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Cardio-metabolic risk factors in Tunisia: state of the art

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Abstract

Cardiometabolic risk factors in Tunisia are growing fast. The main risk factor is metabolic syndrome which is a global health issue in both developing and developed countries. It is resulting from a new phase of epidemiological transition characterised by ageing and an increase in non-communicable diseases. It is common in both genders with some disparities between urban and rural regions, educational levels and social classes. Hypertension and diabetes are also additional risk factors predicting alarming mortality rates. We propose here a review of the determinants of metabolic syndrome in Tunisia and the overall cardiometabolic risk factors.

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References

  1. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA et al (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112(17):2735–2752

    Article  PubMed  Google Scholar 

  2. Isomaa B, Almgren P, Tuomi T, Forsèn B, Lahti K, Nissèn M et al (2001) Cardio-vascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 24(4):683–689

    Article  CAS  PubMed  Google Scholar 

  3. Mittal BV, Singh AK (2010) Hypertension in the developing world: challenges and opportunities. Am J Kidney Dis 55(3):590–598

    Article  PubMed  Google Scholar 

  4. Ben Romdhane H, Haouala H, Belhani A, Drissa H, Kafsi N, Boujnah R et al (2005) Epidemiological transition and health impact of cardiovascular disease in Tunisia. Tunis Med 83(Suppl 5):1–7

    PubMed  Google Scholar 

  5. Allal-Elasmi M, Haj Taieb S, Hsairi M, Zayani Y, Omar S, Sanhaji H et al (2010) The metabolic syndrome: prevalence, main characteristics and association with socio-economic status in adults living in Great Tunis. Diabetes Metab 36(3):204–208

    Article  CAS  PubMed  Google Scholar 

  6. National Institute of Statistics (2015) Yearly statistics report. National Institute of Statistics, Tunis

    Google Scholar 

  7. Aounallah-Skhiri H, Romdhane HB, Traissac P, Eymard-Duvernay S, Delpeuch F, Achour N et al (2008) Nutritional status of Tunisian adolescents: associated gender, environmental and socio-economic factors. Public Health Nutr 11(12):1306–1317

    Article  PubMed  Google Scholar 

  8. Institut National de la Nutrition et de la Technologie Alimentaire (1998) Evaluation de l’état nutritionnel de la population tunisienne 1996–1997. Rapport National. Tunis: INNTA

  9. Belfki H, Ben Ali S, Aounallah-Skhiri H, Traissac P, Bougatef S, Maire B et al (2013) Prevalence and determinants of the metabolic syndrome among Tunisian adults: results of the Transition and Health Impact in North Africa (TAHINA) project. Public Health Nutr 16(4):582–590

    Article  PubMed  Google Scholar 

  10. Harzallah F, Alberti H, Ben Khalifa F (2006) The metabolic syndrome in an Arab population: a first look at the new International Diabetes Federation criteria. Diabet Med 23(4):441–444

    Article  CAS  PubMed  Google Scholar 

  11. Jaber LA, Brown MB, Hammad A, Zhu Q, Herman WH (2004) The prevalence of the metabolic syndrome among Arab Americans. Diabetes Care 27(1):234–238

    Article  PubMed  Google Scholar 

  12. Tamashiro KL (2011) Metabolic syndrome: links to social stress and socioeconomic status. Ann N Y Acad Sci 1231:46–55

    Article  PubMed  Google Scholar 

  13. Gannar F, de León AC, Díaz BB, Pérez MD, Rodríguez IM, Dahmen FB et al (2015) Social class and metabolic syndrome in populations from Tunisia and Spain. Diabetol Metab Syndr 7:88

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Aounallah-Skhiri H, El Ati J, Traissac P, Ben Romdhane H, Eymard-Duvernay S, Delpeuch F et al (2012) Blood pressure and associated factors in a North African adolescent population. A National Cross-Sectional Study in Tunisia. BMC Public Health 12:98

