A systematic review, meta-analysis, and meta-regression of the prevalence of self-reported disordered eating and associated factors among athletes worldwide.

BACKGROUND: The purpose of this meta-analysis was to provide a pooled prevalence estimate of self-reported disordered eating (SRDE) in athletes based on the available literature, and to identify risk factors for their occurrence. METHODS: Across ten academic databases, an electronic search was conducted from inception to 7th January 2024. The proportion of athletes scoring at or above predetermined cutoffs on validated self-reporting screening measures was used to identify disordered eating (DE). Subgroup analysis per country, per culture, and per research measure were also conducted. Age, body mass index (BMI), and sex were considered as associated/correlated factors. RESULTS: The mean prevalence of SRDE among 70,957 athletes in 177 studies (132 publications) was 19.23% (17.04%; 21.62%), I2 = 97.4%, τ2 = 0.8990, Cochran's Q p value = 0. Australia had the highest percentage of SRDE athletes with a mean of 57.1% (36.0%-75.8%), while Iceland had the lowest, with a mean of 4.9% (1.2%-17.7%). The SRDE prevalence in Eastern countries was higher than in Western countries with 29.1% versus 18.5%. Anaerobic sports had almost double the prevalence of SRDE 37.9% (27.0%-50.2%) compared to aerobic sports 19.6% (15.2%-25%). Gymnastics sports had the highest SRDE prevalence rate, with 41.5% (30.4%-53.6%) while outdoor sports showed the lowest at 15.4% (11.6%-20.2%). Among various tools used to assess SRDE, the three-factor eating questionnaire yielded the highest SRDE rate 73.0% (60.1%-82.8%). Meta-regression analyses showed that female sex, older age, and higher BMI (all p < 0.01) are associated with higher prevalence rates of SRDE. CONCLUSION: The outcome of this review suggests that factors specific to the sport affect eating behaviors throughout an athlete's life. As a result, one in five athletes run the risk of developing an eating disorder. Culture-specific and sport-specific diagnostic tools need to be developed and increased attention paid to nutritional deficiencies in athletes.

Disordered eating (DE) refers to eating behaviors that limit food choices, reduce or exaggerate food intake, cause physical discomfort, create a sense of loss of control, or lead to negative emotions like shame or guilt. The DE label does not signify the presence of a diagnosed mental health disorder, but, rather, describes self-reported, regular eating patterns that psychiatrists consider to fall into the at-risk category for an eating disorder. In this review, we performed a search of academic databases to find all relevant studies that measured the frequency of self-reported DE in athletes. We analyzed 177 studies involving over 70,000 athletes in total. In this study, DE was defined as a score above cut-off on validated screening tests for problematic eating behaviors. Our goal was to estimate the prevalence of DE in athletes globally and to determine the factors that increase risk. We found that approximately 1 in 5 athletes (19%) endorsed DE behaviors such as, among others, restrictive dieting, bingeing, and purging. These behaviors were seen most commonly in indoor sports like gymnastics and less commonly in the context of outdoor sports. Rates were highest in female athletes, older athletes, athletes with high body mass index (BMI) scores, and those from Eastern countries and cultures. Australia had the highest rates (over 50%), while rates were lowest in Iceland. We suggest the development of screening tests specifically tailored and applicable to athletes. In addition, we recommend raising public awareness of the health effects of nutrition in sports.

The global prevalence of screen-based disordered eating and associated risk factors among high school students: systematic review, meta-analysis, and meta-regression.

OBJECTIVE: Estimate the prevalence, and associated risk factors, of high school students who are considered at risk for an eating disorder based on screening measures. METHODS: An electronic search of nine databases was completed from their inception until 1st September 2022. A random-effects meta-analysis was conducted, and confounder (moderator) analyses and meta-regressions examined whether the overall prevalence estimate for of screen-based disordered eating (SBDE) was moderated by student age, BMI, or gender, as well as culture and type of SBDE assessment. RESULTS: The mean estimate of the prevalence of SBDE among high school students (K = 42 (66 datapoints), N = 56282] in the sample of 25 countries was 13% ([95% CI] = 10.0-16.8%, I2 = 99.0%, Cochran's Q p = 0.001). This effect was not moderated by features of the samples such as gender, BMI, or age. Among cultures, non-Western countries had a higher prevalence of SBDE prevalence than Western countries, but the difference was not significant. There was considerable variability in the prevalence estimates as a function of the assessment measure, but no meaningful pattern emerged. CONCLUSION: The estimated figure of 1 in 8 high school students with SBDE-unmoderated by gender and BMI-stands out as a problem in need of attention from public health officials, psychologists, psychiatrists, pediatricians, parents, and educators. There is a great need for innovative, integrated policy and program development all along the spectrum of health promotion and universal, selective, and indicated prevention. Further research is also needed to validate and refine this estimate by (a) conducting basic research on the accuracy of eating disorder screening measurements in samples ages 14 through 17; (b) examining representative samples in more countries in general and Latin American countries in particular; (c) clarifying the relationships between SBDE and age throughout the different phases of late childhood, adolescence, and emerging adulthood; and (d) investigating whether there are meaningful forms of disordered eating and whether these are associated with variables such as gender, ethnicity, and BMI.

