plan should be prioritised.

Accumulating evidence suggests an increased prevalence of vitamin D deficiency in the Middle East and North African countries. Sunlight has long been recognized as a major provider of vitamin D and lighter skin color has been associated with better vitamin D status. In this context, we aimed to determine whether 25-hydroxyvitamin D[25-(OH)D] concentrations are related to skin color, sun exposure and gender among healthy Saudi children and adults. A total of 808 Saudi children (age=14.6±0.04years) and 561 (age=31.4±0.3years) adults of both genders were included in this study. Levels of sun exposure and skin color were determined using a standard questionnaire. Anthropometry and plasma 25-(OH)D concentrations were analyzed. On the basis of duration of sun exposure (20min vs.20min), a significantly lower concentration of 25-(OH)D (40.9±1.2 vs. 35.5±1.8nmol/l; p0.019) was demonstrated in dark-skinned boys with exposure time less than 20min than those exposed longer than 20min. We were unable to show an effect of sunlight exposure or skin color on vitamin D status of children or adults, except in dark-skinned boys who had lower 25(OH)D concentrations associated with limited sun exposure.

Objectives: To determine seasonal variations in the vitamin D status of Saudi adolescent girls in Riyadh, Kingdom of Saudi Arabia (KSA) and its effect in biochemical and clinical characteristics. Methods: In this prospective study, a total of 2000 Saudi females aged 12-18 years from different schools in Riyadh, KSA participated and submitted a generalized questionnaire with clinical information. Fasting blood samples were obtained in 1618 subjects for the winter season (December to February) and only 499 subjects returned to submit fasting blood samples for the summer season (June-August). Circulating serum 25(OH)D, parathyroid hormone (PTH), and other biomarkers of bone remodeling were measured during both seasons. Results: Vitamin D deficiency (serum 25(OH)D less than 25 nmol/L) was significantly higher during summer than winter (63.5% versus 40.8%; p less than 0.001). Mean serum PTH was also significantly higher during summer than winter ( p less than 0.01). In all subjects, serum PTH showed a significant inverse association with 25(OH)D at levels below 40 nmol/L (r=-0.21; p less than 0.001). The prevalence of subjects having clinical and metabolic manifestations suggestive of osteomalacia was 2.13% (N=33 out of 1548). Conclusion: Seasonal variations in the vitamin D status of Saudi adolescent females significantly modifies biochemical parameters as response to vitamin D status change. In the meantime, heightened public health awareness should be given to populations at higher risk for vitamin D deficiency. Saudi Med J 2016; Vol. 37 (9): 1002-1008 doi: 10.15537/smj.2016.9.15248 How to cite this article: Sulimani RA, Mohammed AG, Alfadda AA, Alshehri SN, Al-Othman AM, Al-Daghri NM, Hanley DA, Khan AA. Vitamin D deficiency and biochemical variations among urban Saudi adolescent girls according to season. Saudi Med J 2016; 37(9): 1002-1008. doi: 10.15537/smj.2016.9.15248.

Objectives: To determine whether 12-month, 2000IU/day vitamin D supplementation cardiometabolically improves treatment naive type 2 diabetes mellitus (T2DM) Saudi patients with vitamin D deficiency. Methods: This 12-month interventional study was conducted at primary health centers in 5 different residential areas in Riyadh, Saudi Arabia between January 2013 and January 2014. Forty-five Saudi T2DM patients were enrolled. Baseline anthropometrics, glycemic, and lipid profiles were measured and repeated after 6 and 12 months. All subjects were provided with 2000IU vitamin D supplements for one year. Results: Vitamin D deficiency at baseline was 46.7%, 31.8% after 6 months, and 35.6% after 12 months, indicating an overall improvement in the vitamin D status in the entire cohort. Insulin and homeostatic model assessment-insulin resistance (HOMA-IR) after 12 months were significantly lower than a 6 months ( p less than 0.05), but comparable to baseline values. Mean levels of triglycerides increased overtime from baseline (1.9±0.01 mmol/l) to 12 months (2.1±0.2 mmol). This modest increase in serum triglycerides was parallel to the insignificant decrease in circulating high-density lipoprotein -cholesterol levels. Conclusion: Twelve-month vitamin D supplementation of 2000IU per day in a cohort of treatment naive Saudi patients with T2DM resulted in improvement of several cardiometabolic parameters including systolic blood pressure, insulin, and HOMA-IR. Further studies that include a placebo group are suggested to reinforce findings. Saudi Med J 2015; Vol. 36 (12): 1432-1438 doi: 10.15537/smj.2015.12.12923

