Nutrition and Health in Arab Adolescents (NaHAR): Study protocol for the determination of ethnic-specific body fat and anthropometric cut-offs to identify metabolic syndrome

Lara Nasreddine; Mohamad Adel Bakir; Tareq Al-Ati; Abeer Salman Alzaben; Rawhieh Barham; Nahla Bawazeer; Elie-Jacques Fares; Kholoud Hammad; Pernille Kaestel; John J Reilly; Mandy Taktouk

doi:10.1371/journal.pone.0298306

Nutrition and Health in Arab Adolescents (NaHAR): Study protocol for the determination of ethnic-specific body fat and anthropometric cut-offs to identify metabolic syndrome

PLoS One. 2024 Feb 23;19(2):e0298306. doi: 10.1371/journal.pone.0298306. eCollection 2024.

Authors

Affiliations

¹ Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon.
² Department of Radiation Medicine, Atomic Energy Commission, Damascus, Syrian Arab Republic.
³ Food and Nutrition Program, Environment and Life Sciences Research Institute Center, Kuwait Institute for Scientific Research, Safat, Kuwait.
⁴ Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
⁵ Department of Nutrition, Ministry of Health, Amman, Jordan.
⁶ Department of Nuclear Sciences and Applications, Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
⁷ Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland.

Abstract

The prevalence of adolescent obesity in the Middle-East is considered among the highest in the world. Obesity in adolescents is associated with several cardiometabolic abnormalities, the constellation of which is referred to as the metabolic syndrome (MetS). This multi-country cross-sectional study aims to determine the optimal cut-off values for body fat (BF); body mass index (BMI) z-score; waist circumference (WC) percentile, and mid-upper arm circumference (MUAC) for the prediction of MetS among adolescents from Kingdom of Saudi-Arabia (KSA), Kuwait, Jordan, Lebanon and Syria. A secondary objective is to examine the validity of Bioelectrical Impendence Vector Analysis (BIVA) in estimating BF against the deuterium dilution technique (DDL). In each country, a sample of 210 adolescents will be recruited. Data collection will include demographics, socioeconomic, lifestyle and dietary data using a multi-component questionnaire; anthropometric measurements will be obtained and body composition will be assessed using the DDL and BIVA; blood pressure and biochemical assessment will be performed for the identification of the MetS. Receiver operating characteristic analyses will be undertaken to determine optimal cut-off values of BMI, WC, MUAC and BF in identifying those with MetS. Odds ratios (OR) and their respective 95% confidence interval (CI) for the association of the anthropometric measurements with MetS will be computed based on multiple logistic regression analysis models. The Bland and Altman approach will be adopted to compare BIVA against the reference DDL method for the determination of body composition parameters. This study responds to the need for ethnic-specific anthropometric cut-offs for the identification of excess adiposity and associated cardiometabolic risks in the adolescent population. The adoption of the generated cut-offs may assist policy makers, public health professionals and clinical practitioners in providing ethnic-specific preventive and curative strategies tailored to adolescents in the region.

Copyright: © 2024 Nasreddine et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Adipose Tissue
Adolescent
Arabs
Body Mass Index
Cardiovascular Diseases* / complications
Cross-Sectional Studies
Humans
Lebanon
Metabolic Syndrome* / diagnosis
Metabolic Syndrome* / epidemiology
Pediatric Obesity* / complications
Risk Factors
Waist Circumference

Grants and funding

The study is funded by International Atomic Energy Agency (IAEA), and supported through collaboration among ARASIA State Parties under the framework of the IAEA technical cooperation project RAS6094, ‘Applying Nuclear Techniques for the Determination of Body Fat and Anthropometric Cutoffs (ARASIA)’. (ARASIA is a Cooperative Agreement for Arab States in Asia for Research, Development and Training related to Nuclear Science and Technology). There are no grants awarded to individual researchers in the respective countries. Instead, each of the countries receive the supplies and deuterium from the IAEA but there are no grants per se.