A systematic review on the associations between the built environment and adult's physical activity in global tropical and subtropical climate regions.

BACKGROUND: Physical inactivity is a major public health concern, exacerbated in countries with a (sub)tropical climate. The built environment can facilitate physical activity; however, current evidence is mainly from North American and European countries with activity-friendly climate conditions. This study explored associations between built environment features and physical activity in global tropical or subtropical dry or desert climate regions. METHODS: A systematic review of four major databases (Web of Science, Scopus, PubMed, and SportDISCUS) was performed. To be included, studies had to investigate associations between perceived or objective built environment characteristics and adult's physical activity and had to be conducted in a location with (sub)tropical climate. Each investigated association was reported as one case and results were synthesized based upon perceived and objectively assessed environment characteristics as well as Western and non-Western countries. Study quality was evaluated using a tool designed for assessing studies on built environment and physical activity. RESULTS: Eighty-four articles from 50 studies in 13 countries with a total of 2546 built environment-physical activity associations were included. Design (connectivity, walking/cycling infrastructure), desirability (aesthetics, safety), and destination accessibility were the built environment characteristics most frequently associated with physical activity across the domains active transport, recreational physical activity, total walking and cycling, and moderate-to-vigorous physical activity, particularly if multiple attributes were present at the same time. Very few studies assessed built environment attributes specifically relevant to physical activity in (sub)tropical climates. Most studies were conducted in Western countries, with results being largely comparable with non-Western countries. Findings were largely generalizable across gender and age groups. Results from natural experiments indicated that relocating to an activity-friendly neighborhood impacted sub-groups differently. CONCLUSIONS: Built environment attributes, including destination accessibility, connectivity, walking and cycling infrastructure, safety, and aesthetics, are positively associated with physical activity in locations with (sub)tropical climate. However, few studies focus on built environment attributes specifically relevant in a hot climate, such as shade or indoor recreation options. Further, there is limited evidence from non-Western countries, where most of the urban population lives in (sub)tropical climates. Policy makers should focus on implementing activity-friendly environment attributes to create sustainable and climate-resilient cities.

Health and economic burden of insufficient physical activity in Saudi Arabia.

BACKGROUND: Insufficient physical activity (PA) was estimated to cause 4.8% of deaths and 2.6% of disability-adjusted life-years (DALYs) due to noncommunicable diseases in Saudi Arabia in 2019. While Saudi Arabia is already achieving great improvements, we predict the health and economic burden of insufficient PA up to 2040 to present a case for policy makers to invest more in the uptake of PA. METHODS: Using a population health model to estimate avoidable health loss, we identified four causes of health loss related to low PA (cardiovascular diseases, diabetes, breast cancer, and colorectal cancer) and estimated the deaths and DALYs from these causes. We projected the expected disease burden until 2040 under alternative assumptions about future PA levels and trends by using three health scenarios: baseline (no change in 2019 PA levels), intervention (81% of the population achieving sufficient PA levels), and ideal (65% of population: moderate PA, 30%: high PA, and 5%: inactive). We applied an "intrinsic value" approach to estimate the economic impact of each scenario. RESULTS: Overall, we estimate that between 2023 and 2040, about 80,000 to 110,000 deaths from all causes and 2.0 million to 2.9 million DALYs could be avoided by increasing PA levels in Saudi Arabia. The average annual economic loss from insufficient PA is valued at 0.49% to 0.68% of the current gross domestic product, with an average of US$5.4 billion to US$7.6 billion annually till 2040. The most avoidable disease burden and economic losses are expected among males and because of ischemic heart disease. CONCLUSIONS: This study highlights that low PA levels will have considerable health and economic impacts in Saudi Arabia if people remain inactive and do not start following interventions. There is an urgent need to develop innovative programs and policies to encourage PA among all age and sex groups.

The association between academic performance indicators and lifestyle behaviors among Kuwaiti college students.

