Antenatal Depression and its Associated Factors: Findings from Kuwait Birth Cohort Study.

BACKGROUND: Pregnant and postpartum women are at high risk of depression due to hormonal and biological changes. Antenatal depression is understudied compared to postpartum depression and its predictors remain highly controversial. AIM: To estimate the prevalence of depressive symptoms during pregnancy and investigate factors associated with this condition including vitamin D, folate and Vitamin B12 among participants in the Kuwait Birth Study. METHODS: Data collection occurred as part of the Kuwait Birth Cohort Study in which pregnant women were recruited in the second and third trimester during antenatal care visits. Data on antenatal depression were collected using the Edinburgh Postnatal Depression Scale (EPDS), considering a score of ≥ 13 as an indicator of depression. Logistic regression was used to investigate factors associated with depressive symptoms in pregnant women. RESULTS: Of 1108 participants in the Kuwait Birth Cohort study, 1070(96.6%) completed the EPDS. The prevalence of depressive symptoms was 21.03%(95%CI:18.62-23.59%) and 17.85%(95%CI:15.60-20.28%) as indicated by an EPDS ≥ 13 and EPDS ≥ 14 respectively. In the multivariable analysis, passive smoking at home, experiencing stressful life events during pregnancy, and a lower level of vitamin B12 were identified as predisposing factors. Conversely, having desire for the pregnancy and consumption of fruits and vegetables were inversely associated with depressive symptoms. CONCLUSION: Approximately, one fifth of pregnant women had depressive symptoms indicating the need to implement screening program for depression in pregnant women, a measure not systematically implemented in Kuwait. Specifically, screening efforts should focus on pregnant women with unintended pregnancies, exposure to passive smoking at home, and recent stressful live events.

Sex and obesity status modify the association between vitamin D and eczema among adolescents.

BACKGROUND: Epidemiologic studies have reported inconsistent associations between vitamin D and eczema. This study sought to assess whether sex and obesity status could modify the association between vitamin D and eczema. METHODS: A cross-sectional study enrolled 763 adolescents in Kuwait. 25-hydroxyvitamin D (25(OH)D) was measured in venous blood. Current eczema was defined according to clinical history and characteristic morphology and distribution. RESULTS: In sex-stratified analysis, decreased 25(OH)D levels were associated with increased current eczema prevalence among males (adjusted odds ratio (aOR)tertile 1 vs. tertile 3: 2.14, 95% confidence intervals (CI): 1.07-4.56), but not among females (aORtertile 1 vs. tertile 3: 1.08, 95% CI: 0.71-1.66). Further stratification by obesity status showed that lower 25(OH)D levels were associated with increased current eczema prevalence among overweight/obese males (per 10-unit decrease in 25(OH)D levels: aOR: 1.70, 95% CI: 1.17-2.46). Such an association was weaker and statistically non-significant among overweight/obese females (per 10-unit decrease in 25(OH)D levels: aOR: 1.26, 95% CI: 0.93-1.70). CONCLUSIONS: Sex and obesity status modified the association between vitamin D levels and eczema, with an inverse association observed among overweight/obese males, but not among overweight/obese females. These results suggest that preventive and clinical management strategies could vary by sex and obesity status. IMPACT: The current study showed that sex and obesity modify the association between vitamin D and eczema among adolescents. An inverse association between vitamin D and eczema was observed among overweight/obese males, but this association was not as pronounced among overweight/obese females. Vitamin D was not associated with eczema among underweight/normal weight males and females. The identification of effect modification by sex and obesity status add to the current scientific knowledge and further highlight the complexity of the association between vitamin D and eczema. These results may promote a more individualized approach to the future prevention and clinical management of eczema.

Increased LRG1 Levels in Overweight and Obese Adolescents and Its Association with Obesity Markers, Including Leptin, Chemerin, and High Sensitivity C-Reactive Protein.

