Adipocyte "Fatty Acid Binding Protein" Gene Polymorphisms (rs1054135, rs16909196 and rs16909187) in Jordanians with Obesity and Type 2 Diabetes Mellitus.

Background: Obesity, type 2 diabetes mellitus (T2DM), and dyslipidemia may result from the interactions of genetic and environmental factors. There are controversial reports concerning the association of polymorphisms (rs1054135, rs16909196 and rs16909187) in the gene of adipocyte fatty acid binding protein (FABP4) with obesity and T2DM. Therefore, we designed this study to determine the association of these polymorphisms with obesity, T2DM, and dyslipidemia among Jordanian subjects. Methods: The study was approved by the National Center for Diabetes, Endocrinology, and Genetics (NCDEG) Institutional Review Board (IRB). A total of 397 subjects were enrolled in the study and divided into four groups as described in materials and methods section. The fatty acid binding protein 4 (FABP4) gene containing (rs1054135, rs16909196 and rs16909187) single nucleotide polymorphisms (SNP) was amplified by polymerase chain reaction (PCR) followed by Sanger DNA sequencing of the PCR product. Results: None of the three SNPs were associated with T2DM (p > 0.05). The rs16909187 and rs16909196 were significantly associated with obesity. The wild type (CC) of rs16909187 was significantly higher among the overweight and obese group compared with normal weight controls (OD = 2.17, 95% CI = 1.18 - 3.96, p =0.01). The wild type of rs16909196 (AA) was significantly higher among the overweight and obese group compared to controls, (OD = 2.26, 95% CI = 1.24 - 4.14, p = 0.01). These results may indicate that the wild-type may be a risk factor for obesity.Only the rs1054135 SNP was significantly associated with increased low density lipoprotein (LDL) levels in the overweight and obese group compared with the controls (p = 0.03). Conclusions: The wild-type genotypes of rs16909196 and rs16909187 may be risk factors for obesity but not T2DM. None of the three SNPs was associated with T2DM.

Time trends in diabetes mellitus in Jordan between 1994 and 2017.

AIM: The prevalence of diabetes has been increasing over the past few decades. The objective of this study is to assess the time trends in diabetes between 1994 and 2017 in Jordan. METHODS: Surveys were conducted in 1994, 2004, 2009 and 2017 by the same investigators using generally similar methods. Fasting blood glucose was measured in all surveys. Variables were obtained using structured questionnaires designed specifically for the surveys. Crude and age-specific diabetes prevalence rates were derived for each sex, together with overall, crude and age-standardized prevalence rates. RESULTS: The prevalence of diabetes in men aged ≥ 25 years increased from 14.2% in 1994 to 18.3% in 2004, 26.8% in 2009 and 32.4% in 2017. The corresponding prevalence rates in women were 12.3%, 16.9%, 18.8%, and 18.1%, respectively. The overall age-standardized prevalence rate increased from 13.0% in 1994 to 17.1% in 2004, 22.2% in 2009 and 23.7% in 2017. Known diabetes in the 2017 survey accounted for 82.6% of people with diabetes. A HbA1c of < 59 mmol/mol (7.5%) was observed in 41.4% of participants with known diabetes. CONCLUSION: The results showed a high prevalence of diabetes in Jordan among people aged ≥ 25 years. Prevalence increased from 1994 to 2009, but slowed thereafter. The increase was greater in men than in women. Previously diagnosed diabetes accounted for a high percentage of people with diabetes in all surveys and was highest in 2017 survey, suggesting that the national strategy against diabetes has brought some benefits. Efforts should be made to improve glycaemic control in people with diabetes.

Are insulin analogues an unavoidable necessity for the treatment of type 2 diabetes in developing countries? The case of Jordan.

Despite their reported benefits in terms of glycaemic control, insulin analogues are expensive for patients in developing countries. This study in Jordan aimed to compare the effectiveness and adverse events of premixed human insulin (BHI30) versus premixed insulin analogue (BIAsp30) in patients with type 2 diabetes. In a retrospective cohort study from October 2012 to March 2013, outcomes (HbA1c, weight, hypoglycaemia and lipohypertrophy) were compared at baseline and 6 months after treatment in 628 patients. BHI30 produced a significantly greater reduction in HbA1c than did BIAsp30. This difference in HbA1c remained significant after controlling for the effects of age, sex, duration of diabetes, body mass index and hypoglycaemia (ß-coefficient was -0.18 in favour of BHI30). Weight gain and mild hypoglycaemia was significantly higher with BHI30 than with BIAsp30. BHI30 achieved better reduction in HbA1c compared with BIAsp30, with less cost, slightly more weight gain and greater reported mild hypoglycaemia.

