The risk of eating disorders among children and adolescents with attention deficit hyperactivity disorder: Results of a matched cohort study.

BACKGROUND AND OBJECTIVES: There are some studies on the association between attention deficit and hyperactivity disorder (ADHD) and the risk of eating disorders (ED). Only few have examined the risk of ED among children and adolescents with ADHD. Previous research which included subjects with ADHD with other comorbidities used inadequate controls and did not focus on the type of ADHD or the role of pharmacological treatment. METHODS: This matched cohort study was conducted in the Child/Adolescents Psychiatry Unit (CAPU), Bahrain. Using the CAPU diagnostic frameworks, 70 subjects with ADHD were recruited and matched with their corresponding age- and sex- healthy controls at 1:2 ratio (70 cases:140 controls). The participants were children or adolescents aged between 8 and 19 years old. A brief interview was used to collect socio-demographic information and anthropometrics. The risk of ED was estimated using the eating attitude test -26 (EAT-2). Data were analyzed using cohort analysis. RESULTS: A total of 31.43% of the subjects with ADHD were screened using EAT-26 and found to be 'at risk' for ED, compared to 12.14% of the controls (OR 3.31, 95% CI 1.62-6.78). The prevalence of ED among female cases with ADHD was slightly higher than males (33.33% and 30.77%, respectively). Body weight or body mass index was a statistically significant explanatory factor for the risk of ED. CONCLUSIONS: The present study shows that children and adolescents with ADHD have a three-fold increased risk of ED compared to healthy controls. This research raised the recommendation that children and adolescents with ADHD should be screened for disordered eating patterns.

Diet-Related Inflammation is Associated with Major Depressive Disorder in Bahraini Adults: Results of a Case-Control Study Using the Dietary Inflammatory Index.

PURPOSE: This case-control study aimed to examine the association between the inflammation potential of the diet and depression. PATIENTS AND METHODS: Ninety-six patients with major depression disorder were matched with 96 age- and sex-matched healthy controls. Energy-adjusted DII (E-DIITM) scores were calculated based on the participants' responses to a detailed nutritional assessment using a quantitative food frequency questionnaire. Descriptive results were reported. Logistic regression was used to estimate odds ratios and 95% confidence intervals associated with E-DII scores and depression adjusting for covariates including age, sex, body mass index, comorbidities, level of education, and employment. RESULTS: The mean E-DII score of participants in the study was 1.32±1.08, indicating a generally pro-inflammatory diet. Patients with depression had elevated E-DII scores compared to age- and sex-matched controls with E-DII scores of 1.72± 1.09 vs 0.90±0.90, respectively (P=0.001). Results of logistic regression analysis revealed that patients with depression were nearly three times more likely to be in the extreme ends of pro-inflammatory diet (OR 2.75; 95% CI 1.82-4.15). CONCLUSION: Adult Bahraini patients with depression have higher dietary inflammation potential compared to the general population controls. Further research is needed to confirm these results and provide effective interventions to reduce the burden of this dietary inflammation.

Sleep quality and Dietary Inflammatory Index among university students: a cross-sectional study.

PURPOSE: Evidence indicates that most college students face reduced sleep quality due to unhealthy dietary habits and hectic daily schedules. While the relationship between sleep quality and general health has been the subject of intensive research, little is known about the association between sleep and its relation with the inflammatory potential of the diet until recently. This study aimed to investigate the association between Energy-Adjusted Dietary Inflammatory Index (E-DII®) scores and sleep quality in a group of students from the University of Sharjah (UOS). METHODS: A cross-sectional study design was followed, and convenience sampling was used. Participants were assessed for sleep quality using the Pittsburgh Sleep Quality Index (PSQI), E-DII scores were derived from a semi-quantitative food frequency questionnaire (FFQ), and physical activity level was measured using the International Physical Activity Questionnaire (IPAQ). Chi-square tests and two-sample t tests were used to find an association between E-DII scores and sleep quality. RESULTS: A total of 379 college students were included in the study of whom 64 % were female and 81% were between 18 and 21 years of age. Two-thirds of participants experienced poor sleep quality. Although results were trending in the hypothesized direction, no significant association was found between E-DII scores and sleep quality. Among the individual components of sleep quality, a direct significant association was found between E-DII scores and day dysfunction (P = 0.03). CONCLUSIONS: These results suggest that a pro-inflammatory diet maybe related to increased day dysfunction among UOS students. Consuming a more anti-inflammatory diet may reduce daytime dysfunction. Further prospective and controlled studies are required to confirm this association, and to explore other attributes and their sequelae on sleep quality.