BACKGROUND: Lifestyle behaviors are developed during young adulthood and carried through life. Accordingly, early detection of unhealthy behaviors can help prevent the increase in non-communicable diseases in the population. College students are an especially vulnerable group who, upon entering a new environment, tend to engage in unhealthy behaviors. OBJECTIVE: The present study aims to evaluate the lifestyle behaviors of Kuwaiti college students and their association with markers of academic achievements. METHODS: One thousand two hundred fifty-nine students participated in the present study and answered an online questionnaire pertaining to their sociodemographic status, academic performance indicators, body weight and height, and lifestyle behaviors. Data were collected from November 2020 to February 2021. RESULTS: Results of the present study showed that obesity was significantly more prevalent among male participants than among females even though males were more physically active. Alternatively, females had a greater grade point average in college, slept more, and had more screen time. Interestingly, we were unable to detect a significant correlation between lifestyle behaviors and academic achievements. CONCLUSION: The observed differences in body mass index between genders may have been attributed to energy intake rather than energy expenditure.

Patterns and Associations of Physical Activity, Screen Time, Sleep, and Dietary Habits among Saudi Females Participating in Fitness Centers.

This study was designed to investigate the level and associations of physical activity, sedentary behavior, sleep, and dietary habits among Saudi women attending fitness centers in Riyadh. A descriptive cross-sectional study was carried out from 12 fitness centers in Riyadh, Saudi Arabia. A total of 460 participants answered a two-part survey self-administered questionnaire, which included information about the demographic characteristics and lifestyle. The analysis found significant differences between the two groups in terms of age, weight, BMI, and combined prevalence of being overweight and obese. Compared with less active females, high active females showed significantly more favorable dietary habits (p < 0.05). Significantly higher values were observed for the total physical activity energy expenditure in METs-min/week (p = 0.028). Moreover, females with high screen time (>3 h per day) were younger, less active, slept longer, and had higher intakes of fast foods and chocolates/candy intake (p = 0.001). Overall, the participants were highly active, exceeding the recommended physical activity needed to enhance health. The analysis also showed sufficient sleep duration (>7 h/night) was significantly associated with the diet and nutrition of the participants. Health education programs are needed to reduce the risks of sedentary behavior, sleep problems, and dietary habits.

Lifestyle behaviors trend and their relationship with fear level of COVID-19: Cross-sectional study in Saudi Arabia.

INTRODUCTION: COVID-19 pandemic cautionary measures have affected the daily life of people around the globe. Further, understanding the complete lifestyle behaviors profile can help healthcare providers in designing effective interventions and assessing overall health impact on risk of disease development. Thus, this study aims to assess the complete spectrum of lifestyle behaviors (physical activity, sedentary behavior, sleep, distress, social support, dietary habits, and smoking) prevalence and its association with fear of COVID-19 in people living in Saudi Arabia. METHODS: Self-administered survey consisted of seven sections was used to collect data on fear of COVID-19 using Fear of COVID-19 Scale (FCV-19S), physical activity and sedentary behavior using the Global Physical Activity Questionnaire (GPAQ), sleep quality using the Pittsburgh Sleep Quality Index (PSQI), psychosocial distress using Kessler Psychological Distress Scale (K-10), social support using the MOS social support survey, and dietary habits using a short version of food frequency questionnaire (FFQ). The online survey was distributed via social media platforms during lockdown period of COVID-19 pandemic (May-June 2020). Each section consisted of validated questionnaire examining one of aforementioned lifestyle behaviors. Associations were analyzed using multiple linear regression. RESULTS: A total of 669 individuals attempted to complete the online survey, 554 participants completed at least 2 sections of the survey (82.8%), and 41.3% (n = 276) completed the whole online survey. The majority of the sample were female (83%), not smokers (86.5%), had sufficient sleep duration (7.5 hrs ± 2.1), and only indicated mild level of distress (21.4 ± 8.9); they also reported high level of sedentary behavior (7.7 hrs ± 4.5), poor sleep quality (5.4 ± 2.4), were not engaged in healthy eating habits, and moderate level of perceived social support (62.0% ± 27). Only physical activity results indicated that about half of the sample were engaged in moderate to vigorous level of physical activity (54.3%). Further, being female (ß = 0.12; 95% CI: 0.45, 2.94) and married (ß = 0.13; 95% CI: 0.3, 2.63) were associated with fear of COVID-19 level (ß = 0.21; 95% IC: 0.05, 0.19) with a confidence interval level of 95%. In addition, distress was associated with fear. CONCLUSION: The trend of lifestyle behaviors measured during lockdown period changed from previously published rates. Future research needs to establish the short-term and long-term effect of lifestyle behaviors complete profile on physical and mental health.