Prevalence of coeliac disease among adult patients with autoimmune hypothyroidism in Jordan.

The prevalence of coeliac disease among patients with autoimmune hypothyroidism has not been studied before in Jordan and other Arab countries. A cross-sectional record-based review was made of all adult autoimmune hypothyroidism patients who attended a referral centre in Jordan, during an 8-month period. Coeliac disease in these patients was diagnosed by the attending physician based on positive serological tests for anti-endomysial antibodies IgA and IgG followed by duodenal biopsy to confirm the diagnosis of coeliac disease. Of 914 patients recruited, 117 (12.8%) were seropositive for coeliac disease. Of 87 seropositive patients who underwent duodenal biopsy, 39 had positive histological findings of coeliac disease (44.8%). Extrapolating from these findings the overall rate of coeliac disease among autoimmune hypothyroidism patients was estimated to be 5.7%. In multivariate logistic regression coeliac disease was significantly associated with older age (> 40 years), presence of other autoimmune diseases, vitamin B12 deficiency and anaemia.

Depression is associated with low levels of 25-hydroxyvitamin D among Jordanian adults: results from a national population survey.

Although low serum 25-hydroxyvitamin D (25(OH)D) and elevated serum parathyroid hormone (PTH) have been associated with depression in clinical settings, this link in community-dwelling individuals is inconclusive. The present study aimed at examining the association between serum 25(OH)D and PTH levels and the presence of depression in a national population-based household sample of 4,002 Jordanian participants aged ≥25 years. The DASS21 depression scale was used to screen for depression, and serum concentrations of 25(OH)D and PTH were measured by radioimmunoassay. Multiple logistic regression models were used to explore the association between serum 25(OH)D and PTH levels and depression. The unadjusted odds ratio (OR) decreased linearly with increasing quartiles of serum 25(OH)D (P(trend) = 0.00). The OR for having depression was significantly higher among individuals in the first and second quartiles (OR = 1.4, 1.23, respectively) than among those in the fourth quartile (P values = 0.00 and 0.03, respectively). This relationship remained significant after adjusting for age, sex, marital status, education, BMI, serum creatinine, number of chronic diseases (OR = 1.39 and 1.21 and P values = 0.00 and 0.05, respectively) and after further adjustment for exercise, altitude, and smoking (OR = 1.48 and 1.24, respectively, and P values = 0.00 and 0.03, respectively). No significant association was found between serum PTH levels and depression. The decrease in risk of depression among participants started to be significant with serum 25(OH) D levels higher than 42.3 ng/ml (lower limit of the range of the third quartile). This value may help pinpoint the desirable level of serum 25(OH)D to be attained to help aid the prevention and treatment of depression.

Vitamin D status in Jordan: dress style and gender discrepancies.

BACKGROUND/AIMS: Vitamin D deficiency is highly prevalent worldwide and has been linked to many diseases. The aims of the present study were to assess the vitamin D status of Jordanians at the national level and to identify groups of the population at high risk for vitamin D deficiency. METHODS: Vitamin D status was assessed in a national sample of 5,640 subjects aged ≥7 years. The study involved interviews, laboratory measurements of 25(OH)D and others, and physical measurements. The present report deals, exclusively, with subjects aged >18 years. RESULTS: The prevalence of low vitamin D status [25(OH)D <30 ng/ml] was 37.3% in females compared to 5.1% in males. Dress style in females was independently related to low vitamin D status; women wearing 'Hijab' (adjusted OR = 1.7, p = 0.004) or 'Niqab' (adjusted OR = 1.5, p = 0.061) were at a higher risk for low vitamin D status than were western-dressed women. CONCLUSION: The high prevalence of low vitamin D status in females in contrast with a low prevalence in males, together with a higher prevalence in women wearing Hijab or Neqab, calls for action to increase the population's awareness and to develop strategies to reduce this risk among women, particularly those wearing dress styles that cover most or all of their skin.

