Werner syndrome in a Lebanese family.

Werner syndrome (WS) is an extremely rare, autosomal recessive segmental progeroid disorder caused by biallelic pathogenic variants in the WRN, which encodes a multifunctional nuclear protein that belongs to the RecQ family of DNA helicases. Despite extensive research on WS in the last years, the population-specific mutational spectrum still needs to be elucidated. Moreover, there is an evident lack of detailed clinical descriptions accompanied with photographs of affected individuals. Here, we report a consanguineous Lebanese family in whom we identified a pathogenic homozygous nonsense variant c.1111G>T, p.Glu371* in the WRN. The index individual, at the age of 54 years, was suspected to have WS due to a history of early-onset cataracts, premature hair loss and graying, chronic nonhealing leg ulcers, Achilles' tendon calcifications, type 2 diabetes mellitus, dyslipidemia, hypothyroidism, and premature coronary artery disease. His four sisters, three of which deceased in the fifth decade, had clinical signs suggestive of WS. Moreover, his daughter, aged 23 years, had short stature, hair loss and flat feet. Taken together, we report a detailed clinical course of disease in several affected members of a consanguineous family, which is additionally documented by photographs.

Pituitary incidentalomas in paediatric population: Incidence and characteristics.

OBJECTIVE: To determine the incidence of pituitary incidentalomas in the paediatric population and among its different age subgroups as well as to identify the characteristics of these lesions. Additionally, we aim to give a perspective on the management and follow-up of these patients. DESIGN AND PATIENTS: We retrospectively studied MRI of children aged 18 years or below who underwent MRI with sellar region within their field of view between January 2010 and December 2018. MEASUREMENTS: Pituitary lesions were considered incidental according to the definition by the Endocrine Society. We reported the size, location and signal characteristics of each lesion. Medical charts of the subjects were reviewed for age, sex, the MRI indication and the hormonal assays levels. RESULTS: We identified 40 pituitary lesions of which 31 were incidental lesions. The incidence of pituitary incidentaloma in our cohort was 22 per 1000 patients with female predisposition ( 64.5%) and a mean age of 11 ± 6 years. Rathke's cleft cyst was the most prevalent lesion, accounting for 67.7% followed by cystic pituitary lesions and microadenomas. The most common indications for imaging were growth disturbance (12.9%) followed by headache (9.7%). Abnormal laboratory workup was present in 13% of the subjects. Incidental lesions were more common in the older age groups compared to young children. CONCLUSION: Incidental pituitary lesions in the paediatric population are relatively infrequent and increases with age. Rathke's cleft cyst is the most common incidentally encountered pituitary lesion followed by cystic pituitary lesions and microadenomas.

A healthy lifestyle pattern is associated with a metabolically healthy phenotype in overweight and obese adults: a cross-sectional study.

PURPOSE: This study tried at identifying lifestyle patterns in a sample of Lebanese adults and investigating their association with metabolically healthy overweight and obesity (MHOv/O). METHODS: This study used data from a community-based survey of Lebanese adults living in Greater Beirut (n = 305). Dietary intake was assessed using an 80-item food frequency questionnaire. MHOv/O was defined as having one or none of the following metabolic abnormalities: triglycerides ≥ 150 mg/dL; systolic blood pressure ≥ 130 mmHg; diastolic blood pressure ≥ 85 mmHg; fasting blood glucose ≥ 100 mg/dL; HDL-cholesterol < 40 mg/dL for men and < 50 mg/dL for women. 201 subjects were overweight/obese and 98 had MHOv/O. Factor analysis was implemented to derive lifestyle patterns. RESULTS: Two lifestyle patterns were identified: the unhealthy lifestyle pattern, which included foods such as fast food and soft drinks and was characterized by alcohol consumption and cigarette smoking. Eating at home loaded negatively on this pattern. The healthy lifestyle pattern was characterized by positive loadings of food groups such as milk and dairy products, fruits, vegetables and legumes. Sleep difficulties loaded negatively on this pattern, while vigorous and moderate physical activity loaded positively. Multiple logistic regression analyses showed that subjects belonging to the 3rd tertile of the healthy pattern scores had higher odds of MHOv/O as compared to those in the 1st tertile (OR 2.33, CI 1.04-4.81). CONCLUSIONS: Findings of this study provided evidence on the combined effect of lifestyle patterns in relation to cardiometabolic abnormalities and highlighted the importance of focusing on 'holistic' lifestyle pattern modifications in designing and implementing prevention interventions in overweight and obese subjects.

