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Are Trump tariffs to blame? Big names bullish on gold What to buy? Will quantitative tightening tank the stock market? Where's the inflation? Is all this optimism warranted? Power moves east, along with gold Plan for higher rates of inflation Is 2 percent inflation enough? Gold smuggling in India continues, predicted to increase Money as debt Black Swans to stir interest in gold and silver?

Is gold showing signs of a bottom? Krugman's recipe for economic prosperity: Print more food stamps. Only the dollar is money. Excessive government spending guarantees it. Industrial demand for silver increases but still not the best reason for buying silver Don't fear the robots, fear the Fed. Argentina heads down the path to another hyperinflation. Is the US far behind? A brilliant ten minutes with Daniel Hannan. So little time.

Gold: a problem of perception Bill Gates attacks gold. Gold wins. There is no free market in gold Romney promises to feed the gold bull Another bullish technical indicator for silver? A coming paradigm shift in silver? How to package silver for shipment Paul Krugman vs. Roger Altman's flawed economic theory: more stimulus Missing: tons of gold.

Please call USTreasury if found. QE2 to bankrupt Fed? Have Asian buyers checkmated silver shorts? Make only crude observation, and could not provide measures of confidence in the outcomes. They include School student population in their study in the same table with adult population. This study concentrated mainly on obesity and DM. The rest of CVD risk factors such as HTN and Hyperlipidaemia and their result have not been included as they reported the prevalence in both genders. There is high prevalence of risk factors for diabetes and diabetic complications in the GCC region, indicative that their current management is suboptimal.


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Enhanced management will be critical if escalation of diabetes-related problems is to be averted as industrialization, urbanization and changing population demographics continue. WHO InfoBase and manual cross references from retrieved articles. English language between 1st January and 31st June The only limitation that reported was the comparison of the prevalence trend for children and adolescents which is difficult due to differing standards used. N-NCDs are largely preventable.

Musaiger, [ 21 ]. Health ministry and other official reports which included the prevalence of overweight and obesity among preschool children, school-aged children, adolescents, and adults were also covered. Possible factors determining obesity in this region include: nutrition transition, inactivity, urbanization, marital status, a shorter duration of breastfeeding, frequent snacking, skipping breakfast, a high intake of sugary beverages, an increase in the incidence of eating outside the home, long periods of time spent viewing television, massive marketing promotion of high fat foods, stunting, perceived body image, cultural elements and food subsidize policy.

In all high and middle income countries in the EMR, overweight and obesity has become a major public health problem, with a prevalence higher than many of developed countries. This creates the need for urgent action to prevent and control obesity in EMR countries.

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A national plan of action to overcome obesity is urgently needed to reduce the economic and health burden of obesity in this region. Only one study used validated tools to measure exposure to water pipe smoking. All studies included were cross sectional in design and did not allow analyses for time trends.

While very few national surveys have been conducted, the prevalence of water pipe smoking appears to be alarmingly high among school students and university students in Middle Eastern countries and among groups of Middle Eastern descent in Western countries. This review focuses on Studies that are published in the English language.

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It is possible that additional studies are available within the grey literature such as government reports of studies carried out by each country as well in Arabic-language publications. There was noticed variation in the methodological quality of the studies included, non-population base sample, use of un-validated measurement instruments, and varying physical activity definitions. Significant socio-demographic associations with the MetS identified in the individual studies include: age, women, higher income, lower educational, urban residence in Saudi Arabia, and rural residence in the UAE.

Included only the national population in the sample. The prevalence of sufficient physical activity in the overall adult population including both national and non-national residents may differ from what has been reported. Use of un-validated measurement instruments, and varying physical activity definitions. Lack of standardized study protocols, make it difficult for cross-country comparisons. Prevalence estimates for participation in physical activity in the GCC States are considerably lower than those for many developed countries. Given the increasing prevalence of overweight and obesity and associated chronic diseases in the GCC States, and with physical inactivity being an important and modifiable risk factor, health promotion strategies should aim to increase physical activity among both men and women as a priority public health issue.

Studies included in this review varied in study design, population include definition of risk factor. Lack of standardized definitions of dyslipidaemia limits ability to provide summary estimates for this risk factor. Low prevalence of Smoking was reported due to smoking being culturally unaccepted Underreporting may occur. Middle East region GCC specifically was considerably higher among women compared with the men.