We searched nine databases to identify studies of high school students that yielded an estimate of disordered eating based on screening measures such as the Eating Attitudes Test. Forty-two 42 studies (N = 56282 students) from 25 countries met the selection criteria. A random effects meta-analysis indicated that across those countries the best estimate of the prevalence of screen-based disordered eating is 13%. This estimate was not significantly moderated by BMI, gender, age, and whether the country was Western or non-Western. There was considerable variability in the prevalence estimates as a function of the assessment measure, but no meaningful pattern emerged. The estimated figure of 1 in 8 high school students with disordered eating is a problem deserving of attention from public health officials, psychologists, psychiatrists, pediatricians, parents, educators, and leaders committed to prevention and early identification of eating disorders and referral for treatment. Further research in many more countries is also needed to validate this estimate and to explore its relationship with development throughout adolescence and with variables that can help us to refine prevention and effective early identification and treatment of eating disorders.

Diet-related inflammation increases the odds of multiple sclerosis: Results from a large population-based prevalent case-control study in Jordan.

Background: Multiple sclerosis, a chronic inflammatory disease in young and middle-aged adults, is one of the leading causes of non-traumatic disability in adults. Diet is known to have an important role in the modulating inflammatory processes and influencing molecular pathways. Purpose: This study aims to examine the association of the inflammatory capacity of diet measured by DII with MS in Jordan. Methods: This prevalent case-control study included participants of both sexes, aged between 20 and 60 years. The cases (n = 541) had a confirmed diagnosis of prevalent Multiple Sclerosis (MS) in the previous 3 years, and controls (n = 607) were apparently healthy individuals matched on sex and age (42 ± 4 years). A validated Arabic food frequency questionnaire (FFQ) was utilized to obtain estimated dietary intake. Dietary data from the FFQ were analyzed using ESHA's Food Processor® nutrition analysis software, and the results were used to calculate the DII scores. Logistic regression analyses, controlling for covariates such as age, sex, body mass index, and smoking status, were used to measure the association between DII score and MS outcomes. Results: Cases represent a mixed sample of MS phenotypes and controls were comparable on age and sex. However, controls tended to be taller, lighter, had a lower BMI, and had a lower smoking rate. After controlling for age, BMI, sex, and smoking status, there was a consistent increase in MS risk according to DII score, with a 10-fold increase in odds in quartile 4 vs. quartile 1 [ORquartile 4vs1 = 10.17 (95% CI: 6.88; 15.04)]. For each point increase in DII score, there was nearly a doubling of odds [OR1 = 1.75 (95% CI: 1.59; 1.92)]. Individual nutrients and food values aligned according to their contribution to the DII score calculations. Conclusion: The findings of this study, obtained in MS patients with varied illness duration over the previous 3 years, are consistent with an association between the overall inflammatory potential of diet and MS odds. Our findings among MS participants showed a significantly more pro-inflammatory DII scores than age- and sex-matched controls. Our results also suggest that MS group had a diet rich in pro-inflammatory foods and nutrients.

Religious fasting and its impacts on individual, public, and planetary health: Fasting as a "religious health asset" for a healthier, more equitable, and sustainable society.

Religious fasting is practiced by people of all faiths, including Christianity, Islam, Buddhism, Jainism, as well as Hinduism, Judaism, and Taoism. Individual/clinical, public, global, and planetary health has traditionally been studied as separate entities. Nevertheless, religious fasting, in conjunction with other religious health assets, can provide several opportunities, ranging from the individual to the population, environmental, and planetary levels, by facilitating and supporting societal transformations and changes, such as the adoption of healthier, more equitable, and sustainable lifestyles, therein preserving the Earth's systems and addressing major interconnected, cascading, and compound challenges. In this review, we will summarize the most recent evidence on the effects of religious fasting, particularly Orthodox and Ramadan Islamic fasting, on human and public health. Further, we will explore the potential effects of religious fasting on tackling current environmental issues, with a special focus on nutrition/food restriction and planetary health. Finally, specific recommendations, particularly around dietary intake during the fasting rituals, will be provided to ensure a sustainable healthy planet.

The impact of Ramadan fasting on the metabolic syndrome severity in relation to ethnicity and sex: Results of a systematic review and meta-analysis.