Sleepless in Beirut: sleep duration and associated subjective sleep insufficiency, daytime fatigue, and sleep debt in an urban environment.

PURPOSE: Insufficient sleep is not well studied in developing countries. We assessed sleep duration among adults in Lebanon and examined its potential predictors and relationship with subjective sleep insufficiency, daytime fatigue, and weekday sleep debt. METHODS: This cross-sectional study included 501 adults (mean age 45.2 (SD15.2) years, 64% females) from the community in Beirut and Mount Lebanon. Socio-demographic, lifestyle and health characteristics, subjective sleep insufficiency, daytime fatigue, and weekday sleep debt (weekend vs. weekdays sleep duration) were compared between individuals who reported sleeping < 6:00, 6-7:59(reference), or ≥ 8:00 h/night. Symptoms and predictors of sleep duration were assessed using logistic regression. RESULTS: Thirty-nine percent of participants reported sleeping < 6 h/night while 15% reported sleeping ≥ 8:00 h/night. Age (OR = 1.16/year, 95% CI [1.02-1.33]) and female sex (OR = 1.71, 95% CI [1.14-2.58]) were significant predictors of short sleep (< 6:00 h/night) in multivariable adjusted analyses. Compared to referent (6:00-7:59 h/night) and long sleepers (≥ 8:00 h/night), short sleepers were significantly more likely to report subjective sleep insufficiency (OR = 3.00, 95% CI [2:00-4.48], and OR = 4.52, 95% CI [2.41-8.51]; respectively) and daytime fatigue (OR = 1.53, 95% CI [1.04-2.24], and OR = 1.83, 95% CI [1.06-2.04]; respectively). Compared to long weekdays sleepers, short and referent weekdays sleepers were more likely to sleep longer on weekend (OR = 2.47, 95% CI [1.18-5.15], and OR = 4.16, 95% CI [2.03-8.5]; respectively). CONCLUSIONS: Short sleep is highly prevalent in this urban cohort from a low- to medium-income country especially among women and older adults, and is associated with subjective sleep insufficiency, daytime fatigue, and weekday sleep debt. The socio-cultural determinants of sleep duration need to be studied across different populations to better evaluate the causes and implications of short sleep.

Long-Term Effect on HbA1c in Poorly Controlled Diabetic Patients Following Nonmydriatic Retinal Image Review at the Time of Endocrinology Visit.

Background:Patient education demonstrates variable benefits on diabetes control.Introduction:To examine the effect of discussing nonmydriatic retinal imaging findings during a single endocrinology visit on HbA1c levels after 6, 12, and 60 months.Materials and Methods:Patients with HbA1c >8.0% and diabetic retinopathy were previously recruited for a prospective study looking at the change in HbA1c at 3 months between those assigned to a session of nonmydriatic imaging with discussion of retinal findings and those assigned to routine endocrinology evaluation alone. The patients were subsequently evaluated at 6, 12, and 60 months after the initial intervention.Results:Fifty-three of the 57 originally recruited intervention subjects (93%) and 48 of 54 subjects in the original control group (89%) were evaluated at 6 and 12 months and 44 patients in each group (75% and 81%, respectively) at 60 months. At 6 months, the intervention group maintained larger decreases in median HbA1c compared to control (-1.1 vs. -0.3, respectively, p = 0.002) with a trend persisting at 12 months (-0.6 vs. -0.2, respectively, p = 0.07). After 60 months, there was no significant difference in the median change in HbA1c between treatment and control groups (0.3 vs. 0.1, respectively, p = 0.54).Discussion:The short-term improvement in HbA1c resulting from discussion of retinal findings persists throughout the first year in this diabetic cohort, but its magnitude declines with time and becomes statistically insignificant at some point between 6 and 12 months.Conclusions:In patients with poorly controlled diabetes, retinal imaging review may help improve glycemic control but may require repetition periodically for benefit beyond 6 months.