Outcomes of COVID-19 in the Eastern Mediterranean Region in the first 4 months of the pandemic.

OBJECTIVES: To summarize the outcomes of the coronavirus disease 2019 infections in the Eastern Mediterranean Region (EMR) in the first 4 months of the pandemic. METHODS: A meta-analysis approach was used in this context. We used the aggregate data from the World Health Organization Regional Office for the EMRO (until 26 May 2020) to generate this report. RESULTS: An analysis of official data from all 22 countries and territories in the Middle East, North Africa, the Horn of Africa, and Central Asia K=22 (a total of 438,717 cases) was performed. The total number of cases, recovered cases were 438,717,228,986,  and deaths was 11,290 in the EMR. Meta-analytic pooling of the point estimates of recovery rate per country in the EMR was 52.5% (95% CI 52.3% - 52.6%). The lowest recovery rates were in Somalia (4.3%), and the highest rates were in Tunisia (87.4%). Meta-analytic pooling of the point estimates of death rate per country in the EMR yielded 3.85% [95% CI 3.80% - 3.9%]. Meta-analytic pooling of the point estimates of recovery rate per country in the Gulf Cooperation Council countries was 46.1% (95% CI 45.8% - 46.3%). Meta-analytic pooling of the point estimates of death rate per country in the Gulf Cooperation Council countries was 0.6% (95% CI 0.50% - 0.65%). CONCLUSION: Wide variability was found between EMR countries in recovery and mortality, implying the possible impact of resource availability, and genetic and environmental factors on the morality and recovery of the COVID-19.

Energy Drinks Consumption Is Associated With Reduced Sleep Duration and Increased Energy-Dense Fast Foods Consumption Among School Students: A Cross-Sectional Study.

The study aimed to investigate the prevalence of energy drinks (EDs) consumption and its relationship with sociodemographic characteristics, eating habits, sleep duration, physical activity, and screen time among school students. A cross-sectional study was carried out with a total of 1611 students aged 10 to 18 years from the United Arab Emirates. ED consumption among school students was 27%, with less than half consumed at least one can of EDs 1 to 3 days per week. ED consumers were less likely to meet recommended sleep duration (37% vs 62%, P < .001), more likely to consume high energy-dense fast foods (33% vs 20%, P < .001), and more likely to spend more than 6 hours in front of a screen (40.5% vs 32.3%, P < .001). Students aged 14 to 18 years were twice as likely to consume EDs as students aged 10 to 13 years (P < .001). Overall, the use of EDs was associated with male sex, older age, not meeting sleep recommendations, high energy-dense fast food consumption, and spending a longer time in front of a screen. Educational intervention programs about ED consumption and healthy lifestyle habits are highly recommended.

A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on body weight in healthy subjects aged 16 years and above.

PURPOSE: Studies on the effect of Ramadan diurnal intermittent fasting (RDIF) on body weight have yielded conflicting results. Therefore, we conducted a systematic review and meta-analysis to estimate the effect size of body weight changes in healthy, non-athletic Muslims practicing Ramadan fasting, and to assess the effect of covariates such as age, sex, fasting time duration, season, and country, using subgroup analysis, and meta-regression. Covariate adjustments were performed to explain the variability of weight change in response to Ramadan fasting. METHODS: CINAHL, Cochrane, EBSCOhost, EMBASE, Google Scholar, ProQuest Medical, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science databases were searched from date of inception in 1950 to the end of August 2019. RESULTS: Eighty-five studies, conducted in 25 countries during 1982-2019, were identified. RDIF yielded a significant, but small reduction in body weight (K = 85, number of subjects, N = 4176 (aged 16-80 years), Hedges' g =- 0.360, 95% confidence interval (CI) - 0.405 to - 0.315, I2 = 45.6%), this effect size translates into difference in means of - 1.022 kg (95% CI - 1.164 kg to - 0.880 kg). Regression analysis for moderator covariates revealed that fasting time (min/day) is a significant (P < 0.05) moderator for weight change at the end of Ramadan, while age and sex are not. Variable effects for the season and country were found. CONCLUSION: RDIF may confer a significant small reduction in body weight in non-athletic healthy people aged 16 years and above, directly associated with fasting time and variably correlated with the season, and country.

Effect of diurnal fasting on sleep during Ramadan: a systematic review and meta-analysis.