Anthropometric Measurements, Sociodemographics, and Lifestyle Behaviors among Saudi Adolescents Living in Riyadh Relative to Sex and Activity Energy Expenditure: Findings from the Arab Teens Lifestyle Study 2 (ATLS-2).

The aim of the study was to examine the anthropometric measurements, sociodemographics, and lifestyle behaviors among Saudi adolescents relative to sex and physical activity (PA). A random cross-sectional survey conducted on Saudi adolescents from secondary schools in Riyadh, using a multistage stratified cluster sampling technique. Measurements included demographics, weight, height, waist circumference, PA, sedentary behaviors (SB), sleep duration, and dietary habits using a validated questionnaire. A total of 1262 adolescents (16.4 ± 0.95 years; 52.4% males) were studied. Overweight/obesity was more than 40%. Physical inactivity among adolescents was 53%, which indicates some improvement over the past years, especially among females. More than 80% of adolescents had over three hours/day of screen time, with no significant sex differences. Insufficient sleep was highly prevalent with gender differences. A large proportion of the participants did not consume daily breakfast (65.7%), vegetables (73.2%), fruits (84.2%), or milk/dairy products (62.4%), whereas significant proportions of the adolescents consumed sugar-sweetened drinks, fast food, French fries/potato chips, cake/donuts, and chocolates/candy on at least three days or more per week. It was concluded that non-daily intake of breakfast and vegetables was significantly associated with lower PA. The updated information can aid in effectively planning and implementing promotional programs toward improving the lifestyle behaviors of Saudi adolescent.

Anthropometric, Familial- and Lifestyle-Related Characteristics of School Children Skipping Breakfast in Jeddah, Saudi Arabia.

Breakfast is a vital meal that provides children with important nutrients and energy. This study examined the anthropometric, familial- and lifestyle-related characteristics of school children skipping breakfast. A total of 1149 children (boys: 45.5%), 6 to 12 years old (mean and SD: 9.3 ± 1.7 years), were randomly selected from elementary schools in Jeddah. Weight and height were measured. Breakfast eating frequency, socio-demographics, and lifestyle behaviors were assessed using a specifically designed self-report questionnaire reported by the parents. Nearly 80% of the children skipped daily breakfast at home with no significant age or gender differences. The most common reasons for skipping breakfast at home included not feeling hungry and waking up late for school. Fried egg sandwiches and breakfast cereals were most frequently consumed for breakfast. Strong parental support for breakfast as the main daily meal was significantly associated with daily breakfast intake. Logistic regression analyses, adjusted for age, gender, and socio-demographics, revealed that paternal education (aOR = 1.212, 95% CI = 1.020-1.440, p = 0.029), maternal education (aOR = 1.212, 95% CI = 1.003-1.464, p=0.046), insufficient sleep (aOR = 0.735, 95% CI = 0.567-0.951, p = 0.019), and BMI <25 kg/m2 (aOR = 1.333, 95% CI = 1.015-1.752, p = 0.039) were significantly associated with breakfast intake. The findings have implications for children's health and school performance. Concerted effort is required to promote breakfast consumption among Saudi children.

The Relationship between Lifestyle Factors and Obesity Indices among Adolescents in Qatar.

