Saudi Cultural Missions Theses & Dissertations
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Item Restricted Body Composition among Healthy Controls: Association with Eating Disorder Symptoms and Muscular Function(University College London, 2024-08-12) Abumunaser, Albatool; Robinson, PaulBackground and Aim: Despite its widespread use, the Body Mass Index (BMI) has significant limitations as a nutritional status indicator. This study aims to advocate for including complementary parameters like body composition (BC) and muscle strength tests for a thorough nutritional assessment. It also explores BC associations with disordered eating behaviour and muscle strength. Methods: The study included 33 participants aged 20-53 from University College London (UCL) or their acquaintances. Participants completed online demographic and Eating Disorder Examination questionnaires (EDE-Q). BC was assessed using a Bioelectrical Impedance Analysis (BIA) device, and muscle strength was measured using mid-upper arm circumference (MUAC), handgrip strength (HGS), and Sit-Up Squat-Stand (SUSS). Results: The median EDE-Q global score was 0.66 [0-4.01], with 30.30% engaging in shape or weight-influencing behaviours. Males scored significantly higher in the restraint subscale (P <0.01). Gender differences were observed in all BIA parameters except fat mass (FM).19.23% of females were classified as low HGS. Significant associations were found between EDE-Q global score and BMI (P < 0.01), FM Index (FMI) (P < 0.05), and MUAC (P < 0.05). Both BMI (β = -0.657, p = 0.001) and Fat-Free Mass Index (FFMI) (β = 0.983, p < 0.001) were significant predictors of HGS. BMI (β = 10.19, p = 0.77) became insignificant for MUAC when FMI and FFMI were included. No significant differences in FFM across BMI categories, but significance was observed in FM between normal weight and both overweight/obese categories (P <0.001). Discussion: This study emphasises the need to supplement BMI with additional measurements and the insights BIA and muscle function parameters provide. It recommends incorporating parameters reflecting nutritional and hydration status within eating disorder (ED) assessments. These measurements should be adopted to improve nutritional assessment in ED settings.1 0Item Restricted An evaluation of the Rashaka Initiative: a school-based obesity intervention in Makkah City, Saudi Arabia(University of Technology Sydney, 2024-03) Banany, Mohammed; Sibbritt, David; Gebel, KlausBackground: Childhood overweight and obesity are public health issues worldwide. In Saudi Arabia, in 2016/2017 the Rashaka Initiative, a national school-based, multicomponent, weight-related intervention, was launched to decrease the prevalence of obesity among students by 5% within five years. Neither the development stage of the initiative nor its implementation has been evaluated to explore its processes and outcomes. Aim: This study was aimed at evaluating the implementation of the Rashaka Initiative in intermediate and secondary schools in Makkah City, Saudi Arabia, covering both process and outcome. To this end, the following objectives were pursued: (1) to develop an evaluation framework that can be used to assess the processes and outcomes of the initiative, (2) to determine whether there was a change in students’ body mass indices (BMIs) during the implementation period, and (3) to explore the knowledge and attitudes of the Rashaka stakeholders regarding the perceived barriers and facilitators of implementation in their schools. Methods: This retrospective study, conducted after the implementation of the Rashaka Initiative, was completed in three phases. In phase I, a conceptual framework called the school-based weight-related intervention evaluation framework (SWIEF) was developed by integrating some elements of the program evaluation framework used by the US Centers for Disease Control and Prevention (CDC) with the components of a logic model. In phase II, secondary data from the Rashaka Initiative were analysed. Phase III was a cross-sectional exploration of the Rashaka stakeholders’ knowledge and attitudes as well as what they perceive as facilitators and barriers to implementing the intervention at their schools. Results: The comprehensive literature review yielded a published systematic review (Banany et al. 2024, Systematic Reviews). This systematic review found 11 school-based weight-related intervention studies in the six Gulf Cooperation Council countries (GCC). Despite the methodological limitations of some of these studies, there is preliminary evidence of the possible benefits of school-based interventions on students' weight and associated lifestyle factors in these countries. A review of the literature also facilitated the development of the SWIEF. The analysis of the secondary data revealed a significant reduction in BMI (p<0.001) across schools that participated in the Rashaka Initiative over two school years (2016/17 and 2018/19). However, this reduction was not associated with the school environmental factors attributed to the initiative. The study findings found that students’ BMIs decreased more considerably in girls’ and intermediate schools than in boys’ and secondary schools (p<0.001 and p=0.031, respectively). The cross-sectional study indicated that significantly better knowledge of risk factors and interventions for childhood obesity was exhibited by female Rashaka stakeholders (vs their male counterparts), stakeholders who completed tertiary education (vs those with lower education levels) and stakeholders engaged in the initiative for more than two years (vs participants who joined more recently) (p<0.001, p<0.007 and p<0.033, respectively). School health counsellors had more positive attitudes towards children’s health and weight than principals (p<0.008). Significantly more favourable attitudes towards the Rashaka intervention were also found among female stakeholders (p<0.011) and those with better knowledge of the initiative’s objectives, components, activities, and outcomes (p<0.049). Among the stakeholders, 73% perceived collaboration with different government and private sector institutions as the most common facilitator of the Rashaka implementation at their