Registered Dietitians' enteral feeding practices, obstacles, and needs during the management of critically Ill hospitalized patients in Riyadh, Saudi Arabia: A qualitative study.

Objectives: Nutritional protocols and guidelines are essential to guide health-care practitioners toward effective enteral feeding management for critically ill patients. Despite the wide availability of international guidelines to direct enteral feeding practices, there are no nutritional guidelines regarding enteral feeding practices tailored for the Saudi Arabian population. In addition, different enteral feeding practices may result in negative outcomes like malnutrition. Methods: A qualitative study was conducted through multiple focus group sessions. Pre-formulated structured open-ended questions were asked from the participants during the focus group sessions to gain an in-depth understanding of the current enteral feeding practices. All sessions were audio-recorded, and the transcript was coded and cross-validated. Results: A total of five focus group sessions were conducted until data saturation was reached. Data saturation was reached when no additional information was mentioned in the fifth focus group session when compared to all previous sessions. All 24 participants were specialized in the clinical nutrition field with enteral feeding experience in critically ill patients and working in Riyadh city. Twelve themes of the current practices, four themes of obstacles, and four themes of needs were identified with subthemes. Conclusion: This qualitative study shows different enteral feeding practices, obstacles, and needs among registered dietitians. Thus, the need for developing national nutritional guidelines tailored to local population characteristics is highlighted. National guidelines are recommended to be compatible with a defined registered dietitian role with clear standards of practices and responsibility for each discipline to achieve a competent health care service.

How Could Different Obesity Scenarios Alter the Burden of Type 2 Diabetes and Liver Disease in Saudi Arabia?

INTRODUCTION: Obesity is a major risk factor for type 2 diabetes (T2DM) and liver disease, and obesity-attributable liver disease is a common indication for liver transplant. Obesity prevalence in Saudi Arabia (SA) has increased in recent decades. SA has committed to the WHO "halt obesity" target to shift prevalence to 2010 levels by 2025. We estimated the future benefits of reducing obesity in SA on incidence and costs of T2DM and liver disease under two policy scenarios: (1) SA meets the "halt obesity" target; (2) population body mass index (BMI) is reduced by 1% annually from 2020 to 2040. METHODS: We developed a dynamic microsimulation of working-age people (20-59 years) in SA between 2010 and 2040. Model inputs included population demographic, disease and healthcare cost data, and relative risks of diseases associated with obesity. In our two policy scenarios, we manipulated population BMI and compared predicted disease incidence and associated healthcare costs to a baseline "no change" scenario. RESULTS: Adults <35 years are expected to meet the "halt obesity" target, but those ≥35 years are not. Obesity is set to decline for females, but to increase amongst males 35-59 years. If SA's working-age population achieved either scenario, >1.15 million combined cases of T2DM, liver disease, and liver cancer could be avoided by 2040. Healthcare cost savings for the "halt obesity" and 1% reduction scenarios are 46.7 and 32.8 billion USD, respectively. CONCLUSION: SA's younger working-age population is set to meet the "halt obesity" target, but those aged 35-59 are off track. Even a modest annual 1% BMI reduction could result in substantial future health and economic benefits. Our findings strongly support universal initiatives to reduce population-level obesity, with targeted initiatives for working-age people ≥35 years of age.

Validity and Consistency of the Arabic Version of the Eating Disorder Examination Questionnaire (EDE-Q) among Saudi Adults.

The prevalence of eating disorders (EDs) is growing, and early screening is important to prevent related health complications. The Eating Disorder Examination Questionnaire (EDE-Q) has been widely used as a diagnostic tool to identify cases of EDs; however, a validated Arabic version of the tool is needed to help in the screening process of EDs. The aim of this study was to validate the Arabic version of EDE-Q. A cross-sectional study included a sample of 549 adults, who were recruited mainly from the four major provinces in Saudi Arabia. A forward-backward translation method was conducted, and then the tool was validated using the confirmatory factor analysis (CFA). The dataset was split for further convergent analysis using exploratory factor analysis (EFA) and CFA. The results of CFA from the main dataset did not support the four-factor original EDE-Q. The results of EFA from the first data-split suggested a three-factor EDE-Q-14 Arabic version. This was supported by the results of CFA of the second data-split. A total of five items were allocated in each shape and weight concern, and restraint component, with correlations ranging from 0.969 and 0.462 and from 0.847 to 0.437, respectively. A total of four items were allocated in eating concern, with correlations ranging from 0.748 to 0.556. The internal consistency of the global and the three subscales were high, with Cronbach's α ranging from 0.762 to 0.900. Findings of the current study suggest that the Arabic version of the EDE-Q-14 is a valid and reliable tool to screen for EDs among adults in Saudi Arabia.