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ben Romdhane H, Ben Ali S, Aissi W, Traissac P, Aounallah-Skhiri H, Bougatef S et al (2014) Prevalence of diabetes in Northern African countries: the case of Tunisia. BMC Public Health 14:86

    Article  PubMed  PubMed Central  Google Scholar 

  16. El Ati J, Traissac P, Delpeuch F, Aounallah-Skhiri H, Béji C, Eymard-Duvernay S et al (2012) Gender obesity inequities are huge but differ greatly according to environment and socio-economics in North African setting: a national cross-sectional study in Tunisia. PLoS ONE 7(10):e48153

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Regaieg S, Charfi N, Kamoun S, Eulleuch M, Marrakchi R, Jamoussi K et al (2015) Prevalence of metabolic syndrome and its components among overweight and obese secondary school adolescent in SFAX, Tunisia. Int J Clin Nutr 3(1):1–6

    Article  Google Scholar 

  18. Jamoussi H, Mahjoub F, Sallemi H, Berriche O, Ounaissa K, Amrouche C et al (2012) Metabolic syndrome in Tunisian obese children and adolescents. Tunis Med 90(1):36–40

    PubMed  Google Scholar 

  19. Romdhane HB, Ali SB, Skhiri H, Traissac P, Bougatef S, Maire B et al (2012) Hypertension among Tunisian adults: results of the TAHINA project. Hypertens Res 35(3):341–347

    Article  PubMed  Google Scholar 

  20. Allal-Elasmi M, Feki M, Zayani Y, Hsairi M, Taieb SH, Jemaa R et al (2012) Prehypertension among adults in Great Tunis region (Tunisia): a population-based study. Pathol Biol (Paris) 60(3):174–179

    Article  CAS  Google Scholar 

  21. Ibrahim MM, Rizk H, Appel LJ, el Aroussy W, Helmy S, Sharaf Y et al (1995) Hypertension prevalence, awareness, treatment, and control in Egypt. Results from the Egyptian National Hypertension Project (NHP). NHP investigative team. Hypertension 26(6 Pt 1):886–890

    Article  CAS  PubMed  Google Scholar 

  22. Mbanya JC, Minkoulou EM, Salah JN, Balkau B (1998) The prevalence of hypertension in rural and urban Cameroon. Int J Epidemiol 27:181–185

    Article  CAS  PubMed  Google Scholar 

  23. Agyemang C (2006) Rural and urban differences in blood pressure and hypertension in Ghana, West Africa. Public Health 120:525–533

    Article  PubMed  Google Scholar 

  24. Wu Y, Huxley R, Li L, Anna V, Xie G, Yao C et al (2008) Prevalence, awareness, treatment, and control of hypertension in China: data from the China National Nutrition and Health Survey 2002. Circulation 118(25):2679–2686

    Article  PubMed  Google Scholar 

  25. Ahmad K, Jafar TH (2005) Prevalence and determinants of blood pressure screening in Pakistan. J Hypertens 23(11):1979–1984

    Article  CAS  PubMed  Google Scholar 

  26. Al-Nozha MM, Abdullah M, Arafah MR, Khalil MZ, Khan NB, Al-Mazrou YY et al (2007) Hypertension in Saudi Arabia. Saudi Med J 28(1):77–84

    PubMed  Google Scholar 

  27. Rampal L, Rampal S, Azhar MZ, Rahman AR (2008) Prevalence, awareness, treatment and control of hypertension in Malaysia: a national study of 16,440 subjects. Public Health 122(1):11–18

    Article  CAS  PubMed  Google Scholar 

  28. Dorobantu M, Darabont RO, Badila E, Ghiorghe S (2010) Prevalence, awareness, treatment, and control of hypertension in Romania: results of the SEPHAR study. Int J Hypertens. https://doi.org/10.4061/2010/970694