AIMS: The primary goal of this meta-analysis was to examine the changes in various components of metabolic syndrome (MetS) in healthy adults who observed Ramadan fasting (RF) before Ramadan (T1) and at the end of RF (T2). A secondary goal was to assess the impact of RF on MetS severity in various ethnic and sex groups using the MetS z-score. DATA SYNTHESIS: Using PRISMA2020, seven databases were searched for relevant studies published between January 1950 and March 2022. Data extraction involved high-density lipoprotein cholesterol (HDL), triglycerides (TG), fasting blood glucose (FBG), waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) for T1 and T2, respectively. The MetS z-score was computed according to international diabetes federation criteria. At T1, the pooled estimates of HDL, TG, FBG, WC, SBP, DBP, and MAP were 1.20 [1.13; 1.27] mmol/L, 1.32 [1.23; 1.42] mmol/L, 4.98 [4.82; 5.15] mmol/L, 87.21 [84.21; 90.21] Cm, 114.22 [101.45; 126.99] mmHg, 76.80 [70.12; 83.47] mmHg, and 89.27 [80.56; 97.98] mmHg, respectively. At T2, the pooled estimates of HDL, TG, FBG, WC, SBP, DBP, and MAP were 1.24 [1.18; 1.31] mmol/L, 1.24 [1.14; 1.34] mmol/L, 4.77 [4.55; 4.99] mmol/L, 85.73 [82.83; 88.64] Cm, 109.48 [97.20; 121.75] mmHg, 74.43 [68.01; 80.85] mmHg, and 86.11 [77.74; 94.48] mmHg, respectively. The MetS z-score showed improvement at T2 for all ethnic groups and both sexes by -0.22 [-0.24; -0.01]. CONCLUSIONS: The current meta-analysis suggests that the RF positively impact the MetS components and the overall MetS z-score. PROSPERO REGISTRATION NUMBER: ID CRD42022329297 OPEN SCIENCE FRAMEWORK IDENTIFIER: DOI 10.17605/OSF.IO/U9H7T.

The Prevalence of "at Risk" Eating Disorders among Athletes in Jordan.

Eating disorders (EDs) are addressed as one of the expanding mental health problems worldwide. While an ED is a clinical psychiatric diagnosis that can only be established after a psychiatric assessment, it is important to note that "at-risk" refers to people who will exhibit aberrant eating patterns but do not fully meet the requirements for an ED diagnosis. This study was designed to address the ED symptoms (i.e., "at-risk") in Jordanian athletes and their association with age, sex, body mass index (BMI), and type of sport. A convenient, cross-sectional study was conducted among 249 athlete participants by answering the Eating Attitude Test (EAT-26). The EAT-26 results indicated an ED prevalence of 34% among Jordanian athletes. Within "at-risk" ED athletes, sex, age, and BMI had no significant differences in the rates of EDs. Outdoor sports had the least effect on EDs, while the highest was amongst gymnastics. EDs prevalence is alarming among Jordanian athletes. Gymnastics is a risk factor for increasing EDs. Our results should be taken into consideration by physicians, mental health professionals, sports nutritionists, coaches, and sport medicine specialists. We recommend establishing strategies pertaining to mental health, especially EDs in sports centers, along with screening programs for those who demand additional assessment and supervision.

The prevalence and risk factors of screen-based disordered eating among university students: a global systematic review, meta-analysis, and meta-regression.

PURPOSE: The purpose of this review was to estimate the prevalence of screen-based disordered eating (SBDE) and several potential risk factors in university undergraduate students around the world. METHODS: An electronic search of nine data bases was conducted from the inception of the databases until 1st October 2021. Disordered eating was defined as the percentage of students scoring at or above established cut-offs on validated screening measures. Global data were also analyzed by country, research measure, and culture. Other confounders in this review were age, BMI, and sex. RESULTS: Using random-effects meta-analysis, the mean estimate of the distribution of effects for the prevalence of SBDE among university students (K = 105, N = 145,629) was [95% CI] = 19.7% [17.9%; 21.6%], I2 = 98.2%, Cochran's Q p value = 0.001. Bayesian meta-analysis produced an estimate of 0.24, 95% credible intervals [0.20, 0.30], τ = 92%. Whether the country in which the students were studying was Western or non-Western did not moderate these effects, but as either the mean BMI of the sample or the percentage of the sample that was female increased, the prevalence of SBDE increased. CONCLUSIONS: These findings support previous studies indicating that many undergraduate students are struggling with disordered eating or a diagnosable eating disorder, but are neither receiver effective prevention nor accessing accurate diagnosis and available treatment. It is particularly important to develop ever more valid ways of identifying students with high levels of disordered eating and offering them original or culturally appropriate and effective prevention or early treatment. LEVEL OF EVIDENCE: I, systematic review and meta-analysis.

Sleep dissatisfaction is a potential marker for nomophobia in adults.

