<strong>June</strong> <strong>2007</strong>KUWAIT MEDICAL JOURNAL 161management of labor and involvement of seniorstaff in the decision making process of repeat CS inpatients with history of prior CS.ACKNOWLEDGEMENTSWe offer our sincere gratitude to our past andpresent medical colleagues who participated in themanagement of patients who form the subject ofthis study and to all the nurses and support staff.REFERENCES1. Notzon FC, Cnattingius S, Bergsjo P, Cole S Taffel S, Irgen I,Dattveit AK. CS delivery in the 1980’s: Internationalcomparison by indication. Am J Obstet Gynecol 1994;170:495-504.2. Wilkinson C, McIIwaine G, Boulton-Jones C, Cole S. Is arising CS rate inevitable? Brit J Obstet Gynaecol 1998;105:45-52.3. Socol ML, Gancia PM, Paeceman AM, Dooley SL. Reducingcesarean births in a primarily private university hospital.Am J Obstet Gynaecol 1993; 168:1748-1754.4. Cowan RK, Kinch RAH, Ellis B, Anderson R. Trial of laborfollowing CS. Obstet Gynecol 1994; 83:933-936.5. Miller DA, Fidelia GD, Paul RH. Vaginal Birth afterCaesarean Section. N Engl J Med 1996; 335:689-695.6. Wall LL. Cost effectiveness of elective CS after one prior lowtransverse cesarean. Obstet Gynecol 2000; 96:482.7. Grobman WA, Peaceman AM, Socol ML. Cost-effectivenessof elective cesarean delivery after one prior low transversecesarean. Obstet Gynecol 2000; 95:745-751.8. Walker R, Golois E, Turnbull D, Wilkinson C. Why chooseCS. Lancet 2001; 357: 635-636.9. Myers SA, Gleischer N. A successful programe to lower CSrates. N Eng J Med 1998; 319:1511-1516.10. Landon MB, Hauth JC, Leveno KJ, et al. Maternal andperinatal outcomes associated with a trial of labor afterprior cesarean delivery N Engl J Med 2005; 352:1718-1720.11. Lopez-Zeno JA, Peaceman AM, Adashek JA, Socol ML. Acontrolled trial of program for active management of labor.N Engl J Med 1992; 326:450-454.12. Chazotte C, Cohen WR. Catastrophic complications ofprevious CS. Am J Obstet Gynecol 1990; 163:738-742.13. Caughey AB, Shipp T D, Repke JT, Zelop CM, Cohen A,Lierberman E. Rate of uterine rupture during trial of laborin women with one or two prior cesarean deliveries. Am JObstet Gynecol 1999; 181:872-876.14. McMahon MJ, Luther ER, Bowes WA, Olshan A F.Comparison of a trial of labor with an elective second CS. NEngl J Med 1996; 335:689-695.15. Pare E, Quinones JN, Macones GA. Vaginal birth after CSversus elective repeat CS: assessment of maternaldownstream health outcomes. BJOG 2006; 113:75-78.16. Phelan JP. Clark SL, Diaz FP. Am J Obstet Gynecol 1987;157:1510-1515.17. Rageth I.C, Fuz,G Grossenbacher H. For the Swiss workingGroup of Obstetric and Gynecologic Institutions. ObstetGynecol 1999; 93:332-337.18. Bujold E, Gauthier RJ. Should we allow a trial of labor aftera previous Cesarean for dystocia in the second stage oflabor? Obstet Gynecol 2001; 98:652-655.19. Smith GCS, White IR, Pell JP, Dobbie R. Predicting Cesareanand Uterine Rupture among women Attempting VaginalBirth after Prior CS. PLos Med 2: e 25220. Lagrew DC Jr, M<strong>org</strong>an MA. Decreasig the caesaereansection rate in a private hospital: Success without mandatedclinical changes. Am J Obstet Gynecol 1996; 174:184-191.21. Davies GAL, Hatin PM, McGrath MJ. Vaginal Birth afterCaesaerean. Physcian’s perception and practice. J ReprodMed 1996; 41:515-520.22. Hibbard JU, Ismail MA, Wang Y, Te C, Karrison T, IsmailMA. Failed vaginal birth after a CS: how risky is it? Am JObstet Gynecol 2001; 184:1365-1371.23. Rozenberg P. The counselling of patient with prior C-section. Gynecol Obstet Fertil 2005; 33:1003-1008.24. Smith GC. Outcome Associated with a trial of Labor afterPrior Cesarean Delivery. N Engl J Med 2005; 352:1718-1720.25. Martel MJ, MacKinnon CJ. Guidelines for vaginal birth afterp revious Cesarean birth. J Obstet Gynaecol Can 2005;27:164-188.