PURPOSE: The current meta-analysis aimed to obtain a more stable estimate of the effect size of Ramadan diurnal intermittent fasting (RDF) on sleep duration and daytime sleepiness. METHODS: Databases (Scopus, ScienceDirect, ProQuest Medical, PubMed/MEDLINE, Web of Science, EBSCOhost, Cochrane, CINAHL, and Google Scholar) were searched from database inception to the end of June 2019. The sleep quality measures analyzed were excessive daytime sleepiness (EDS) measured by the Epworth sleepiness scale (ESS) and total sleep time (TST). Subgroup analyses for age, sex, and levels of physical activity were conducted. RESULTS: We identified 24 studies (involving 646 participants, median age 23.7 years, 73% men) conducted in 12 countries from 2001 to 2019. The results revealed that TST decreased from 7.2 h per night [95% confidence interval (CI) 6.7-7.8] before Ramadan to 6.4 h (95% CI 5.3-7.5) during Ramadan, while the ESS score increased slightly from 6.1 (95% CI 4.5-7.7) before Ramadan to 7.0 (95% CI 5.2-8.8) during Ramadan. Effect sizes on sleep quality measures during RDF demonstrated a moderate reduction in TST (number of studies, K = 22; number of subjects, N = 571, Hedges' g value of -0.43, 95% CI - 0.64 to -0.22, Q = 90, τ2 = 0.15, I2 = 78%, P < 0.001), while ESS score showed negligible effect on EDS (K = 9, N = 362, Hedges' g value of -0.06, 95% CI -0.43 to 0.28, Q = 21, τ2 = 0.13, I2 = 76%, P value = 0.001). CONCLUSION: During the month of Ramadan, there is approximately a 1 hour reduction in TST and nearly a 1 point increase in the ESS score.

Impact of Ramadan diurnal intermittent fasting on the metabolic syndrome components in healthy, non-athletic Muslim people aged over 15 years: a systematic review and meta-analysis.

Studies on the impact of Ramadan diurnal intermittent fasting (RDIF) on the metabolic syndrome (MetS) components among healthy Muslims observing Ramadan month have yielded contradictory results. This comprehensive meta-analysis aimed to obtain a more stable estimate of the effect size of fasting during Ramadan on the MetS components, examine variability among studies, assess the generalisability of reported results and perform subgroup analyses for associated factors. We searched the CINAHL, Cochrane, EBSCOhost, Google Scholar, ProQuest Medical, PubMed/MEDLINE, ScienceDirect, Scopus and Web of Science databases for relevant studies published from 1950 to March 2019. The MetS components analysed were: waist circumference (WC), systolic blood pressure (SBP), fasting plasma/serum glucose (FG), TAG, and HDL-cholesterol. We identified eighty-five studies (4326 participants in total) that were conducted in twenty-three countries between 1982 and 2019. RDIF-induced effect sizes for the MetS components were: small reductions in WC (no. of studies K = 24, N 1557, Hedges' g = -0·312, 95 % CI -0·387, -0·236), SBP (K = 22, N 1172, Hedges' g = -0·239, 95 % CI -0·372, -0·106), FG (K = 51, N 2318, Hedges' g = -0·101, 95 % CI -0·260, 0·004) and TAG (K = 63, N 2862, Hedges' g = -0·088, 95 % CI -0·171, -0·004) and a small increase in HDL-cholesterol (K = 57, N 2771, Hedges' g = 0·150, 95 % CI 0·064, 0·236). We concluded that among healthy people, RDIF shows small improvement in the five MetS components: WC, SBP, TAG, FG and HDL.

Premenstrual Syndrome Is Associated with Dietary and Lifestyle Behaviors among University Students: A Cross-Sectional Study from Sharjah, UAE.

Premenstrual syndrome (PMS) is a cyclical late luteal phase disorder of the menstrual cycle whereby the daily functioning of women is affected by emotional and physical symptoms substantially interfering with their quality of life. Little is known about PMS in the United Arab Emirates (UAE). This study aimed to determine the prevalence and severity of PMS among university students in Sharjah, UAE, and clarify its associations with dietary habits, lifestyle behaviors, and anthropometric factors. A cross-sectional study was conducted on female college students at the University of Sharjah, UAE. Data were collected using self-administered questionnaires and anthropometric assessments. Descriptive statistics and multiple logistic regression analyses were performed. Participants were 300 adult university students aged 18-24 years (mean age 20.07 ± 1.53 years). In total, 95% of participants reported at least one PMS symptom during their menstrual period. The prevalence of PMS was 35.3%, with mild symptoms being the most commonly reported. Multiple regression analysis showed that smoking was associated with increased risk of reporting psychological (OR 2.5, 95% CI 1.1-5.8; p < 0.05) and behavioral symptoms (OR 2.2, 95% CI 1.0-4.9; p < 0.05), while high calorie/fat/sugar/salt foods intake was associated with increased risk of reporting physical symptoms (OR 3.2, 95% CI 1.4-7.3; p < 0.05). However, fruit consumption (OR 0.34, 95% CI 0.125-0.92; p < 0.05) was associated with a decreased risk of reporting behavioral symptoms. A high prevalence of PMS was reported among university students, with smoking and high calorie/fat/sugar/salt food consumption identified as strong risk factors for PMS.