This study examined the effects of weekly 35,000 IU vitamin D supplementation for 4 weeks on bone turnover markers (BTMs). There was improvement in the levels of parathyroid hormone (PTH), osteocalcin, and carboxy-terminal telopeptides of crosslinks of type 1 collagen (βCTX) which paralleled the increase in vitamin D levels. The effects of vitamin D supplementation on bone turnover markers (BTMs) have been inconsistent. This study examined the effects of weekly 35,000 IU vitamin D supplementation for 1 month on BTMs. Sixty-eight vitamin D deficient adolescent females were given 35,000 IU of vitamin D3 for 4 weeks. Pre and post intervention blood samples were taken for 25(OH) D, PTH, osteocalcin and βCTX. There was a significant increase in serum 25 (OH) D in the post intervention period which was accompanied by a significant decrease in PTH, osteocalcin and βCTX (P

Riyadh, the capital of the Kingdom of Saudi Arabia, has experienced unusual levels of urbanization in the past few decades, making it one of the fastest growing cities in the world. This paper examines flood hazards in the rapidly urbanizing catchment of Al-Aysen in Riyadh. Remote sensing and geographic information system techniques were employed to obtain and prepare input data for hydrologic and hydraulic models, with the former based on the very popular curve number approach. Due to the limited nature of the rainfall data, observations from two rain gauges in the vicinity of the catchment were used to estimate design storms. The hydrologic model was run in a semi-distributed mode by dividing the catchment into many sub-catchments. The impact of urbanization on run-off volume and peak discharge resulting from different storms was investigated, with various urbanization scenarios simulated. Flood hazard zones and affected streets were also identified through hydrologic/hydraulic model simulation. The mismatch between administrative and catchment boundaries can create problems in flood risk management for similar cities since hydrologic processes and flood hazards are based on the hydrologic connectivity. Since flooding events impact the road network and create driving hazards, governmental decision-makers must take the necessary precautions to protect drivers in these situations.

Pesticide exposure has been implicated as an environmental risk factor for the development of type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the association of the body burden of the pesticide hexachlorocyclohexane (HCH) with the risk of T2DM in a sample of adults from Saudi Arabia. Serum samples were obtained from 280 adult subjects. Hexachlorocyclohexane isomer residues were measured by high-resolution gas chromatography-mass spectrometry. Data on lifestyle, dietary habits, and health status were gathered. Associations between exposure and T2DM were analyzed by logistic regression. Around 49% of adults enrolled in this study were diagnosed with T2DM. Among various HCH isomers, serum concentrations of the pesticides β and γ-HCH were most strongly and consistently linked to T2DM in our studied subjects. Associations of HCH varied across five components of the metabolic syndrome. It positively and significantly associated with four out of the five components, especially elevated triglycerides, high fasting glucose, high blood pressure and HOMA-IR but negatively and significantly with HDL-cholesterol. This study in line with earlier ones about diabetes associated with HCH pesticide exposure and proposes possible hormonal pathways worthy of further investigation.

In this prospective study we wanted to determine whether perceived stress over time among students in the Preparatory Year of King Saud University (KSU) predisposes them to cardiometabolic abnormalities. A total of 110 apparently healthy Saudi students (35 men and 75 women enrolled during the 2010−2011 academic year) were included. Perceived stress was determined at baseline and 1 year later. Anthropometrics were obtained and morning fasting serum glucose, lipid profile and cortisol were measured at both times. Perceived stress was noted among 48.2% of subjects at baseline and was not significantly different after follow-up, with 45.4% scoring high. In men, the prevalence of perceived stress was 48.6% at baseline (13 out of 35) and 37.1% at follow-up (13 out of 35), while in women it was 48% at baseline and 49.3% at follow-up. Interestingly, significant improvements in the blood pressure and lipid profiles, with the exception of HDL-cholesterol, were observed in both men and women, while fasting glucose also improved in women. Serum cortisol was inversely associated to fasting glucose, and total- and LDL-cholesterol (p-values 0.007, 0.04 and 0.04, respectively). These data are opposite to findings in students entering Western universities, in whom increasing stress and a deteriorating cardiometabolic profile have been repeatedly noted. Perceived stress and morning cortisol levels among students of the Preparatory Year in KSU remained constant for both genders over time, yet an improved cardiometabolic profile was observed, suggesting good adaptation among our pre-college students in their first year of university life.