INTRODUCTION: NOMOPHOBIA is a term used to describe an anxiety disorder in which people fear being disconnected from their mobile phones. Strong associations between nomophobia and insomnia have previously been documented. However, there is no clear explanation for this relationship between the two disorders. The present study was designed to first determine the diagnostic precision of the Insomnia Severity Index (ISI) various components in detecting or classifying nomophobia; and second, examine the diagnostic performance of the identified ISI components in classifying nomophobia. METHODS: From a previous study 549 participants completed demographic information, the Nomophobia Questionnaire (NMP-Q), and the ISI. The sample was divided into two parts so that each part represented the original sample, using a 40% (n = 209) allocation for sample 1 and 60% (n = 340) for sample 2. To determine common components between nomophobia and insomnia, an exploratory factor analysis was performed using sample 1 to determine the diagnostic precision of the ISI's various components in detecting or classifying nomophobia. A test of the ISI and a cut-off value (ISI-4 ≥2) was then conducted on Sample 2 to determine whether they would accurately identify significant nomophobia. RESULTS: Sleep dissatisfaction was a common component of insomnia and nomophobia. Sleep dissatisfaction had excellent diagnostic accuracy in detecting individuals with nomophobia (sensitivity 75.13%, specificity 100%, Youden' index 0.75, area under curve 0.88). CONCLUSION: Questioning patients sleep dissatisfaction may serve as a marker for both nomophobia and insomnia, both of which may demand more comprehensive evaluation.

Camel milk composition by breed, season, publication year, and country: A global systematic review, meta-analysis, and meta-regression.

Camel milk consists of an essential macro/micronutrient for human nutrition in the arid and urban regions. This review study aimed to use meta-analysis statistical techniques for assessment and correction of publication bias, exploration of heterogeneity between studies, and detailed assessment of the effect of a comprehensive set of moderators including breed, season, country, year of publication, and the interaction between composition elements. This could provide a single synthesis of the camel milk composition to warrant strong generalizability of results, examine variability between available studies, and analyze differences in camel milk composition among different exposures. Such a finding will aid future researchers and health professionals in acquiring a more precise understanding of camel milk composition and drawing more clinical implications. Six searching databases and bibliographic were used including PubMed/MEDLINE, ScienceDirect, Springer, EBSCOhost, Scopus, and Web of Science from January 1980 to December 2021. The DerSimonian-Laird estimator was used to create the current random-effects meta-analysis. This systematic review and meta-analysis included a total of 7298 camel milk samples from 23 countries. This review comprises 79 studies published in the English language on or after 1980, including a subgroup of 117 analyses consisting of seasons, sub-breeds, and countries. The contents of macro/micronutrients in camel milk were identified as follows: protein, 3.17%; fat, 3.47%; lactose, 4.28%; ash, 0.78%; and total solids, 11.31%; calcium, 112.93 mg/100 g; iron, 0.45 mg/100 g; potassium, 116.13 mg/100 g; magnesium, 9.65 mg/100 g; sodium, 53.10 mg/100 g; zinc, 1.68 mg/100 g; vitamin C, 5.38 mg/100 g; vitamin A, 0.36 mg/100 g; vitamin B1 ,0.05 mg/100 g; vitamin B2 , 0.13 mg/100 g; vitamin B3 , 0.51 mg/100 g; vitamin B6 , 0.09 mg/100 g; and vitamin B12 , 0.0039 mg/100 g. Our meta-regression analysis found that fat and total solids were statistically significant moderators of protein; moreover, total solids content is a statistically significant moderator of fat. Discrepancies observed in camel milk profiles are dependent upon several factors, including number of included studies, number of samples, different analytical techniques, feeding patterns, camel's breeds, geographical locations, and seasonal variations.

Comparison of Ethanol Stability and Chemical Composition of Camel Milk from Five Samples.

This research was carried out to study the variation in ethanol stability and chemical composition of five camel milk samples, including two pasteurized samples (Alwatania and Darir alabaker) and three raw samples (Majaheim, Wadah, and Hamra). Ethanol stability was analyzed by dispersing camel milk samples with 0 to 100% ethanol (v/v). The findings indicate that camel milk samples precipitated after adding an equal volume of ethanol at concentrations between 50% and 64% ethanol, depending on the milk sample. The addition of sodium chloride at different concentrations (1−10%) to camel milk resulted in a significant increase in ethanol stability, and samples from Majaheim and Alwatania exhibited the highest ethanol stability values (88%). In contrast, the addition of EDTA to camel milk for pH ranging between 5.9 and 7.1 has increased ethanol stability with a sigmoidal shape in camel milk. The largest ethanol stability differences were observed in a camel milk sample from Alwatania. Thus, the level of Ca2+ in camel milk may contribute to ethanol stability by shifting the entire profile to higher ethanol stability values. The chemical composition of different camel samples was also determined. The lactose content of camel milk varied significantly (p < 0.05) across samples, ranging from 4.37% in Majaheim camel milk to 4.87% in Alwatania camel milk. The total solids of camel milk varied significantly between raw and pasteurized samples, ranging between 10.17% and 12.10%. Furthermore, protein concentration in camel milk obtained from different camel samples varied, from 2.43% to 3.23% for Hamra and Alwatania, respectively. In conclusion, ethanol stability in camel milk was dependent on the camel breed, pH level, ionic strength, and EDTA addition.