Leucine-rich α-2 glycoprotein1 (LRG1) is a member of the leucine-rich repeat (LRR) family that is implicated in multiple diseases, including cancer, aging, and heart failure, as well as diabetes and obesity. LRG1 plays a key role in diet-induced hepatosteatosis and insulin resistance by mediating the crosstalk between adipocytes and hepatocytes. LRG1 also promotes hepatosteatosis by upregulating de novo lipogenesis in the liver and suppressing fatty acid ß-oxidation. In this study, we investigated the association of LRG1 with obesity markers, including leptin and other adipokines in adolescents (11−14 years; n = 425). BMI-for-age classification based on WHO growth charts was used to define obesity. Plasma LRG1 was measured by ELISA, while other markers were measured by multiplexing assay. Median (IQR) of LRG1 levels was higher in obese (30 (25, 38) µg/mL) and overweight (30 (24, 39) µg/mL) adolescents, compared to normal-weight participants (27 (22, 35) µg/mL). The highest tertile of LRG1 had an OR [95% CI] of 2.55 [1.44, 4.53] for obesity. LRG1 was positively correlated to plasma levels of high sensitivity c-reactive protein (HsCRP) (ρ = 0.2), leptin (ρ = 0.2), and chemerin (ρ = 0.24) with p < 0.001. Additionally, it was positively associated with plasma level of IL6 (ρ = 0.17) and IL10 (ρ = 0.14) but not TNF-α. In conclusion, LRG1 levels are increased in obese adolescents and are associated with increased levels of adipogenic markers. These results suggest the usefulness of LRG1 as an early biomarker for obesity and its related pathologies in adolescents.

Vitamin D level in relation to depression symptoms during adolescence.

BACKGROUND: This study aimed to investigate the association between 25-hydroxyvitamin D (25(OH)D) and depression symptoms among adolescents in Kuwait, a country with a high prevalence of vitamin D deficiency. METHODS: A school based cross-sectional study was conducted on randomly selected 704 adolescents in middle schools. Data on depression symptoms were collected using the Children's Depression Inventory (CDI). Data on covariates were collected from the parents by self-administered questionnaire and from adolescents by face-to-face interview. Blood samples were analyzed in an accredited laboratory; and 25(OH)D was measured using liquid chromatography-tandem mass spectrometry. RESULTS: Of 704 adolescents, 94 (13.35%; 95%CI:10.35-17.06%) had depression symptom (a score of 19 or more on the CDI). There was no significant difference in the median CDI score between different vitamin D status (p = 0.366). There was also no significant correlation between serum 25(OH)D concentration and CDI score (Spearman's rank correlation = 0.01; p = 0.825).There was no significant association between 25(OH)D and depression symptoms whether 25(OH)D was fitted as a continuous variable (crude odds ratio (OR) 0 .99 [95%CI: 0.98, 1.01], p = 0.458 and adjusted OR 1.01 [95%CI: 0.99, 1.02], p = 0.233), categorical variable as per acceptable cut-of points (crude analysis p = 0.376 and adjusted analysis p = 0.736), or categorical variable as quartiles (crude analysis p = 0.760 and adjusted analysis p = 0.549). CONCLUSION: Vitamin D status does not seem to be associated with depression symptoms among adolescents in our setting. Nevertheless, it is important to have sufficient vitamin D levels during adolescence for several other health benefits.

Is age of menarche directly related to vitamin D levels?

