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Title: Dietary factors and type 2 diabetes mellitus in urban Saudi adults
Author: Al-Khudairy, Lena
ISNI:       0000 0004 5364 2103
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2014
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Background: Saudi Arabia is ranked sixth for the highest prevalence of T2DM worldwide. There is very little information on dietary factors associated with the prevalence of T2DM in Saudi Arabia. There is an urgent need for the identification of culturally specific T2DM risk factors to then develop culturally tailored public awareness programs and interventions, to reduce the prevalence of T2DM. Objectives: To conduct a systematic review of the association between dietary factors and T2DM in the Middle Eastern region. To determine the association between dietary factors, including anthropometric measures, selected food items and beverages, selected dietary biomarkers and T2DM in Saudi adults. To identify culturally specific barriers to healthy eating in Saudi adults, with and without T2DM. Methods: The systematic review was conducted by searching several electronic databases and contacting authors, libraries, and research centres in the Middle East. Included studies assessed potential dietary factors for T2DM in Middle Eastern adults. An existing cross-sectional survey (n = 2631), which is part of a larger Biomarkers Screening Survey conducted in the urban area of Riyadh, Saudi Arabia (2009), of Saudi adults aged ≥ 18 years, was used to examine the association between dietary factors and T2DM. Anthropometric measures (n = 2355) included body mass index (BMI), waist circumference (WC), waist to hip ratio and sagittal abdominal diameter. Selected food/beverage included 17 items collected from a food freque ncy questionnaire (FFQ) (n = 1867). The FFQ was validated in this study against two 24 hour dietary recalls (n = 98). Dietary biomarkers included vitamin D and selenium (n = 567). Barriers to healthy eating were assessed by face-to-face interviews (n =108) carried out using modified predeveloped Saudi questionnaires and an additional questionnaire developed and piloted for the purpose of this study. Results: The systematic review highlighted the large gap in evidence of associations between dietary factors and T2DM in the Middle Eastern region in general and Saudi Arabia specifically. For the cross-sectional analyses, the overall sample was 2631 adults (females: 1280, males: 1351) and the prevalence of T2DM was 29.3% (females: 25.4%, males: 32.9%). WC was associated with T2DM independently of BMI, specifically in males. The intake of dates showed an inverse association with T2DM in males. Vitamin D levels were significantly higher in females with diabetes in comparison to nondiabetics. Serum selenium was associated positively with lipid parameters in females and fasting insulin in males. However, selenium was not associated with diabetes. Lack of dietary knowledge and culturally specific barriers (lack of social support, lack of will power and reliance) were barriers to healthy eating in participants with and without T2DM. Conclusion: The findings of this thesis highlight culturally specific factors associated with T2DM in Saudi adults. Further dietary studies in relation to T2DM are required in Saudi Arabia. Cultural issues should be incorporated when designing health awareness campaigns to address Saudis specific needs.
Supervisor: Not available Sponsor: Maktab al-Thaqāfī al-Saʻūdī (London, England)
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RC Internal medicine