Background Vitamin D deficiency is common in the Middle East and in Saudi Arabia, in particular. While several international recommendations on the management of vitamin D deficiency have been documented and practiced globally, these recommendations should be adapted to the conditions of the Middle Eastern region. To address this challenge, the Prince Mutaib Chair for Biomarkers of Osteoporosis (PMCO) in King Saud University (KSU), Riyadh, KSA, together with local experts and in cooperation with the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), organized a panel that formulated unified recommendations in the diagnosis and treatment of vitamin D deficiency in the region. Methods The selection of local and international experts commenced during the 2nd International Vitamin D Symposium conducted in Riyadh, Saudi Arabia, last January 20-–21, 2016. Reviews of the most recent literature were done, and face-to-face meetings were conducted for revisions and final recommendations.Results: Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided. Results Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided. Conclusion Vitamin D supplementation/correction is advised in all persons whose serum 25(OH)D falls below 50 nmol/l (20 ng/ml), and achieving a target of 75 nmol/l (30 ng/ml) is particularly suited for frail, osteoporotic, and older patients. Conducting well-designed clinical trials in the region that will address economic implications and investigations on the treatment persistence and compliance to vitamin D treatment in the region are encouraged.

Malnutrition is highly prevalent in dialysis patients, and a major contributor to morbidity and mortality. We have investigated the inter-relationship between malnutrition and its impact on morbidity and mortality in peritoneal dialysis (PD) patients. We enrolled 60 PD patients, and measured C-reactive protein (CRP) and various nutritional markers, including pre-albumin. Patients were classified into two groups according to the albumin level since albumin is a good marker of nutrition condition: Group I (n = 32) patients with normal albumin (NAP) where the albumin level was above or equal to 35 g/L and Group II (n = 28) patients with low albumin level (LAP) less than 35 g/L. The level (mean ± SD) of blood urea nitrogen was significantly high (p

Pistacia integerrima Stewart in traditionally used as folk remedy for various pathological conditions including diabetes. In order to identify the bioactive compound responsible for its folk use in diabetes, a phytochemical and biological study was conducted. Pistagremic acid (PA) was isolated from the dried galls extract of P. integerrima . Strong α-glucosidase inhibitory potential of PA was predicted using its molecular docking simulations against yeast α-glucosidase as a therapeutic target. Significant experimental α-glucosidase inhibitory activity of PA confirmed the computational predictions. PA showed potent enzyme inhibitory activity both against yeast (IC 50 : 89.12 ± 0.12 μM) and rat intestinal (IC 50 : 62.47 ± 0.09 μM) α-glucosidases. Interestingly, acarbose was found to be more than 12 times more potent an inhibitor against mammalian (rat intestinal) enzyme (having IC 50 value 62.47 ± 0.09 μM), as compared to the microbial (yeast) enzyme (with IC 50 value 780.21 μM). Molecular binding mode was explored via molecular docking simulations, which revealed hydrogen bonding interactions between PA and important amino acid residues (Asp60, Arg69 and Asp 70 (3.11 A)), surrounding the catalytic site of the α-glucosidase. These interactions could be mainly responsible for their role in potent inhibitory activity of PA. PA has a strong potential to be further investigated as a new lead compound for better management of diabetes.

Biochemical bone turnover markers (BTMs) provide important information on the diagnosis, therapy and monitoring of metabolic bone diseases. They are evident before measurable changes in bone mineral density (BMD) take place. A total of 35 adult Saudi patients (23 males, 12 females) with type 2 diabetes and diagnosed to be vitamin D deficient were recruited in this prospective study. Here we investigated the effects of gender, season, and vitamin D status on bone biochemical markers of bone remodeling. Anthropometry and blood samples were collected at different intervals. Metabolic parameters and bone biomarkers were measured routinely and by ELISA. Both males and females had a significant increase in their vitamin D status over time, but no significant changes in the bone biomarkers were observed in females. In males there was a significant increase in circulating levels of corrected calcium and OPN (p = 0.004 and 0.01 respectively) and a significant decrease in crosslaps (p = 0.005). In all subjects there was a modest but significant positive relationship between vitamin D status and OC (R = 0.34, p = 0.04). In conclusion, our study demonstrates that changes in bone remodeling markers are affected by season, gender, and possibly vitamin D status. This gender difference may well reflect the physiologic pathway responsible for the higher peak bone mass achieved in males compared to females.