INTRODUCTION: Very few studies have examined the direct link between age of menarche and vitamin D level and controversial results have been reported. This study aimed to investigate the association between vitamin D and age of menarche in a group of adolescent girls in an area with plenty of sunshine. METHODS: At baseline, data were collected on 722 middle schoolgirls that were randomly selected by probability proportional to size sampling method. Of this group, 598 were followed including 173 who had their menarche during the follow-up. Serum 25-hydroxyvitamin D (25OHD) was measured at baseline using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Data on potential confounders were collected at baseline from the parents using self-administered questionnaire and from schoolgirls through face-to-face interview. Multiple linear regression and time-to-event analysis were used to investigate the association between 25OHD concentration and age of menarche. RESULTS: The mean (SD) age of the study group was 12.51 (0.91) years while the main (SD) age of menarche was 11.82 (1.04) years. The prevalence of vitamin D deficiency (<50 nmol/L) among schoolgirls was 91.69%. We found no evidence for the association between 25OHD levels and age of menarche before (ß, .00, 95% confidence interval (CI) [-0.01, 0.01]; p = .808) or after (ß, .00, 95% CI [-0.01, 0.01]; p = .765) adjusting for potential confounders. We also found no evidence for association between 25OHD status and age of menarche before (p = .424) or after (p = .356) adjusting for potential confounders. Time-to-event analysis showed no association between 25OHD level or status and age of menarche (p = .850). CONCLUSION: In Middle Eastern setting, where vitamin D deficiency is common despite plenty of sunshine, vitamin D is not a major determinant of the age at menarche. Regardless of the link between vitamin D and age of menarche, there are several other health benefits of having adequate vitamin D level during childhood and adolescence.

Association of blood lead level with vitamin D binding protein, total and free 25-hydroxyvitamin D levels in middle-school children.

A negative association between blood Pb level (BPbL) and vitamin D metabolites in occupationally exposed populations has been reported, but data from the general population are scarce. Furthermore, the association between BPbL and vitamin D binding protein (DBP) and free 25-hydroxyvitamin D (25(OH)D) has not been reported. We investigated the association of BPbL with DBP, total and free 25(OH)D in healthy adolescents (n 1347; age range 11-16 years) cross-sectionally selected from all Governorates of Kuwait, utilising multi-stage cluster random sampling. Pb in whole blood was analysed by inductively coupled plasma MS, and DBP with ELISA. Plasma 25(OH)D was analysed by LC-MS/MS, and free 25(OH)D was calculated utilising the levels and binding affinities of DBP and albumin for 25(OH)D. DBP was positively associated with BPbL (ß = 0·81; 95 % CI 0·14, 0·22; P < 0·001). A negative association between BPbL and total 25(OH)D was non-significant (P = 0·24) when BPbL was used as a continuous variable but was significant when used as quartiles (P = 0·02). The negative association between BPbL and free 25(OH)D was significant whether BPbL was used as continuous, as quartiles or as cut-off point of <5 µg/dl (0·24 µmol/l). In multinomial logistic regression, the odds of vitamin D insufficiency and deficiency were more than two-fold higher in the upper quartiles of BPbL compared with the lowest quartile. The negative correlation of BPbL with free 25(OH)D was more robust than its correlation with total 25(OH)D. Future studies must consider the levels of DBP when assessing the association between Pb and vitamin D metabolites.

Psychometric properties of the Arabic version of the hospital anxiety and depression scale in hemodialysis patients.

The literature lacks a rigorous psychometric evaluation of the Arabic version of Hospital Anxiety and Depression Scale (HADS) in hemodialysis (HD) patients. This study aims to evaluate reliability, determine the underlying factor structure of the Arabic version of HADS and assess its suitability as screening tool for depression and anxiety among Arabic HD patients.A sample of 370 HD patients were recruited from all health districts in Kuwait. Reliability for HADS (all items) and its subscales HADS-A (anxiety) and HADS-D (depression) were estimated using Cronbach's alpha and item analysis was conducted. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to extract and test the factor structure for the Arabic version of HADS. Eight models were tested using CFA to determine goodness-of-fit.The Cronbach α for the Arabic HADS (all items), HADS-A and HADS-D were 0.884, 0.852 and 0.764, respectively. Pearson correlation coefficient between HADS-A and HADS-D subscales indicated significant correlation (r = +0.69, PV < 0.001). EFA indicated two factors with eigenvalues >1, which accounted for 48.5% of the total variance. CFA revealed the one-factor model had the poorest fit, the two-factor models with acceptable fit, and three-factor models showed good fit.The Arabic HADS has good reliability and internal consistency, which warrants its use in screening for anxiety and depression among Arabic HD patients. Furthermore, the three-factor structure has shown a better fit which warrants further exploration in HD patients with the advancement in theory of psychological models for anxiety and depression.

