Global estimates of the prevalence of diabetes for 2010 and 2030.

IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040.

Global estimates of diabetes prevalence for 2013 and projections for 2035.

Despite decades of unequivocal evidence that waist circumference provides both independent and additive information to BMI for predicting morbidity and risk of death, this measurement is not routinely obtained in clinical practice. This Consensus Statement proposes that measurements of waist circumference afford practitioners with an important opportunity to improve the management and health of patients. We argue that BMI alone is not sufficient to properly assess or manage the cardiometabolic risk associated with increased adiposity in adults and provide a thorough review of the evidence that will empower health practitioners and professional societies to routinely include waist circumference in the evaluation and management of patients with overweight or obesity. We recommend that decreases in waist circumference are a critically important treatment target for reducing adverse health risks for both men and women. Moreover, we describe evidence that clinically relevant reductions in waist circumference can be achieved by routine, moderate-intensity exercise and/or dietary interventions. We identify gaps in the knowledge, including the refinement of waist circumference threshold values for a given BMI category, to optimize obesity risk stratification across age, sex and ethnicity. We recommend that health professionals are trained to properly perform this simple measurement and consider it as an important 'vital sign' in clinical practice.

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Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity

OBJECTIVE The purpose of this study was to provide the first national estimate on the prevalence of the metabolic syndrome and its components and the first ethnic-specific cutoff point for waist circumference in the Eastern Mediterranean Region. RESEARCH DESIGN AND METHODS This national survey was conducted in 2007 on 3,024 Iranians aged 25–64 years living in urban and rural areas of all 30 provinces in Iran. The metabolic syndrome was defined by different criteria, namely the definition of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), the International Diabetes Federation (IDF) criteria, and the modified definition of the NCEP/ATP III (ATP III/American Heart Association [AHA]/National Heart, Lung, and Blood Institute [NHLBI]). RESULTS The age-standardized prevalence of the metabolic syndrome was about 34.7% (95% CI 33.1–36.2) based on the ATP III criteria, 37.4% (35.9–39.0%) based on the IDF definition, and 41.6% (40.1–43.2%) based on the ATP III/AHA/NHLBI criteria. By all definitions, the prevalence of the metabolic syndrome was higher in women, in urban areas, and in the 55- to 64-year age-group compared with the prevalence in men, in rural areas, and in other age-groups, respectively. The metabolic syndrome was estimated to affect >11 million Iranians. The optimal cutoff point of waist circumference for predicting at least two other components of the metabolic syndrome as defined by the IDF was 89 cm for men and 91 cm for women. CONCLUSIONS The high prevalence of the metabolic syndrome with its considerable burden on the middle-aged population mandates the implementation of national policies for its prevention, notably by tackling obesity. The waist circumference cutoff points obtained can be used in the region.

https://care.diabetesjournals.org/content/diacare/32/6/1092.full.pdf

First Nationwide Study of the Prevalence of the Metabolic Syndrome and Optimal Cutoff Points of Waist Circumference in the Middle East: The National Survey of Risk Factors for Noncommunicable Diseases of Iran

The prevalence of diabetes mellitus is known to be increasing rapidly worldwide, but few population-based surveys have been undertaken in Africa or the Middle East. The aims of this study are to report the prevalence of diabetes mellitus and impaired fasting glucose (IFG) in Tunisia, to compare the prevalence to previous studies and to analyse the relationship between diabetes and age, sex, area of residency and body mass index (BMI). We have used data from the Tunisian National Nutrition Survey, a cross-sectional health study providing a large nationally representative sample of the Tunisian population including 3729 adults. We used the American Diabetes Association diagnostic criteria to determine the prevalence of diabetes mellitus and IFG. The overall diabetes prevalence was 9.9% (9.5% in men and 10.1 in women) giving age-adjusted prevalence of diabetes of 8.5% (7.3% in men and 9.6% in women). Step-wise logistic regression showed age of more than 40 years, urban residency and high BMI to each be significantly and independently related to diabetes prevalence. The prevalence of diabetes mellitus has more than doubled in Tunisia over a 15-year period. Our study has demonstrated a high prevalence of diabetes in the adult population with a wide difference among the rural and urban areas with an increased prevalence compared to previous studies. The results underline the need to increase public awareness and to emphasize the benefit of lifestyle modification in order to prevent type II diabetes.

The global diabetes pandemic: the Tunisian experience

Aims: Waist circumference (WC) is a convenient measure of abdominal adipose tissue. It itself is a cardiovascular disease (CVD) and diabetes-risk factor and is strongly linked to other CVD risk factors. There are, however, ethnic differences in the relationship of WC to the other risk factors.The aim of this study was to determine the optimal cut-off points of WC and body mass index (BMI) at which cardiovascular risk factors can be identified with maximum sensitivity and specificity in a representative sample of the Tunisian adult population and to investigate any correlation between WC and BMI.



Methods:  We used a sample of the Tunisian National Nutrition Survey, a cross-sectional population-based survey, conducted in 1996 on a large nationally representative sample, which included 3435 adults (1244 men and 2191 women) of 20 years or older. WC, BMI, blood pressure and fasting blood measurements (plasma glucose, total cholesterol, triglycerides) were recorded. Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut-off values of WC and BMI to identify with maximum sensitivity and specificity the detection of high blood pressure, hyperglycaemia, high blood cholesterol and hypertriglyceridaemia.



