Waleed Tamimi

Background: Type 2 diabetes (T2D) is a growing health concern among adolescents, driven by rising obesity rates. Early identification of prediabetes, particularly impaired fasting glucose (IFG), can guide interventions to reduce long‐term risks. Despite the global burden of diabetes, limited data exist on Saudi adolescents, a population experiencing high rates of obesity. Objective: To determine the prevalence and associated factors for IFG in a representative sample of Saudi adolescents. Methods: We conducted a cross‐sectional analysis on a subgroup of participants from the national Jeeluna study (2011–2012), which sampled adolescents aged 10–19 years from all 13 regions of Saudi Arabia. Anthropometric measurements, fasting plasma glucose levels, and lifestyle data were collected. Dysglycemia (IFG or diabetes) was defined using American Diabetes Association (ADA) criteria. A logistic regression analysis was conducted to identify factors associated with dysglycemia. Results: The study included 5,421 participants (50.8% females; mean ± SD age was 15.9 ± 1.8 years). Prevalence of dysglycemia was 4.8% (IFG: 4.1%; diabetes: 0.7%). Dysglycemia was more prevalent in obese adolescents (8.2%) compared to overweight (4.8%) and nonobese/nonoverweight peers (4.1%), p < 0.0001. Regional differences were noted with the highest prevalence in Mecca (6.1%). Compared with nondysglycemic patients, those who were dysglycemic had higher proportion of individuals consuming fast food meals per week ( p = 0.03), body mass index (BMI) ( p < 0.0001), tri‐ponderal mass (TMI) ( p < 0.001), waist‐to‐height ratio ( p = 0.001) and systolic BP ( p < 0.001) and lower triglycerides ( p < 0.0001). Factors independently associated with dysglycemia included systolic BP (OR = 1.03; 95% CI 1.01–1.04, p < 0.0001), triglyceride levels (OR = 1.60; 95% CI 1.27–2.00, p < 0.0001) and geographical region (Mecca OR = 1.54, 95% CI 1.07–196, Riyadh OR = 0.61,95% CI 0.42–0.89, p < 0.001, compared with other regions combinedly). Conclusion: Our study highlights the prevalence of dysglycemia (4.8%) among Saudi adolescents, particularly in those with obesity. Risk factors included higher BMI and increased fast food consumption. Notably, regional differences were observed, with Mecca reporting the highest prevalence. Our findings underscore the need for targeted interventions in obesity, focusing on promoting healthy lifestyles and early screening for T2D in this vulnerable population.

Objective. Puberty has a significant contribution to the final height. Therefore, it is crucial to understand the normal variations in the onset and tempo of puberty in a specific population. In this study, we aimed to provide normative data on the timing of puberty and late pubertal height (LPH) in Saudi schoolboys in Riyadh. Methods. This is a cross-sectional field study (20112013) including Saudi schoolboys (grades 112; aged 6 to 19 years). Schools were chosen to represent the population from urban and rural areas in the Riyadh region. Pubertal maturity staging for gonads was assessed by measuring testicular size using a Prader orchidometer and assessing the Tanner staging of pubic hair. The marginal mean age was calculated using regression analysis. Results. We recruited 1086 schoolboys. The estimated mean age of pubertal onset at G2 was 11.8 (95 CI 11.6012.0) years, for gonadal development at G3 was 13.2 (95 CI 12.913.5), G4=15.0 (95 CI 14.715.2), and G5=16.1 (95 CI 15.916.3) years, and for pubic hair stage 2 (PH2) was 12.6 (95 CI 12.412.9) years. The estimated time from G2/PH2 to G5/PH5 was 4.3 and 3.9years, respectively. At the onset of puberty, the mean height was 144.7cm and it reached 167.8cm at G5 with a pubertal height gain of 23.1cm. Conclusion. Our data present the norms of the timing of puberty and LPH in Saudi schoolboys. Saudi adolescent males are shorter than some European and American comparatives mainly due to shortness during childhood. However, they could have shorter LPH than Turkish, Greek, Thai, and Japanese due to a less pubertal height gain.