Profiling of Insulin-Like Growth Factor Binding Proteins (IGFBPs) in Obesity and Their Association With Ox-LDL and Hs-CRP in Adolescents.

Insulin-like growth factor binding proteins (IGFBPs) are critical modulators of metabolism. In adults, IGFBPs are associated with obesity and insulin resistance. However, the association of IGFBPs with metabolic homeostasis in children and adolescents is not yet fully characterized. In this study we investigated the association of plasma IGFBPs (IGFBP-1, 3 and 7) with weight, central adiposity and cardiovascular disease markers Hs-CRP and Ox-LDL. A total of 420 adolescents (age 11-14 years) were recruited from public middle schools in Kuwait. IGFBPs were measured using bead-based multiplexing while Hs-CRP and Ox-LDL were measured using ELISA. Results showed that levels of IGFBP-1 were significantly lower in obese and overweight children when compared to normal weight children. Correlation analysis showed negative association between the level of IGFBP-1 and waist circumference to height (WC/Ht) ratio. IGFBP-1 level was also negatively associated with Hs-CRP. It was also observed that the levels of IGFBP-3 and IGFBP-7 were negatively correlated with Ox-LDL. Our data demonstrate a strong negative association of IGFBP-1 with overweight/obesity, and the inflammatory marker Hs-CRP. This was not seen with the levels of IGFBP-3 and 7. The association of IGFBP-1 with central adiposity (WC/Ht ratio) was stronger than its association with BMI-for-age z-score. Therefore we suggest that IGFBP-1 could potentially be used as a sensitive biomarker for obesity and its subsequent effects in screening and monitoring of obesity-related metabolic complications in adolescents.

Prevalence of depression, anxiety, and their associations among end-stage renal disease patients on maintenance hemodialysis: a multi-center population-based study.

Depression and anxiety are the most common mood disorder among end-stage renal disease (ESRD) patients, which can negatively affect quality-of-life and treatment outcomes. This study aimed to estimate the prevalence of depression and anxiety symptoms among ESRD patients undergoing hemodialysis (HD) and test associations with several covariates. In across-sectional study, we collected data from 457 patients using Hospital Anxiety and Depression Scale (HADS). We used multinomial logistic regression to model the associations between depression/anxiety symptoms and several covariates. The prevalence of depression (anxiety) symptoms was 21.7%(21.4%). About 12.6% had both depression and anxiety. Males were significantly less likely to have anxiety (depression) compared to females. Married with children were significantly less likely to have anxiety compared to divorced/widowed. Patients with Glomerulonephritis were significantly more likely to have anxiety (depression) compared to other causes of dialysis. Depression and anxiety are prevalent among HD patients with their HADS scores significantly positively correlated. This requires regular screening for symptoms of anxiety/depression. Future interventions should target females, those on dialysis between one and three years, and those with glomerulonephritis as ESRD cause. Finally, HADS is ascreening tool for symptoms of anxiety and depression for which aspecialist should assess the definitive diagnosis clinically.

The routine chemiluminescence assay for plasma 25-hydroxyvitamin D analysis does not overestimate the prevalence of vitamin D deficiency in adolescents.