KUWAIT MEDICAL JOURNAL <strong>June</strong> <strong>2007</strong>Original ArticleObesity and Cardiovascular Risk Factors in Kuwaiti AdultsFasial H. Al Orifan 1 , Hanan E. Badr 2 , Mohammed Abdul Sabour Se’adah 1 , Khalid Elias Khadadah 3 , Basel AlKordi 1 , Adel Abass 11Ministry of Health, Kuwait2Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait3Primary Health Care Department, Kuwait Oil Company, KuwaitABSTRACTObjective: To assess the association between obesity[adult Body Mass Index (BMI) ≥ 30] and cardiovascularrisk factors among adult Kuwaiti nationalsDesign: A cross sectional study conducted among adultKuwaiti nationals (20-44 years old)Setting: Qurtoba Police Health Center and Abdulla AlSalem Health Center, KuwaitSubjects: A sample of 296 subjects was selectedIntervention: Routine examination for those who havenever been diagnosed with any chronic health problem.Main Outcome Measure: Prevalence of obesity, levels offasting blood sugar, blood pressure and blood lipidprofile.Results: Obesity was prevalent among 42% of the samplewith male preponderance. Obese individuals were significantlyKuwait Medical Journal <strong>2007</strong>, <strong>39</strong> (2): 162-166KEY WORDS: obesity, cardiovascular risk factors, Kuwaitat higher risk of developing cardiovascular risk factorssuch as higher total cholesterol (OR=48, CI:9.8-235.9),LDL (OR=28, CI:9.3-81.3), impaired fasting blood sugar(OR=16, CI:6.2-43.2), prehypertensive systolic bloodp re s s u re (OR=5.4, CI:1.9-15.4) and pre h y p e r t e n s i v ediastolic blood pressure (OR=5.5, CI:1.2-25.9) than nonobesesubjects after adjusting other confounders.Conclusion: Obesity prevalence is an alarming healthproblem in the studied areas in Kuwait. It is associatedwith a wide range of cardiovascular risk factors thatindicate a warning sign of probable future increase in CVdiseases in this population. Further studies coveringrepresentative samples of all Kuwaitis are suggested.Obesity prevention programs related to communityconcerns are recommended.INTRODUCTIONObesity and overweight are both labels forranges of weight that are greater than what isnormally considered healthy for a given height.Adult obesity (BMI ≥ 30) and its co-morbidd i s o rders re p resent a significant public healthconcern and they are considered the leading causesof morbidity and premature mortality around theworld [1,2] . In the United States, about one third ofthe population was overweight and another thirdwas obese [2] . The prevalence of adult overweight(BMI range 25 - 29.9) and obesity is increasingre g a rdless of age, socioeconomic, or ethnicitydifferences [3] .Body weight is the result of a balance betweene n e rgy taken in and energy expended. It is acondition in which natural energy stored in fattissue is expanded far beyond usual levels to thepoint where it impairs health [4] . Obesity is definedas too much body fat with an abnormalaccumulation of fat in proportion to body size [2,4] .Obesity is now recognized as a major risk factorfor coronary heart disease. It also harms more thanjust the heart and blood vessels system; it is a majorcause of gall stones and can worsen degenerativejoint disease [ 4 ] . Obesity is associated with significantmorbidity including hypertension, type-2 diabetesmellitus and hyperlipidemia, as well as hyperuricemiaand some forms of cancer especiallycancer colon [5] .Coronary heart disease (CHD) is an importantand a prime cause of premature death; it remainsthe major killer of both men and women. Obesity isbecoming a major concern worldwide due to itsp roven relation to CHD. Multiple risk factorscontribute to the pro g ression and primarydevelopment of CHD and that the risk of CHD canbe significantly reduced through reduction ofmodifiable risk factors. Obesity is one of the majormodifiable risk factors [6] . Multiple cardiovasculardisease (CVD) risk factors tend to cluster inindividuals, thereby compounding the risk. Obesityand physical inactivity are associated with(This article was presented in the 12 th International Conference of the Kuwait Medical Association, April 1-4, <strong>2007</strong>)Address correspondence to:Hanan E. Badr, MD, MPH, Dr. Ph, Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University. Fax:965 533 8948, E-mail: hanan29@yahoo.com, hanan@hsc.edu.<strong>kw</strong>