Characterization of metabolic changes in the phenotypes of women with polycystic ovary syndrome in a large Mediterranean population from Sicily.

OBJECTIVE: To better characterize the metabolic alterations in various phenotypes of polycystic ovary syndrome (PCOS) in a large homogeneous (Sicilian) Mediterranean population with a low prevalence of obesity. DESIGN: Retrospective study. PATIENTS: A total of 1215 consecutively evaluated women with PCOS divided into four Rotterdam phenotypes (A, B, C and D) and in 108 matched ovulatory, nonhyperandrogenic women. MEASUREMENTS: BMI, fasting glucose, total cholesterol, HDL cholesterol, triglycerides, LDL cholesterol and an oral glucose tolerance test. RESULTS: The overall prevalence of obesity was 31%, metabolic syndrome 6.6%, diabetes 2.1%, altered glucose metabolism 13.1%, and abnormal lipid profile 60%. Phenotype B had the highest prevalence of obesity, metabolic syndrome, altered glucose metabolism and lipid abnormalities compared to other PCOS phenotypes and controls. Phenotype A was more obese and more women had metabolic syndrome compared to phenotypes C and D but phenotype C had a similar prevalence of altered glucose metabolism and lipid abnormalities compared to phenotype A which had a higher BMI. These metabolic abnormalities in A and C were higher compared to phenotype D and controls. Multivariate analysis showed that BMI predicts only abnormalities in fasting glucose and triglycerides, while there was no association with androgens. CONCLUSIONS: In Mediterranean women with PCOS from Sicily with a lower prevalence of obesity, the prevalence of diabetes, altered glucose metabolism and metabolic syndrome were much lower than reported in US studies. Phenotype B was the most metabolically affected phenotype, followed by phenotype A. Phenotype C had an intermediate disorder but with a high prevalence of altered glucose metabolism and lipid alterations. Only the normoandrogenic phenotype D had no metabolic abnormalities.

A minimally processed dietary pattern is associated with lower odds of metabolic syndrome among Lebanese adults.

OBJECTIVE: To (i) estimate the consumption of minimally processed, processed and ultra-processed foods in a sample of Lebanese adults; (ii) explore patterns of intakes of these food groups; and (iii) investigate the association of the derived patterns with cardiometabolic risk. DESIGN: Cross-sectional survey. Data collection included dietary assessment using an FFQ and biochemical, anthropometric and blood pressure measurements. Food items were categorized into twenty-five groups based on the NOVA food classification. The contribution of each food group to total energy intake (TEI) was estimated. Patterns of intakes of these food groups were examined using exploratory factor analysis. Multivariate logistic regression analysis was used to evaluate the associations of derived patterns with cardiometabolic risk factors. SETTING: Greater Beirut area, Lebanon. SUBJECTS: Adults ≥18 years (n 302) with no prior history of chronic diseases. RESULTS: Of TEI, 36·53 and 27·10 % were contributed by ultra-processed and minimally processed foods, respectively. Two dietary patterns were identified: the 'ultra-processed' and the 'minimally processed/processed'. The 'ultra-processed' consisted mainly of fast foods, snacks, meat, nuts, sweets and liquor, while the 'minimally processed/processed' consisted mostly of fruits, vegetables, legumes, breads, cheeses, sugar and fats. Participants in the highest quartile of the 'minimally processed/processed' pattern had significantly lower odds for metabolic syndrome (OR=0·18, 95 % CI 0·04, 0·77), hyperglycaemia (OR=0·25, 95 % CI 0·07, 0·98) and low HDL cholesterol (OR=0·17, 95 % CI 0·05, 0·60). CONCLUSIONS: The study findings may be used for the development of evidence-based interventions aimed at encouraging the consumption of minimally processed foods.