Ramadan diurnal intermittent fasting modulates SOD2, TFAM, Nrf2, and sirtuins (SIRT1, SIRT3) gene expressions in subjects with overweight and obesity.

AIM: A growing body of evidence supports the impact of intermittent fasting on normalizing body metabolism and lowering oxidative stress and inflammation. Mounting evidence confirms that oxidative stress and chronic inflammation trigger the way for the development of metabolic diseases, such as diabetes. This research was conducted to evaluate the impact of Ramadan intermittent fasting (RIF) on the expression of cellular metabolism (SIRT1 and SIRT3) and antioxidant genes (TFAM, SOD2, and Nrf2). METHODS: Fifty-six (34 males and 22 females) overweight and obese subjects and six healthy body weight controls were recruited and monitored before and after Ramadan. RESULTS: Results showed that the relative gene expressions in obese subjects in comparison to counterpart expressions of controls for the antioxidant genes (TFAM, SOD2, and Nrf2) were significantly increased at the end of Ramadan, with percent increments of 90.5%, 54.1% and 411.5% for the three genes, respectively. However, the metabolism-controlling gene (SIRT3) showed a highly significant (P < 0.001) downregulation accompanied with a trend for reduction in SIRT1 gene at the end of Ramadan month, with percent decrements of 61.8% and 10.4%, respectively. Binary regression analysis revealed significant positive correlation (P < 0.05) between high energy intake (>2000 Kcal/day vs. <2000 Kcal/day) and expressions of SOD2 and TFAM (r = 0.84 and r = 0.9, respectively). CONCLUSION: Results suggest that RIF ameliorates the genetic expression of antioxidant and anti-inflammatory, and metabolic regulatory genes. Thus, RIF presumably may entail a protective impact against oxidative stress and its adverse metabolic-related derangements in non-diabetic obese patients.

Effect of Ramadan diurnal fasting on visceral adiposity and serum adipokines in overweight and obese individuals.

AIM: Excessive visceral adiposity is a major risk factor for developing insulin resistance and systemic low-grade inflammation. Ramadan diurnal fasting (RDF) is a religious ritual practiced by more than one billion Muslim throughout the world. It has been considered as one of the most common types of complementary and integrative health practices. The aim of this study is to examine the impact of RDF on visceral adiposity, circulating adipokines and glucoregulatory markers in patients with overweight or obesity. METHODS: Overweight and obese subjects (n = 61; 23 men and 38 women) were included in the study. Body weight, visceral fat tissue area (measured by 3D-MRI), glucoregulatory factors, serum adipokines concentrations, dietary intake, and physical activity were assessed one week before and at the end of the lunar month of Ramadan. RESULTS: From baseline, body weight and visceral fat tissue area serum total cholesterol, triglycerides, HDL-cholesterol, and systolic blood pressure significantly decreased (P < 0.05 for each) at the end of Ramadan. The serum levels of adiponectin, IL-6, TNF-α, and IGF-1 significantly decreased (P < 0.05 for each), but serum visfatin, leptin, apelin, IL-10, and IL-10/IL-6 ratio significantly increased (P < 0.05 for each) at the end of Ramadan. Changes in visceral adiposity significantly correlated with changes in plasma glucose (r = 0.4, P < 0.5) and resistin (r = 0.44, P < 0.001) at the end of Ramadan. CONCLUSION: RDF lowers visceral adiposity, body weight and variably affects adipokines without adversely affecting markers of glucose homeostasis in individuals with overweight or obesity.

Energy drink consumption is associated with reduced sleep quality among college students: a cross-sectional study.