Background: Physical inactivity, sedentary behaviour and an unhealthy diet are factors that may increase weight and general and/or abdominal obesity. Objective: To evaluate the relationship between general and abdominal obesity and lifestyle factors among adolescents in Qatar. Methods: The study data are based on the Arab Teens Lifestyle Study (ATLS). The target population consisted of 1184 adolescents aged between 14 and 18 years old (563 boys and 621 girls), randomly selected through multistage sampling. A validated questionnaire was used to collect data on lifestyle indicators. Anthropometric indicators, which included body weight, height and waist circumference (WC), were measured according to standardised procedures. International Obesity Task Force (IOTF) age- and sex-specific body mass index (BMI) reference values were used to define overweight and obesity. Abdominal obesity was defined by the 'waist-to-height ratio' (WHtR > 0.5) and by sex- and age-specific WC cutoff values. Results: Females were more inactive than males (63.7% vs. 36.3%; p < 0.001). The proportion of adolescents who reported screen time of over 2 h per day was 82.5%. Females engaged in more sedentary behaviour than males (53.4% vs. 46.4%, p = 0.009). Being male (OR: 1.3; CI: 1.0-1.7) and skipping breakfast (OR: 1.5; CI: 1.2-2) were significantly associated with overweight/obesity. In contrast, high intake of fast food, fries, sweets and cake were negative predictors of general and abdominal obesity. Conclusions: The findings revealed the prevalence of unhealthy lifestyle habits among adolescents in Qatar and indicated relationships between certain dietary habits and obesity. The findings of this study may help in advocating for the implementation of an intervention that includes lifestyle changes targeting adolescents.

Activity energy expenditure, screen time and dietary habits relative to gender among Saudi youth: interactions of gender with obesity status and selected lifestyle behaviours.

BACKGROUND AND OBJECTIVES: Lifestyle-related risks are linked to several non-communicable diseases, with enormous global mortality and economic cost. Women in Saudi Arabia are faced with high prevalence of obesity, inactivity and sedentary behaviours. This study examined the interaction effects of gender with obesity status and lifestyle behaviours among Saudi adolescents. METHODS AND STUDY DESIGN: A total of 2888 adolescents (1500 females) aged 15-19 years were randomly selected from secondary schools in three major cities in Saudi Arabia, using a multistage stratified cluster sampling technique. Weight, height and waist circumference were measured and physical activity (PA), screen time, sleep duration and dietary habits were assessed using a validated questionnaire. ANCOVA and multivariate tests were used while controlling for age. RESULTS: A number of lifestyle behaviours displayed significant gender effects, with some selected variables having multiple interaction effects. Total activity energy expenditure and sum of vigorous-intensity PA showed significant interaction effects between gender and obesity status, whereas sum of moderate activity energy expenditure, non-leisure-time PA and sleep duration exhibited significant interaction effects between gender and screen time. Vegetable intake showed significant three-way interaction effects between gender, waist/height ratio and screen time. CONCLUSIONS: The presence of several lifestyle behavioural risks, including physical inactivity, sedentary behaviours and some dietary habits was confirmed. The high inactivity level and screen time represents a double burden on the health of young Saudi females. Future studies must address the psycho-social, cultural and environmental determinants associated with healthy lifestyle relative to gender and initiate novel interventions to reduce sedentary behaviour. and future nutrition science degrees and lead to improved employability skills of nutrition science graduates.

Gender differences in leisure-time versus non-leisure-time physical activity among Saudi adolescents.

OBJECTIVES: The aim of the study was to examine the gender differences and predictors of leisure versus non-leisure time physical activities among Saudi adolescents aged 14-19 years. MATERIALS AND METHOD: The multistage stratified cluster random sampling technique was used. A sample of 1,388 males and 1,500 females enrolled in secondary schools in three major cities in Saudi Arabia was included. Anthropometric measurements were performed and Body Mass Index was calculated. Physical activity, sedentary behaviours and dietary habits were measured using a self-reported validated questionnaire. RESULTS: The total time spent in leisure and non-leisure physical activity per week was 90 and 77 minutes, respectively. The males spent more time per week in leisure-time physical activities than females. Females in private schools spent more time during the week in leisure-time physical activities, compared to females in Stateschools. There was a significant difference between genders by obesity status interaction in leisure-time physical activity. Gender, and other factors, predicted total duration spent in leisure-time and non-leisure-time physical activity. CONCLUSIONS: The study showed that female adolescents are much less active than males, especially in leisure-time physical activities. Programmes to promote physical activity among adolescents are urgently needed, with consideration of gender differences.