Vitamin D deficiency (VDD) is a global public health problem. Inaccurate methods for measuring plasma 25-hydroxyvitamin D (25[OH]D) may have contributed to the reported high prevalence of VDD. We hypothesized that the most commonly used assay for vitamin D status, chemiluminescence immunoassay (CLIA), underestimates 25(OH)D levels and thus overestimates VDD. Using both liquid chromatography-tandem mass spectrometry and CLIA for plasma 25(OH)D, we evaluated the prevalence of VDD in adolescents (11-16 years-old; n = 410) by both methods in a cross-sectional study. Subjects were selected from public middle schools from all the 6 Governorates of Kuwait using stratified multistage cluster random sampling. Cohen κ agreement, linear regression, and Bland-Altman plots were used to evaluate the classification of VDD by the 2 methods. VDD (25[OH]D < 50 nmol/L) was 85.9% with CLIA and 81.2% with liquid chromatography-tandem mass spectrometry. There was a good agreement between the 2 methods in classifying the study subjects as deficient, insufficient, or sufficient (κ = 85.1%, P < .001). The between-assay bias was very small with a mean percentage difference < 1% from the mean value of the 25(OH)D as assessed by the 2 methods. These data did not support our hypothesis, and we conclude that the routine methods used for plasma 25(OH)D levels have no or little impact on evaluating VDD as a public health problem or in clinical management.

Plasma 25-hydroxyvitamin D is positively associated with folate and vitamin B12 levels in adolescents.

Vitamin D affects the absorption of folate in vitro, and perhaps of vitamin B12 (B12). However, epidemiological studies on the association of vitamin D with folate and B12 are inconclusive. We hypothesized a positive association of plasma 25-hydroxyvitamin D [25(OH)D] with folate and B12 levels in adolescents. This hypothesis was tested in a cross-sectional study of healthy adolescents (11-16 years old; n = 1416), selected from public middle schools from across Kuwait, using stratified multistage cluster random sampling. Plasma 25(OH)D was measured by LC-MS/MS. Serum B12 and total folate in hemolyzed whole blood were analyzed with commercial kits; RBC and plasma folate were calculated from total folate. Data on potential confounders were collected from the parents and adolescents. In a univariable model, 25(OH)D as a continuous variable was positively associated with each of total, RBC, and plasma folate (P < .001). After adjusting for potential confounders, this association remained significant with total folate (ß = 2.0, P < .001) and red blood cell folate (ß = 1.8, P < .001), but not with plasma folate (ß = 0.2, P = .34). A similar pattern of association was evident when 25(OH)D was fitted as categorical variable. Correlation between B12 and 25(OH)D was weak but significant (ρ = 0.1, P < .001). 25(OH)D was positively associated with B12 in both univariable and multivariable models (P < .001) when fitted as a categorical variable only. Simultaneous quantile regression confirmed these results. We conclude that plasma 25(OH)D is positively associated with folate and B12 levels in adolescents. Properly designed large-scale randomized controlled trials are warranted to investigate the causal role of vitamin D in folate and B12 absorption.

Season of birth and sugary beverages are predictors of Raven's Standard Progressive Matrices Scores in adolescents.

To investigate factors associated with cognitive functioning in healthy adolescents, a school-based cross-sectional study was conducted on 1370 adolescents aged 11-16 years that were randomly selected from all governorates of Kuwait. Raven's Standard Progressive Matrices (SPM), a non-verbal test of intelligence, was used to measure cognitive functioning of the study participants. Data on predictors of cognitive functioning were collected from parents and adolescents. Weight and height of the participants were measured in a standardized manner and blood samples were tested in an accredited laboratory under strict measures of quality control. In multivariable linear regression analysis, factors that showed significant association with the SPM score were gender (p = 0.002), season of birth (p = 0.009), place of residence (p < 0.001), father's (p < 0.001) and mother's (p = 0.025) educational level, type of housing (p < 0.001), passive smoking at home (p = 0.031), sleeping hours during weekends (p = 0.017), students' educational level (p < 0.001) and the frequency of consumption of sugary drinks (p < 0.001). The link between cognitive functioning and season of birth seems to be robust in various geographical locations including the Middle East. The association between sugary drinks and cognitive functioning highlights the importance of diet independently of obesity and support efforts to reduce consumption of sugary drinks among children.

