ObjectivesIn Kuwait, as in many Arab states in the Gulf region, there are limited data on the prevalence of vitamin D deficiency among healthy adolescents. This study aimed to estimate the prevalence of vitamin D deficiency in a nationally representative sample of adolescents and investigate factors associated with vitamin D status.MethodsA cross-sectional study was conducted on 1416 adolescents aged 11–16 years, who were randomly selected from middle schools in all governorates of Kuwait. Data were collected from parents through self-administered questionnaire and from adolescents through face-to-face interview. Vitamin D was measured using liquid chromatography-tandem mass spectrometry. Logistic regression was used to investigate the independent factors associated with vitamin D status.ResultsThe prevalence of vitamin D deficiency was 81.21% (95% CI 71.61% to 90.81%), while severe deficiency was 39.48%. Only 3.60% of adolescents were vitamin D-sufficient. The prevalence of vitamin D deficiency was significantly higher among girls compared with boys (91.69% vs 70.32%; p<0.001). There was a significant inverse correlation between vitamin D and parathyroid hormone (Spearman correlation=−0.35; p<0.001). In the final model, gender, age, governorate, parental education, body mass index, vitamin D supplement and the number of times adolescents walk to schools per week were all significantly related to vitamin D deficiency.ConclusionHigh prevalence of vitamin D deficiency was noted among adolescents in Kuwait despite the abundant sunshine, which may reflect strong sun avoidance behaviour. Adequate outdoor daytime activities should be encouraged especially for girls. We call for locally tailored guidelines for vitamin D supplement in which girls should have a higher dose compared with boys.

We estimated the prevalence of anemia among school children and investigated factors associated with this problem in Kuwait. A cross-sectional study was conducted on 1415 adolescents randomly selected from middle schools in Kuwait. Hemoglobin, iron, ferritin, folate and vitamin B 12 , in addition to many other laboratory indicators, were measured in a venous blood sample. Data on risk factors for anemia were collected from parents and adolescents. Multiple logistic regression was used to investigate factors associated with anemia. The prevalence of anemia was 8.06% (95% CI: 6.69-9.60%), which was significantly higher among females compared to males (10.96% vs. 5.04%; p < 0.001). Mean (SD) Hb level was 133.7 (9.89) g/L and 130.00 (10.48) g/L among males and females, respectively (p < 0.001). The prevalence of mild, moderate and severe anemia was 5.94%, 1.91% and 0.21%, respectively. Gender, age, iron concentration and ferritin were associated with anemia in multivariable analysis. These data indicate that anemia among school children in Kuwait is of mild public health significance. Further reduction in anemia in school girls should focus on correcting iron deficiency. Surveillance systems for anemia may consider using a cutoff point that is specific for the method of blood sampling and the method of Hb measurement. Anemia is characterized by hemoglobin (Hb) concentration being lower than a specific threshold, and thus creating an impairment in meeting the oxygen demands of tissues 1. It is a major public health problem with around 1,620 million people worldwide diagnosed with anemia 2. Generally, a quarter of the world's population is considered anemic but the prevalence of anemia varies considerably between high-income countries (around 9%) and low-income countries (around 43%) 2. Due to physiological reasons, pregnant women, women of childbearing age and young children are particularly vulnerable 3. Anemia has significant implications in terms of mortality 4 , as well as impaired work capacity and economic development 5. Anemia during childhood has been linked to growth delay, high risk of infections, and poor cognitive and motor development, which may lead to loss of work productivity later in life 3,6. In fact, anemia is among the top leading causes of disability-adjusted life years lost among adolescents 7. Anemia can result from decreased erythrocyte production or increased blood loss, either through hemolysis, bleeding or both. These are determined by nutritional, infectious or genetic factors 8. Genetic factors are responsible for hemoglobinopathies, such as sickle cell anemia and thalassemia, while in some settings infectious diseases like malaria, soil-transmitted helminths and schistosomiasis are major contributors to anemia. Nutritional anemia results from insufficient nutrients that are needed during Hb synthesis and erythropoiesis. These particularly include iron deficiency (assumed to be responsible for 50% of all anemias 4), folic acid deficiency, vitamin B 12 deficiency, vitamin A deficiency and p...