Numerous cross-sectional studies have noted significant negative associations between circulating levels of 25-hydroxyvitamin D and cardiometabolic risk factors, highlighting potential extraskeletal functions of this sterol hormone. Prospective studies, however, have been limited; and hence, no cause-and-effect relations can be inferred. This study aims to determine whether vitamin D status correction can reverse already established manifestations of the metabolic syndrome (MetS). A total of 59 adult nondiabetic, overweight, and obese Saudis (31 male, 28 female) were prospectively enrolled in this 1-year interventional study. Anthropometry and biochemical evaluation were performed, including determination of serum 25-hydroxyvitamin D, calcium, and phosphorous concentrations, as well as fasting blood glucose and lipid profile. Subjects were advised to regularly expose themselves to sunlight and increase intake of vitamin D–rich foods. All measurements were repeated 6 and 12 months later. At the initial baseline visit, the prevalence of both low high-density lipoprotein cholesterol and hypertension was significantly increased among patients with 25-vitamin D deficiency (P < .05), even after adjusting for sex and body mass index. Overall prevalence of MetS patients by the modified National Health and Nutrition Examination Survey Adult Treatment Panel III definition decreased from 25.2% to 13.0%; and this was largely due to a parallel decrease in the prevalence of low high-density lipoprotein cholesterol, triglycerides, and hypertension. Optimization of vitamin D status through sun exposure and increased intake of a vitamin D–rich diet can lead to an improved cardiometabolic profile, offering a promising nonpharmacologic approach in the prevention of MetS manifestations.

The aim of the present study was to evaluate the potential hepatoprotective effect of � -tocopherol and/or sele- nium on some plasmatic biochemical indices of liver profile and hepatic damage induced in adult male rats exposed to subchronic dose of malathion (MTN) equivalent to 1/50 LD50. Oral administration of MTN for 45 days significantly in- duced severe hepatic injury as revealed by increased activity of plasmatic biochemical indices, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and gamma-glutamyl trans- ferase (GGT) enzymes. Oral administration of � -tocopherol (� -T) and selenium (Se) concomitant with MTN resulted in a significant ameliorative effect by lowering the elevated plasma levels of the previous enzymes. Light microscopic investi- gation revealed that MTN exposure was associated with necrosis of hepatocytes and marked degenerative changes of liver tissues. Coadministration of (� -T) and Se concomitant with MTN to rats improved the histopathological severity score from severe to normal. However the individual treatment of (� -T) or Se correlated with a relative protection as reflected in the change of the histopathological severity score from severe to mild and moderate, respectively. Thus, it appears that the treatment with (� -T) and/or Se improves MTN hepatotoxicity but is not completely protective.

Concentrations of lead (Pb) in domestic water and blood plasma in the Olya and Al-Batha regions of Riyadh City, Saudi Arabia were correlated (r 2 00.03, p 40 μg Pb/ dl, respectively. In Olya, 37 and 10 % of the population had concentrations of Pb in blood that exceeded 10 and 20- 40 μg Pb/dl, respectively, while none of the concentrations of PB exceeded 40 μg Pb/dl.

Purpose Seasonal variations in circulating vitamin D levels provide vital information as to the most appropriate time to either start or increase vitamin D supplementation to maintain optimal vitamin D levels. In this follow-up study, we determined seasonal differences in serum 25(OH)-vitamin D (25(OH)D) levels, as well as parallel changes in metabolic parameters, in a cohort of adult, overweight and obese Saudis. Methods A total of 121 adult, overweight, obese, and consenting Saudis aged 18–70 years were randomly recruited from four Primary Health Care Centers in Riyadh, Saudi Arabia. They were divided according to the season when baseline measurements were made [74 summer (April–October); 47 winter (November–March)]. Anthropometrics were obtained, and fasting blood samples were taken at baseline and every 3 months for 1 year. Fasting blood glucose, corrected calcium levels, and lipid profiles were measured routinely. Serum 25(OH)-vitamin D was quantified using a specific enzyme-linked immunosorbent assay (ELISA). Results Age- and BMI-matched mean 25(OH)-vitamin D levels from the winter group were significantly higher than those of the summer group (P < 0·001). In both groups, HDL-C levels improved significantly as 25(OH)-vitamin D levels increased with subsequent follow-ups, even after adjusting for age, gender and BMI (P < 0·001). Conclusion Seasonal differences in serum 25(OH)-vitamin D levels in Saudi Arabia are counterintuitive, with circulating levels being higher during the winter than the summer season. Increased vitamin D supplementation is thus recommended to maintain optimal serum 25(OH)-vitamin D levels during the summer season.