Correlation of circulating ANGPTL5 levels with obesity, high sensitivity C-reactive protein and oxidized low-density lipoprotein in adolescents.

Angiopoietin-like proteins (ANGPTL) is a family of eight members known to play an important role in metabolic diseases. Of these, ANGPTL5 is suggested to regulate triglyceride metabolism and is increased in obesity and diabetes. However, its role in metabolic diseases in adolescents is not well-studied. In this study, we tested the hypothesis of a positive association between plasma ANGPTL5, and obesity, high sensitivity C-reactive protein (HsCRP) and oxidized low-density lipoprotein (Ox-LDL) in adolescents. Adolescents (N = 431; age 11-14 years) were randomly selected from middle schools in Kuwait. Obesity was classified by the BMI-for-age based on the WHO growth charts. Plasma ANGPTL5, HsCRP, and Ox-LDL were measured using ELISA. The prevalence of overweight and obesity was 20.65% and 33.18%, respectively. Mean (SD) plasma ANGPTL5 levels were significantly higher in obese, compared with overweight and normal-weight adolescents (23.05 (8.79) vs 18.39 (7.08) ng/mL, and 18.26 (6.95) ng/ml, respectively). ANGPTL5 was positively associated with both HsCRP (ρ=0.27, p < 0.001) and Ox-LDL (ρ = 0.24, p < 0.001). In Conclusion, ANGPTL5 levels are elevated in obese adolescents and are associated with cardiovascular disease risk factors, HsCRP and Ox-LDL. The use of ANGPTL5 as a powerful diagnostic and prognostic tool in obesity and metabolic diseases needs to be further evaluated.

Anemia and its associated factors among Adolescents in Kuwait.

We estimated the prevalence of anemia among school children and investigated factors associated with this problem in Kuwait. A cross-sectional study was conducted on 1415 adolescents randomly selected from middle schools in Kuwait. Hemoglobin, iron, ferritin, folate and vitamin B12, in addition to many other laboratory indicators, were measured in a venous blood sample. Data on risk factors for anemia were collected from parents and adolescents. Multiple logistic regression was used to investigate factors associated with anemia. The prevalence of anemia was 8.06% (95% CI: 6.69-9.60%), which was significantly higher among females compared to males (10.96% vs. 5.04%; p < 0.001). Mean (SD) Hb level was 133.7 (9.89) g/L and 130.00 (10.48) g/L among males and females, respectively (p < 0.001). The prevalence of mild, moderate and severe anemia was 5.94%, 1.91% and 0.21%, respectively. Gender, age, iron concentration and ferritin were associated with anemia in multivariable analysis. These data indicate that anemia among school children in Kuwait is of mild public health significance. Further reduction in anemia in school girls should focus on correcting iron deficiency. Surveillance systems for anemia may consider using a cut-off point that is specific for the method of blood sampling and the method of Hb measurement.

Vitamin D levels in relation to low back pain during adolescence.

This study aimed to investigate the association between 25-hydroxyvitamin D (25(OH)D) level and low back pain (LBP) among adolescents while adjusting for potential confounders pertinent to this age group including the weight of school bags, BMI and physical activity. A cross-sectional study was conducted on 760 randomly selected adolescents in middle schools. Data on LBP and the risk factors for LBP were collected from parents by a self-administered questionnaire and from adolescents by face-to-face interview. Blood samples were tested in an accredited laboratory; and 25(OH)D was measured using liquid chromatography-tandem MS. The lifetime prevalence and the 6-month prevalence of LBP were 32·28 (95 % CI 28·97, 35·73) % and 21·26 (95 % CI 18·40, 24·33) %, respectively. There was no difference in the geometric mean of 25(OH)D between those with and without LBP in the past 6 months (28·50 nmol/l and 30·82 nmol/l, respectively; P = 0·122). There was no association between 25(OH)D and LBP in the univariable or multivariable analysis whether 25(OH)D fitted as a continuous or as a categorical variable. We found no association between vitamin D level and LBP in adolescents in an area with high prevalence of vitamin D deficiency. Although it is important to have sufficient vitamin D levels during adolescence for several other health benefits, we concluded that vitamin D is not a major determinant for LBP among adolescents in our setting.