Although the exact cause of such sex variations is not entirely clear, it has been reported that women are less active compared with men in certain areas. Physical and cultural barriers to physical activity have been reported among women in Saudi Arabia. Six systematic reviews reported the prevalence of obesity among women in the GCC region.

The prevalence of obesity among women in the GCC is high and ranges from The highest prevalence was among Qatari women The lower prevalence levels are reported in UAE While obesity has greater prevalence in women than men, being overweight is more prevalent among men within the GCC See Table 4. The prevalence of physical inactivity among the female population in the GCC region is reaching an alarming level, ranging from In Al-Nozha et al.

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Bahraini women share the same high level of physical inactivity with a prevalence of up to Furthermore, the prevalence of physical inactivity among Kuwaiti women stands between The reviews in Qatar and Oman report a prevalence from UAE stands at The prevalence of diabetes is high within the GCC countries.

Most of the studies use the WHO definition for diabetes [ 21 , 24 , 26 — 28 ]. However, several studies within the reviews combined both types of diabetes type 1 and type 2. Studies before the year report low prevalence of diabetes while reviews citing more recent studies report higher prevalence rates.

For example, the review by Alhyas et al. The prevalence of diabetes in the GCC region is higher among people above 50 [ 24 , 26 ]. Unlike obesity, there is no clear gender gap in diabetes See Table 4. An additional study did not take gender into consideration [ 25 ]. HTN among Qatari women ranges from Two studies within the reviews in UAE report contradictory results. The Aljefree and Ahmed review reports a prevalence between This result was based on self-reported data, whereas HTN measured in the same region was Similarly, blood pressure values measured among Omani women are higher compared to selfreports More recent studies in the review conducted by Aljefree and Ahmed show a range between There were a limited number of studies that reported the prevalence among the Kuwaiti population within these reviews.

With regards to gender differences, several studies have revealed slightly greater prevalence of HTN in men [ 20 , 25 , 26 , 31 ]. Three reviews have reported the prevalence of smoking [ 26 , 27 , 32 ]. It is generally lower among women than men within the GCC region. Currently, though, water pipe smoking is increasing among GCC women.

In UAE, it is No data on prevalence of MetS among female population in Bahrain was reported. Our review showed that the prevalence of major lifestylerelated risk factors for CVD is very high among women in GCC countries and seem to be increasing over the past decades.

Obesity among Arab women is highly prevalent, with the greatest increase reported in the literature among Middle Eastern countries in the six GCC countries [ 34 ]. The prevalence of obesity among women in GCC countries is higher than in countries such as Iraq, Libya, Algeria as well as European countries [ 35 ].

With regards to the marital status, married women within the GCC are more susceptible to obesity than unmarried one [ 35 ]; one of the possible reasons is that married couples are less active and tend to eat together, which may reinforce increased food intake [ 36 ]. The Middle East is recording the fastest increase in obesity prevalence over time, with more women than men being obese [ 34 ].

This may be attributed to multiple factors; for example the majority of households in this region, especially in Kuwait and Saudi Arabia, commonly hire housemaids which could lead to low activity and sedentary lifestyle [ 38 ]. Multiple pregnancies can also contribute to weight gain, as women may retain an average of 4. Physical inactivity is a global public health problem.

Physical inactivity is very common in the Muslim world especially among Arabs. Also, in a study conducted by Daryani et al, Arab immigrants in Sweden reported a higher prevalence of abdominal obesity than Swedish-born women, and a high degree of physical inactivity during leisure time, highlighting potential cultural factors [ 44 ]. Sedentary lifestyle is very common, especially among women in the Middle Eastern countries. This could be due to various reasons. Other barriers may include the desert climate, high temperatures and frequent sand storms, which makes it difficult to exercise outdoors, the lack of social support, and the common use of cheap migrant labor for household work [ 46 ].

Diabetes is a complex disease that is linked between multiple genetic and environmental factors including diet, lifestyle, and obesity [ 47 ]. Several studies show that Arabs have a greater genetic predisposition to diabetes than Caucasians [ 48 , 49 ]. Additionally, the fast urbanization and increased per capita income have had negative influences on GGC lifestyle resulting in increased sedentary lifestyle, leading to obesity [ 54 ].

Obesity is a major risk factor for developing diabetes, where in many cases, more than half of the diabetic patients were found to be obese [ 55 , 56 ]. In El Bcheraoui et al. The overall prevalence was Underreporting should not be ruled out, as many of the studies included collected self-reported data [ 28 ]. Low prevalence of smoking among women in the GCC countries could be an indication of under reporting, as smoking cigarettes traditionally is not accepted among Arab Muslim women, especially in the GCC countries [ 61 ].

In contrast, the acceptance and popularity of water pipe smoking is very common among Arabs in general, especially women [ 62 — 66 ]. There is also a false perception that water pipe smoking is less harmful than cigarettes [ 67 ]. Up to this point, the data shows a growing trend of women smoking water pipes in the GCC countries, but it is still less than other neighboring Arab countries [ 32 ].

The heterogeneity of the reviewed studies and variable availability of sub-group data was a major limitation in the review process within the GCC countries. We presented the actual reported percentage or the range of percentages in the cited studies that pertain to the prevalence of CVD risk factors among women.

However, some studies do not report the actual percentage pertaining to the women studied and just presents the total percentage of both genders or male population only. Some studies were mixing adult and children within their included studies, hence some reported low prevalence. Moreover, some studies do not cover all the six members of the GCC countries, with some systematic reviews that present data from only two to three countries in the GCC region. This review indicated high levels of modifiable risk factors among women. Gender inequality damages the physical and mental health of millions of women across the globe.

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A continuous rising prevalence of lifestyle-related diseases increases the need for gender equality throughout the GCC countries, especially for Saudi Arabian women, to empower them in regards to their role in the society, their decision-making and more involvement in health care. Women in GCC countries are facing a major struggle in challenging physical inactivity, which results in one of the highest obesity rates globally. Al-Bahilani and Mabry reported the legislations and policies issued by the GCC in regards behavioral risk of NCD, where most of them were related to tobacco control.

Introducing a more active lifestyle by expanding the field of physical education through the GCC region and sports competitiveness among women is highly recommended. There is a high requirement for diet control and awareness in regards to total daily calorie intake. Although food labeling was introduced by the GCC customs union, the labeling requirements are basic and do not require regulations regarding the nutrition content of processed foods, such as sodium content and trans-fat [ 68 ]. Additionally, the direct and indirect costs of care and treatment of patients suffering from these diseases are significant and will become more burdensome as the price of oil has declined, and is likely to remain at lower levels due to the increased global supply.

This results in not only a significant savings, but improved quality of life for the patients [ 10 ] and magnifies why the healthcare sector needs to focus more on preventable measures, such as motivating society to adopt healthy lifestyles. Implementing the health belief model and understanding health-related behavior among the female population in the GCC countries in regards to CVD and its risk factors would help in understanding why women are not adopting a healthier lifestyle.

The high prevalence of lifestyle-related diseases among women population in GCC is a ticking time bomb and is reaching alarming levels, and require a fundamental social, cutural and political changes. These findings highlight the need for comprehensive work among the GCC to strengthen the regulatory framework to reduce and control the prevalence of these factors. IDF definition includes the same general criteria as the other definition; it requires that obesity, but not necessarily insulin resistance, be present.

American heart association. Assessment of multiple systematic review tool. Adult treatment panel III. Body mass index. Cardiovascular disease. Disability-adjusted life years. Gulf cooperation council. Health belief model. International diabetes federation. Kingdom of Saudi Arabia. Metabolic syndrome. National cholesterol education program. United Arab Emirates. World health organization. The authors would like thank Ms. Riyadh, Saudi Arabia for all the help in data extraction. This included designing the search strategy, helping in selecting studies for inclusion and developing a data extraction form.

MA and HA also helped in selecting studies for inclusion. MA and HA carried out the search, identified potential studies for inclusion, extracted the data, assessed the quality of the included studies, and carried out the data analysis under the supervision of SR and AM and FF wrote the manuscript, which was then revised by SR, AM and AS.