Vitamin D deficiency has been linked to several chronic diseases in adults. Studies focusing on children and adolescents, however, are limited. In this randomized cross-sectional study, we aimed to determine the prevalence of vitamin D deficiency and its relationship with childhood obesity and dietary calcium intake among a population of healthy urban Saudi children and adolescents. To achieve this, 331 randomly selected Saudi children (53.8% females and 46.2% males) aged 6-17 years were included. Demographic, medical, and dietary information were collected; anthropometrics were measured. Levels of serum fasting glucose, lipid profile, 25(OH) D, and for albumin corrected calcium were analyzed. Vitamin D deficiency was noted in all subjects, with girls having significantly lower vitamin D levels than boys. Mean calcium intake was found to be 60% of the required dietary allowance (RDA), while the mean vitamin D intake was 23% of RDA. Vitamin D status and calcium intake were comparable in both normal and overweight/obese children and adolescents. Vitamin D status was highest among children who had calcium intake800 mg/day. In adolescents there was insignificant but decreasing trend in BMI, which was observed to be highest among those whose calcium intake was250 mg/day and lowest among those taking800 mg/day.results from this study suggest the importance of vitamin D fortification and increased dietary calcium in the Saudi diet to meet RDA requirements and avoid onset of vitamin D deficiency-related diseases in Saudi children and adolescents.

We report the dietary intake of selected nutrients in apparently healthy adults and children and its correlation with circulating levels of serum leptin and resistin. In this observational study, 47 Saudi children (mean age 13.1 ± 2.8 year) and 47 adults (mean age 45.7 ± 10.5 year) were recruited. Anthropometric data and lipid profile were obtained. Food intake was assessed by a food questionnaire and a 24-hour diet recall method. The dietary intake of selected nutrients was compared with the estimated average requirement (EAR) or adequate intake (AI) for establishing nutritional status. Results demonstrated that the levels of choline and calcium intake were significantly lower than the EAR in adults (p= 0.01 and 0.04, respectively) and relatively low in children. The level of manganese in adults was significantly higher (p= 0.02) than their AI level. The increasing levels of dietary vitamin B6 and B12 were associated with a significant increase in serum concentrations of leptin in adults and children (p=0.02). Overall, the dietary intakes of selected nutrients in Saudi adults and children were not adequate with most of them below cut-off EAR values except for essential amino acids.

Hypovitaminosis D and increased cardiometabolic risk have been well established in adults. This study aims to determine whether or not vitamin D also influences cardiometabolic risk in children and adolescents. To test this hypothesis, we recruited 186 boys (mean age 12.4 ± 3.7 years) and 114 girls (11.6 ± 3.7) in a cross-sectional observational study. Anthropometrics were obtained and morning fasting blood samples were collected. Serum glucose and lipid profile were determined using routine methods. Serum 25-hydroxyvitamin D was quantified using an enzyme-linked immunosorbent assay. In our population, approximately 10% of subjects had severe 25-hydroxyvitamin D deficiency (< 12.5 nmol/L), while 50% of the boys and 40% of the girls had mild vitamin D deficiency (12.5–24.9 nmol/L). Circulating 25-hydroxyvitamin D concentrations were inversely correlated with age, body mass index (BMI), blood pressure, waist and hip circumferences and serum triglyceride concentrations, and positively associated with HDL-cholesterol. Age and systolic blood pressure were significant predictors of 25-hydroxyvitamin D, explaining about 30% of the variance (p = 0.0005). In conclusion, significant associations between serum 25-hydroxyvitamin D and cardiometabolic parameters support promising cardioprotective benefits from vitamin D sufficiency at an early age. Follow-up with prospective clinical intervention studies are needed to validate this hypothesis.

Background The prevalence of vitamin D deficiency in the kingdom of Saudi Arabia is rising unexpectedly in every age group. Apart from several risk factors, the lack of awareness is posing a serious threat for low vitamin D levels in children as well. The aim of our study was to compare the knowledge and status of vitamin D in Saudi school children. Methods Saudi students, 1188 boys (15.1 ± 2.2 years) and 1038 girls (15.1 ± 2.0 years), were recruited and a pre-designed questionnaire with regards to knowledge about vitamin D was administered. Blood samples were collected and serum 25hydroxyvitamin D (25(OH)D was measured. Results A significantly higher percentage of boys answered correctly than girls regarding knowledge questions as sun exposure (p = 0.002, and 0.011), breastfeeding (p

Background In this observational study, we aimed to see whether transition in Saudi students entering university life could be a breeding stage for cardiometabolic risk factor emergence and clustering. Methods A total of 1878 apparently healthy Saudi students of the Preparatory Year, King Saud University, Riyadh, KSA (1112 men and 766 women) spanning 2 academic years were included. They were divided into 2 groups based on the validated perceived stress test (PST). Anthropometrics were obtained and fasting blood samples were collected for measurement of fasting blood glucose and a lipid profile. Results PST score (>27) considered indicative of stress was noted in 44.4% of students. The prevalence of this score was higher in women than in men (49.7% versus 40.7%). The prevalence of obesity, hypertension and dyslipidemia was significantly higher in men than women (p

Background: The objective of this study was to determine the effect of vitamin D3 supplementation in a cohort of Saudi DMT2 population on diet, insulin and/or different oral hypoglycemic agents and...