Predictors of Acne Vulgaris among Adolescents in Kuwait.

OBJECTIVES: The prevalence of acne vulgaris (AV) among adolescents in Kuwait has remained mostly unknown. This study aimed to estimate the prevalence of AV and its predictors among adolescents in Kuwait. SUBJECTS AND METHODS: A cross-sectional study was conducted on 714 participants who were randomly selected from public schools using multistage cluster random sampling. The presence or absence of AV, as well as severity of AV, were assessed using the Global Acne Grading Scale. Data on risk factors and potential confounders were collected from the parents through a self-administered questionnaire, and from the adolescents by face-to-face interview. Weight and height were measured in a standardized manner. RESULTS: Of 714 participants, 320 (44.8%; 95% CI 41.1-48.6%) self-reported AV. By clinical examination, AV was found among 479 (67.1%; 95% CI 63.5-70.5%) participants. Factors that were found to be significantly associated with AV in multivariable analysis were age, gender, nationality, and BMI categories. Females compared to males (adjusted prevalence ratio [APR] 1.16 [95% CI 1.05-1.25]; p = 0.006) and overweight or obese adolescents compared to normal weight (APR 1.15 [95% CI 1.02-1.26] and 1.14 [95% CI 1.02-1.23], respectively; p = 0.026) were more likely to have AV. None of the food items studied showed an association with AV in multivariable analysis. CONCLUSION: The prevalence of self-reported AV seems to be lower than that reported in other settings, while the prevalence of AV by clinical examination resembles that reported in many other countries. BMI was the only modifiable risk factor associated with AV in multivariable analysis, and none of the food items studied was related to the presence or absence of AV in multivariable analysis.

Plasma 25-Hydroxy Vitamin D is not Associated with Acne Vulgaris.

Few studies have investigated the association between Acne vulgaris (AV) and vitamin D level. In this study we aimed to investigate the association between 25-hydroxyvitamin D (25-OH-VitD) level and AV in a country with plenty of sunshine. A cross-sectional study was conducted on 714 adolescents who were randomly selected from public schools using multistage cluster random sampling with probability proportional to size. 25-OH-VitD levels were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The Global Acne Grading System (GAGS) was used to assess the severity of AV. Data on potential confounders were collected from the parents through a self-administered questionnaire, and from the adolescents using a face-to-face interview. Of 714 participants, 351 (41.16%) were males. The mean (standard deviation (SD)) age was 12.28 (0.81) years. AV was observed in 479 (67.1%) adolescents. There was no significant association between 25-OH-VitD level and clinically assessed AV before or after adjusting for potential confounders. This was consistent whether 25-OH-VitD was fitted as a continuous variable or categorized using acceptable cutoff points or tertiles. In this study vitamin D status was not associated with AV, therefore our data do not support vitamin D supplementation either to treat or to prevent AV.

Plasma 25-Hydroxy Vitamin D Is Not Associated with Either Cognitive Function or Academic Performance in Adolescents.

Several observational studies have reported an association between low levels of vitamin D (VD) and poor cognition in adults, but there is a paucity of data on such an association in adolescents. We investigated the association between VD and cognitive function or academic achievement among 1370 adolescents, who were selected from public middle schools in Kuwait, using stratified multistage cluster random sampling with probability proportional to size. Plasma 25-hydroxy VD (25-OH-D) was measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). An age-adjusted standard score (ASC), calculated from Raven's Standard Progressive Matrices test, was used to evaluate cognitive function; academic achievements were extracted from the schools' records. Data on various covariates were collected from the parents through a self-administered questionnaire and from the adolescents using face-to-face interviews. 25-OH-D was weakly correlated positively with ASC (ρ = 0.06; p = 0.04). Univariable linear regression analysis showed an association between 25-OH-D categories and ASC after adjusting for gender, but adjusting for parental education was sufficient to explain this association. Multivariable analysis showed no association between 25-OH-D and ASC after adjusting for potential confounders whether 25-OH-D was fitted as a continuous variable (p = 0.73), a variable that is categorized by acceptable cutoff points (p = 0.48), or categorized into quartiles (p = 0.88). Similarly, 25-OH-D was not associated with academic performance. We conclude that 25-OH-D is associated with neither cognitive function nor academic performance in adolescents.

Vitamin D status among adolescents in Kuwait: a cross-sectional study.

OBJECTIVES: In Kuwait, as in many Arab states in the Gulf region, there are limited data on the prevalence of vitamin D deficiency among healthy adolescents. This study aimed to estimate the prevalence of vitamin D deficiency in a nationally representative sample of adolescents and investigate factors associated with vitamin D status. METHODS: A cross-sectional study was conducted on 1416 adolescents aged 11-16 years, who were randomly selected from middle schools in all governorates of Kuwait. Data were collected from parents through self-administered questionnaire and from adolescents through face-to-face interview. Vitamin D was measured using liquid chromatography-tandem mass spectrometry. Logistic regression was used to investigate the independent factors associated with vitamin D status. RESULTS: The prevalence of vitamin D deficiency was 81.21% (95% CI 71.61% to 90.81%), while severe deficiency was 39.48%. Only 3.60% of adolescents were vitamin D-sufficient. The prevalence of vitamin D deficiency was significantly higher among girls compared with boys (91.69% vs 70.32%; p<0.001). There was a significant inverse correlation between vitamin D and parathyroid hormone (Spearman correlation=-0.35; p<0.001). In the final model, gender, age, governorate, parental education, body mass index, vitamin D supplement and the number of times adolescents walk to schools per week were all significantly related to vitamin D deficiency. CONCLUSION: High prevalence of vitamin D deficiency was noted among adolescents in Kuwait despite the abundant sunshine, which may reflect strong sun avoidance behaviour. Adequate outdoor daytime activities should be encouraged especially for girls. We call for locally tailored guidelines for vitamin D supplement in which girls should have a higher dose compared with boys.

Attitudes to knee osteoarthritis and total knee replacement in Arab women: a qualitative study.

BACKGROUND: Total Knee Arthroplasty (TKA) is offered to patients with knee osteoarthritis (OA) in the oil-rich countries in the Gulf region without adequate understanding of their perceptions, preferences or pain experiences. This study aimed to explore the pain experience and mobility limitation as well as the patient's decision making process to undertake TKA among women with knee pain in the waiting list for surgery. METHODS: Five focus group discussions were conducted comprised of 39 women with severe knee OA from the waiting list for TKA in the only orthopaedic hospital in Kuwait. Discussions were recorded, transcribed and coded for themes to identify the factors considered to be important in decision-making for TKA. RESULTS: Experiencing knee pain was central to daily living and affected patients and their families. Mobility limitation was shaped by a strong sense of expected obligation to take care of the family. Two major sources of TKA delay were identified; one was due to late clinical advice to undergo TKA which was the result of receiving several consultations from different clinicians each of whom tried the medical management for OA. The second delay occurred after the clinical advice for TKA and was mainly due to ambivalence of patients because of fear of the operation and the lack of information about TKA that resulted in unclear expectations of the surgery. CONCLUSIONS: Both verbal and written information about TKA should be provided as part of preoperative rehabilitation. This is critical to improve doctor-patient interactions and facilitate informed decision about the procedure and thus achieve patient-centered healthcare.