Type 1 diabetes (T1D) is one of the most common endocrine and metabolic conditions in children. In fact, this disease in children and adolescents has been increasing exponentially, with Kuwait being ranked second highest in the world regarding the number of T1D incidences. Kuwait is an oil-rich country known for its strong sense of familism, affiliative obedience, and filial obligation. Therefore, a familial study of this disease may disclose certain causative agents responsible for passing the disease on to subsequent generations. To recruit T1D patients and their family members, three different scenarios were developed. First, since Kuwaiti families are generally obedient to their doctors, the authors decided to recruit the patients through their endocrine physicians. Second, home visits were performed for meeting the families’ requirements. In this case, a team consisting of one nurse, two phlebotomists (a male and a female, since some refused to be seen by the opposite gender), and a driver of the institute’s car was arranged. Finally, two diabetes educators were employed to resolve any issues raised during the recruitment process. Utilizing these approaches helped convince the culturally and religiously oriented Kuwaiti families to participate in this study. In this case, the doctors and educators were not only aware of the obstacles in this population but also sensitive to the families’ beliefs. This paper reports on our experience in recruitment and presents a roadmap for any future familial studies on culturally tailored societies i.e. Arab populations.

BackgroundRates of diabetes in Kuwait are among the highest in the world.AimsTo inform prevention initiatives, this study assessed diabetes knowledge, attitudes towards it, and personal behaviour relating to risk factors among the Kuwaiti population.MethodsA cross-sectional knowledge, attitudes, beliefs and practices survey of 1124 people was performed between July and September 2015. Descriptive analysis and χ2 tests were performed.ResultsAlthough most participants (94%) had heard of diabetes and 87% believed type 2 diabetes to be preventable, knowledge of risk factors was poor [family history (87%), age (44%), low exercise (10%), obesity (4%), diet (0%) and stress (0%)]. Dietary patterns in Kuwait were variable and, of concern, 42% of those with diabetes had been eating more since diagnosis. Lifestyle, particularly among Kuwaitis and people with diabetes, was sedentary - 47% of participants walked < 20 minutes per day.ConclusionsDespite the importance of diet and exercise for diabetes prevention, significant gaps in public education clearly exist. At a policy level, much remains to be done and intensified intersectoral programmes are required to improve public awareness.

Objectives: This analysis aimed to determine how people living in Kuwait perceive their body size and to identify possible determinants of this. Design: Data on perceived body size were gathered as part of a larger cross-sectional Knowledge, Attitudes, Behaviours and Practices (KABP) survey of 1124 participants. Results: Over 60% of participants were either overweight or obese. The overall rate of body size misperception was also high, with 19% of participants underestimating their body size. Gender and diabetes status were found to be associated with body size perception. Conclusions: Many overweight individuals may be underestimating their body size. As such, they may not appreciate the need for behavioural interventions designed to control weight and promote health. There is an evident need to strengthen health education and to address this issue within national policies and community engagement activities.

AbstractObjectiveThe beneficial role of breast-feeding for maternal and child health is now well established. Its possible role in helping to prevent diabetes and obesity in children in later life means that more attention must be given to understanding how patterns of infant feeding are changing. The present study describes breast-feeding profiles and associated factors in Kuwait.Design/Setting/SubjectsInterviews with 1484 recent mothers were undertaken at immunisation clinics across Kuwait. Descriptive analysis and binary logistic regression of results were performed.ResultsRates of breast-feeding initiation in Kuwait were high (98·1 %) but by the time of discharge from hospital, only 36·5 % of mothers were fully breast-feeding, 37·0 % were partially breast-feeding and 26·5 % were already fully formula-feeding. Multiple social and health reasons were given for weaning the child, with 87·6 % of mothers who had stopped breast-feeding completely doing so within 3 months postpartum. Nationality (P<0·001), employment status 6 months prior to delivery (P<0·001), mode of delivery (P=0·01), sex of the child (P=0·026) and breast-feeding information given by nurses (P=0·026) were all found to be significantly associated with breast-feeding. Few women (5·6 %) got information on infant nutrition and feeding from nursing staff, but those who did were 2·54 times more likely to be still breast-feeding at discharge from hospital. Over 70 % of mothers had enjoyed breast-feeding and 74 % said they would be very likely to breast-feed again.ConclusionsIn Kuwait where the prevalence of both obesity and type 2 diabetes is growing rapidly, the public health role of breast-feeding must be recognised and acted upon more than it has in the past.

BACKGROUNDRapid development and westernisation in Kuwait and other Gulf states have been accompanied by rising rates of obesity, diabetes, asthma, and other chronic conditions. Prenatal experiences and exposures may be important targets for intervention. We undertook a prospective pregnancy-birth cohort study in Kuwait, the TRansgenerational Assessment of Children's Environmental Risk (TRACER) Study, to examine prenatal risk factors for early childhood obesity. This article describes the methodology and results of follow-up through birth.METHODSWomen were recruited at antenatal clinical visits. Interviewers administered questionnaires during the pregnancy and collected and banked biological samples. Children are being followed up with quarterly maternal interviews, annual anthropometric measurements, and periodic collection of biosamples. Frequencies of birth outcomes (i.e. stillbirth, preterm birth, small and large for gestational age, and macrosomia) were calculated as a function of maternal characteristics and behaviours.RESULTSTwo thousand four hundred seventy-eight women were enrolled, and 2254 women were followed to delivery. Overall, frequencies of stillbirth (0.6%), preterm birth (9.3%), and small for gestational age (7.4%) were comparable to other developed countries, but not strongly associated with maternal characteristics or behaviours. Macrosomia (6.1%) and large for gestational age (23.0%) were higher than expected and positively associated with pre-pregnancy maternal overweight/obesity.CONCLUSIONSA large birth cohort has been established in Kuwait. The collected risk factors and banked biosamples will allow examination of the effects of prenatal exposures on the development of chronic disease in children. Initial results suggest that maternal overweight/obesity before pregnancy should be targeted to prevent macrosomia and its associated sequelae of childhood overweight/obesity.