Few studies have investigated the association between Acne vulgaris (AV) and vitamin D level. In this study we aimed to investigate the association between 25-hydroxyvitamin D (25-OH-VitD) level and AV in a country with plenty of sunshine. A cross-sectional study was conducted on 714 adolescents who were randomly selected from public schools using multistage cluster random sampling with probability proportional to size. 25-OH-VitD levels were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The Global Acne Grading System (GAGS) was used to assess the severity of AV. Data on potential confounders were collected from the parents through a self-administered questionnaire, and from the adolescents using a face-to-face interview. Of 714 participants, 351 (41.16%) were males. The mean (standard deviation (SD)) age was 12.28 (0.81) years. AV was observed in 479 (67.1%) adolescents. There was no significant association between 25-OH-VitD level and clinically assessed AV before or after adjusting for potential confounders. This was consistent whether 25-OH-VitD was fitted as a continuous variable or categorized using acceptable cutoff points or tertiles. In this study vitamin D status was not associated with AV, therefore our data do not support vitamin D supplementation either to treat or to prevent AV.

Background. The State of Kuwait has a growing obesity epidemic in both genders and all age groups; however, obesity rates in the young seem to be rising. Methods. We conducted a cross-sectional survey in 169 Kuwaiti female adolescents attending both private and public schools spanning the six governorates in the State of Kuwait in order to explore female adolescents' self-image, body dissatisfaction, type of school (private versus public), TV viewing, and computer games and their relationship to body mass index. Results. Approximately half the students classified as obese perceived their body image to lie in the normal range. Females in the obese category were the most dissatisfied with their body image, followed by those in the overweight category. Eating behavior, level of physical activity, school type, television viewing, computer/video usage, and desired BMI were not significantly associated with level of obesity. Conclusion. This study was one of the few studies to assess adolescent females' body image dissatisfaction in relation to obesity in the State of Kuwait. The results suggest that including body image dissatisfaction awareness into obesity prevention programs would be of value.

Angiopoietin-like proteins (AnGptL) is a family of eight members known to play an important role in metabolic diseases. Of these, ANGPTL5 is suggested to regulate triglyceride metabolism and is increased in obesity and diabetes. However, its role in metabolic diseases in adolescents is not wellstudied. In this study, we tested the hypothesis of a positive association between plasma ANGPTL5, and obesity, high sensitivity c-reactive protein (HscRp) and oxidized low-density lipoprotein (ox-LDL) in adolescents. Adolescents (n = 431; age 11-14 years) were randomly selected from middle schools in Kuwait. Obesity was classified by the BMI-forage based on the WHO growth charts. Plasma ANGPTL5, HsCRP, and Ox-LDL were measured using ELISA. The prevalence of overweight and obesity was 20.65% and 33.18%, respectively. Mean (SD) plasma ANGPTL5 levels were significantly higher in obese, compared with overweight and normal-weight adolescents (23.05 (8.79) vs 18.39 (7.08) ng/mL, and 18.26 (6.95) ng/ml, respectively). ANGPTL5 was positively associated with both HsCRP (ρ=0.27, p < 0.001) and Ox-LDL (ρ = 0.24, p < 0.001). In Conclusion, ANGPTL5 levels are elevated in obese adolescents and are associated with cardiovascular disease risk factors, HscRp and ox-LDL. the use of ANGPTL5 as a powerful diagnostic and prognostic tool in obesity and metabolic diseases needs to be further evaluated. Childhood obesity has emerged as a major public health problem worldwide. In Arab states in the Gulf region, extremely high prevalence of childhood obesity has been reported 1. On a sample of 13, 000 school children each year, Kuwait Nutritional Surveillance has consistently reported that more than 45% of school children aged 5-19 are either overweight or obese 2. Similarly, a cross-sectional study conducted on 635 public intermediate school children reported that one quarter of the children (25.5%) were overweight and over one third (36.5%) were classified as obese 3. Indoor lifestyle, lack of physical activity and changes in the dietary pattern have been implicated as the underlying causes of childhood obesity in the region. According to the World Health Organization (WHO), the worldwide prevalence of obesity nearly tripled between 1975 and 2016 and is expected to double in the next 25 years. This highlights the importance of dealing with this epidemic. Given the widespread prevalence of obesity and its long-term and short-term complications, one approach to the problem is to focus on the key molecular pathways involved in the development of childhood obesity. This would help identify potential biomarkers that might be used to guide preventive and therapeutic interventions.