Background: Low‐density lipoprotein cholesterol (LDL‐C), as a modifiable risk factor for atherosclerotic cardiovascular disease, should be assessed and monitored. This study compared directly measured and Friedewald‐estimated LDL‐C values in children and adolescents.Methods: Blood samples were collected from 464 children and adolescents. Calculated LDL‐C (CLDL‐C) levels were estimated using the Friedewald formula for any triglyceride value below 4.6 mmol/L. Direct LDL‐C (DLDL‐C) levels were measured on an ARCHITECT c8000 Abbott Clinical Chemistry Analyzer. The differences in LDL‐C were then calculated.Results: The correlation coefficients (R) between DLDL‐C and CLDL‐C were 0.978 (P = .148) and R = 0.970 (P = .052) for children and adolescents, respectively. Children with LDL‐C values above 4.92 mmol/L had a correlation value of 0.971 (P = .419). The correlation and agreement between DLDL‐C and CLDL‐C in adolescents were moderate for LDL‐C below 2.85 mmol/L (R = 0.806; 84.1%) and improved above 2.85 mmol/L (R = 0.978; 91.5%). In children, good correlations between DLDL‐C and CLDL‐C were observed for normal (R = 0.9782, 0.990, and 0.951, respectively). The rates of agreement were better for normal (80.5%) and borderline (82.9%) but not abnormal (68.2%) triglyceride levels.Conclusion: We observed good agreement between DLDL‐C and CLDL‐C in both children and adolescents. The Friedewald formula provided an adequate estimate of LDL‐C for most fasting specimens. LDL‐C difference percentage can also be used as a quality indicator to check laboratory analyzer performance in healthy subjects.

Background: Diabetes mellitus is a chronic illness that is a worldwide issue. HbA1c has been used to monitor glycemic control in patients with diabetes for many years. Although HbA1c measurement is needed for calculating estimated average blood glucose (eAG), it is now recommended that eAG is used instead of HbA1c for expression of blood glucose control and communication with patients and health care providers. This study, investigated fasting blood glucose (FBS) as an indicator of overall chronic blood sugar control by assessing the correlation between FBS with eAG derived from HbA1c. Methods: The blood samples for HbA1c assay were collected in EDTA tubes and were analyzed by an HPLC analyzer (G8 Tosoh, Japan). Blood samples for FBS were collected in serum separator tubes, transported, and centrifuged for 15 minutes at 3,000 g. FBS levels were determined in serum samples with the enzymatic hexokinase method by a clinical chemistry analyzer (Architect 8000, Abbott, USA). Results: Statistical analysis was performed on 1,740 patients with type 2 diabetes mellitus with HbA1c levels above 6.5 mmol/L. The difference between FBS (9.3 +/- 3.7 mmol/L) and eAG (11.14 +/- 2.7 mmol/L) was statistically significant (p < 0.0001). The correlation coefficient between FBS and eAG was r = 0.65 (95% CI; 0.62 - 0.69), with a p-value < 0.0001. While the correlation coefficient between FBS and eAG at HbA1c < 6.5% was r = 0.251 (95% CI, 0.16 - 0.34), with a significant p-value of < 0.00001. The combined data, standard deviation (SD), median, and interquartile range of eAG and FBS for all of the diabetic groups (n = 2,315), were 10.1 +/- 3.00 mmol/L, 9.5 mmol/L, and 7.75 - 12.03 mmol/L for eAG, respectively. Similarly, these values were 8.5 +/- 3.6 mmol/L, 7.5 mmol/L, and 6.0 - 10.00 mmol/L for FBS, respectively. Conclusions: We concluded that there is a moderate and significant positive correlation between fasting blood sugar and the estimated average blood glucose derived from HbA1c. Although FBS might be helpful for daily monitoring of diabetes. Further studies must be conducted to provide solid results to support that FBS and its derived variable eAG can replace HbA1c as an indicator of long-term overall control of T2DM patients.

The objective of this study was to evaluate leptin, ghrelin, and leptin/ghrelin ratio in critically ill patients and association of leptin/ghrelin ratio with outcomes. This is a sub-study of the PermiT trial (ISRCTN68144998). A subset of 72 patients who were expected to stay >14 days in the Intensive care unit were enrolled. Blood samples were collected on days 1, 3, 5, 7, and 14. Samples were analyzed for leptin and active ghrelin in addition to other hormones. Baseline leptin/ghrelin ratio was calculated, and patients were stratified into low and high leptin/ghrelin ratio based on the median value of 236. There was a considerable variation in baseline leptin level: Median 5.22 ng/mL (Q1, Q3: 1.26, 17.60). Ghrelin level was generally low: 10.61 pg/mL (Q1, Q3: 8.62, 25.36). Patients with high leptin/ghrelin ratio compared to patients with low leptin/ghrelin ratio were older, had higher body mass index and more likely to be diabetic. There were no differences in leptin/ghrelin ratio between patients who received permissive underfeeding and standard feeding. Multivariable logistic regression analysis showed that age and body mass index were significant independent predictors of high leptin–ghrelin ratio. Leptin–ghrelin ratio was not associated with 90-day mortality or other outcomes. Age and body mass index are predictors of high leptin/ghrelin ratio. Leptin/ghrelin ratio is not affected by permissive underfeeding and is not associated with mortality.

