Impact of Skills for Change Program on metabolic control, diet and physical activity levels in adults with type 2 diabetes: A cluster randomized trial.

BACKGROUND: Type 2 diabetes mellitus is highly prevalent in the Arab Gulf countries. Despite this, limited culturally-adapted lifestyle intervention studies have been conducted in this region. METHODS: In this culturally adapted 12-month cluster randomized trial, 382 patients with type 2 diabetes, aged 20-70 years were recruited from 6 public healthcare centers (3 interventions and 3 controls) in Al Ain, United Arab Emirates. The primary outcome of this study was a change in hemoglobin A1c (HbA1c). The secondary outcomes were Body Mass Index (BMI), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, total cholesterol, dietary intake, and physical activity levels. A diet and physical activity intervention, guided by the social cognitive theory, was delivered individually and in group format to the intervention group. The control group continued receiving only their usual diabetes management care. The data were collected at baseline and 1 year after participation. RESULTS: The mean baseline HbA1c levels of the control and the intervention groups were 7.45 ± 0.11% and 7.81 ± 0.11%, respectively. At the end of the 12-month intervention, there was no significant difference in the changes of mean HbA1c between the intervention and the control groups. On the other hand, BMI and daily caloric intake were significantly decreased in the intervention compared to the control group by 1.18 kg/m2 (95% CI: -1.78 - -0.60) and 246 kcal (95% CI: -419.52 - -77.21), respectively, after controlling for age, gender, education, marital status, duration since diabetes diagnosis, diabetes treatment, treatment clinic, and baseline values. Sitting time during the week-end was significantly lower, difference 52.53 minutes (95% CI: 93.93 - -11.14). CONCLUSIONS: This community-based lifestyle intervention for patients with baseline HbA1c <8% did not result in a significant decrease of HbA1c but reduced caloric intake, body weight, and weekend inactivity after controlling for the covariates. TRIAL REGISTRATION: This trial was registered on February 11, 2020 with Clinicaltrials.gov (NCT04264793).

Associations of Dyslipidemia with Dietary Intakes, Body Weight Status and Sociodemographic Factors among Adults in the United Arab Emirates.

Research on dietary and other factors associated with dyslipidemia in the United Arab Emirates (UAE) is limited. This study assessed the association of diet, body weight and other risk factors of dyslipidemia by conducting a cross-sectional survey among adults residing in three emirates of the UAE. Validated quantitative food frequency questionnaire and the WHO STEPS Instrument were used to assess dietary intakes, body weight and dyslipidemia-related diagnosis. Composite Mediterranean Diet Score was used to assess adherence to the Mediterranean Diet (MD). Of the 610 participants, dyslipidemia was reported by 23.5% of the 319 participants who ever had blood cholesterol levels measured. Self-reported dyslipidemia was associated with increased age, higher BMI, diabetes, hypertension and cardiovascular disease. Most participants did not meet the recommendations for dietary fiber and calorie intake from saturated fats (61.3% and 81.2%, respectively). Participants with dyslipidemia reported a higher median daily intake of vegetables compared to those without dyslipidemia (p < 0.001), who also showed a significantly higher intake of refined grains and sugar-sweetened beverages (p = 0.008). Participants aged ≥50 years were more likely to have adhered to the MD compared to 18−30-year old participants (OR = 4.16; 95% CI 2.59−6.69). Non-Emiratis had higher odds of adherence to the MD compared to UAE nationals (OR = 1.46; 95%CI 1.04−2.06). Interventions targeting behavioral risk factors of dyslipidemia are warranted.

Perceived social support and self-efficacy beliefs for healthy eating and physical activity among Arabic-speaking university students: adaptation and implementation of health beliefs survey questionnaire.