Several observational studies have reported an association between low levels of vitamin D (VD) and poor cognition in adults, but there is a paucity of data on such an association in adolescents. We investigated the association between VD and cognitive function or academic achievement among 1370 adolescents, who were selected from public middle schools in Kuwait, using stratified multistage cluster random sampling with probability proportional to size. Plasma 25-hydroxy VD (25-OH-D) was measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). An age-adjusted standard score (ASC), calculated from Raven’s Standard Progressive Matrices test, was used to evaluate cognitive function; academic achievements were extracted from the schools’ records. Data on various covariates were collected from the parents through a self-administered questionnaire and from the adolescents using face-to-face interviews. 25-OH-D was weakly correlated positively with ASC (ρ = 0.06; p = 0.04). Univariable linear regression analysis showed an association between 25-OH-D categories and ASC after adjusting for gender, but adjusting for parental education was sufficient to explain this association. Multivariable analysis showed no association between 25-OH-D and ASC after adjusting for potential confounders whether 25-OH-D was fitted as a continuous variable (p = 0.73), a variable that is categorized by acceptable cutoff points (p = 0.48), or categorized into quartiles (p = 0.88). Similarly, 25-OH-D was not associated with academic performance. We conclude that 25-OH-D is associated with neither cognitive function nor academic performance in adolescents.

Background This study aimed to investigate the association between 25-hydroxyvitamin D (25(OH)D) and depression symptoms among adolescents in Kuwait, a country with a high prevalence of vitamin D deficiency. Methods A school based cross-sectional study was conducted on randomly selected 704 adolescents in middle schools. Data on depression symptoms were collected using the Children’s Depression Inventory (CDI). Data on covariates were collected from the parents by self-administered questionnaire and from adolescents by face-to-face interview. Blood samples were analyzed in an accredited laboratory; and 25(OH)D was measured using liquid chromatography-tandem mass spectrometry. Results Of 704 adolescents, 94 (13.35%; 95%CI:10.35–17.06%) had depression symptom (a score of 19 or more on the CDI). There was no significant difference in the median CDI score between different vitamin D status (p = 0.366). There was also no significant correlation between serum 25(OH)D concentration and CDI score (Spearman’s rank correlation = 0.01; p = 0.825).There was no significant association between 25(OH)D and depression symptoms whether 25(OH)D was fitted as a continuous variable (crude odds ratio (OR) 0 .99 [95%CI: 0.98, 1.01], p = 0.458 and adjusted OR 1.01 [95%CI: 0.99, 1.02], p = 0.233), categorical variable as per acceptable cut-of points (crude analysis p = 0.376 and adjusted analysis p = 0.736), or categorical variable as quartiles (crude analysis p = 0.760 and adjusted analysis p = 0.549). Conclusion Vitamin D status does not seem to be associated with depression symptoms among adolescents in our setting. Nevertheless, it is important to have sufficient vitamin D levels during adolescence for several other health benefits.

AbstractThis study aimed to investigate the association between 25-hydroxyvitamin D (25(OH)D) level and low back pain (LBP) among adolescents while adjusting for potential confounders pertinent to this age group including the weight of school bags, BMI and physical activity. A cross-sectional study was conducted on 760 randomly selected adolescents in middle schools. Data on LBP and the risk factors for LBP were collected from parents by a self-administered questionnaire and from adolescents by face-to-face interview. Blood samples were tested in an accredited laboratory; and 25(OH)D was measured using liquid chromatography-tandem MS. The lifetime prevalence and the 6-month prevalence of LBP were 32·28 (95 % CI 28·97, 35·73) % and 21·26 (95 % CI 18·40, 24·33) %, respectively. There was no difference in the geometric mean of 25(OH)D between those with and without LBP in the past 6 months (28·50 nmol/l and 30·82 nmol/l, respectively; P = 0·122). There was no association between 25(OH)D and LBP in the univariable or multivariable analysis whether 25(OH)D fitted as a continuous or as a categorical variable. We found no association between vitamin D level and LBP in adolescents in an area with high prevalence of vitamin D deficiency. Although it is important to have sufficient vitamin D levels during adolescence for several other health benefits, we concluded that vitamin D is not a major determinant for LBP among adolescents in our setting.