Physical activity and dietary habits among Moroccan adolescents.

OBJECTIVE: The study aimed to detail the lifestyle (physical activity and dietary habits) of Moroccan adolescents. DESIGN: Cross-sectional study undertaken in the framework of the ATLS (Arab Teens Lifestyle Study). SETTING: Physical activity and dietary habits were determined using a validated questionnaire in public secondary schools. SUBJECTS: A total of 669 adolescents aged 15.0-19.9 years were randomly recruited from Kenitra, Morocco. RESULTS: Physical activity patterns and intensity differed between genders. As anticipated, male adolescents were more active than female adolescents across a typical week and engaged in more vigorous-intensity physical activity than female adolescents, who spent more time than male adolescents in moderate-intensity physical activity. Of particular concern was that one in five of the adolescents surveyed was inactive, with almost 45% of the sample reporting television viewing for more than 2 h/d and 38% engaged in computer use for a similar period. From a dietary perspective, most adolescents reported that they do not take breakfast or consume milk and dairy products, fruits and vegetables on a daily basis. In contrast, most reported consumption of doughnuts, cakes, candy and chocolate more than three times per week and approximately 50% consumed sugary drinks more than three times per week. CONCLUSIONS: Based on a continuation of the self-reported lifestyle behaviours, adolescents in the present study are at risk of developing chronic diseases. Education programmes are urgently needed to assist in the promotion of a healthy lifestyle and reduce the likelihood of overweight and obesity and related health risks among young people.

Anthropometric and lifestyle characteristics of active and inactive Saudi and British adolescents.

OBJECTIVES: To compare the anthropometric and lifestyle characteristics of active and inactive adolescents in Saudi Arabia and Britain. METHODS: A school-based cross-sectional study was conducted at four cities in Saudi Arabia (Riyadh and Al-Khobar; N = 1,648) and Britain (Birmingham and Coventry; N = 1,158). The participants (14- to 18-year-olds) were randomly selected using a multistage stratified cluster sampling. Measurements included anthropometric [BMI, Waist circumference (WC), Waist to height ratio], screen time, validated physical activity questionnaire and dietary habits. RESULTS: British males were lighter (P = 0.04, 64.4 vs. 68.2 kg), and had lower values for WC (P = 0.003, 77.1 vs. 78.7 cm) than Saudi males. Males (P = 0.0001) were significantly more active than females but the difference between inactive Saudi and British females was greater than that between inactive Saudi and British males. Being female was significantly (P < 0.001) associated with lower activity levels in both the Saudi and British adolescents. Having lower frequency of fruit intake was significantly (P < 0.001) associated with lower activity levels, whereas increased frequency of consumption of French fries/potato chips was significantly (P = 0.008) associated with increased activity levels in Saudi adolescents. Among British adolescents, lower frequency of breakfast was (P = 0.045) associated with lower activity levels, increased frequency of consumption of sweetened beverages was significantly (P = 0.005) associated with higher activity levels. Higher energy drinks intake frequency was significantly (P = 0.007) associated with higher activity levels. CONCLUSION: The present study identifies crosscultural differences and similarities in lifestyle habits in adolescents from Britain and Saudi Arabia. Activity status (active vs. inactive) appears to play an important role in other lifestyle related behaviors, with active adolescent more likely to engage in healthy dietary behavior than their inactive peers, irrespective of country of origin.

Eating habits, inactivity, and sedentary behavior among adolescents in Iraq: sex differences in the hidden risks of noncommunicable diseases.