    Article  PubMed  PubMed Central  Google Scholar 

  29. McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ (2007) Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 150(6):640–644 (644.e1)

    Article  PubMed  Google Scholar 

  30. Falkner B (2010) Hypertension in children and adolescents: epidemiology and natural history. Pediatr Nephrol 25(7):1219–1224

    Article  PubMed  Google Scholar 

  31. Pall D, Katona E, Paragh G, Zrinyi M, Zatik J, Fulesdi B (2005) Epidemiological data of 15–18 years adolescents and the prevalence of hypertension in Debrecen. The DebrecenHypertension Study. Orv Hetil 146(3):127–132

    PubMed  Google Scholar 

  32. Rosa ML, Fonseca VM, Oigman G, Mesquita ET (2006) Arterial prehypertension and elevated pulse pressure in adolescents: prevalence and associated factors. Arq Bras Cardiol 87(1):46–53

    Article  PubMed  Google Scholar 

  33. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS (2009) Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens 23(6):385–390

    Article  CAS  PubMed  Google Scholar 

  34. Andrade H, Antonio N, Rodrigues D, Da Silva M, Pego M, Providencia LA (2010) High blood pressure in the pediatric age group. Rev Port Cardiol 29(3):413–432

    PubMed  Google Scholar 

  35. Drukteinis JS, Roman MJ, Fabsitz RR, Lee ET, Best LG, Russell M et al (2007) Cardiac and systemic hemodynamic characteristics of hypertension and prehypertension in adolescents and young adults: the Strong Heart Study. Circulation 115(2):221–227

    Article  PubMed  Google Scholar 

  36. Bouguerra R, Alberti H, Ben Salem L, Ben Rayana C, El Atti J, Gaigi S et al (2007) The global diabetes pandemic: the Tunisian experience. Eur J Clin Nutr 61(2):160–165

    Article  CAS  PubMed  Google Scholar 

  37. Al-Lawati JA, Al Riyami AM, Mohammed AJ, Jousi Lahti P (2002) Increasing prevalence of DM in Oman. Diabet Med 19(11):954–957

    Article  CAS  PubMed  Google Scholar 

  38. Bener A, Zirie M, Janahi IM, Al-Hamaq A, Musallam M, Wareham NJ (2009) Prevalence of diagnosed and undiagnosed diabetes mellitus and its risk factors in a population-based study of Qatar. Diabetes Res Clin Pract 84(1):99–106

    Article  PubMed  Google Scholar 

  39. Ben Romdhane H, Khaldi R, Oueslati A, Skhiri H (2002) Epidemiologic and nutritional transition in Tunisia. Opt Méditerranéennes 41:278

    Google Scholar 

  40. Harzallah F, Ncibi N, Alberti H, Ben Brahim A, Smadhi H, Kanoun F et al (2006) Clinical and metabolic characteristics of newly diagnosed diabetic patients: experience of a University Hospital in Tunis. Diabetes Metab 32(6):632–635

    Article  CAS  PubMed  Google Scholar 

  41. Jomaa W, El Mhamdi S, Ali IB, Azaiez MA, El Hraiech A, Hamda KB et al (2018) Prognostic value of hyperglycemia on-admission in diabetic versus non-diabetic patients presenting for ST-elevation myocardial infarction in Tunisia. Indian Heart J 70(6):772–776

    Article  PubMed  PubMed Central  Google Scholar 

  42. Saidi O, O'Flaherty M, Mansour NB, Aissi W, Lassoued O, Capewell S et al (2015) Forecasting Tunisian type 2 diabetes prevalence to 2027: validation of a simple model. BMC Public Health 15:104

    Article  PubMed  PubMed Central  Google Scholar 

  43. Saidi O, Malouche D, O’Flaherty O, Mansour NB, Skhiri HA, Romdhane HB et al (2016) Assessment of cardiovascular risk in Tunisia: applying the Framingham risk score to national survey data. BMJ Open 6:e009195