While moderate to severe vitamin D deficiency is prevalent in Saudi Arabia, skeletal effects associated with this deficiency are not common in this population. In this interventional study we measured the effects of improving vitamin D status on bone biochemical markers in overweight and obese adult Saudis. A total of 47 volunteers (21 males, 26 females) out of the initial 95 subjects were given verbal advice to expose themselves to sunlight for 5–30 min twice weekly and were encouraged to increase their intake of vitamin D–rich foods. Serum 25(OH)D, osteocalcin, and type 1 collagen cross-linked C-telopeptide (CTx), were measured at baseline and after one year. A significant decrease in the prevalence of vitamin D deficiency was observed (44% to 27%) after one year follow-up (p = 0.025). Also, a parallel significant increase in osteocalcin and a decrease in CTX and osteoprotegerin were observed. The results suggest that a modest increase in vitamin D levels among overweight and obese subjects through the promotion of lifestyle changes for one year have marginal effects in bone turnover markers as well as obesity itself.

Background\ud Little or no research has determined the effect of vitamin D3 supplementation in conjunction with pharmacological and non-pharmacological approaches in the diabetes mellitus type 2 (DMT2) patients. The objective of this study was to determine the effect of vitamin D3 supplementation in a cohort of Saudi DMT2 population on diet, insulin and/or different oral hypoglycemic agents and compare them with a non-DMT2 control cohort.\ud \ud Methods\ud A total of 499 randomly selected Saudi subjects divided into 8 groups [Non-DMT2 Control = 151; Rosiglitazone alone = 49; Diet = 15; Insulin alone = 55; Insulin + Orals = 12; Metformin alone = 121; Oral agents combination = 37; Sulphonylurea alone = 59] were included in this 12-month interventional study. All DMT2 patients were given 2000 IU vitamin D3 daily, while the control group received none but were advised to increase sun exposure. Anthropometrics, glucose, lipid profile and 25-hydroxyvitamin D (25-OHVitD) were measured at baseline, 6 and 12 months.\ud \ud Results\ud Circulating 25-OHVitD concentrations improved in all patient groups. The metformin group showed the highest change in circulating vitamin D levels both at 6 months (62.6%) and 12 months (50.6%) as compared to baseline (p

The antibacterial and antifungal activities of water and chloroform extracts of Acorus calamus, Aremisia annua, Chenopodium foloisom, Euphobia heliscopia and Cupressus sempervirens were carried out against six bacterial strains Bacillus subtillis, Proteus vulgaris, Staphylococus aureus (Gram-positive), Escherichia coli, Pseudomonas aeruginosa, Salmonella typhi (Gram-negative), and fungal species Aspergillus niger and Candida albicans. Phytochemical analysis was also performed using the literature methods. Among the studied medicinal plant extracts against the tested bacterial strain, E. helioscopia showed very promising results against both the gram-positive and gram-negative bacterial and fungal species followed by C. foloisom, A. annua and C. sempervirens which have low activity against the fungal. Relatively low activity was shown by A. calamus. The significant antibacterial activity of active extracts was compared with the standard antimicrobics, piperacillin (100 µg/disc) and gentamicin (10 µg/disc). Key words: Phytochemicals, Aremisia annua, Bacillus subtillis, antibacterial activity.

This study was conducted to evaluate the chemical composition and elemental analysis of ethyl acetate crude fraction of Urtica dioca. The result obtained shows that all bioactive constituents are present in this fraction of plant. The ethyl acetate fraction was screened which comprises flavonoid (1.88 mg/100 g), alkaloid (1.32 mg/100 g), phenol (0.09 mg/100 g), saponin (1.64 mg/100 g) and tannins (0.8 mg/100 g). Small amount of elements Na, k, Ca, Mg, Zn, Fe and P are also present in this fraction of plant. Key words: Urtica dioca, Urticaceae, chemical composition.

The aim of this present study was to analyze the hepatotoxic effect of malathion in adult male rats and evaluate the possible hepatoprotective effect of vitamin E and/or selenium. Oral administration of malathion for 45 days significantly induced marked hepatic injury as revealed by increased activity of the plasma enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and gamma-glutamyl transferaseGGT). Oral administration of vitamin E and selenium in combination with malathion exhibited a significant protective effect by lowering the elevated plasma levels of the previous enzymes. Light microscopic investigation revealed that malathion exposure was associated with necrosis of hepatocytes, marked changes of liver tissues in the form of dilated veins, hemorrhagic spots and some degenerative signs of hepatocytes. Co-administration of vitamin E and selenium with malathion to rats showed mild histopathological changes. Thus, it appears that vitamin E and/or selenium ameliorate malathion hepatotoxicity but are not completely protective. Key words: Malathion, rats enzymes, selenium, vitamin E.