BACKGROUND: Few assessment tools exist for investigating perceived social support and self-efficacy behaviors in Arabic-speaking populations. Moreover, literature on the levels of social support and self-efficacy for adopting healthy eating and engaging in regular physical activity among Arabic-speaking young adults is currently lacking. This study aimed to adapt the Health Beliefs Survey Questionnaire (HBSQ) for Arabic-speaking populations and assess perceived social support and self-efficacy for adopting healthy eating and increased physical activity among university students. METHODS: In the first stage of the study, forward and backward translation and pretesting of the social support and self-efficacy scales of the HBSQ were conducted. The adapted questionnaire was administered to female university students (n = 258), and a subsample of 195 participants retook the questionnaire after 1 month. Construct validity was assessed with confirmatory factor analysis. The internal consistency of each subscale item was assessed by Cronbach's alpha coefficient, and reproducibility was tested with intraclass correlation coefficients (ICCs) and Bland-Altman plots. In the second stage, the adapted questionnaire was used to assess the perceived social support and self-efficacy levels in a different sample of Arabic-speaking female university students (n = 283). RESULTS: Based on the results from confirmatory factor analysis, 6 items were selected for the social support scale and 19 items for the self-efficacy scale. The adapted questionnaire showed moderate to high internal reliability (Cronbach alpha coefficient = 0.681 to 0.900). The ICCs of the various subscales ranged from 0.666 to 0.997, indicating moderate to excellent reproducibility of the culturally adapted questionnaire. This was confirmed by Bland-Altman analysis. Participants in the second stage of the study reported significantly higher (P < 0.001) perceived support from family compared to friends in reducing sugar intake and increasing fiber consumption. CONCLUSIONS: The results of the psychometric testing indicate the shortened Arabic HBSQ is a reliable tool for assessing perceived social support from family and close friends as well as for evaluating self-efficacy for choosing healthy foods and increasing physical activity among female university students.

Feasibility Study of a Newly Developed Technology-Mediated Lifestyle Intervention for Overweight and Obese Young Adults.

BACKGROUND: Poor eating habits and sedentary lifestyle are common among young adults and increase the risk for chronic diseases later in life. Due to the widespread use of information technology among young adults, the Rashakaty (Fitness for Me) study aimed to develop and test the feasibility of a technology-based nutrition education intervention. This would support overweight and obese university students to achieve weight loss, enhance nutrition knowledge, and increase physical activity levels. METHODS: We enrolled 246 participants in a 16-week non-randomized feasibility study with two arms: Rashakaty-Basic and Rashakaty-Enhanced. The intervention was guided by social cognitive theory and was delivered via a website and mobile apps. RESULTS: Among the 161 participants who completed the endline assessments, there was no significant difference in weight loss between the two arms. However, waist circumference decreased more (p = 0.003) in the Rashakaty -Enhanced group. Additionally, changes in knowledge related to sources of nutrients (p < 0.001) and diet-disease relationships (p = 0.006) were significantly higher among the Rashakaty-Enhanced group. Rashakaty-Enhanced participants reported increased number of days spent on moderate physical activity (p = 0.013) and minutes walked (p < 0.001). Moreover, they also reported higher scores in social support from friends to reduce fat intake (p = 0.006) and from family and friends to increase physical activity (p = 0.001). CONCLUSIONS: The results of this feasibility study can assist in the development and implementation of future technology-mediated health promotion programs in the UAE, especially for young adults.

Water and Beverage Consumption among a Nationally Representative Sample of Children and Adolescents in the United Arab Emirates.

There are limited studies examining water consumption among individuals in hot climates. We assessed the daily total water intake from plain water, other beverages, and food in a nationally representative sample of children and adolescents aged 6-18 years in the United Arab Emirates. Total water intake was compared against the recommendations of the Institute of Medicine and the European Food Safety Authority. Sociodemographic information, 24 h dietary recall, physical activity levels, and anthropometric data were collected from 527 participants. The mean ± SE of total water intake was 1778.4 ± 33.8 mL/day. Plain drinking water was the largest contributor to total water intake (51.6%), followed by food (27.3%). Sugar-sweetened beverages constituted 13.9% of water intake. The proportion of participants who met the Institute of Medicine recommendations ranged from 15% (males aged 14-18) to 25% (children aged 6-8). The proportion of participants who met the European Food Safety Authority recommendations ranged from 31% (females aged 14-18) to 36% (males aged 14-18). The water-to-energy ratio was 1.0-1.15 L/1000 kcal, meeting recommendations. The majority of participants failed to meet water intake recommendations, highlighting the need for targeted interventions to promote increased water consumption among children and adolescents.