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Yahia-Berrouiguet A, Benyoucef M, Meguenni K, Brouri M (2009) Enquête sur la prévalence des facteurs de risque de maladies cardiovasculaires à Tlemcen (Algérie). Médecine des maladies métaboliques 3:313–319

    Article  Google Scholar 

  45. Baynouna LM, Revel AD, Nagelkerke NJ, Jaber TM, Omar AO, Ahmed NM et al (2008) High prevalence of the cardiovascular risk factors in Al Ain, United Arab Emirates. Saudi Med J 29(8):1173–1178

    PubMed  Google Scholar 

  46. Galán AM, García FA, Taix MF, Ros XA, Martí EA, Gil AC (2004) Cardiovascular risk of SCORE compared to Framingham: consequences of the change proposed by the European Societies. Med Clin (Barc) 123:681–685

    Article  Google Scholar 

  47. Ezzati M, Vander Hoorn S, Lawes CM, Leach R, James WP, Lopez AD et al (2005) Rethinking the “diseases of affluence” paradigm: global patterns of nutritional risks in relation to economic development. PLoS Med 2(5):e133

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kreatsoulas C, Anand S (2010) The impact of social determinants on cardiovascular disease. Can J Cardiol 26(Suppl C):8C–13C

    Article  PubMed  PubMed Central  Google Scholar 

  49. Dallongeville J, Cottel D, Wagner A, Ducimetière P, Ruidavets J-B, Arveiler D et al (2008) The APOA5 Trp19 allele is associated with metabolicsyndrome via its association with plasma triglycerides. BMC Med Genet 9:84

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Demirdöğen BC, Şahin E, Özçelik AT, Bek S, Demirkaya Ş, Adali O (2012) Apolipopro-tein A5 polymorphisms in Turkish population: association with serum lipidprofile and risk of ischemic stroke. Mol Biol Rep 39(12):10459–10468

    Article  CAS  Google Scholar 

  51. Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M et al (2018) The 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 39(33):3021–3104

    Article  PubMed  Google Scholar 

  52. Takeuchi F, Isono M, Katsuya T, Yokota M, Yamamoto K, Nabika T et al (2012) Association of genetic variants influencing lipid levels with coronary arterydisease in Japanese individuals. PLoS ONE 7:9

    Google Scholar 

  53. Tan A, Sun J, Xia N, Qin X, Hu Y, Zhang S et al (2012) A genome-wide associa-tion and gene-environment interaction study for serum triglycerides levelsin a healthy Chinese male population. Hum Mol Genet 21:1658–1664

    Article  CAS  PubMed  Google Scholar 

  54. Sarbakhsh P, Mehrabi Y, Daneshpour MS, Zayeri F, Zarkesh M (2013) Logicregression analysis of association of gene polymorphisms with low HDL: tehran lipid and glucose study. Gene 513:278–281

    Article  CAS  PubMed  Google Scholar 

  55. Kefi R, Hechmi M, Dallali H, Elouej S, Jmel H, Halima YB et al (2017) Association of apolipoprotein A5 gene variants with metabolic syndrome in Tunisian population. Ann Endocrinol (Paris) 78(3):146–155

    Article  Google Scholar 

  56. Wu Y, Yu Y, Zhao T, Wang S, Fu Y, Qi Y et al (2016) Interactions of environmental factors and APOA1–APOC3–APOA4–APOA5 gene cluster genepolymorphisms with metabolic syndrome. PLoS ONE 11:e0147946

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Cha S, Yu H, Park AY, Song KH (2014) Effects of apolipoprotein A5 haplotypeson the ratio of triglyceride to high-density lipoprotein cholesterol and therisk for metabolic syndrome in Koreans. Lipids Health Dis 13:1–7

    Article  CAS  PubMed Central  Google Scholar 

  58. Qi L, Liu S, Rifai N, Hunter D, Hu FB (2006) