ObjectiveAdequate sleep is an important factor for maintaining good health among children. However, there have been few studies reporting on the association of sleep duration with breakfast intake frequency. This study examined the prevalence of nocturnal sleep duration among Saudi children and its association with breakfast intake, screen time, physical activity levels and socio-demographic variables.MethodsA multistage stratified cluster random sampling technique was used to select 1051 elementary school children in Riyadh. Weight and height were measured and body mass index was computed. The sleep duration, daily breakfast intake frequency, socio-demographic and lifestyle behaviors were assessed using a specifically designed self-reported questionnaire filled by the children’s parents.ResultsOver 71% of the Saudi school children did not attain the recommended sufficient sleep duration at night. Results of logistic regression analysis, adjusted for confounders, exhibited significant associations between longer sleep duration and younger age (aOR=1.12, p=0.046), being female (aOR=1.39, p=0.037), higher father educational levels, daily breakfast intake (aOR=1.44, p=0.049) and lower screen time (aOR for >2 hrs/day=0.69, p=0.033). However, no significant (p> 0.05) association was found for mother education, family income, number of family member in the house, overweight/obesity, or physical activity levels.ConclusionThe prevalence of insufficient nocturnal sleep among Saudi children was high. Insufficient sleep was associated with breakfast and several important socio-demographic and lifestyle behaviors. The findings of this study support the development of interventions to prevent insufficient sleep and help Saudi children improve their sleeping habits.

Background Breakfast is an important meal that provides essential nutrients and energy. However, few comprehensive studies have reported breakfast habits and related behaviors among Saudi children. This study investigated breakfast consumption patterns and the associations of socio-demographic variables with daily breakfast intake among Saudi children. Methods A multistage stratified cluster random sampling technique was used to select 1051 elementary school boys and girls in Riyadh. Body weight and height were measured and body mass index (BMI) was computed. The breakfast eating habits and behaviors were assessed using a specifically designed self-reported questionnaire that was completed by the children’s parents. Results More than 79% of children skipped daily breakfast, with no significant sex difference. Children in private schools consumed breakfast more frequently than those attending public schools. Multivariate analyses showed that boys in private schools had a significantly higher intake of breakfast than that in boys in public schools, yet, boys in public schools had significantly higher BMI than boys in private schools. Using logistic regression while adjusting for confounders showed insignificant effect for parent education. Among breakfast eaters, spread cheese sandwiches were consumed most frequently, followed by fried egg sandwiches and breakfast cereals. Full-fat milk, tea with milk, water, and fruit juice were the most consumed drinks. Girls consumed significantly more fresh fruits during breakfast than did boys. Mothers prepared breakfast at home most of the time (84.5%). Parents appeared mostly satisfied with the breakfast consumed by their child at home and placed high importance on breakfast compared to lunch or dinner. Conclusions The proportion of school children who ate daily breakfast at home was low, which may have implications for children’s school performance. Effort is needed to promote daily breakfast consumption among Saudi school children and to introduce appropriate interventions aimed at promoting daily breakfast consumption among Saudi children.

Objective: To explore the impact of auditory integrative training (AIT) on the inflammatory biomarker transforming growth factor (TGF)-β1 and to assess its effect on social behavior in children with autism spectrum disorder (ASD). Subjects and Methods: In this cross-sectional study, 15 patients (14 males and 1 female) with ASD aged 3-12 years were recruited. All were screened for autism using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Plasma levels of TGF-β1 were measured in all patients using a sandwich enzyme-linked immunoassay (ELISA) immediately and 1 and 3 months after the AIT sessions. Pre- and post-AIT behavioral scores were also calculated for each child using the Childhood Autism Rating Scale (CARS), the Social Responsiveness Scale (SRS), and the Short Sensory Profile (SSP). Data were analyzed using the Statistical Package for the Social Sciences (SPSS 21.0 for Windows). Results: Plasma levels of TGF-β1 significantly increased to 85% immediately after AIT (20.13 ± 12 ng/mL, p < 0.05), to 95% 1 month after AIT (21.2 ± 11 ng/mL, p < 0.01), and to 105% 3 months after AIT (22.25 ± 16 ng/mL, p < 0.01) compared to before AIT (10.85 ± 8 ng/mL). Results also revealed that behavioral rating scales (CARS, SRS, and SSP) improved in terms of disease severity after AIT. Conclusion: Increased plasma levels of TGF-β1 support the therapeutic effect of AIT on TGF-β1 followed by improvement in social awareness, social cognition, and social communication in children with ASD. Furthermore, TGF-β1 was associated with severity in all scores tested (CARS, SRS, and SSP); if confirmed in studies with larger sample sizes, TGF-β1 may be considered as a marker of ASD severity and to assess the efficacy of therapeutic interventions.

Objective: To explore a possible role for activity-regulated cytoskeleton-associated (Arc/Arg3.1) protein in the clinical identification of children with autism. Subjects and Methods: The plasma levels of Arc/Arg3.1 in 62 boys with autism and 32 healthy boys were measured using an enzyme-linked immunosorbent assay (ELISA). The Childhood Autism Rating Scale (CARS) was used to assess the severity of autism as defined in theDiagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). The Mann-Whitney U test was used for comparisons between children with autism and healthy children. The Spearman r correlation coefficient (r) was used to determine the relationship between the CARS scores among patients with autism and different variables. Results: The mean plasma level of Arc/Arg3.1 protein in autism was 1.689 ± 0.917 pg/ml, significantly higher than that of healthy controls, i.e. 0.792 ± 1.056 pg/ml (p < 0.001). No significant relationship was found between plasma levels of Arc/Arg3.1 protein and CARS scores (r = -0.06; p > 0.05) or age (r = -0.27; p > 0.05). Conclusions: The mean plasma level of Arc/Arg3.1 protein was higher in children with autism than in controls, suggesting that Arc/Arg3.1 could be a potential early blood biomarker for diagnosis of autism.

Autism spectrum disorder (ASD) is complex neurodevelopmental condition described by impairments in three main behavioral areas: social deficits, impaired communication, and repetitive behaviors. Despite many years of vast study, the causes of ASD are still unknown. Various risk factors including genetic, infectious, metabolic and immunological have been investigated however, environmental, nutritional and diabetes related risk factors have not received sufficient attention. This study has provided an insight into the comprehensive interaction between environmental pollution, dietary factors and diabetes mellitus that could lead to the advancement of this debilitating neurodevelopment disorder. The literature search was done using PubMed and Google Scholar databases up to October 2018. Key words “Environmental Pollution”, “Nutritional Factors”, “Diabetes Mellitus”, “Autism Spectrum Disorder” were selected. doi: https://doi.org/10.12669/pjms.35.4.269 How to cite this:Alhowikan AM, AL-Ayadhi LY, Halepoto DM. Impact of environmental pollution, dietary factors and diabetes mellitus on Autism Spectrum Disorder (ASD). Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.269 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ObjectiveTo compare three body mass index (BMI) classifications that are used to assess the prevalence of overweight and obesity among Saudi children aged 6–13 years: the International Obesity Task Force (IOTF) age and gender cutoffs, the World Health Organization (WHO) growth references for school-aged children, and the Saudi (KSA) national growth references.MethodsThe sample comprised 2,169 children (52.5% girls) derived from two cross-sectional studies conducted in Riyadh and Jeddah during the 2017 and 2019 school years, respectively. Body weight and height were measured, and BMI was calculated.ResultsThe proportions (%) of the participants who were classified as underweight, overweight, and obese varied according to the reference used: IOTF reference (13.8, 18.4, and 12.7), WHO reference (17.2, 19.1, and 18.9), and KSA reference (7.0, 22.4, and 9.3), respectively, indicating higher values for overweight and obesity prevalence when the WHO references were used. Kappa agreement measures between the three references were found to be high, with the coefficients ranging from 0.936 (between the IOTF and KSA references) to 0.849 (between the IOTF and WHO references). In all three classifications, girls exhibited lower overweight or obesity prevalence than boys. Family income, but not paternal or maternal education, was significantly (p = 0.015) associated with overweight/obesity when using the IOTF standards. In addition, having a small family in the house was significantly (p &lt; 0.05) associated with obesity, irrespective of the classification system.ConclusionInconsistency was observed when estimating the prevalence of underweight, overweight, and obesity among Saudi children. However, when defining the overall prevalence of overweight plus obesity among Saudi children, the IOTF classification system performed in a similar way to the KSA references (31.1% versus 31.7%) compared to the WHO references (38.0%).

BackgroundCisplatin is a common anticancer drug with potential cardiac and renal toxicities. Rutin, a natural compound present in various medicinal plants, has been shown to protect against chemotherapy-induced toxicities. In this study, we explored the protective effect of rutin against the dose-dependent cardiotoxic effects of cisplatin such as perfusion pressure, histopathologic effect on the myocardium, and oxidative stress in isolated perfused rat hearts. MethodologyThe cardiotoxic effects of cisplatin were studied at three dosages (1, 7, and 14 mg/L) in isolated perfused rat hearts. The dose-dependent, cisplatin-induced toxic effects on left ventricular pressure (LVP), heart rate (HR), dp/dt (maximum), dp/dt (minimum), perfusion pressure, pressure-time index, contractility index, and duration of diastole were assessed. The effects of cisplatin were measured one minute before perfusion of cisplatin and 60 minutes after perfusion of the isolated rat hearts. ResultsCisplatin (1-14 mg/L) caused a significant (p < 0.05) dose-dependent reduction in LVP. The percentage LVP values reduced from 94 ± 9 (control untreated hearts) to 70 ± 6, 69 ± 5, and 65 ± 4 in hearts treated with 1, 7, and 14 mg/L of cisplatin, respectively. Similarly, cisplatin at similar doses caused a marked reduction in the values of dp/dt (maximum), dp/dt (minimum), and pressure-time index in isolated rat hearts. The respective percentage values of these parameters compared to those of untreated hearts were significantly reduced from 101 ± 7 to 72 ± 5, 92 ± 8 to 69 ± 4, and 92 ± 12 to 57 ± 7 in hearts treated with 14 mg/L of cisplatin. Perfusion of hearts with rutin trihydrate (1 µM/L) 10 minutes before administration of cisplatin and throughout the experiment attenuated the detrimental effects of cisplatin on cardiac functions in isolated rat hearts (p < 0.05). In addition, cisplatin-induced degeneration and necrosis of cardiac muscle cells reduced with the concurrent administration of rutin and restored normal heart histology. Moreover, cisplatininduced reduction in glutathione and increased level of malondialdehyde in the myocardium was reversed by concurrent administration of rutin in isolated rat hearts. ConclusionsCisplatin produced a dose-dependent impairment of several parameters of cardiac function such as LVP, contractility index, and pressure-time index. It caused histopathological alterations in isolated rat hearts. These harmful effects of cisplatin were suppressed by rutin trihydrate, suggesting the potential protective effects of rutin against cisplatin-induced cardiotoxicity. Rutin trihydrate also improved the reduced glutathione contents and suppressed the malondialdehyde contents in the cardiac tissue of isolated rat hearts, suggesting that the observed beneficial effects of rutin trihydrate in this study could be related to its antioxidant properties.

Introduction: Resistant starch (RS) has been considered to have many of the health benefits of dietary fibre (1)(2) . Although resistant starch type-3 (retrograded starch, RS3) has a particular interest, due to its thermal stability where it has high gelatinization temperatures, a very limited number of studies have investigated its beneficial impact on health (3)(4) . The current study aimed to examine the effects of RS3 on postprandial glycemic and insulinemic responses as well as appetite in young healthy males.Methods: Eight healthy males aged 18-35 years, BMI 23.9 ± 0.8 kg/m2, participated in this randomized, single-blind crossover control study. Participants attended the laboratory after overnight fasting (≥8 h) on two separate occasions, at least 1 week apart. On each laboratory visit, participants were given either a control meal or an RS3 meal. Both of the two meals were vegetarian pasta and were matched for energy intake and composition, ingredients and amount but were prepared in a different way. The control meal was hot freshly cooked pasta and the RS3 meal was re-heated pasta that had been chilled overnight. Blood samples were taken at fasting and 15-min intervals for 3 h after the meal consumption. Subjective appetite ratings were also assessed using visual analogue scale (VAS) while fasting and 3 h following the meal consumption. Differences in postprandial blood variables and subjective appetite ratings were determined.A significant increase in iAUC for satiety following the RS3 meal consumption compared with the control meal was observed (mean±SD: RS3 meal: 10181.25 ±3140.65 mm; control meal: 7132.37 ± 3187.31 mm; p = 0.03, paired T-test). iAUC for desire to eat was significantly decreased following the RS3 meal consumption compared with the control meal (−8190.75 ± 4333.34 mm vs −4594.50 ± 1481.11 mm; p = 0.03, paired T-test). On the other hand, no significant differences were found in postprandial blood glucose, serum insulin and plasma ghrelin levels between the two meals (All p > 0.05, paired T-test). There were also no differences in fasting blood glucose, serum insulin, plasma ghrelin and subjective appetite ratings between the control and RS3 meals (All p > 0.05, paired T-test).This study shows that consuming the RS3 meal was associated with greater satiety and lower desire to eat in young healthy males which may lead to weight management in the long term. Further intervention studies are warranted to examine the beneficial impact of long-term consumption of RS3 on health.