Sleep disturbances during the COVID-19 pandemic: A systematic review, meta-analysis, and meta-regression.

This systematic review and meta-analysis evaluated the extent of sleep disturbances during the COVID-19 pandemic. Eleven databases and six preprint repositories were searched for the period from November 1, 2019, to July 15, 2021. The DerSimonian and Laird method was used to develop random-effect meta-analyses. Two hundred and fifty studies comprising 493,475 participants from 49 countries were included. During COVID-19, the estimated global prevalence of sleep disturbances was 40.49% [37.56; 43.48%]. Bayesian meta-analysis revealed an odds of 0.68 [0.59; 0.77] which translates to a rate of approximately 41%. This provides reassurance that the estimated rate using classical meta-analysis is robust. Six major populations were identified; the estimated prevalence of sleep problem was 52.39% [41.69; 62.88%] among patients infected with COVID-19, 45.96% [36.90; 55.30%] among children and adolescents, 42.47% [37.95; 47.12%] among healthcare workers, 41.50% [32.98; 50.56%] among special populations with healthcare needs, 41.16% [28.76; 54.79%] among university students, and 36.73% [32.32; 41.38%] among the general population. Sleep disturbances were higher during lockdown compared to no lockdown, 42.49% versus 37.97%. Four in every ten individuals reported a sleep problem during the COVID-19 pandemic. Patients infected with the disease, children, and adolescents appeared to be the most affected groups.

Symptoms of Nomophobia, Psychological Aspects, Insomnia and Physical Activity: A Cross-Sectional Study of ESports Players in Saudi Arabia.

(1) Background: ESports is a new trend of sports, which has gained considerable popularity worldwide. There is a scarcity of evidence that focuses on the lifestyle of ESports players (eSP) particularly on symptoms of nomophobia, level of anxiety, sleep quality, food consumption and physical activity. (2) Objective: to determine the prevalence and relationship between symptoms of nomophobia, psychological aspects, insomnia and physical activity of eSP in Saudi Arabia. (3) Methods: A cross-sectional study was conducted between March and April 2021 using a convenient self-selection adult sample. A total of 893 (216 eSP vs. 677 non-eSP (NeSP)) participants aged over 18 years were included. All participants answered a seven-part validated questionnaire that included: (i) sociodemographic questions; (ii) a symptoms of nomophobia questionnaire; (iii) general anxiety disorder questions, (iv) an insomnia severity index, (v) an Internet addiction scale, (vi) the Yale food addiction scale 2.0 short form and (vii) an international physical activity questionnaire. (4) Results: Among the entire population, the prevalence of moderate to severe nomophobia, anxiety, insomnia, Internet addiction and low physical activity were 29.8%, 13.9%, 63.3%, 27% and 2.8%, respectively. The eSP and NeSP differed significantly in nomophobia scale, anxiety and insomnia values. Compared to NeSP, eSP had a higher level of severe nomophobia p = 0.003, a severe level of anxiety p = 0.025 and symptoms of insomnia p = 0.018. Except for food addiction and physical activity, a positive correlation was identified between symptoms of nomophobia, anxiety and insomnia among eSP. (5) Conclusion: This study reported high prevalence of nomophobia, anxiety and insomnia among eSP compared to NeSP.

The prevalence of feeding and eating disorders symptomology in medical students: an updated systematic review, meta-analysis, and meta-regression.

PURPOSE: Medical students have a higher risk of developing psychological issues, such as feeding and eating disorders (FEDs). In the past few years, a major increase was observed in the number of studies on the topic. The goal of this review was to estimate the prevalence risk of FEDs and its associated risk factors in medical students. METHODS: Nine electronic databases were used to conduct an electronic search from the inception of the databases until 15th September 2021. The DerSimonian-Laird technique was used to pool the estimates using random-effects meta-analysis. The prevalence of FEDs risk in medical students was the major outcome of interest. Data were analyzed globally, by country, by research measure and by culture. Sex, age, and body mass index were examined as potential confounders using meta-regression analysis. RESULTS: A random-effects meta-analysis evaluating the prevalence of FEDs in medical students (K = 35, N = 21,383) generated a pooled prevalence rate of 17.35% (95% CI 14.15-21.10%), heterogeneity [Q = 1528 (34), P = 0.001], τ2 = 0.51 (95% CI 0.36-1.05), τ = 0.71 (95% CI 0.59-1.02), I2 = 97.8%; H = 6.70 (95% CI 6.19-7.26). Age and sex were not significant predictors. Body mass index, culture and used research tool were significant confounders. CONCLUSION: The prevalence of FEDs symptoms in medical students was estimated to be 17.35%. Future prospective studies are urgently needed to construct prevention and treatment programs to provide better outcomes for students at risk of or suffering from FEDs. LEVEL OF EVIDENCE: Level I, systematic review and meta-analysis.