PREVALENCE OF DIABETES IN GREATER BEIRUT AREA: WORSENING OVER TIME.

OBJECTIVE: The Middle East North Africa region has one of the highest rates of diabetes, both in prevalence and in rate of increase. The aim of this study was to examine the prevalence and associated risk factors of type 2 diabetes mellitus (T2D) in the adult population of Beirut. METHODS: A random sample of 501 men and women aged 18 to 79 years was examined in a cross-sectional manner. The sample was then divided into 3 groups based on T2D self-report, glycosylated hemoglobin (HbA1c), and fasting glucose (no diabetes [ND], at risk for diabetes [RD], and probable diabetes [PD]). These were compared to determine the various associated risks. RESULTS: The sample consisted of 64.3% women, with an average age of 45.4 ± 15 years, and a mean body mass index (BMI) of 29.4 ± 5.9 kg/m2. The subjects were predominantly from a low socio-economic status, and more than half smoked either cigarettes or a waterpipe. The percentages of the 3 groups were as follows: 41.7%, 40.3%, and 18.0% for ND, RD, and PD, respectively. Out of 90 subjects diagnosed with PD, 26 did not know they had diabetes. Independent, positively associated risk factors were age, BMI, heart rate, hypertension, triglyceride, and high-density lipoprotein cholesterol. CONCLUSION: The prevalence of T2D was high in this study and seems to be increasing compared to prior diabetes reports. Overall, the whole sample had a high prevalence of cardiovascular risk factors such as smoking, obesity, and physical inactivity. However, subjects with diabetes had significantly more components of the metabolic syndrome. ABBREVIATIONS: ADA = American Diabetes Association CRP = C-reactive protein DD = definite diabetes FPG = fasting plasma glucose HbA1c = glycosylated hemoglobin MENA = Middle-East North Africa ND = no diabetes PD = probable diabetes RD = at risk of diabetes T2D = type 2 diabetes mellitus TSH = thyroid-stimulating hormone.

Bisphenol A urinary level, its correlates, and association with cardiometabolic risks in Lebanese urban adults.

Bisphenol A (BPA) is an endocrine disruptor with multiple purported metabolic effects. This study aimed to measure BPA among Lebanese population, to identify its predictors, and to explore any link to metabolic disorders. A representative sample of 501 adults from Lebanon was recruited in a cross-sectional study. Urinary BPA was measured, and data were collected for anthropometric measurements, medical history, food intake, and laboratory markers of metabolic conditions. BPA data was divided into tertiles. A total of 89% of the subjects had detectable urinary BPA levels, with an overall mean of 3.67 ± 4.75 µg/L and a mean creatinine-adjusted BPA of 2.90 ± 4.79 µg/g. There was a significant positive association with female gender and older age for being in the highest BPA tertile. BPA level was linked to metabolic syndrome (MetS), obesity, type-2 diabetes (T2D), hypertension, and dyslipidemia. After adjustment, the trend remained for BPA in association with MetS and T2D. Though urinary BPA in the Lebanese population was higher in older women, the levels were similar to world-reported figures. Our results suggest a link with metabolic disorders but not at a significant level. These findings call for longitudinal and broader sample measurements.

The prevalence of endocrinopathies among Lebanese women presenting with hirsutism to an endocrine clinic.