BACKGROUND: Noncommunicable diseases have become the main causes of death in several developing countries. There is a severe shortage of information about the risk factors for these diseases in Iraq. OBJECTIVE: To explore the eating habits, physical activity, and sedentary behaviors of adolescents in Mosul City, Iraq, as risk factors for noncommunicable diseases. METHODS: A multistage stratified sampling method was carried out on adolescents aged 15 to 18 years in Mosul City, Iraq. A pretested and validated questionnaire was used to obtain information on frequency of intake of certain foods, physical activity, and screen time (television, video, and computer). Weight and height were measured to obtain the body composition status. The total sample included 723 adolescents (350 boys and 373 girls). RESULTS: There were significant differences between boys and girls in most eating habits and activity behaviors. The frequency of skipping breakfast and the intakes of fruits and vegetables, french fries, and sweets and chocolates were significantly higher among girls than boys (p < .001). Boys were significantly more likely to consume fast foods, sugar-sweetened drinks, and energy drinks than girls. Boys spent more time in physical activity (p < .001) and looking at screens than girls. CONCLUSIONS: The health authorities of Iraq should focus not only on interventions for undernutrition among adolescents, but also on behavioral risk factors for diet-related noncommunicable diseases.

Patterns and determinants of physical activity among Saudi adolescents.

BACKGROUND: Few studies have reported comprehensive and valid physical activity (PA) data for Saudi youth. Therefore, the purpose of this study was to examine patterns and determinants of PA among Saudi adolescents. METHODS: A cross-sectional study was conducted in Saudi secondary schools (15-19 years) during 2009/2010 and used multistage stratified cluster sample (N = 2866, 51.7% females). Weight, height, sedentary behaviors, PA, and dietary habits were assessed. RESULTS: Roughly 44% of males and 20% of females were active (≥ 1 hour/day). Males in public schools were more active than in private schools, whereas the opposite was true for females. Females exercise mostly at home, whereas males exercise at public places. The majority of females exercise alone or with relatives, whereas males largely exercise with friends. Males were active for health and recreation whereas females were active for weight loss and recreation. Lack of time was the primary reason for inactivity in both sexes. The predictors of total PA time were gender, intakes of fruit, milk, energy drinks and vegetables and waist/height ratio (R2 = 0.145). CONCLUSIONS: The high inactivity levels, especially among females, are of great concern. Promotion of active living among youth should be a national public health priority.

Physical activity, sedentary behaviours and dietary habits among Kuwaiti adolescents: gender differences.

OBJECTIVE: The present study was designed to assess physical activity, sedentary behaviours and dietary habits among adolescents in Kuwait and to compare the differences between genders. DESIGN: A cross-sectional study was conducted among secondary-school children who participated in the Arab Teens Lifestyle Study (ATLS), a multi-centre collaborative project. SETTING: Secondary schools in Kuwait. SUBJECTS: Adolescents (463 boys and 443 girls), aged 14-19 years. RESULTS: Nearly half (44·6 %) of the boys and three-quarters (76·0 %) of the girls did not meet the recommended daily physical activity levels (≥2520 MET-min/week, moderate to vigorous intensity). Nearly all (96·3 % of boys and 96·7 % of girls) adolescents reported spending >2 h/d on screen time, with girls found to spend more time per day watching television (P = 0·02) and using a computer (P < 0·001). The large majority of the adolescents reported skipping breakfast and not having milk and milk products, vegetables and fruit daily, while nearly two-thirds of the boys and girls had sugar-sweetened drinks on more than 3 d/week. Compared with girls, boys reported consuming more fruit (3·4 v. 2·8 times/week, P = 0·001), dairy products (4·5 v. 3·6 times/week, P = 0·001) and energy drinks (1·3 v. 1·1 times/week, P = 0·003). CONCLUSIONS: The majority of the Kuwaiti adolescents, especially girls, do not perform adequate physical activity, spend more time on sedentary activities and have unhealthy dietary practices. The findings emphasize an urgent need for implementing an appropriate intervention for promoting physical activity, healthy eating and reducing sedentary behaviours among these children.

A cross-cultural comparison of health behaviors between Saudi and British adolescents living in urban areas: gender by country analyses.