Glycaemic control and its associated factors in type 2 diabetic patients in Amman, Jordan.

A study of 1000 patients attending a diabetes referral centre in Amman, Jordan, identified factors associated with good glycaemic control, as measured by glycosylated haemoglobin (HbA1c) levels. Glycaemic control improved significantly between the first clinic visit and at 12-months follow-up. The proportion of patients with extreme HbA1c (> or = 10%) decreased from 15.3% to 6.0% after 12 months. The percentage of patients with optimal control (HbA1c < 7%) increased from 25.4% at the first visit to 27.5% at 12-month follow-up. Multivariate regression showed that low body mass index, shorter duration of diabetes and higher baseline HbA1c were related to reductions in HbA1c between the first and 12-month visits.

Diabetes mellitus: the leading cause of haemodialysis in Jordan.

This study aimed to define the role of diabetes mellitus as a cause of end-stage renal disease requiring haemodialysis in Jordan, and to compare diabetic and nondiabetic patients. All patients on haemodialysis in Jordan at the time of the survey in 2003 (n = 1711) were personally interviewed and additional data were obtained from medical records. Diabetes mellitus was the most common cause of end-stage renal disease (29.2% of cases). The mean age of patients was higher in diabetics [57.5 years, standard deviation (SD) 12.3] than nondiabetics (45.4 years, SD 17.1). Duration on haemodialysis was significantly shorter in diabetics compared to nondiabetic patients.

Epidemiology and cost of haemodialysis in Jordan.

To assess the epidemiology and burden of haemodialysis in Jordan, all patients on haemodialysis (1711 patients) were surveyed during September/October 2003. Mean age was 48.9 years, 56% were male, 86.8% were unemployed and 92% were poor. Mean distance to the haemodialysis service was 13.6 km. Annual hepatitis B and C seroconversion for patients negative before dialysis was 0.34% and 2.6% respectively. Prevalence of haemodialysis was 312 per million population; the incidence in 2002 was 111 per million population. Fatality rate at 1 year was 20%. Diabetes mellitus was the leading cause of haemodialysis, 29.2% of cases. Total estimated cost of haemodialysis in 2003 was US$ 29.7 million.

Effect of glucose on the growth hormone response to L-dopa in normal and diabetic subjects.

The effect of hyperglycemia on the growth hormone response to oral L-dopa (500 mg.) was assessed in eight normal and eight insulin-dependent diabetic subjects. A peak growth hormone response of 21.0 +/- 4.0 ng./ml. (mean +/- S.E.M.), significantly above baseline (p less than 0.01), was achieved in the normal group following oral L-dopa. Glucose concentrations did not change and were approximately 80 mg./100 ml. throughout. Administration of 100 gm. oral glucose with the L-dopa, or thirty minutes thereafter, totally suppressed the growth hormone response in all eight and six of the subjects, respectively. A peak growth hormone response of 20.0 "/- 1.7 ng./ml. (mean +/- S.E.M.), significantly above baseline (p less than 0.001), was obtained in eight nonobese, insulin-dependent diabetics, in spite of prevailing hyperglycemia (mean plasma glucose 243-258 mg./100 ml.) throughout the test. Endogenous hyperglycemia was achieved in these patients by lessening the usual strict adherence to plasma glucose control for the purpose of the study. These results suggest an abnormality in the hypothalamus or pituitary of diabetic subjects allowing growth hormone responsiveness in spite of hyperglycemia.

Penile measurements in normal adult Jordanians and in patients with erectile dysfunction.