UNLABELLED: Hirsutism is a common condition in women characterized by excessive growth of terminal hair in a male pattern distribution. It may be a manifestation of underlying pathologies. Since there is no data published about the prevalence of endocrinopathies among hirsute women in Lebanon, this study's aim was to reveal the most common etiologies of hirsutism in this population. METHODS: The study is a descriptive review of cases of 160 females with hirsutism presenting to a single endocrinologist clinic. Data about history, physical exam, blood tests and imaging results were collected after review of medical charts. RESULTS: Out of the 160 cases reviewed, 14 females (8.8%) were left undiagnosed. Out of 146 subjects diagnosed, 72.6% were found to have polycystic ovary syndrome (PCOS), 18.5% idiopathic hirsutism (IH), 4.6% non-classic congenital adrenal hyperplasia, 2.6% hyperprolactinemia, 0.6% Cushing's syndrome and 0.6% hypothyroidism. A higher percentage of irregular menses and a trend for overweight were found among the PCOS group. CONCLUSIONS: PCOS remains the most common cause of hirsutism in an endocrine referral clinic, similar to other populations. A low threshold for diagnostic workup is in order, especially when there is associated menstrual irregularity or overweight.

Comparison of quality of life in a group of Lebanese type 1 diabetics on insulin pump and those on multiple daily injections.

AIM: The aim of the study is to investigate the differences in the quality of life (QOL) in Lebanese youths with type 1 diabetes using continuous subcutaneous insulin infusion (CSII) and those using multiple daily injections (MDI) treatment modalities. METHODS: A descriptive, cross-sectional, comparative matched design was used. The sample included 36 adolescents and young adults on one of two treatment modalities (CSII or MDI) and matched for age, gender, and level of education. QOL was measured with the Indiana Diabetes Quality of Life for Youth and latest HbA1C level was recorded. RESULTS: The CSII group had significantly lower HbA1C levels (p < 0.001), and reported better health perception (p = 0.029), more satisfaction with life (p = 0.002), less impact of the disease (p = 0.002), and fewer worries about their disease (p = 0.029), compared to the MDI group. The overall quality of life score was also significantly better in the CSII group than in the MDI group (p = 0.001). CONCLUSIONS: Findings suggest that CSII is associated with better glycemic control and QOL in the Lebanese youth population with type 1 diabetes.

Polycystic Ovary Syndrome: Pathophysiology and Controversies in Diagnosis.

Polycystic ovary syndrome (PCOS) is a complex and heterogeneous disorder that commonly affects women in the reproductive age group. The disorder has features that propose a blend of functional reproductive disorders, such as anovulation and hyperandrogenism, and metabolic disorders, such as hyperglycemia, hypertension, and obesity in women. Until today, the three implemented groups of criteria for the diagnosis of PCOS are from the National Institutes of Health (NIH) in the 1990s, Rotterdam 2003, and the Androgen Excess Polycystic Ovary Syndrome 2009 criteria. Currently, the most widely utilized criteria are the 2003 Rotterdam criteria, which validate the diagnosis of PCOS with the incidence of two out of the three criteria: hyperandrogenism (clinical and/or biochemical), irregular cycles, and polycystic ovary morphology. Currently, the anti-Müllerian hormone in serum is introduced as a substitute for the follicular count and is controversially emerging as an official polycystic ovarian morphology/PCOS marker. In adolescents, the two crucial factors for PCOS diagnosis are hyperandrogenism and irregular cycles. Recently, artificial intelligence, specifically machine learning, is being introduced as a promising diagnostic and predictive tool for PCOS with minimal to zero error that would help in clinical decisions regarding early management and treatment. Throughout this review, we focused on the pathophysiology, clinical features, and diagnostic challenges in females with PCOS.

Fructose intake and its association with relative telomere length: an exploratory study among healthy Lebanese adults.

