Mohammed S Ellulu

A b s t r a c t Obesity is the accumulation of abnormal or excessive fat that may interfere with the maintenance of an optimal state of health. The excess of macronu-trients in the adipose tissues stimulates them to release inflammatory mediators such as tumor necrosis factor α and interleukin 6, and reduces production of adiponectin, predisposing to a pro-inflammatory state and oxidative stress. The increased level of interleukin 6 stimulates the liver to synthesize and secrete C-reactive protein. As a risk factor, inflammation is an imbedded mechanism of developed cardiovascular diseases including coagulation, ath-erosclerosis, metabolic syndrome, insulin resistance, and diabetes mellitus. It is also associated with development of non-cardiovascular diseases such as psoriasis, depression, cancer, and renal diseases. On the other hand, a reduced level of adiponectin, a significant predictor of cardiovascular mortality, is associated with impaired fasting glucose, leading to type-2 diabetes development , metabolic abnormalities, coronary artery calcification, and stroke. Finally, managing obesity can help reduce the risks of cardiovascular diseases and poor outcome via inhibiting inflammatory mechanisms.

Background: To find out the differences on biomedical data between obese and non-obese participants, and to identify risk factors associated with systemic inflammation in healthy Palestinian adults. Methodology: A cross-sectional study involved 105 apparently healthy adults. Interview questionnaire was used to collect personal information. Participants were excluded if they suffered from acute or chronic inflammatory diseases, or continued using medicines, which might affect the biomedical results. Results: In association with increased Body Mass Index (BMI), the obese group displayed significant higher markers including: interleukin 6 (IL-6), high sensitivity C reactive protein (hs-CRP), total cholesterol (TC), systol-ic blood pressure (SBP), and diastolic blood pressure (DBP). Obese group in association with increased waist circumference (WC) was higher significantly in inflammatory markers (IL-6, hs-CRP), lipid profile (TC) and triglyceride (TG), and blood pressure (SBP, DBP). A tertile of a feature of systemic inflammation (hs-CRP) was created , by Ordinal Logistic Regression, after adjusting for the age, gender, smoking habits, physical activity pattern, father and mother's health history; risk factors were the increased BMI [OR: 1.24] (95% CI: 1.005–1.548, P = 0.050), IL-6 [OR: 3.35] (95% CI: 1.341–8.398, P = 0.010), DBP [OR: 1.19] (95% CI: 1.034–1.367, P = 0.015), and reduced Adiponectin [OR: 0.59] (95% CI: 0.435–0.820, P = 0.001). Finally, BMI correlated with IL-6 and hs-CRP (r = 0.326, P = 0.005; r = 0.347, P b 0.001; respectively), and hs-CRP correlated with IL-6 (r = 0.303, P = 0.010), and inversely with Adiponectin (r = −0.342, P = 0.001). Conclusion: The increased level of IL-6 and reduced Adiponectin, which strongly associated with obesity, indicated that having high BMI is a useful marker in association with IL-6 and further developed systemic inflammation.

To assess the differences on inflammatory and metabolic indicators between pre-menopause and post-menopause women among hypertensive and/or diabetic type-2 women. A total of 236 obese women included in the study have chosen from Primary Health Care Centers in Gaza City, Palestine, through a cross-sectional study. Selection depended on health status hypertensive and/or diabetic type-2 (HT, T2DM, HT+T2DM). In HT group, post-menopause women had significant higher values than pre-menopause women on TC (200±47 vs. 172.5±55 mg dLG1, p<0.01) and TG
(166±89 vs. 120.5±82 mg dLG1, p<0.01). In T2DM group, post-menopause women had significant higher values than pre-menopause women on SBP (132±24 vs. 120±20 mm Hg, p<0.01), TC (213±40 vs. 185±46 mg dLG1, p<0.05) and TG (196±118 vs. 136±64 mg dLG1, p<0.05). Finally, in
HT+T2DM group, post-menopause women had significant higher value than pre-menopause women on SBP (144±21 vs. 133±14 mmHg, p<0.05), TC (214±54 vs. 181±55 mg dLG1, p<0.05), TG (231±83 vs. 158±85 mg dLG1, p<0.05), IL-6 (2.32±1.34 vs. 1.71±1.45 pg mLG1, p<0.05) and BMI (36.48±7.1 vs. 32.18±5.6 kg mG 2, p<0.05). Post-menopause women diseased of HT and T2DM accompanied with higher rates of BMI are at risk for developing inflammatory and metabolic
morbidities.