The purpose of this work was to determine penile size in adult normal (group one, 271) and impotent (group two, 109) Jordanian patients. Heights of the patients, the flaccid and fully stretched penile lengths were measured in centimeters in both groups. Midshaft circumference in the flaccid state was recorded in group one. Penile length in the fully erect penis was measured in group two. In group one mean midshaft circumference was 8.98+/-1.4, mean flaccid length was mean 9.3+/-1.9, and mean stretched length was 13.5+/-2.3. In group two, mean flaccid length was 7.7+/-1.3, and mean stretched length was 11.6+/-1.4. The mean of fully erect penile length after trimex injection was 11.8+/-1.5. In group 1 there was no correlation between height and flaccid length or stretched length, but there was a significant correlation between height and midpoint circumference, flaccid and stretched lengths, and between stretched lengths and midpoint circumference. In group 2 there was no correlation between height and flaccid, stretched, or fully erect lengths. On the other hand, there was a significant correlation between the flaccid, stretched and fully erect lengths. Comparing group 1 and group 2, the patients in group 1 were slightly older than in group 2 (P=0.035), but there was no significant difference in their height. However, there was a significant difference regarding the mean flaccid length 9.3 vs 7.7 (P=0.001), and the mean stretched length 13.5 vs 11.6 (P=0.000). We divided both groups into those who are less than 40 y of age, and over 40 y old. There was no statistical difference in the stretched and flaccid lengths between the younger and older individuals in each group. However, when we compared the stretched and flaccid lengths in those of less than 40 y old in group 1 and 2, a significant difference was noticed. Similarly, a significant difference in the stretched and flaccid lengths in those patients over 40 y of age was also present.

Prevalence of blindness and visual impairment among Jordanian diabetics.

PURPOSE: To investigate the prevalence of blindness and visual impairment among a population of Jordanian diabetics. METHODS: A total of 986 diabetic patients were fully assessed, including complete history, examination, and laboratory tests. All patients underwent detailed eye examination, which included visual acuity, slit-lamp examination, tonometry, funduscopy, and fundus fluorescein angiography (FFA). RESULTS: Of all patients examined, 53.2% were male and 46.8% were female. The mean age and duration of diabetes were 55.3 and 11.9 years. Of all patients, 93.3% had type 2 while 6.7% had type 1 diabetes mellitus (DM). Over half (50.3%) were on oral hypoglycemic agents, 34% on insulin, and 14.5% on both types of treatment, whereas only 1.2% were on diet alone. The mean value for HbA1c was 7.7%. The prevalence of blindness among participants was found to be 7.4%, while 10.1% were visually impaired. Diabetic retinopathy (DR) was present in 64.1%, 37.8% had cataract, and 8.7% had undergone cataract surgery. Using multivariate logistic regression analysis, visual impairment was significantly associated with age, treatment of diabetes, and DR, while only age and retinopathy were significantly related to blindness. CONCLUSIONS: DM is a common disease in Jordan and DR is highly prevalent among Jordanian diabetics. National screening and educational programs are highly needed to reduce the risk of blindness and visual impairment among diabetic patients.

The effect of hypoglycemia on hypothalamic thyrotropin-releasing hormone (HRH) in the rat.

A rapid radioimmunoassay for TRH with a high degree of specificity and sensitivity is described. The procedure is capable of measuring TRH in amounts less than 15 pg/tube. Such an assay system has enabled us to study the effect of hypoglycemia on hypothalamic TRH content. Forty-eight female, adult Holtzman rats were divided into 8 groups of 6. Regular insulin was injected intraperitoneally into each rat except for the basal group. A separate batch of similar rats was studied in the same fashion except that saline was injected instead of insulin. Each group of rats was decapitated and the trunk blood collected at 0, 15, 30, 45, 60, 90, 120 and 180 min post-injection. Appropriate tissues were rapidly taken and immediately extracted in ice-cold methanol. Hypothalamic TRH, pituitary TSH, serum TSH and serum triiodothyronine (T3) and thyroxine (T4) were serially determined. In the insulin-treated group, a rapid fall in blood sugar was observed reaching a nadir in 15 min. Hypothalamic TRH fell from a basal mean +/- SE value of 3.25 +/- 0.31 ng to 1.54 +/- 0.14 ng/hypothalamus (P less than 0.01). Pituitary TSH decreased from 10.0 +/- 0.9 mug to a low of 2.6 +/- 0,8 mug/pituitary (P less than 0.02) at 30 min postinsulin. Serum TSH increased from a basal level of 42.5 +/- 20.5 muU/mo to a peak of 102.1 +/- 10.0 muU/ml 45 min (P less than 0.05) after insulin administration. The incremental change in serum T3 occurred at 90 min when T3 levels increased from a baseline of 107.5 +/- 53.7 ng/100 ml to a peak of 711.7 +/- 20.2 ng/100 ml (P less than 0.01). No changes in T4 were observed. The control group of rats did not show significant changes in hypothalamic TRH. The results of the study indicate that hypoglycemia can induce depletion (presumably release) of hypothalamic TRH with a consequent cascade stimulation of the pituitary-thyroid axis.