Effect of seaweed (Ecklonia cava extract) on blood glucose and insulin level on prediabetic patients: A double-blind randomized controlled trial.

To investigate the effect of polyphenolic-rich seaweed extract (Ecklonia cava) on postprandial blood glucose (PPBG) and postprandial insulin level (PPIL) as well as investigating any associated side effects related to the study intervention in 20 prediabetic patients in Saudi Arabia. The double-blind, randomized-controlled trial was conducted from November 2020 to April 2021 in Riyadh, in 20 prediabetic patients with no other health complications. Subjects were given 600 mg of seaweed extract in a single dose for acute effect investigation. PPBG and PPIL were measured immediately at intervals of 30, 60, 90, and 120 min following 75 g of carbohydrate consumption, iAUC and peak concentration were calculated accordingly. Insignificant differences were shown for PPBG levels between study groups at intervals of 30 and 60 min (p > .05). However, PPBG results were significantly lower in the intervention group compared to placebo of 90 and 120 min after carbohydrate (75 g) consumption. The mean (SD) of PPBG in the seaweed group at 90 and 120 min was 108.1 (±8.9) and 101.3 (±8.7), respectively, compared to the placebo group at 90 and 120 min with a mean of 122.2 (±16.9) and 112.9 (±12.1), respectively (p value at 90 min = 0.032) and (p value at 120 min = 0.024). iAUC of PPBG shows no significant differences between the study groups (p > .05). There was no significant difference in PPIL between study groups at all study measurements (p > .05). Discomfort symptoms were similar between study groups (p > .05). This study indicated that a single dose of 600 mg of E. cava extract has a lowering effect on postprandial blood glucose with no associated side effects. Further research should investigate the glycemic modulating effects of marine algal extracts in the long-term investigation.

Physicians' Knowledge of Clinical Nutrition Discipline in Riyadh Saudi Arabia.

BACKGROUND: Nutrition plays a major role in the prevention and management of diet-related disease. With the absence of clinical nutrition dietitians, physicians are considered responsible for prescribing nutritional support. Identifying weaknesses in nutritional knowledge among Saudi physicians may provide guidance to improve their nutritional knowledge. METHODS: A cross-sectional study that used an anonymous electronic questionnaire to investigate physicians' knowledge of the clinical nutrition discipline. In addition to demographics, the questionnaire consisted of 15 questions covering six areas in the clinical nutrition discipline (macro- and micronutrients, nutrition and chronic diseases, nutrition and metabolic diseases, nutrition care process, nutrition support therapy, and research). For continuous variables, independent t-tests and one-way ANOVA were used. RESULTS: A total of 332 had completed the questionnaire and were included in the study. Most of the physicians were Saudi (87%), male (73.5%), aged between 26 and 35 years (63.3%), and without health problems (56.3%). The mean score of the physicians' knowledge was 5.3 ± 1.97 out of 15. Physicians who reported that they received some sort of nutritional training or course (M = 5.57, SD = 2.08) scored significantly more than physicians who did not (M = 5.10, SD = 1.86); t(330) = -2.174, p = 0.30. CONCLUSIONS: Nutrition should be reinforced as an important component of continuing medical education. There is a need for hiring more dietitians in health care settings in Saudi Arabia as an integral part of a multidisciplinary team delivering medical care services.

Teachers' perspectives on nutrition education in boys' public high schools in Riyadh, Saudi Arabia.