All the authors have approved the final version. The guarantor is MA. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The ticking time bomb in lifestyle-related diseases among women in the Gulf Cooperation Council countries; review of systematic reviews. Method Literature searches were carried out in three electronic databases for all published systematic reviews on the prevalence of cardiovascular disease risk factors in the GCC countries between January and February Results Eleven systematic reviews were identified and selected for our review.

Conclusions The high prevalence of lifestyle-related diseases among women population in GCC is a ticking time bomb and is reaching alarming levels, and require a fundamental social and political changes. The GCC was established in to ensure mutual investment and free trade between its member countries.

This agreement also contributed to improvements in several fields including: education, culture, tourism, social opportunities, and health among member states [ 7 ]. Life in the GCC has changed dramatically after the discovery of oil, which became the main revenue for financing healthcare services. However, the recent fluctuation in the price of oil has affected the healthcare budget. Although GCC countries are examining different options to finance the healthcare service, up to this point, there is no clear alternative or implemented approach to achieve this goal [ 8 , 9 ].

In , Chahine et al. However, with these healthcare expenses, the current healthcare systems adopted by some of the GCC countries is below what is available in middle-income countries [ 9 ]. Electronic literature searches for all systematic reviews published from January to February were conducted to identify all systematic reviews of CVD risk among women in the GCC region.

The search was carried out in the following electronic databases: Medline, Google Scholar, and Cochrane Database see Table 2 for search terms. No language restrictions were applied. Throughout this review, special attention was given to the modifiable risks such as HTN, diabetes, obesity, MetS, physical inactivity and smoking.

Unhealthy diet, although a known CVD risk factor, was not explored in this study. The effect of diet on health is complex and different studies have focused on either overall diet patterns or individual components that include salt, sugar, fat content, fruit and vegetables, also, Also the problem with an acceptable definition of healthy diet. Hence, a comprehensive assessment of unhealthy diet would warrant a separate review. We included all systematic reviews that reported the prevalence of CVD risk factors among women in the GCC region countries.

We excluded studies that reported combined data for both genders without separate prevalence for women. However, all included studies that reported the differences between genders were documented to compare gender differences in the prevalence of CVD risk factors. Abstracts of reviews were inspected by two authors MA, HA and those appearing to meet the inclusion criteria were retrieved and read in full by both authors see Fig. The quality of those studies was assessed by two authors using the Assessment of Multiple Systematic Review Tool AMSTAR , a tool which has been validated as a means to assess the methodological quality of systematic reviews [ 17 ].

It uses an 11 point scale, where the maximum score is Scores 0—4 indicate low quality, 5—8 moderate quality, and 9—11 high quality [ 18 ]. The data has been extracted independently by two researchers MA, HA. Table 2 selected search terms. Was there duplicate study selection and data extraction? Was a comprehensive literature search performed? Was a list of studies included and excluded provided? Were the characteristics of the included studies provided? Was the likelihood of publication bias assessed? Was the conflict of interest included? Thirteen out of 88 systematic reviews were deemed to meet inclusion criteria; however, two of them were excluded as they report results for both genders combined [ 19 , 20 ].

As a result, only 11 of them were considered in this paper See Figure 1. The majority of these studies are conducted in Saudi Arabia Table 4. Three studies were identified as low quality [ 21 — 23 ] and one as high [ 24 ]. See Table 3 for more information. Table 4 Data Extraction. Bahrain 1 study.

Few studies focusing on HTN, dyslipidaemia and physical activity. Most studies cited were publish before Summary: Effective preventative strategies and education programs are crucial in the Gulf region to reduce the risk of CVD mortality and morbidity in the coming years. DM Kuwait 3 studies. KSA 10 studies. Obesity Kuwait 3 studies. Most studies cited published before Only national data used in this review. Summary: Several risk factors may be contributing to the high prevalence of N-NCDs in EMR, including nutrition transition, low intake of fruit and vegetables, demographic.

The quality of reporting of results is also variable. Summary: While very few national surveys have been conducted, the prevalence of water pipe smoking appears to be alarmingly high among school students and university students in Middle Eastern countries and among groups of Middle Eastern descent in Western countries. No standardized protocols provided. Summary: Significant socio-demographic associations with the MetS identified in the individual studies include: age, women, higher income, lower educational, urban residence in Saudi Arabia, and rural residence in the UAE.

The years of starting the search not reported.