This study investigated the cross-cultural differences and similarity in health behaviors between Saudi and British adolescents. A school-based cross-sectional study was conducted at four cities in Saudi Arabia (Riyadh and Al-Khobar; N = 1,648) and Britain (Birmingham and Coventry; N = 1,158). The participants (14-18 year-olds) were randomly selected using a multistage stratified cluster sampling technique. Measurements included anthropometric, screen time, validated physical activity (PA) questionnaire and dietary habits. The overweight/obesity prevalence among Saudi adolescents (38.3%) was significantly (p < 0.001) higher than that found among British adolescents (24.1%). The British adolescents demonstrated higher total PA energy expenditure than Saudi adolescents (means ± SE = 3,804.8 ± 81.5 vs. 2,219.9 ± 65.5 METs-min/week). Inactivity prevalence was significantly (p < 0.001) higher among Saudi adolescents (64%) compared with that of British adolescents (25.5%). The proportions of adolescents exceeding 2 h of daily screen time were high (88.0% and 90.8% among Saudis and British, respectively). The majority of Saudi and British adolescents did not have daily intakes of breakfast, fruit, vegetables and milk. MANCOVA showed significant (p < 0.05) gender by country interactions in several lifestyle factors. There was a significant (p < 0.001) gender differences in the ratio of physical activity to sedentary behaviors. In conclusion, Saudi and British adolescents demonstrated some similarities and differences in their PA levels, sedentary behaviors and dietary habits. Unhealthy lifestyle behaviors among adolescents appear to be a cross-cultural phenomenon.

Relative contribution of physical activity, sedentary behaviors, and dietary habits to the prevalence of obesity among Kuwaiti adolescents.

BACKGROUND: The increasing rate of obesity among Kuwaiti adolescents is associated with immediate and long term-risks to their health and well-being. OBJECTIVE: To update data on the prevalence of overweight and obesity among Kuwaiti adolescents and to examine the relative contribution of selected lifestyle factors to overweight and obesity in this population. METHODS: The present study is part of the Arab Teens Lifestyle Study (ATLS). A total of 906 adolescents (463 boys and 443 girls) aged between 14 and 19 years were selected from Kuwaiti schools by a multistage stratified randomization process. A validated questionnaire was used to collect data on physical activity, sedentary lifestyle, and eating habits. The International Obesity Task Force (IOTF) cutoff values for adolescents under 18 years of age were used to define overweight and obesity. Total energy expenditure was calculated using metabolic equivalent-minutes per week. A general linear model was used to establish the proportion of the variance (expressed in partial eta squared) in excess weight attributable to differences in eating habits and physical activity. RESULTS: The prevalence of overweight and obesity was 50.5% in boys and 46.5% in girls. Among boys, moderate and vigorous activities were found to be significantly negatively associated with overweight and obesity (p < .05), whereas in girls, only those with not less than moderate activities were negatively associated with overweight and obesity (p < .05). Sedentary behaviors, time spent watching television, and time spent working on the computer were not significantly associated with obesity in either sex. Consumption of breakfast, vegetables, and fast foods (boys and girls) and potatoes, cakes and doughnuts, and sweets (girls only) was significantly associated with overweight and obesity (p < .05). In general, the partial eta square explained by physical activity was less than 3.6% in boys compared with less than 1.0% in girls, and eating habits explained less than 1.8% in boys compared with 2.5% in girls. CONCLUSIONS: Physical activity explains a greater proportion of variation in body mass index than do eating habits, particularly in boys. Eating habits explain a greater proportion of variation in body mass index than does physical activity in girls. Prospective studies are needed to clarify the relative effects of sedentary behaviors on overweight in adolescents.

Lifestyle factors associated with overweight and obesity among Saudi adolescents.