BACKGROUND: Nutrition education in school may positively affect students' eating behaviour. Teachers need to be empowered to teach nutrition, but no studies have investigated teachers' views on this topic in Saudi Arabia. AIMS: This study investigated the perspective of teachers on nutrition education and their confidence in teaching it in boys' public high schools in Riyadh, Saudi Arabia. METHODS: In 2015, 80 boys' public high schools were randomly selected from four areas of Riyadh, and 80 teachers (biological sciences, physical education and health education teachers) were interviewed using a validated questionnaire. A Fisher exact test was run to test the relationship between teachers' perspective and confidence level, and their subject taught. RESULTS: Almost all the teachers (98%) agreed that the health education curriculum should be taught as a core subject for high-school students. Most of the teachers (89%) were interested in teaching nutrition. However, 64% indicated that they did not have adequate nutrition curricular materials and 70% considered that they had not received adequate training on nutrition education. However, 89% were confident that their students would be interested in nutrition and that such education would change their dietary behaviour. Science and health education teachers were more interested in teaching nutrition and were more confident in their ability to do so than physical education teachers (P < 0.05). CONCLUSIONS: Most of the teachers were interested in teaching nutrition but barriers existed, such as lack of training and teaching materials, which affected teachers' confidence in delivering nutrition education in their curricula.

Necessary Knowledge and Skills for Dietitians in Saudi Arabia: A Qualitative Study.

BACKGROUND: Dietitians play a major role in health promotion and chronic diseases prevention. Graduates from clinical nutrition and dietetics major should be equipped with the necessary knowledge and skills for their role to be more effective. The purpose of this study is to investigate the knowledge and skills needed by current and future graduates in clinical nutrition and dietetics. METHODS: In this qualitative study, structured interviews by focus groups were conducted. Dietitians from different governmental and private sectors were invited to participate in the study. Focus groups were stratified based on the participants' gender and years of experience to promote self-disclosure. Abridged transcript of relevant and useful points was performed. The transcripts were coded and cross-validated by two researchers. RESULTS: A total of four focus groups were conducted. Two focus groups comprise 9 male participants and the other two comprise 10 females. The age of participants ranged 25-40 years old. Participants were employees in Riyadh city with experience that ranged 3-10 years old. Nine themes of the necessary knowledge and skills were identified. CONCLUSION: It is recommended for the Saudi government to create standards specialised for clinical nutrition and dietetics undergraduate and graduate programmes.

Compliance with school nutrition policy in Saudi Arabia: a quantitative study.

BACKGROUND: An evidence-based school nutrition policy that helps increase the availability and accessibility of healthy foods is needed in the Kingdom of Saudi Arabia. AIMS: This study investigated the compliance of selected schools with Saudi nutrition policy and assessed the nutritional value of food offered in such schools using the Institute of Medicine (IOM) standards. METHODS: A total of 76 boys public high schools were randomly selected from four areas in Riyadh, Saudi Arabia. Principals and canteen managers were interviewed using validated questionnaires. Schools were observed using a food checklist. RESULTS: Meals offered in Saudis schools come prepackaged with minimal cooking in schools. From a calorie perspective, there was not a significant difference between the food allowed and food not allowed. For the Saudi policy, 94.7% of the schools scored in between category 2 and 3 (moderate compliance). For the IOM standards, 96.1% of the schools scored in category 1 (low alignment). CONCLUSIONS: While the Saudi policy is clear on what should not be served in school cafeterias, it fails to provide guidance on what must be served to improve the nutritional value of meals provided.

Factors Influencing Efficacy of Nutrition Education Interventions: A Systematic Review.

OBJECTIVE: To examine systematically factors that contribute to the efficacy of nutrition education interventions in promoting behavior change for good health based on their stated objective. In a departure from previous reviews, the researchers investigated factors that lead to success of various types of interventions. Critical analysis of these factors constituted the outcome of this review. METHODS: This study followed Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria. A total of 246 original articles published between 2009 and 2015 in PubMed, Medline, Web of Science, Academic Search Complete, Science Direct, Cochrane Reviews, ERIC, and PsychLIT were initially considered. The number was screened and scaled down to 40 publications for the final analysis. Quality assessment was based on the Cochrane Handbook for Systematic Reviews of Intervention. Studies were rated as having low risk of bias, moderate risk, or high risk. RESULTS: Efficacy of nutrition education interventions depended on major factors: interventions that lasted ≥5 months; having ≤3 focused objectives; appropriate design and use of theories; fidelity in interventions; and support from policy makers and management for worksite environmental interventions. CONCLUSIONS AND IMPLICATIONS: Intervention duration of ≥5 months, ≤3 focused objectives, randomization, use of theories, and fidelity are factors that enhance success of interventions based on the results of this study.