AIM: Intake of caffeinated energy drinks has significantly increased, specifically among young adults and adolescents. College students are prone to developing unhealthy eating habits and dependence on stimulants, which puts them at a greater risk of sleep problems. This study aims to investigate the prevalence of caffeinated energy drink consumption and its association with sleep quality in college students. METHODS: A sample of 919 randomly selected adults (237 males and 682 females) from various colleges at the University of Sharjah/United Arab Emirates participated in this cross-sectional study. Data were collected using an online validated questionnaire. RESULTS: The current study revealed that 376 students (41%) were consuming energy drinks on a regular basis. Approximately half of the students had normal sleep patterns; the other half had sleep problems (anxiety and intermittent sleep). Results of the present study revealed a significant (r = -0.10, P < 0.05) relationship between the consumption of energy drinks and sleep quality and patterns. CONCLUSIONS: Moderate consumption of energy drinks was reported among college students. Consumption of energy drinks was significantly associated with changes in sleep quality and patterns of students.

Intermittent fasting during Ramadan attenuates proinflammatory cytokines and immune cells in healthy subjects.

Intermittent fasting and caloric restriction have been shown to extend life expectancy and reduce inflammation and cancer promotion in animal models. It was hypothesized that intermittent prolonged fasting practiced during the month of Ramadan (RIF) could positively affect the inflammatory state. To investigate this hypothesis, a cross-sectional study was designed to investigate the impact of RIF on selected inflammatory cytokines and immune biomarkers in healthy subjects. Fifty (21 men and 29 women) healthy volunteers who practiced Ramadan fasting were recruited for the investigation of circulating proinflammatory cytokines (interleukin [IL]-1ß, IL-6, and tumor necrosis factor α), immune cells (total leukocytes, monocytes, granulocytes, and lymphocytes), and anthropometric and dietary assessments. The investigations were conducted 1 week before Ramadan fasting, at the end of the third week of Ramadan, and 1 month after the cessation of Ramadan month. The proinflammatory cytokines IL-1ß, IL-6, and tumor necrosis factor α; systolic and diastolic blood pressures; body weight; and body fat percentage were significantly lower (P < .05) during Ramadan as compared with before Ramadan or after the cessation of Ramadan fasting. Immune cells significantly decreased during Ramadan but still remained within the reference ranges. These results indicate that RIF attenuates inflammatory status of the body by suppressing proinflammatory cytokine expression and decreasing body fat and circulating levels of leukocytes.

Chemopreventive effect of raw and cooked lentils (Lens culinaris L) and soybeans (Glycine max) against azoxymethane-induced aberrant crypt foci.

Although lentils (Lens culinaris L) contain several bioactive compounds that have been linked to the prevention of cancer, the in vivo chemopreventive ability of lentils against chemically induced colorectal cancer has not been examined. Our present study examined the hypothesis that lentils could suppress the early carcinogenesis in vivo by virtue of their bioactive micro- and macroconstituents and that culinary thermal treatment could affect their chemopreventive potential. To accomplish this goal, we used raw whole lentils (RWL), raw split lentils (RSL), cooked whole lentils (CWL), and cooked split lentils (CSL). Raw soybeans (RSB; Glycine max) were used for the purpose of comparison with a well-studied chemopreventive agent. Sixty weanling Fischer 344 male rats, 4 to 5 weeks of age, were randomly assigned to 6 groups (10 rats/group): the control group (C) received AIN-93G diet, and treatment leguminous groups of RWL, CWL, RSL, CSL, and RSB received the treatment diets containing AIN-93G+5% of the above-mentioned legumes. After acclimatization for 1 week (at 5th to 6th week of age), all animals were put on the control and treatment diets separately for 5 weeks (from 6th to 11th week of age). At the end of the 5th week of feeding (end of 11th week of age), all rats received 2 subcutaneous injections of azoxymethane carcinogen at 15 mg/kg rat body weight per dose once a week for 2 consecutive weeks. After 17 weeks of the last azoxymethane injection (from 12th to 29th week of age), all rats were euthanized. Chemopreventive ability was assessed using colonic aberrant crypt foci and activity of hepatic glutathione-S-transferases. Significant reductions (P < .05) were found in total aberrant crypt foci number (mean +/- SEM) for RSB (27.33 +/- 4.32), CWL (33.44 +/- 4.56), and RSL (37.00 +/- 6.02) in comparison with the C group (58.33 +/- 8.46). Hepatic glutathione-S-transferases activities increased significantly (P < .05) in rats fed all treatment diets (from 51.38 +/- 3.66 to 67.94 +/- 2.01 micromol mg(-1) min(-1)) when compared with control (C) diet (26.13 +/- 1.01 micromol mg(-1) min(-1)). Our findings indicate that consumption of lentils might be protective against colon carcinogenesis and that hydrothermal treatment resulted in an improvement in the chemopreventive potential for the whole lentils.