Overweight and obesity are worldwide public health issues which are defined as abnormal or excessive fat accumulation. WHO reported that there are one billion overweight people in the world, 300 million of whom are obese. Total body and abdominal obesity have well-known associations with all-cause
mortality, morbidity and disability, resulting in unhealthy life-years with poor quality of life and increased health care costs. The increased measure of BMI more than 25 and 30 kg/m2 will result in overweight and obesity respectively, while waist circumference is important for determining the central obesity. All Arab Countries including Palestine referred as the Eastern Mediterranean Region according to WHO. Palestine has many reports about increasing levels of Non Communicable Diseases (NCDs) like diabetes, hypertension, stroke and heart diseases which linked directly with overweight and obesity. The death
conditions in Palestine due to NCDs are also escalated over years. However, the number of studies and reports focused on overweight and obesity in Palestine is very little in comparing with the high evidences of NCDs linked to them. The main data was collected from three sources; Governmental, Non-governmental organizations and individual studies from Master Thesis. In other way, the data collected divided into three categories; the first one designed mainly to evaluate overweight and obesity, the second had assessed
overweight and obesity as a secondary objective in the way for evaluating nutritional status and the last one had the assessment within the context of the study. The results revealed data collected among vulnerable groups in both sexes. Most of studies indicated high measure of overweight and obesity among older adults rather than young adults. Finally; Palestine still in need for more studies to include all age groups and different cities.
Key words: Overweight, obesity, Palestine, public health

Atherosclerotic cardiovascular disease (CVD) is a collective term comprising of a group of disorders of the heart and blood vessels. These diseases are the largest cause of morbidity and premature death worldwide. Coronary heart disease and cerebrovascular disease (stroke) are the most frequently occurring diseases. The two major initiators involved in the development of atherosclerotic CVD are vascular production of reactive oxygen species (ROS) and lipid oxidation. In atherosclerosis development, ROS is associated with rapid loss of anti-inflammatory and anti-atherogenic activities of the endothelium-derived nitric oxide (NO(·)) resulting in endothelial dysfunction. In part involving activation of the transcription factor NF-κB, ROS have been involved in signaling cascades leading to vascular pro-inflammatory and pro-thrombotic gene expression. ROS is also a potent activator of matrix metalloproteinases (MMPs), which indicate plaque destabilization and rupture. The second initiator involved in atherosclerotic CVD is the oxidation of low-density lipoproteins (LDL). Oxidation of LDL in vessel wall leads to an inflammatory cascade that activates atherogenic pathway leading to foam cell formation. The accumulation of foam cells leads to fatty streak formation, which is the earliest visible atherosclerotic lesion. In contrast, the cardiac sarco/endoplasmic reticulum Ca(2+)-ATPase (SERCA2a) and hepatic apolipoprotein E (apoE) expression can improve cardiovascular function. SERCA2a regulates the cardiac contractile function by lowering cytoplasmic calcium levels during relaxation, and affecting NO(·) action in vascular cells, while apoE is a critical ligand in the plasma clearance of triglyceride- and cholesterol-rich lipoproteins.

Almost all countries are facing obesity endemic, although great variation exists between and within countries. Sedentary lifestyle and high fat (high caloric) diet have increased globally as a result of industrial, urban and mechanic changes of developing countries. Improved economic status promotes the obesity and metabolic syndrome in all age groups particularly young adults. Developing counties became in desperate need for establishing new polices and strategies within regulated and managed programs; in order to encounter factors of highly spread malnutrition displayed by obesity and its consequences like diabetes, CVD and metabolic syndrome. Developed and developing countries have studied the obesity prevalence, showing important statistics as the obesity hugely escalated in all population groups. Obesity and its related non- communicable diseases (NCDs) have new pandemic facts that
force the World Health Organization (WHO) to deal with.WHO noticed that obesity and NCDs will affect majorly the developing countries, and the expected numbers of new cases within the next 2 decades will exceed hundreds of millions. This review, discusses the epidemiology of obesity, lifestyle and nutritional transitions, determinants, social and economic impacts, and possible solutions for prevention of obesity in developing countries.
Keywords: Epidemiology, obesity, prevention, non-communicable diseases