Background Vitamin D deficiency has been associated with impaired human insulin action, suggesting a role in the pathogenesis of diabetes mellitus type 2 (T2DM). In this prospective interventional study we investigated the effects of vitamin D3 supplementation on the metabolic profiles of Saudi T2DM subjects pre- and post-vitamin D supplementation over an 18-month period. Methods T2DM Saudi subjects (men, N = 34: Age: 56.6 ± 8.7 yr, BMI, 29.1 ± 3.3 kg/m2; women, N = 58: Age: 51.2 ± 10.6 yr, BMI 34.3 ± 4.9 kg/m2;) were recruited and given 2000 IU vitamin D3 daily for 18 months. Anthropometrics and fasting blood were collected (0, 6, 12, 18 months) to monitor serum 25-hydroxyvitamin D using specific ELISA, and to determine metabolic profiles by standard methods. Results In all subjects there was a significant increase in mean 25-hydroxyvitamin D levels from baseline (32.2 ± 1.5 nmol/L) to 18 months (54.7 ± 1.5 nmol/L; p p = 0.003). A significant decrease in LDL- (baseline = 4.4 ± 0.8 mmol/L vs. 18 months = 3.6 ± 0.8 mmol/L, p p p = 0.002). Majority of the improvements elicited were more prominent in women than men. Conclusion In the Saudi T2DM population receiving oral Vitamin D3 supplementation (2000 IU/day), circulating 25-hydroxyvitamin D levels remained below normal 18 months after the onset of treatment. Yet, this “suboptimal” supplementation significantly improved lipid profile with a favorable change in HDL/LDL ratio, and HOMA-β function, which were more pronounced in T2DM females.

The objective of the current study was to purify and partially characterize an alkaline protease (AP) from a newly isolated Egyptian Bacillus sphaericus strain. The enzyme was subjected to a 3-step purification scheme involving i) ammonium sulfate [(NH4)2SO4] fractionation, ii) acetone precipitation and iii) Sephadex G-200 gel permeation chromatography. Fractions precipitated with 30 to 60% [(NH4)2SO4] saturation levels exhibited the highest enzyme activities, whereas acetone in the ranges between 50 to 75% (v/v). Gel permeation utilizing Sephadex G-200 column resulted in approx. 50 fold purification level, as compared to the original crude enzyme, with a yield recovery of 27%. The AP enzyme was successfully purified to homogeneity as a monomeric band with an estimated molecular mass of ~29 kDa, based on sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and zymogram activity staining analyses. While, the maximum enzymatic activity was recorded at pH 10, AP showed an optimal activity at incubation temperature range AP between 55 to 60°C. A thermal stability at temperatures ≥ 40°C for 15 min, using casein as a substrate, with a total loss of enzymatic activity upon heating at 70°C. Results for kinetic parameters indicated that the apparent Km and Vmaxvalues for AP, with casein as substrate under optimal reaction conditions (pH 10 and 55°C), were found to be 230 µg min-1 ml-1 and 0.05% (w/v), respectively. Thus, the potentials of AP as an industrially important enzyme were assessed in the light of our current knowledge on microbial alkaline proteases. Key words: Bacillus sphaericus, alkaline protease, biochemical characterization, fodder yeast, enzyme purification, biopesticide.

Concentrations of selenium (Se) in food from local markets of Riyadh, Kingdom of Saudi Arabia (KSA) were measured and daily intake calculated based on information from a questionnaire of foods eaten by healthy Saudis. The daily intake of Se was then compared to concentrations of Se in blood serum. Primary sources of Se in the diet of Saudis were as follows: meat and meat products (31%), egg (20.4%), cereals and cereal products (16%), legumes (8.7%), fruits (6.8%), milk and dairy products (2.0%), beverages (2%), sweets (1.8%), pickles (0.2%), and oil (0.02%). Daily intake of Se, estimated to be 93 μg Se/person/day, was slightly greater than that calculated from the Food and Agriculture Organization (FAO) food balance sheet for KSA, which was approximately 90 μg Se/person/day. The daily intake of Se by Saudis in Riyadh was greater than that of Australians or Dutch but less that of Canadians and Americans. There was a statistically significant correlation (R = +0.38, P