The Validation and Reliability of the Food and Health Questionnaire to Assess Health and Nutrition Knowledge.

PURPOSE: This study aimed to translate and test the content validity and reliability of an English questionnaire used in the American food and health survey. METHODS: The questionnaire was developed using 6 stages, then examined for test-retest. A total of 672 participants were recruited for validation and reliability. Validity test was performed using a correlation coefficient to measure the linear correlation between 2 questions at one given time. Moreover, the Kaiser-Meyer-Olkin, Measure of Sampling Adequacy, and Bartlett's Test of Sphericity were performed to statistically determine the suitability for conducting exploratory factor analysis. Furthermore, reliability tests using Cronbach α was used to estimate the reliability coefficient properties of the translated scale. Finally, the most important correlated questions was plotted using a color-coded correlogram. RESULTS: The test-retest reliability of all tested items was significantly correlated. The reliability test for all questions was 0.9. The cross-correlation test showed that all questions of the translated questionnaire were correlated significantly (P < .05) indicating reliability of the questionnaire. CONCLUSION: The tested questionnaire is applicable and may be used in population-based studies to raise awareness regarding health, food consumption, nutrition, and food safety among people in Jordan and/or other Arab countries.

Knowledge, Attitude, and Practice Towards COVID-19 Among Pharmacists: A Cross-Sectional Study.

PURPOSE: The COVID-19 outbreak has caused governments to put pandemic-related guidelines requiring compliance and understanding by healthcare professionals to mitigate its spread uncontrollably. We studied pharmacists' knowledge, attitude, and practice towards the COVD-19 outbreak compared with other healthcare workers during the pandemic in Saudi Arabia. METHODS: We surveyed pharmacists' socio-demographics (n=50) compared with other healthcare professionals (n=378) during lockdown starting in June 2020. We measured respondents' level of knowledge (n=10 questions, maximum score of 10), attitude (n=17 questions, maximum score of 80), and their practices (n=16 questions, maximum score of 80) towards COVID-19 infection. RESULTS: Median knowledge score was 8 (25th-75th percentiles: 7-9), attitude score 76 (70-80) and practice score 74 (68-78). Good knowledge predictors were >20 years working experience [OR: 2.05 (95% CI: 1.03-4.06); P=0.04] and >50% working in clinical practice [OR: 1.72 (95% CI: 1.12-2.66); P=0.01], in inverse relationship with paramedical professions [OR: 0.45 (95% CI: 0.45 (0.28-0.72)); P=0.001] and working in a university hospital [OR: 0.51 (95% CI: 0.33. 0.81); P=0.004]. Availability of pharmaceutical information and treatment options was associated with good attitude [OR: 2.19 (95% CI: 1.04-4.59); P=0.039] and acquaintance as primary information sources negatively associated with good attitude [OR: 0.34 (95% CI: 0.15-0.8); P=0.013]. Good practice predictors were female gender [OR: 3.84 (95% CI: 2.37-6.24); P<0.001], military hospital employment [OR: 2.32 (95% CI: 1.25-4.31); P=0.008], USA [OR: 3.41 (95% CI: 1.03-11.22); P=0.044] or UK [OR: 8.86 (95% CI: 1.91-41.07); P=0.005] qualifications, and information on supportive measures [OR: 2.2 (95% CI: 1.36-3.56); P=0.001]. CONCLUSION: Health workers displayed good knowledge about COVID-19, while profession and working experience predicted adequate knowledge, positive attitude, or practice towards disease management.

The Association between Symptoms of Nomophobia, Insomnia and Food Addiction among Young Adults: Findings of an Exploratory Cross-Sectional Survey.