Introduction: Shorter relative telomere length (RTL) has been associated with increased incidence of morbidity. Although still disputed, available evidence suggests that dietary factors, including sugar-sweetened beverages (SSB) may be linked with shorter RTL. It was argued that the link between SSB and RTL may be explained by the sugar content of these beverages, and specifically fructose given its impact on oxidative stress and the inflammatory response. However, none of the existing studies have examined the specific link between fructose intake and RTL. This exploratory study aimed at (1) assessing the intake of dietary fructose (total, added and natural) in Lebanese healthy adults and (2) examining dietary fructose as a predictor of short telomere length. Methods: Following a cross-sectional design (n = 282), anthropometric and biochemical data were collected. RTL was assessed by utilizing real-time polymerase chain reaction (RT-qPCR) to amplify both telomere and single-copy gene segments. Dietary intake was evaluated using a culture-specific food frequency questionnaire (FFQ). Intakes of added fructose, naturally-occurring fructose, and total fructose were estimated. Results: Mean intakes of added and natural fructose were of 39.03 ± 34.12 and 12.28 ± 8.59 g/day, respectively, representing 4.80 ± 3.56 and 1.78 ± 1.41% of total energy intake (EI). Mean total fructose intake was of 51.31 ± 35.55 g/day, contributing 6.58 ± 3.71% EI. Higher intakes of total and added fructose were significantly associated with shorter RTL 2nd RTL tertile as compared to the 3rd RTL tertile; relative risk ratio (RRR) = 3.10 [95% confidence interval (CI): 1.38, 6.94] and RRR = 2.33 (95% CI: 1.02, 5.36), respectively after adjustment for confounders identified using a directed acyclic graph (DAG). Conclusion: In conclusion, although we could not observe a dose-dependent relation between fructose intakes and RTL shortening and although the study is limited by its small sample size, the findings suggest that total and added dietary fructose intakes may be associated with shorter RTL. Larger studies, of longitudinal nature, are needed to further confirm the study findings.

Lifestyle habits in Saudi adolescents with diagnosed diabetes: An opportunity for health promotion.

AIMS: This study assessed lifestyle and health behavior habits among a representative sample of Saudi adolescents with self-reported diabetes and compared them to non-diabetic peers. METHODS: This was a nested case-control study, from the Jeeluna cohort, a nationwide, cross-sectional study of 12,575 Saudi boys and girls aged 10-19 years. Non-diabetic adolescents were matched to those with diabetes on a ratio of 4:1 based on age, gender and region. Retained information from the original study included: socio-demographics, lifestyle behaviors, tobacco/substance use, screen use, anthropometric measurements, and laboratory results. RESULTS: The prevalence of diabetes was 0.7% (n = 87). Overall, 65% of diabetic participants were males, and 22.4% aged ≤14 years. Overall, both groups had low rates of healthful habits in their diet and physical activity. Both groups had similar rates of tobacco use, and high digital screen time. Adolescents with diabetes had more consistent sleeping pattern, were more likely to be on a diet, thought they spent enough time with their physician and obtained medical information more often from their health clinic. They were also more likely to feel down and to chat more often. CONCLUSION: Adolescents with diabetes remain far from guideline targets but seem predisposed to better lifestyle and have more access to health as compared to their non-diabetic peers.

Dietary fructose and its association with the metabolic syndrome in Lebanese healthy adults: a cross-sectional study.

BACKGROUND: Epidemiological studies investigating the association between dietary fructose intake and the metabolic syndrome (MetS) are scarce and have produced controversial findings. This study aimed at (1) assessing total dietary fructose intake in a sample of Lebanese healthy adults, and determining the intake levels of natural vs. added fructose; (2) investigating the association of dietary fructose with MetS; and (3) identifying the socioeconomic and lifestyle factors associated with high fructose intake. METHODS: A cross-sectional survey was conducted on a representative sample of adults living in Beirut, Lebanon (n = 283). Anthropometric and biochemical data were collected, and dietary intake was assessed using a food frequency questionnaire. Intakes of naturally-occurring fructose from fructose-containing food sources, such as fruits, vegetables, honey, were considered as "natural fructose". Acknowledging that the most common form of added sugar in commodities is sucrose or High Fructose Corn Syrup (HFCS), 50% of added sugar in food products was considered as added fructose. Total dietary fructose intake was calculated by summing up natural and added fructose intakes. Logistic regression analyses were conducted to investigate the association of total, added and natural fructose intakes with the MetS and to identify the socioeconomic predictors of high fructose intake. RESULTS: Mean intake of total fructose was estimated at 51.42 ± 35.54 g/day, representing 6.58 ± 3.71% of energy intakes (EI). Natural and added fructose intakes were estimated at 12.29 ± 8.57 and 39.12 ± 34.10 g/day (1.78 ± 1.41% EI and 4.80 ± 3.56% EI), respectively. Participants in the highest quartile of total and added fructose intakes had higher odds of MetS (OR = 2.84, 95%CI: 1.01, 7.94 and OR = 3.18, 95%CI: 1.06, 9.49, respectively). In contrast, natural fructose intake was not associated with MetS. Age, gender and crowding index were identified as factors that may modulate dietary fructose intakes. CONCLUSIONS: The observed association between high added fructose intake and the MetS highlights the need for public health strategies aimed at limiting sugar intake from industrialized foods and promoting healthier dietary patterns in Lebanon.