Understanding the interplay between sleep duration and quality, diet and hormones of obesity may help design effective lifestyle intervention strategies. Here we studied such associations in lean and obese teen-aged Saudi girls. In this cross-sectional observational study, 126 girls (62 lean and 64 obese) aged 14 -18 years (16.5 ± 1.5) were evaluated. A general questionnaire, which included sleep and diet questions, was obtained and anthropometric measurements and overnight fasting blood samples for determination of glucose, lipid profile and serum levels of leptin, adiponectin, resistin and ghrelin were collected. Subjects that slept5 hours/day had a higher percent of carbohydrate intake (p = 0.04) than those who slept7 hours/day. Adiponectin levels were higher in the lean than the obese group and increased in proportion to hours of sleep. Ghrelin had an inverse association with subjective sleep duration (p = 0.04), while resistin levels were directly proportional to it. Thus, the duration and quality of sleep influenced diet composition and the circulating levels of adipocytokines and ghrelin in adolescent girls. Long and uninterrupted sleep was associated with a better diet and a more favorable hormonal profile.

To study mothers' practices during pregnancy, lactation and care during the first 2 years.A cross section study was carried out in 5 Primary Health Care Centres (PHCC) in Riyadh, Kingdom of Saudi Arabia. Two hundred and fifty women (50 from each PHCC) who have children less than 2-years of age who visited the selected PHCCs during the study period were selected by systematic random sampling. Data was collected via a questionnaire which contained sociodemographic characteristics of the mother and their children and mothers' practices during pregnancy, lactation and the care of their children.Approximately 73% of the mothers breast fed their children initially but only 37.6% are currently breast feeding their children. The majority of the mothers started breast feeding during 1-8 hours after delivery, 63% added supplementary foods to their children at 4-8 months. The majority of mothers visited antenatal clinics during pregnancy, vaccinated their children and followed up their children in well baby clinics. Half of the mothers are currently using contraceptives and 19% are consuming less food during pregnancy. The mothers' educational level was the most important factor associated with mothers' practices.Some mothers' practices during pregnancy, lactation and child care needs corrective intervention.

Background Sub-clinical hypothyroid dysfunction, a relatively understudied disorder in the Kingdom of Saudi Arabia (KSA), has significant clinical implications if not properly monitored. Also from KSA, more than 50% of the population suffer from hypovitaminosis D ( Methods A total of 94 consenting adult Saudis [52 controls (without subclinical hypothyroidism), 42 cases (previously diagnosed subjects)] were included in this cross-sectional study. Anthropometrics were obtained and fasting blood samples were taken for ascertaining lipid and thyroid profile, as well as measuring PTH, 25(OH) vitamin D and calcium. Results Cases had a significantly higher body mass index than the controls (p p = 0.001). A significant positive association between HDL-cholesterol and PTH (R = 0.56; p = 0.001), as well as a negative and modestly significant negative association between LDL-cholesterol and PTH (R = - 20.0; p = 0.04) were observed. FT3 was inversely associated with circulating 25 (OH) vitamin D (R = -0.25; p = 0.01). Conclusions Patients with hypothyroid dysfunction possess several cardiometabolic risk factors that include obesity and dyslipidemia. The association between PTH and cholesterol levels as well as the inverse association between vitamin D status and FT3 needs to be reassessed prospectively on a larger scale to confirm these findings.

Prevalence of Iron Deficiency Anaemia in Children presenting to the Royal Hospital for Sick Children, Edinburgh

Background Coffee and tea consumption was hypothesized to interact with variants of vitamin D-receptor polymorphisms, but limited evidence exists. Here we determine for the first time whether increased coffee and tea consumption affects circulating levels of 25-hydroxyvitamin D in a cohort of Saudi adolescents. Methods A total of 330 randomly selected Saudi adolescents were included. Anthropometrics were recorded and fasting blood samples were analyzed for routine analysis of fasting glucose, lipid levels, calcium, albumin and phosphorous. Frequency of coffee and tea intake was noted. 25-hydroxyvitamin D levels were measured using enzyme-linked immunosorbent assays. Results Improved lipid profiles were observed in both boys and girls, as demonstrated by increased levels of HDL-cholesterol, even after controlling for age and BMI, among those consuming 9–12 cups of coffee/week. Vitamin D levels were significantly highest among those consuming 9–12 cups of tea/week in all subjects (p-value 0.009) independent of age, gender, BMI, physical activity and sun exposure. Conclusion This study suggests a link between tea consumption and vitamin D levels in a cohort of Saudi adolescents, independent of age, BMI, gender, physical activity and sun exposure. These findings should be confirmed prospectively.