schools, while 69% perceived a lack of time as the main barrier. Conclusions: Addressing childhood obesity is a public health priority that requires substantial efforts from all relevant key stakeholders in Saudi Arabia. The evidence derived in this thesis revealed that the Rashaka Initiative has yet to satisfy its objectives. Future studies should be more rigorous, theory-based, and holistic to tackle obesity among school students. Evaluations of school-based obesity interventions should use control groups, validated and reliable measures and rigorous data analysis. Long-term monitoring of the implemented interventions is highly recommended for their improvement and sustainability.27 0Item Restricted An acute dietary intervention in lactation has variable impacts on the maternal and infant microbiota and milk antimicrobial proteins(The University of Western Australia, 2025-01-01) Sindi, Azhar; Payne, Matthew; Geddes, Donna; Stinson, LisaThe first years of life are a critical period for microbial colonisation of the infant gut, which has been linked with health and disease outcomes in later life. Breastfeeding has been shown to have a significant impact on both composition and function of the infant gut microbiome. This is due to vertical transmission of microbes and exposure to other non-microbial factors, such as antimicrobial proteins, in human milk (HM). Given the importance of HM and the infant gut microbiome for lifelong health, this thesis investigated factors that influence HM composition (both microbial and non-microbial), with a focus on maternal diet as a modifiable determinant. Further, by utilising an acute maternal dietary intervention during lactation, the significance of maternal diet for infant gut composition and function was explored. While many studies have assessed the determinants of the HM microbiota, this has not been investigated in an Australian population. To address this gap, we first collected HM samples from a small cohort (n=29) of Australian mothers to characterise HM bacterial profiles. We investigated potential associations between HM bacterial composition and maternal factors, such as body mass index (BMI), mode of delivery, breast pump use, allergy, and parity, and infant factors, such as sex, mode of feeding, pacifier use, and introduction of solids. Our findings confirmed previous reports that maternal BMI, mode of delivery, and breast pump use are associated with HM bacterial profiles. Additionally, we found that infant pacifier use was associated with an altered HM microbiome, the first report of such a finding. With a more complete picture of the HM microbiome in Australian women and its key determinants, we next sought to focus on maternal diet and its impact on the maternal and infant microbiota, as diet is the single biggest modifiable determinant of the human microbiome. Previous observational studies have linked maternal diet with the HM microbiota. Such studies have also associated maternal diet during pregnancy with the infant gut microbiota. However, the impact of diet during lactation on the maternal and infant microbiota has not been examined. To address this gap, we performed an interventional study, in which exclusively breastfeeding mothers (n=11) were placed on a low-sugar, low-fat, high-fibre diet for two weeks. We analysed maternal faecal and HM samples collected immediately before, immediately after, and 4-8 weeks after the intervention. Full-length 16S rRNA gene sequencing was used for high-resolution bacterial profiling. Additionally, infant faecal samples were collected for shotgun metagenomic sequencing immediately pre- and postintervention to examine the effect of maternal diet on both composition and function of the infant gut microbiome. The intervention had no significant impact on infant gut microbiome composition; however, it was associated with significant changes in the functional capacity of the infant gut microbiome. The intervention also elicited small changes in a low number of bacterial taxa in both the maternal faecal and HM microbiota, some of which persisted 4-8 weeks post-intervention. Given that the dietary intervention shifted the function, but not the composition, of the infant gut microbiome, we next investigated whether the diet modulated other biologically relevant components in HM, namely the antimicrobial proteins lysozyme and lactoferrin. However, given that little is known about daily, circadian, and between-breast variations in the concentrations of lysozyme and lactoferrin, the stability of these proteins in mature HM needed to first be established. HM samples were collected from 18 mothers who undertook our acute dietary intervention across a 3-week period; daily, three times a day, and from both breasts. Both lactoferrin and lysozyme showed small, but statistically significant, variability over time, with significant day-to-day and circadian differences; however, no significant variation was detected between breasts. These findings underscore the need to standardise sample collection time, or to collect samples at multiple time points throughout the day, in order to obtain reliable estimation of HM lysozyme/lactoferrin content. The concentration of HM lysozyme was reduced during the first week of the dietary intervention, while HM lactoferrin levels were lower in the second week of the intervention. Thus, maternal diet may impact HM antimicrobial protein concentrations. We hypothesise that this may be due to dietary effects on maternal systemic inflammation. Together, these data demonstrate the importance of maternal factors, including BMI and maternal diet and infant feeding practices, including breast pump and pacifier use, as potential modifiers of HM microbial composition. In addition, a controlled maternal dietary intervention elicited small but significant changes to the maternal faecal and HM microbiota, and to HM antimicrobial proteins. While these changes were associated with significant alterations to the functional potential of the infant gut microbiome, they did not affect its composition. The data presented in this thesis therefore highlight potential limitations of maternal diet as a target to improve infant health via manipulation of the microbiome.17 0