Incidence of diabetes and its predictors in the Greater Beirut Area: a five-year longitudinal study.

BACKGROUND: Type 2 Diabetes (T2D) remains a world epidemic. Obtaining accurate estimates of its incidence and their predictors will aid in targeting preventive measures, allocating resources, and strategizing its management. The Middle East North Africa region has high T2D prevalence and rates of rise. Few incidence studies exist for the region, and none from Lebanon. The current study objective was to determine diabetes incidence and diabetes predictors in a community-based Lebanese sample. A secondary objective was to describe the metabolic control over time in adults with preexisting diabetes. METHODS: This is a five-year (2014-2019) follow-up study on a random sample of 501 residents of the Greater Beirut area. Out of 478 people eligible to participate in the follow-up study, 198 returned (response rate 39.5%). Assessment included medical history, anthropometric measures, food frequency, sleep, and lifestyle questionnaires. Laboratory data included glycemic indices (fasting glucose and HbA1C) and other biological markers. The diagnosis of probable diabetes (PD) was based on one abnormal test for either fasting glucose ≥ 126 mg/dL or HbA1C ≥ 6.5% or having history of diabetes. RESULTS: The incidence of diabetes was 17.2 (95% CI 9.6-28.7) per 1000 person-years. Cardiometabolic risk factors independently associated with diabetes were: older age, higher BMI, family history of diabetes, metabolic syndrome, higher CRP and triglyceride level; whereas an independent predictor of diabetes was previous BMI. In addition, the 42 participants with preexisting diabetes had worsening of their metabolic profile over a five-year period. CONCLUSIONS: The incidence of diabetes was high as compared to some reported world rates, and in line with the high prevalence in the MENA region. The risk was highest in those with positive family history and the presence of the metabolic syndrome or its components. Preventive measures should particularly target participants with that specific risk profile. This becomes particularly important when observing that metabolic control gets worse over time in individuals with diabetes.

C-peptide is a predictor of telomere shortening: A five-year longitudinal study.

Aim: Relative telomere length (RTL) predicts the development of many age-related diseases. Yet, few studies have evaluated their longitudinal effect on RTL. We investigated longitudinally the association between cardiometabolic risk factors and RTL. Methods: This was a longitudinal study with a 5-year follow-up period, based on data collected in 2014 and 2019. Of 478 participants in 2014, 198 consented to be followed-up in 2019. The associations between RTL and risk factors were analyzed using t-test, ANOVA or simple linear regression as applicable. Results: RTL was significantly shortened after 5 years (P<0.001). Older age (P=0.018) and gender (P=0.05) were significantly associated with shorter RTL at follow-up. Higher baseline C-peptide correlated with shorter RTL (P=0.04) and shortening of RTL (P=0.03) after 5 years. Multivariate linear regression including both age and gender revealed a significant trend for C-peptide and change in RTL after 5 years (P=0.04). Interestingly, there was a trend of shorter RTL at follow-up with diabetes, though the findings were not statistically significant. Conclusions: Higher C-peptide level contributes to telomere shortening over time, suggesting that metabolic dysregulation may play a role in early aging. Further understanding of this relationship and addressing high C-peptide levels can be important to prevent premature aging.

Vitamin D Deficiency in Lebanese Adults: Prevalence and Predictors from a Cross-Sectional Community-Based Study.

METHODS: A random sample of Lebanese adults residing in the Greater Beirut area was selected based on area probability and multistage cluster sampling. Data from 446 participants (68% females) with mean age 45.3 ± 15 years were used for the analyses. Participants were recruited between March and May. Serum 25-hydroxyvitamin D levels were measured using electrochemiluminescent immunoassay. RESULTS: Vitamin D deficiency was highly prevalent whether using the cutoff of 50 nmol/L or using the more conservative cutoff of 30 nmol/L; more specifically, 71.9% and 39.1% of the study population were deficient using the above cutoffs, respectively In the bivariate analyses, gender, BMI and body fat mass, socioeconomic factors (income and education level), alcohol consumption, dietary intake of fat and of vitamin D, serum LDL-cholesterol, and serum creatinine were all associated with vitamin D status. After adjustment for multiple covariates, age, income, alcohol consumption, and serum creatinine were independent predictors of vitamin D deficiency. CONCLUSION: Vitamin D deficiency is highly prevalent in Lebanon. Preventive measures should target the modifiable risk factors.

Epidemiology of type 2 diabetes in the Middle East and North Africa: Challenges and call for action.

Type 2 diabetes continues to be a serious and highly prevalent public health problem worldwide. In 2019, the highest prevalence of diabetes in the world at 12.2%, with its associated morbidity and mortality, was found in the Middle East and North Africa region. In addition to a genetic predisposition in its population, evidence suggests that obesity, physical inactivity, urbanization, and poor nutritional habits have contributed to the high prevalence of diabetes and prediabetes in the region. These risk factors have also led to an earlier onset of type 2 diabetes among children and adolescents, negatively affecting the productive years of the youth and their quality of life. Furthermore, efforts to control the rising prevalence of diabetes and its complications have been challenged and complicated by the political instability and armed conflict in some countries of the region and the recent coronavirus disease 2019. Broad strategies, coupled with targeted interventions at the regional, national, and community levels are needed to address and curb the spread of this public health crisis.

Early Sialadenitis After Radioactive Iodine Therapy for Differentiated Thyroid Cancer: Prevalence and Predictors.

INTRODUCTION: Sialadenitis is a frequent occurrence after radioactive iodine therapy (RAI). However, reports on its predictors and risk factors in the Eastern Mediterranean Region (EMRO) are scarce. AIM: This study aimed to identify risk factors for early sialadenitis in patients receiving RAI for differentiated thyroid cancer (DTC) at the American University of Beirut Medical Center. It also aimed to determine the prevalence and characteristics of such patients receiving RAI at our institution. METHODS: This was a retrospective study conducted at the American University of Beirut Medical Center. Medical charts were reviewed for all patients 18-79 years of age admitted to receive RAI for DTC between 01/01/2012 and 31/12/2015. Sialadenitis was deemed present if there were any records of neck swelling/pain, dry mouth, or difficulty swallowing within 48 hours of RAI administration. Characteristics between patients with sialadenitis and those without were compared to determine predictors. RESULTS: There were 174 patients admitted to receive RAI, predominantly females (71.3%), with papillary thyroid cancer (93.1%). The majority had lymph node involvement (64.5%). Pretreatment thyroid stimulating hormone (TSH) was greater than 75 mIU/ml in most patients (72.6%). The prevalence of sialadenitis was 20.1% (95% CI (15-27)). Being non-Lebanese and having a positive whole-body scan were associated with sialadenitis and persisted after adjustments (OR = 2.34 and 3.99). Non-Lebanese patients had higher rates of lymph nodes involvement (p value 0.005) and were kept off levothyroxine for longer periods (p value 0.02). CONCLUSION: The prevalence of sialadenitis at our institution was similar to other reported studies from the world. However, risk factors allude to more iodine exposure in the neck with positive whole-body scan uptake, lymph node involvement, and prolonged period of hypothyroidism.