The effect of acute hypercalcemia on growth hormone release in man.

The growth hormone response to acute hypercalcemia was studied in 9 normal subjects. Growth hormone, calcium, glucose, phosphate and magnesium levels were determined at 30-min intervals during 4-h infusions. Infusions, performed in random order in the subjects, consisted of either normal saline at 3 ml/min for / h or 15 mg calcium/kg (calcium gluconate at 3 ml/min for 3 h followed by normal saline for the fourth hour. Significant hypercalcemia (P less than 0.05) was achieved within 60 min and maintained throughout the infusion. No change in calcium concentrations occurred during normal saline infusions, and phosphate, glucose and magnesium were unchanges in all studies. Growth hormone levels were significantly higher (P less than 0.05) at 60 min and all subsequent determinations during calcium infusion when compared to normal saline infusions. In 6 of the subjects, standard l-dopa provocative testing with an oral dose of 500 mg was preformed during normal saline and calcium infusions identical to those described above. Peak growth hormone responses did not differ significantly following l-dopa during saline or calcium infusion. These results suggest that an acute increase in circulating calcium promotes greater basal growth hormone secretion without a synergistic increase in hypothalamic mediated growth hormone release by l-dopa.

Chronic propranolol administration impairs glucagon release during insulin-induced hypoglycemia in normal man.

Failure of a plasma glucagon rise in response to insulin-induced hypoglycemia was demonstrated in normal subjects taking therapeutic doses of the nonselective beta-adrenergic blocker, propranolol, for 7 days before testing. This is the first study to examine glucose homeostasis in normal subjects exposed to chronic propranolol therapy and helps to explain the development of spontaneous hypoglycemia in patients, either diabetic or nondiabetic, during beta-adrenergic receptor blockade. Previous studies of the acute parenteral effects of propranolol administration failed to show any significant effect on glucagon secretory dynamics in response to insulin-induced hypoglycemia. In the present study, however, chronic oral administration of propranolol resulted in severe impairment of the expected glucagon rise in response to hypoglycemia and was associated with severe hypoglycemia in one normal subject.

Acute myelofibrosis and malignant hypercalcemia.

A 33 year old man presented with symptoms of one week's duration; he had a serum calcium of 22.5 mg/dl and a markedly hypercellular bone marrow. Despite therapy with saline diuresis, furosemide mithramycin, total parathyroidectomy and corticosteroids, symptomatic hypercalcemia was poorly controlled. Inappropriate serum parathyroid hormone (PTH) levels were found before and after parathyroidectomy whereas assays of the peripheral blood for osteoclast-activating factor and prostaglandin E (PGE2) were negative. An elevated leukocyte alkaline phosphate level, the inability to aspirate marrow, the marked generalized hyperplasia of all hematopoietic marrow elements, the focal accumulations of blastic cells and increasing reticulin fiber formation led to the diagnosis of acute myelofibrosis. A single course of cytosine arabinoside and thioguanine therapy was followed by profound hyperphosphatemia, hypocalcemia and death. The rarity of hypercalcemia with myeloproliferative disorders is documented by a review of the world literature, and the possible mechanism for hypercalcemia in this patient is discussed.

Prevalence, awareness and management of hypertension in a recently urbanised community, eastern Jordan.

