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1.  Strong Associations Between the Pesticide Hexachlorocyclohexane and Type 2 Diabetes in Saudi Adults 
Pesticide exposure has been implicated as an environmental risk factor for the development of type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the association of the body burden of the pesticide hexachlorocyclohexane (HCH) with the risk of T2DM in a sample of adults from Saudi Arabia. Serum samples were obtained from 280 adult subjects. Hexachlorocyclohexane isomer residues were measured by high-resolution gas chromatography-mass spectrometry. Data on lifestyle, dietary habits, and health status were gathered. Associations between exposure and T2DM were analyzed by logistic regression. Around 49% of adults enrolled in this study were diagnosed with T2DM. Among various HCH isomers, serum concentrations of the pesticides β and γ-HCH were most strongly and consistently linked to T2DM in our studied subjects. Associations of HCH varied across five components of the metabolic syndrome. It positively and significantly associated with four out of the five components, especially elevated triglycerides, high fasting glucose, high blood pressure and HOMA-IR but negatively and significantly with HDL-cholesterol. This study in line with earlier ones about diabetes associated with HCH pesticide exposure and proposes possible hormonal pathways worthy of further investigation.
PMCID: PMC4199001  PMID: 25177822
type 2 diabetes mellitus; organochlorine pesticides; metabolic syndrome
2.  Stress and cardiometabolic manifestations among Saudi students entering universities: a cross-sectional observational study 
BMC Public Health  2014;14:391.
In this observational study, we aimed to see whether transition in Saudi students entering university life could be a breeding stage for cardiometabolic risk factor emergence and clustering.
A total of 1878 apparently healthy Saudi students of the Preparatory Year, King Saud University, Riyadh, KSA (1112 men and 766 women) spanning 2 academic years were included. They were divided into 2 groups based on the validated perceived stress test (PST). Anthropometrics were obtained and fasting blood samples were collected for measurement of fasting blood glucose and a lipid profile.
PST score (>27) considered indicative of stress was noted in 44.4% of students. The prevalence of this score was higher in women than in men (49.7% versus 40.7%). The prevalence of obesity, hypertension and dyslipidemia was significantly higher in men than women (p < 0.01), and this was even more apparent among stressed men, who had a significantly higher prevalence of all the above cardiometabolic factors than the non-stressed ones (p < 0.01).
Perceived stress is alarmingly high among Saudi students entering universities. This study sheds light on the social responsibility of universities in promoting a healthy lifestyle, particularly in this age group, when exposure to different kinds of stressors may result in body weight and metabolic changes.
PMCID: PMC3998220  PMID: 24755010
Stress; Cardiometabolic clustering; Saudi; Students; College life; Perceived stress
3.  Perceived Stress Scores among Saudi Students Entering Universities: A Prospective Study during the First Year of University Life 
In this prospective study we wanted to determine whether perceived stress over time among students in the Preparatory Year of King Saud University (KSU) predisposes them to cardiometabolic abnormalities. A total of 110 apparently healthy Saudi students (35 men and 75 women enrolled during the 2010−2011 academic year) were included. Perceived stress was determined at baseline and 1 year later. Anthropometrics were obtained and morning fasting serum glucose, lipid profile and cortisol were measured at both times. Perceived stress was noted among 48.2% of subjects at baseline and was not significantly different after follow-up, with 45.4% scoring high. In men, the prevalence of perceived stress was 48.6% at baseline (13 out of 35) and 37.1% at follow-up (13 out of 35), while in women it was 48% at baseline and 49.3% at follow-up. Interestingly, significant improvements in the blood pressure and lipid profiles, with the exception of HDL-cholesterol, were observed in both men and women, while fasting glucose also improved in women. Serum cortisol was inversely associated to fasting glucose, and total- and LDL-cholesterol (p-values 0.007, 0.04 and 0.04, respectively). These data are opposite to findings in students entering Western universities, in whom increasing stress and a deteriorating cardiometabolic profile have been repeatedly noted. Perceived stress and morning cortisol levels among students of the Preparatory Year in KSU remained constant for both genders over time, yet an improved cardiometabolic profile was observed, suggesting good adaptation among our pre-college students in their first year of university life.
PMCID: PMC4025010  PMID: 24727357
stress; college life; Saudi students
4.  Differences and associations of metabolic and vitamin D status among patients with and without sub-clinical hypothyroid dysfunction 
Sub-clinical hypothyroid dysfunction, a relatively understudied disorder in the Kingdom of Saudi Arabia (KSA), has significant clinical implications if not properly monitored. Also from KSA, more than 50% of the population suffer from hypovitaminosis D (<50 nmol/l). In this cross-sectional case-control study, we described the differences and associations in the metabolic patterns of adult Saudis with and without hypothyroid dysfunction in relation to their vitamin D status, PTH, calcium and lipid profile.