BACKGROUND: A better understanding of the relationships between obesity and lifestyle factors is necessary for effective prevention and management of obesity in youth. Therefore, the objective of this study was to evaluate the associations between obesity measures and several lifestyle factors, including physical activity, sedentary behaviors and dietary habits among Saudi adolescents aged 14-19 years. METHODS: This was a school-based cross-sectional study that was conducted in three cities in Saudi Arabia (Al-Khobar, Jeddah and Riyadh). The participants were 2906 secondary school males (1400) and females (1506) aged 14-19 years, who were randomly selected using a multistage stratified cluster sampling technique. Measurements included weight, height, body mass index (BMI), waist circumference, waist/height ratio (WHtR), screen time (television viewing, video games and computer use), physical activity (determined using a validated questionnaire), and dietary habits (intake frequency per week). Logistic regression was used to examine the associations between obesity and lifestyle factors. RESULTS: Compared with non-obese, obese males and females were significantly less active, especially in terms of vigorous activity, had less favorable dietary habits (e.g., lower intake of breakfast, fruits and milk), but had lower intake of sugar-sweetened drinks and sweets/chocolates. Logistic regression analysis showed that overweight/obesity (based on BMI categories) or abdominal obesity (based on WHtR categories) were significantly and inversely associated with vigorous physical activity levels (aOR for high level = 0.69, 95% CI 0.41-0.92 for BMI and 0.63, 95% CI 0.45-0.89 for WHtR) and frequency of breakfast (aOR for < 3 days/week = 1.44; 95% CI 1.20-1.71 for BMI and 1.47; 95% CI 1.22-1.76 for WHtR) and vegetable (aOR for < 3 days/week = 1.29; 95% CI 1.03-1.59 for WHtR) intakes, and consumption of sugar-sweetened beverages (aOR for < 3 days/week = 1.32; 95% CI 1.08-1.62 for BMI and 1.42; 95% CI 1.16-1.75 for WHtR). CONCLUSIONS: The present study identified several lifestyle factors associated with obesity that may represent valid targets for the prevention and management of obesity among Saudi adolescents. Primary prevention of obesity by promoting active lifestyles and healthy diets should be a national public health priority.

Prevalence and risk factors associated with nutrition-related noncommunicable diseases in the Eastern Mediterranean region.

This paper reviews the current situation concerning nutrition-related noncommunicable diseases (N-NCDs) and the risk factors associated with these diseases in the Eastern Mediterranean region (EMR). A systematic literature review of studies and reports published between January 1, 1990 and September 15, 2011 was conducted using the PubMed and Google Scholar databases. Cardiovascular disease, type 2 diabetes, metabolic syndrome, obesity, cancer, and osteoporosis have become the main causes of morbidity and mortality, especially with progressive aging of the population. The estimated mortality rate due to cardiovascular disease and diabetes ranged from 179.8 to 765.2 per 100,000 population, with the highest rates in poor countries. The prevalence of metabolic syndrome was very high, ranging from 19% to 45%. The prevalence of overweight and obesity (body mass index ≥25 kg/m(2)) has reached an alarming level in most countries of the region, ranging from 25% to 82%, with a higher prevalence among women. The estimated mortality rate for cancer ranged from 61.9 to 151 per 100,000 population. Osteoporosis has become a critical problem, particularly among women. Several risk factors may be contributing to the high prevalence of N-NCDs in EMR, including nutrition transition, low intake of fruit and vegetables, demographic transition, urbanization, physical inactivity, hypertension, tobacco smoking, stunting of growth of preschool children, and lack of nutrition and health awareness. Intervention programs to prevent and control N-NCDs are urgently needed, with special focus on promotion of healthy eating and physical activity.

The Prevalence of Physical Activity and Sedentary Behaviours Relative to Obesity among Adolescents from Al-Ahsa, Saudi Arabia: Rural versus Urban Variations.

Purpose. The aims of this study were to explore the lifestyle of young people living in Al-Ahsa Governorate; to investigate differences due to gender, age, school type, and geographical location. Methods. 1270 volunteered youth (15-19 years) completed a self-report questionnaire that contained 47 items relating to patterns of physical activity (PA), sedentary activity, and eating habits. The questionnaire allows the calculation of total energy expenditure in metabolic equivalent (MET-min) values per week. Results. Significant differences in the PA levels of youth were evident with regard to gender, geographical areas, and type of school. Also, normal weight males reported the highest levels of PA compared to overweight and obese. Conclusions. Youth living in rural desert were less physically active than those living in urban or rural farm environments. Youth of "normal" weight were more active than obese. Males were more active than females and PA levels appeared to decline with age.