No previous research has examined the association between symptoms of nomophobia and food addiction. Similarly, only a few studies have examined the association between nomophobia and symptoms of insomnia. This exploratory study utilized an online self-administered, structured questionnaire that included: basic sociodemographic and anthropometrics; the nomophobia questionnaire (NMP-Q); the insomnia severity index (ISI); and the Yale Food Addiction Scale (YFAS) in a convenience sample of young adults (18-35 years) in Bahrain (n = 654), 304 (46%) males and 350 (54%) females. Symptoms of severe nomophobia, moderate-severe insomnia, and food addiction were more common among female participants both for each disorder separately and in combination; however, differences did not reach statistical significance. For severe nomophobia, the rate for females was 76 (21.7%) and for males was 57 (18.8%) p = 0.9. For moderate-severe insomnia, the rate for females was 56 (16%) and for males was 36 (11.84%) p = 0.1. For food addiction, the rate for females was 71 (20.29%) and for males was 53 (17.43%) p = 0.3. A statistically significant association was present between nomophobia and insomnia r = 0.60, p < 0.001. No association was found between nomophobia and food addiction. Nomophobia is very common in young adults, particularly in females; nomophobia is associated with insomnia but not with food addiction.

The Prevalence of Psychological Distress and Its Relationship to Sleep Quality in Saudi Arabia's General Population During the COVID-19 Pandemic.

BACKGROUND: We aimed to examine the effect of the COVID-19 pandemic and associated mitigation measures on sleep quality and psychological distress in Saudi Arabia. METHODS: Subjective sleep quality over the preceding 30 days was measured using the Pittsburgh Sleep Quality Index (PSQI). In addition, Kessler Psychological Distress Scale (K10) was used to assess the psychological distress. RESULTS: The study included 836 participants. The median age was 28 years, 624 (74.64%) were females, and 158 (18.90%) were healthcare workers. Factors associated with poor sleep were recent changes in the sleep habits p = 0.004), anxiety or fear because of coronavirus news on social media p = 0.02), fear because there was no approved drug to treat COVID-19 p = 0.03), and unaware of the presence of chronic diseases p = 0.03). Female gender p = 0.02), fear or anxiety because of coronavirus news on social media p = 0.04), recent change in sleep habits (OR: 1.97 (1.15-3.39); p = 0.01), fear because there is no approved drug to treat COVID-19 p = 0.001), monthly income <1000 SR p = 0.01), and isolation p = 0.01) were associated with distress. PSQI and K10 scores were significantly correlated p < 0.001). CONCLUSION: Poor sleep and psychological distress are common during the COVID-19 outbreak in Saudi Arabia. Identifying factors associated with poor sleep and psychological distress would help develop specific intervention programs that enhance mental health and sleep quality during pandemics.

Arab Women Adherence to the Mediterranean Diet and Insomnia.

Background and objective: Sleeping difficulties affect the overall health, nutrition, and wellbeing. The Mediterranean diet has proven effective in improving the quality of life and overall health of people of all ages. Therefore, this study aimed to determine whether adherence to the Mediterranean diet (MD) is linked to reduced insomnia in Arabic-speaking female adults in Jordan. Materials and Methods: A self-administered, cross-sectional survey was used to detect the relationship between MD and sleep quality in Arabic-speaking female adults. Data were collected from 917 Arabic-speaking female participants of 14 Arab nationalities in Jordan between March and May 2021 via social media. All participants answered the whole questionnaire, including questions on sociodemographic aspects, Mediterranean diet adherence, sleeping habits measured with the Athens Insomnia Scale (AIS), and lifestyle components such as smoking and dietary patterns. Results: The mean age of the 917 Arabic-speaking female participants was 36 ± 10 years. Most participants were unemployed (85%) single females (64%) with an undergraduate degree (74%). Most of them (86%) were non-smokers. More than half of the participants were Jordanians (57%). The BMI was normal for 52% of the participants, whereas 26% of them were overweight, and 12% were obese. One-way ANCOVA showed a statistically significant difference between MD adherence score categories and AIS, F (2, 914) = 3.36, p = 0.015. Among the MD adherence score categories, we found that between groups, MD scores above or equal to 10 were associated with a statistically significant difference in AIS. Cohen's value was calculated for the three MD score categories and indicated a 'small' effect size association between all adherence scores of the MD categories and AIS. Conclusions: In conclusion, our findings provide preliminary evidence that participants' adherence to the MD was significantly associated with better sleep and reduced insomnia symptoms, highlighting the need for further research.

Antihypertensive effect of fermented skim camel (Camelus dromedarius) milk on spontaneously hypertensive rats.