A total of 94 consenting adult Saudis [52 controls (without subclinical hypothyroidism), 42 cases (previously diagnosed subjects)] were included in this cross-sectional study. Anthropometrics were obtained and fasting blood samples were taken for ascertaining lipid and thyroid profile, as well as measuring PTH, 25(OH) vitamin D and calcium.
Cases had a significantly higher body mass index than the controls (p < 0.001). Circulating triglycerides was also significantly higher in cases than the controls (p = 0.001). A significant positive association between HDL-cholesterol and PTH (R = 0.56; p = 0.001), as well as a negative and modestly significant negative association between LDL-cholesterol and PTH (R = - 20.0; p = 0.04) were observed. FT3 was inversely associated with circulating 25 (OH) vitamin D (R = -0.25; p = 0.01).
Patients with hypothyroid dysfunction possess several cardiometabolic risk factors that include obesity and dyslipidemia. The association between PTH and cholesterol levels as well as the inverse association between vitamin D status and FT3 needs to be reassessed prospectively on a larger scale to confirm these findings.
PMCID: PMC3751774  PMID: 23962199
Thyroid dysfunction; Obesity; Dyslipidemia; Saudi
5.  Vitamin D supplementation in patients with diabetes mellitus type 2 on different therapeutic regimens: a one-year prospective study 
Little or no research has determined the effect of vitamin D3 supplementation in conjunction with pharmacological and non-pharmacological approaches in the diabetes mellitus type 2 (DMT2) patients. The objective of this study was to determine the effect of vitamin D3 supplementation in a cohort of Saudi DMT2 population on diet, insulin and/or different oral hypoglycemic agents and compare them with a non-DMT2 control cohort.
A total of 499 randomly selected Saudi subjects divided into 8 groups [Non-DMT2 Control = 151; Rosiglitazone alone = 49; Diet = 15; Insulin alone = 55; Insulin + Orals = 12; Metformin alone = 121; Oral agents combination = 37; Sulphonylurea alone = 59] were included in this 12-month interventional study. All DMT2 patients were given 2000 IU vitamin D3 daily, while the control group received none but were advised to increase sun exposure. Anthropometrics, glucose, lipid profile and 25-hydroxyvitamin D (25-OHVitD) were measured at baseline, 6 and 12 months.
Circulating 25-OHVitD concentrations improved in all patient groups. The metformin group showed the highest change in circulating vitamin D levels both at 6 months (62.6%) and 12 months (50.6%) as compared to baseline (p < 0.001). No significant changes were observed in the BMI and glucose in any of the DMT2 groups. In contrast, the insulin + oral agents group showed more significant improvements in the metabolic profile, which included triglycerides and total cholesterol, as well as systolic blood pressure and HDL-cholesterol in males. Also, significant decreases in triglycerides were observed in the rosiglitazone and insulin + oral hypoglycemic agent groups both at 6 and 12 months of supplementation (both p-values <0.001).
While in all DMT2 groups circulating levels of 25-OHVitD increased after supplementation, in DMT2 patients on insulin in combination with other drugs benefitted the most in improving cardiovascular risk. Metformin improves 25-hydroxyvitamin D levels but did not seem to confer other added cardiometabolic benefits.
PMCID: PMC3750473  PMID: 23924389
Vitamin D; Vitamin D supplementation; Diabetes mellitus; Anti-diabetes therapies
6.  Tea and coffee consumption in relation to vitamin D and calcium levels in Saudi adolescents 
Nutrition Journal  2012;11:56.
Coffee and tea consumption was hypothesized to interact with variants of vitamin D-receptor polymorphisms, but limited evidence exists. Here we determine for the first time whether increased coffee and tea consumption affects circulating levels of 25-hydroxyvitamin D in a cohort of Saudi adolescents.
A total of 330 randomly selected Saudi adolescents were included. Anthropometrics were recorded and fasting blood samples were analyzed for routine analysis of fasting glucose, lipid levels, calcium, albumin and phosphorous. Frequency of coffee and tea intake was noted. 25-hydroxyvitamin D levels were measured using enzyme-linked immunosorbent assays.
Improved lipid profiles were observed in both boys and girls, as demonstrated by increased levels of HDL-cholesterol, even after controlling for age and BMI, among those consuming 9–12 cups of coffee/week. Vitamin D levels were significantly highest among those consuming 9–12 cups of tea/week in all subjects (p-value 0.009) independent of age, gender, BMI, physical activity and sun exposure.
This study suggests a link between tea consumption and vitamin D levels in a cohort of Saudi adolescents, independent of age, BMI, gender, physical activity and sun exposure. These findings should be confirmed prospectively.
PMCID: PMC3478213  PMID: 22905922
Coffee intake; Tea intake; Vitamin D levels; Saudi adolescents
7.  Vitamin D supplementation as an adjuvant therapy for patients with T2DM: an 18-month prospective interventional study 
Vitamin D deficiency has been associated with impaired human insulin action, suggesting a role in the pathogenesis of diabetes mellitus type 2 (T2DM). In this prospective interventional study we investigated the effects of vitamin D3 supplementation on the metabolic profiles of Saudi T2DM subjects pre- and post-vitamin D supplementation over an 18-month period.