Purpose: This study examined the effect of permissive underfeeding compared to target feeding and intensive insulin therapy (IIT) compared to conventional insulin therapy (CIT) on the inflammatory mediators monocyte chemoattractant protein 1 (MCP-1), soluble intercellular adhesion molecule 1 (sICAM-1), and tissue factor (TF) in critically ill patients. Methodology: This was a substudy of a 2 × 2 factorial design randomized controlled trial in which intensive care unit (ICU) patients were randomized into permissive underfeeding compared to target feeding groups and into IIT compared to CIT groups (ISRCTN96294863). In this substudy, we included 91 patients with almost equal numbers across randomization groups. Blood samples were collected at baseline and at days 3, 5, and 7 of an ICU stay. Linear mixed models were used to assess the differences in MCP-1, sICAM-1, and TF across randomization groups over time. Results: Baseline characteristics were balanced across randomization groups. Daily caloric intake was significantly higher in the target feeding than in the permissive underfeeding groups (P-value < 0.01), and the daily insulin dose was significantly higher in the IIT than in the CIT groups (P-value < 0.01). MCP-1, sICAM-1, and TF did not show any significant difference between the randomization groups, while there was a time effect for MCP-1. Baseline sequential organ failure assessment (SOFA) score and platelets had a significant effect on sICAM-1 (P-value < 0.01). For TF, there was a significant association with age (P-value < 0.01). Conclusions: Although it has been previously demonstrated that insulin inhibits MCP-1, sICAM-1 in critically ill patients, and TF in non-critically ill patients, our study demonstrated that IIT in critically ill patients did not affect these inflammatory mediators. Similarly, caloric intake had a negligible effect on the inflammatory mediators studied.

Objectives: The objectives of this study were to evaluate the clinical and nutritional correlates of high free fatty acids (FFAs) level in critically ill patients and the association with outcomes, and to study the effect of short-term caloric restriction (permissive underfeeding) on FFAs level during critical illness. Patients/Method: In this pre-planned sub-study of the PermiT (Permissive Underfeeding vs. Target Enteral Feeding in Adult Critically Ill Patients) trial, we included critically ill patients who were expected to stay for ≥14 days in the intensive care unit. We measured FFAs level on day 1, 3, 5, 7, and 14 of enrollment. Of 70 enrolled patients, 23 (32.8%) patients had high FFAs level (baseline FFAs level >0.45 mmol/L in females and >0.6 mmol/L in males). Results: Patients with high FFAs level were significantly older and more likely to be females and diabetics and they had lower ratio of partial pressure of oxygen to the fraction of inspired oxygen, higher creatinine, and higher total cholesterol levels than those with normal FFAs level. During the study period, patients with high FFAs level had higher blood glucose and required more insulin. On multivariable logistic regression analysis, the predictors of high baseline FFAs level were diabetes (adjusted odds ratio (aOR): 5.36; 95% confidence interval (CI): 1.56, 18.43, p = 0.008) and baseline cholesterol level (aOR, 4.29; 95% CI: 11.64, 11.19, p = 0.003). Serial levels of FFAs did not differ with time between permissive underfeeding and standard feeding groups. FFAs level was not associated with 90-day mortality (aOR: 0.49; 95% CI: 0.09, 2.60, p = 0.40). Conclusion: We conclude that high FFAs level in critically ill patients is associated with features of metabolic syndrome and is not affected by short-term permissive underfeeding.

The Role of Urinary Neutrophil Gelatinase-Associated Lipocalin in Predicting Acute Kidney Dysfunction in Patients With Liver Cirrhosis

The routine chemical assays are affected by sample haemolysis, icterus and lipaemia, collectively known as serum indices; however, little attention has been given to the consequences of these conditions on hormonal assays (immunoassays). In this study, we assess the impact of interferences from exogenous serum indices on various endocrine assays performed on the Abbott Architect i2000 system. The pool of 20 serum samples was derived from a hospitalised population. The diluted serum samples were spiked with red cell haemolysate, Intralipid and bilirubin. The interferences were studied at baseline; 12.5%, 25%, 50%, 75% and 100% of 5.0 g/L haemoglobin; 1% of 20% Intralipid; and 0.342 mmol/L of bilirubin according to the EP7-A2 guideline (Interference Testing in Clinical Chemistry; CLSI, USA). Aliquots were analysed in duplicate and/or triplicate for various hormones on the Abbott Architect i2000 immunoassay analyser. Serum ferritin (r²=0.84; P=0.074) and TSH (r²=0.81; P=0.52) levels showed a direct relationship with haemolysis and therefore overestimated because of the effects of haemolysis. The vitamin B₁₂ level progressively decreased as the amount of haemolysis increased (r²=-0.76; P=0.136). There was a significant decrease in progesterone concentration owing to lipaemia (r²=-0.983; P=0.003). For icteric interferences, a strong inverse correlation was observed for folic acid and was shown to be statistically significant (r²=–0.94; P=0.017). Assays for ferritin, TSH, vitamin B₁₂, folic acid and progesterone showed various degrees of interference because of the variability in serum indices.