Results:  ROC curve analysis suggested WC cut-off points of 85 cm in men and 85 cm in women for the optimum detection of high blood pressure, diabetes and dyslipidaemia. The optimum BMI cut-off points for predicting cardiovascular risk factors were 24 kg/m2 in men and 27 kg/m2 in women. The cut-off points recommended for the Caucasian population differ from those appropriate for the Tunisian population. The data show a continuous increase in odds ratios of each cardiovascular risk factor, with increasing level of WC and BMI. WC exceeding 85 cm in men and 79 cm in women correctly identified subjects with a BMI of ≥25 kg/m2, sensitivity of >90% and specificity of >83%.



Conclusions:  Based on the ROC analysis, we suggest a WC of 85 cm for both men and women as appropriate cut-off points to identify central obesity for the purposes of CVD and diabetes-risk detection among Tunisians. WCs of 85 cm in men and 79 cm in women were the most sensitive and specific to identify most subjects with a BMI ≥25 kg/m2.

Waist circumference cut-off points for identification of abdominal obesity among the tunisian adult population.

Prevalence of metabolic abnormalities in the Tunisian adults: a population based study.

Resume Introduction Avec le vieillissement progressif des populations, les problemes de sante geriatrique sont devenus l’une des preoccupations majeures des autorites sanitaires. Les donnees concernant les affections dermatologiques chez le sujet âge sont cependant rares. Le but de ce travail etait de degager le profil de la pathologie cutanee motivant une consultation du sujet âge en dermatologie (secteurs public et prive) dans la region de Tunis. Malades et methodes Il s’agissait d’une etude prospective, multicentrique et descriptive portant sur tous les nouveaux diagnostics d’affections cutanees colliges durant une annee (juin 1999-juillet 2000), en consultation de dermatologie, chez les patients âges de plus de 65 ans. Cette etude a concerne l’activite de 11 dermatologistes exercant a Tunis, dans differentes structures publiques et privees, qui ont collige de maniere exhaustive tous les nouveaux diagnostics d’affections cutanees vues a leur consultation. Resultats 1 518 malades ont ete examines avec un total de 1 550 nouveaux diagnostics. L’âge moyen etait de 72, 6 ans avec un sex-ratio homme/femme = 1,41. Les mycoses representaient le principal motif de consultation (16,9 p. 100), suivies par les tumeurs 12,8 p. 100 (benignes 63,3 p. 100), l’eczema (11,9 p. 100), les troubles de la keratinisation (8,7 p. 100), les dermatoses bacteriennes (8,7 p. 100), les dermatoses virales (6,8 p. 100) et le prurit (6,4 p. 100). Les mycoses etaient essentiellement representees par les intertrigos interorteils et les onychomycoses. Les carcinomes basocellulaires et les kystes epidermoides representaient respectivement les tumeurs malignes et benignes les plus frequentes. Discussion Cette etude montre la frequence des mycoses, des tumeurs benignes et de l’eczema chez les sujets âges. Ceci rejoint les resultats d’autres etudes qui rapportent cependant une predominance de l’eczema. La frequence elevee des mycoses dans notre etude peut s’expliquer par les conditions climatiques (chaleur, humidite). Le prurit semble un motif de consultation frequent chez le sujet âge. Les affections cutanees constituent une cause importante de morbidite chez le sujet âge.

Pathologie cutanée chez le sujet âgé

Resume Introduction Le pied du diabetique est particulierement expose au risque d’infections mycosiques considerees comme facteurs de gravite avec risque de surinfection bacterienne parfois grave. Patients et methode Nous avons mene une etude transversale, portant sur tous les diabetiques hospitalises a l’hopital de jour de l’Institut national de nutrition de Tunis entre janvier et mars 2005. Le but de notre etude etait d’etudier la frequence des mycoses des pieds chez le diabetique (diagnostic porte sur un prelevement mycologique), les facteurs favorisant leur survenue, la flore mycosique du pied chez le diabetique et les eventuelles complications secondaires a ces mycoses. Resultats Durant la periode etudiee, 150 diabetiques ont ete hospitalises. Une mycose du pied a ete retrouvee dans 81 cas (54 % des patients). L’âge des patients, la neuropathie peripherique et l’hypercholesterolemie ont constitue les facteurs favorisant l’apparition de mycose des pieds chez nos patients. L’atteinte des espaces interorteils a constitue le principal siege des mycoses suivie par l’atteinte ungueale et l’atteinte plantaire. Trichophyton rubrum etait le champignon le plus frequent dans toutes les localisations. Les levures etaient principalement observees au niveau des plantes des pieds. Aucune complication n’a ete observee chez nos patients. Discussion et conclusion Si l’âge des patients et la neuropathie peripherique sont classiquement rapportes comme facteurs favorisant la survenue d’une mycose des pieds, les dyslipemies ne sont pas decrites comme telles dans la litterature.

B. Zouari

Papers

The global diabetes pandemic: the Tunisian experience

Waist circumference cut-off points for identification of abdominal obesity among the tunisian adult population.

Prevalence of metabolic abnormalities in the Tunisian adults: a population based study.

Pathologie cutanée chez le sujet âgé

Les mycoses du pied chez le diabétique : étude prospective de 150 patients