T2DM Saudi subjects (men, N = 34: Age: 56.6 ± 8.7 yr, BMI, 29.1 ± 3.3 kg/m2; women, N = 58: Age: 51.2 ± 10.6 yr, BMI 34.3 ± 4.9 kg/m2;) were recruited and given 2000 IU vitamin D3 daily for 18 months. Anthropometrics and fasting blood were collected (0, 6, 12, 18 months) to monitor serum 25-hydroxyvitamin D using specific ELISA, and to determine metabolic profiles by standard methods.
In all subjects there was a significant increase in mean 25-hydroxyvitamin D levels from baseline (32.2 ± 1.5 nmol/L) to 18 months (54.7 ± 1.5 nmol/L; p  < 0.001), as well as serum calcium (baseline = 2.3 ± 0.23 mmol/L vs. 18 months = 2.6 ± 0.1 mmol/L; p = 0.003). A significant decrease in LDL- (baseline = 4.4 ± 0.8 mmol/L vs. 18 months = 3.6 ± 0.8 mmol/L, p  < 0.001] and total cholesterol (baseline = 5.4 ± 0.2 mmol/L vs. 18 months = 4.9 ± 0.3 mmol/L, p < 0.001) were noted, as well as a significant improvement in HOMA-β function ( p  = 0.002). Majority of the improvements elicited were more prominent in women than men.
In the Saudi T2DM population receiving oral Vitamin D3 supplementation (2000 IU/day), circulating 25-hydroxyvitamin D levels remained below normal 18 months after the onset of treatment. Yet, this “suboptimal” supplementation significantly improved lipid profile with a favorable change in HDL/LDL ratio, and HOMA-β function, which were more pronounced in T2DM females.
PMCID: PMC3461474  PMID: 22809461
Vitamin D; Diabetes mellitus; Saudi; Supplementation
8.  Effect of physical activity and sun exposure on vitamin D status of Saudi children and adolescents 
BMC Pediatrics  2012;12:92.
Accumulating evidence suggests an increased prevalence of vitamin D deficiency in the Middle East. In this context, we aimed to determine whether the prevalence of vitamin D deficiency is related to degree of physical activity and sun exposure among apparently healthy Saudi children and adolescents, a little studied population.
A total of 331 Saudi children aged 6–17 years (153 boys and 178 girls) were included in this cross sectional study. Levels of physical activity and sun exposure were determined using a standard questionnaire. Anthropometry, serum calcium and 25-(OH) vitamin D were analyzed.
All subjects were vitamin D deficient, the majority being moderately deficient (71.6%). Age was the single most significant predictor affecting 25 (OH) Vitamin D levels, explaining 21% of the variance perceived (p = 1.68 x 10-14). Age-matched comparisons revealed that for groups having the same amount of sun exposure, those with moderate or are physically active will have higher levels of vitamin D status, though levels in across groups remained deficient.
Vitamin D deficiency is common among Saudi children and adolescents, and is influenced by both sun exposure and physical activity. Promotion of an active outdoor lifestyle among Saudi children in both homes and schools may counteract the vitamin D deficiency epidemic in this vulnerable population. Vitamin D supplementation is suggested in all groups, including those with the highest sun exposure and physical activity.
PMCID: PMC3407533  PMID: 22759399
Vitamin D; Saudi children
The aim of the study was to assess the dietary intake of flavonoids and their effect on serum lipid levels in Saudi patients with coronary heart disease (CHD).
A cross-sectional study with a sample of 50 CHD patients and 50 controls. A 24-hour recall method was used to collect data on the dietary intake of macronutrients, flavonoids, and antioxidant vitamins. A food frequency questionnaire (FFQ) was used to collect data on habitual consumption during the year preceding the interview. Baseline data collection included medical history, anthropometric measurements, physical activity, and smoking status.
CHD patients showed significantly less intake of fruits and vegetables compared to the controls. Serum lipids including total cholesterol (TC), triglycerides (TG), and low density lipoproteins (LDL) were found to be significantly higher in CHD patients than in the controls. The main sources of flavonoids in a typical Saudi diet are tea, fruits (apples), vegetables (onions), and chocolate. The intake of flavonoids and antioxidant vitamins was significantly lower in CHD patients compared to the controls. A negative correlation between the dietary intake of different flavonoids and serum LDL was observed in CHD patients. Significant correlation was found between the intake of flavonol and waist to hip ratio
The findings of the study support a potential protective effect of dietary flavonoids in relation to CHD. The study showed that consuming more Flavonoids may have positive effect on lowering blood lipids.
PMCID: PMC3410154  PMID: 23012157
Flavonoids; antioxidants; coronary heart disease; lipid profile; Saudi Arabia.

Results 1-9 (9)