Background: smoking and physical activities are types of lifestyle habits can affect directly the quality of life and
may interfere with health states. Objective: the explanation established based on questionnaire form questions to explain the scientific methods can help in evaluating smoking habits and physical activity for adults especially in clinical and health researches. Methods: smoking habits evaluated based on Behavioral Risk Factor Surveillance System which established by Center for Disease Control and Prevention (CDC), smoking classified into four groups; smoker, past smoker, passive smoker, and never smoker. Physical activity measured based on the second Global Physical Activity Questionnaire that established by World Health Organization (WHO), and it categorized into three groups; high physical active, moderate, and low. Conclusion: using of this explanation can help health
researchers in all fields to evaluate the smoking habit and
physical activity by standard and validated methods.

The roles of Omega-3 FAs are inflammation antagonists, while Omega-6 FAs are precursors for inflammation. The plant form of Omega-3 FAs is the short chain a-linolenic acid, and the marine forms are the long chain fatty acids: docosahexaenoic acid and eicosapentaenoic acid. Omega-3 FAs have unlimited usages, and they are considered as omnipotent since they may benefit heart health, improve brain function, reduce cancer risks and improve people’s moods. Omega-3 FAs also have
several important biological effects on a range of cellular
functions that may decrease the onset of heart diseases and
reduce mortality among patients with coronary heart disease,
possibly by stabilizing the heart’s rhythm and by reducing blood clotting. Some review studies have described the beneficial roles of Omega-3 FAs in cardiovascular diseases (CVDs), cancer, diabetes, and other conditions, including inflammation. Studies of the effect of Omega-3 FAs gathered from studies in diseased and healthy population. CVDs including atherosclerosis, coronary heart diseases, hypertension, and metabolic syndrome were the major fields of investigation. In studies of obesity, as the central obesity increased, the level of adipocyte synthesis of pro-inflammatory cytokines like tumornecrosis factor alpha (TNF-a) and interleukin 6 (IL-6) were increased and the level of anti-inflammatory adiponectin was decreased indicating a state of inflammation. The level of C reactive protein (CRP) synthesized from hepatocyte is increased by the influence of IL-6. CRP can be considered as a marker of systemic inflammation associated with increased risks of CVDs. In molecular studies, Omega-3 FAs have direct effects on reducing the inflammatory state by reducing IL-6, TNF-a, CRP and many other factors. While the appropriate dosage along with the administrative duration is not known, the scientific evidence-based
recommendations for daily intake are not modified.
Keywords Omega-3 fatty acids Polyunsaturated fatty acids  Inflammation  Mechanism Metabolic syndrome  Obesity  Cardiovascular diseases Cancer  Interleukin 6  C reactive protein

Objectives: to identify risk factors of blood pressure due to change of socio-demographic factors, obesity and health status. Methodology: cross-sectional designed studies of 484 participants have chosen from Primary Health Care Centers in Gaza Strip; Palestine based on objective criteria. Results: female got significant higher percent of obesity by BMI and WC than male (86.8% vs. 67.8%, P= 0.001; and 91.6% vs. 72.9%, P= 0.001; respectively). SBP had significant differences due to change educational background, menopause, obesity and health status, while not significance due to change of sex, marital status and family size. DBP got significant difference due to change of all previous factors. Correlation of SBP with age, WC and weight were significant at level P= 0.001 (rs= 0.444, rs= 0.434, and rs= 0.323; respectively). Correlation of DBP with age, WC and weight were also significant at level P= 0.001 (rs= 0.170, rs= 0.374, and rs= 0.362; respectively).  Finally, predication of risk factors may associate with high BP according to ATP-III, 169 participants out of 482 had SBP≥ 130 mmHg, and DBP≥ 85 mmHg. By multivariate logistic regression model, Odds Ratio (OR) for obesity equal 2.768 (95% CI: 1.183 to 6.475, P=0.019), OR for diseased mother of hypertension and/or diabetes equal 1.886 (95% CI: 1.185 to 3.003, P=0.007), and OR for medium family size (6-10 members) equal 0.611 (95% CI: 1.285 to 8.466, P=0.013). Conclusion: blood pressure increased by elevated BMI and WC, participants who had mother diseased by hypertension and/or diabetes were more likely to have higher BP.