BACKGROUND: Hypertension is one of the most common diseases in worldwide, thus prevention of hypertension is important in reducing the risks of cardiovascular disease. Milk contains bioactive peptides released during milk fermentation which lead to exhibit angiotensin I converting enzyme (ACE) inhibitory. OBJECTIVE: The aim of this study was to investigate the antihypertensive effect of fermented skim camel milk on rats and compared with unfermented skim camel milk as control. METHODS: The antihypertensive effect of fermented skim camel milk on thirty six male spontaneously hypertensive rats (SHR) was carried out for (short-term) and (long-term) using different doses (80, 240 and 1200 mg/kg body weight). Angiotensin converting enzyme (ACE) activity was also measured using ACE Kit. RESULTS: The blood pressure (systolic and diastolic) of spontaneously hypertensive rats (SHR) in short term administration (24 hours) of 1200 mg/kg body weight fermented skim camel milk decreased significantly (p < 0.05) from 22 to 36 mmHg and 28 to 32 mmHg, respectively, at four and eight hour of post administration. On the other hand, the blood pressure of fermented skim camel milk for long-term (20 days) decreased and affected the heart rate (beats/min). The lowest record of systolic (41 mmHg) and diastolic blood pressure (19 mmHg) were at dose of 1200 mg/kg body weight of fermented skim camel milk at 15 days of administration. Likewise, ACE activity in plasma of SHR administered fermented skim camel milk decreased significantly (p < 0.05) compared with the control group. CONCLUSION: The hypotensive effect of fermented skim camel milk by L. helveticus and S. thermophillus in SHR rats depends on the high dose of fermented skim camel milk in short and long-term. The ACE activity inhibitory was clear with fermented skim camel milk.

Antihypertensive effect of fermented skim camel (Camelus dromedarius) milk on spontaneously hypertensive rats / Efecto antihipertensivo de la leche de camello fermentada (Camelus dromedarius) en ratas hipertensas

Background: Hypertension is one of the most common diseases in worldwide, thus prevention of hypertension is important in reducing the risks of cardiovascular disease. Milk contains bioactive peptides released during milk fermentation which lead to exhibit angiotensin I converting enzyme (ACE) inhibitory. Objective: The aim of this study was to investigate the antihypertensive effect of fermented skim camel milk on rats and compared with unfermented skim camel milk as control. Methods: The antihypertensive effect of fermented skim camel milk on thirty six male spontaneously hypertensive rats (SHR) was carried out for (short-term) and (long-term) using different doses (80, 240 and 1200 mg/kg body weight). Angiotensin converting enzyme (ACE) activity was also measured using ACE Kit. Results: The blood pressure (systolic and diastolic) of spontaneously hypertensive rats (SHR) in short term administration (24 hours) of 1200 mg/kg body weight fermented skim camel milk decreased significantly (p < 0.05) from 22 to 36 mmHg and 28 to 32 mmHg, respectively, at four and eight hour of post administration. On the other hand, the blood pressure of fermented skim camel milk for long-term (20 days) decreased and affected the heart rate (beats/min). The lowest record of systolic (41 mmHg) and diastolic blood pressure (19 mmHg) were at dose of 1200 mg/kg body weight of fermented skim camel milk at 15 days of administration. Likewise, ACE activity in plasma of SHR administered fermented skim camel milk decreased significantly (p < 0.05) compared with the control group. Conclusion: The hypotensive effect of fermented skim camel milk by L. helveticus and S. thermophillus in SHR rats depends on the high dose of fermented skim camel milk in short and long-term. The ACE activity inhibitory was clear with fermented skim camel milk (AU)

Introducción: la hipertensión es una de las enfermedades más frecuentes en el mundo, por lo que su prevención es importante en el objetivo de disminuir el riesgo de enfermedad cardiovascular. La leche contiene péptidos bioactivos que se liberan durante su fermentación con un efecto inhibitorio sobre el enzima convertidor de la angiotensina (ECA). Objetivo: el objeto de este estudio fue investigar el efecto antihipertensivo de la leche de camello fermentada en un modelo experimental de ratas con hipertensión comparándolas con un grupo control alimentado con la misma leche sin fermentar. Métodos: se valoró el efecto antihipertensivo de la leche de camello fermentada en 36 ratas macho hipertensas de forma espontánea a corto y a largo plazo usando diferentes dosis (80, 240 y 1.200 mg/kg de peso). También se midió la actividad del ECA. Resultados: la presión arterial (sistólica y diastólica) disminuyó a corto plazo (24 horas) con la dosis de 1.200 mg/kg (p < 0,05), pasando de 36 a 22 mmHg y de 32 a 28 mmHg, respectivamente a las 4 y 8 horas postadministración. Por otra parte, la tensión arterial a largo plazo en el grupo que consumió la leche de camello fermentada afectó disminuyendo la frecuencia cardiaca. Las medidas inferiores de presión sistólica (41 mmHg) y distólica (19 mmHg) aparecieron en el grupo que recibía 1.200 mg/kg a los 15 días del inicio de la administración de leche de camello fermentada. Por otra parte, la actividad del ECA disminuyó signifi cativamente en el grupo con leche fermentada (p < 0,05). Conclusiones: el efecto antihipertensivo de la leche de camello fermentada con L. helveticus y S. Thermophillus en ratas con hipertensión depende la cantidad administrada, tanto a corto como a largo plazo. El efecto inhibitorio sobre el ECA fue manifiesto en el grupo que recibió leche de camello fermentada (AU)