The objectives of this study were to: (1) estimate the magnitude of hypertension, and its levels of awareness and control of hypertension among a recently urbanised community of Jordanian aborigines; and (2) to compare the study findings with findings from other Jordanian communities. A sample was randomly selected from the roster of all inhabitants of the community aged 25 years or older. Data on 545 subjects included in the sample were collected during the months of January and February of 1995. A total of 89 (16.3%) subjects were suffering hypertension defined as systolic blood pressure > or =160 mm Hg and/or diastolic blood pressure > or =95 mm Hg or on antihypertensive medication. Prevalence rate of hypertension was comparable to that reported from other Jordanian communities who have experienced an urban lifestyle earlier than the reference community. Logistic regression analysis indicated that hypertension was positively associated with age, illiteracy, body mass index, family history of hypertension, and diabetes mellitus. No association was detected between hypertension and each of gender, smoking, and total serum cholesterol. This study showed that the vast majority of hypertensive patients (82.0%) were aware of their diagnosis. However, more than two-thirds (68.5%) of those aware of their diagnosis did not achieve control of their hypertension. In conclusion, hypertension is a common public health problem in this community and that the hypertension management programme is far below the optimal level.

Prevalence and associated factors of hypertension: results from a three community-based survey, Jordan.

The aim of this study was to estimate the prevalence of hypertension, to determine its association with certain cardiovascular disease risk factors, and to evaluate level of hypertension awareness and control in an adult population in Jordan. The study used a cross-sectional population survey of a systematic sample of three communities. Data for the sample of 2299 adults, aged 25 years and older, were collected from September 1994 to September 1995. A total of 370 subjects or 16.1% were found to have hypertension. The prevalence rate was higher among women (17.1%) than men (14.4%). Logistic regression analysis indicated that hypertension was positively associated with gender, age, family history of hypertension, diabetes mellitus, and total serum cholesterol, but negatively associated with level of education. No association between hypertension and smoking was detected in this study. About one-half (48.6%) of hypertensives in this study were unaware of their diagnosis. Awareness of hypertension was positively associated with age and family history. More than one-third (36.5%) of those aware of their diagnosis did not achieve control of their hypertension. Hypertension appears to be a common public health problem in Jordan. Awareness and control of hypertension are far below optimal levels.

Growth status of Jordanian schoolchildren in military-funded schools.

OBJECTIVE: To study the growth status of Jordanian boys and girls in comparison with the Centers for Disease Control (CDC) growth charts. DESIGN: Cross-sectional study. SUBJECTS AND DATA COLLECTION: A total of 5826 boys and 1414 girls, aged 6.5-17.5 y, were included in the study. Height and weight were measured. Body mass index (BMI) was calculated as weight (kg) divided by the square of the height (m). Socioeconomic data were collected using a structured questionnaire. RESULTS: The height-for-age values fluctuated between the 5th and 10th percentiles of the CDC for both sexes, and then after the age of 8.5 and 14.5 y for boys and girls, respectively, values were just above the 10th percentile. The body weight-for-age values were just above the 25th percentile for boys and fluctuated between the 25th and 50th percentiles for girls; then after the age of 14.5 and 12.5 y for boy and girls, respectively, values fluctuated between the 25th and 50th percentiles for boys and just above the 50th percentile for girls of the CDC values. BMI values for boys were just above the 50th percentile of the CDC and for girls values fluctuated between the 50th and 75th percentiles until the age of 13.5, then values matched the 75th percentile of the CDC. CONCLUSION: The height of Jordanian children ranges from the 5th to the 10th percentile of the CDC reference values during schools years. Girls have a tendency toward obesity after puberty.

Tertiary hyperparathyroidism after high-dose phosphate therapy in adult-onset hypophosphatemic osteomalacia.

OBJECTIVE: To describe a case of adult-onset hypophosphatemic osteomalacia treated with orally administered phosphate and complicated by tertiary hyperparathyroidism. METHODS: We present pertinent clinical, radiologic, and laboratory details of the study patient for a period of more than 20 years and discuss the few reported cases of tertiary hyperparathyroidism attributable to prolonged phosphate therapy. RESULTS: A 49-year-old Jordanian man, who had been diagnosed at age 26 years as having sporadic adult-onset hypophosphatemic vitamin D-resistant osteomalacia, presented with severe right hip pain, severe osteopenia with lytic bone lesions, and hypercalcemia after prolonged oral treatment with phosphate and vitamin D. These clinical, radiologic, and biochemical findings, in conjunction with a very high serum parathyroid hormone level, indicated the diagnosis of tertiary hyperparathyroidism, which was substantiated histopathologically. CONCLUSION: Physicians should be aware of the potential for development of tertiary hyperparathyroidism in patients receiving prolonged oral phosphate therapy.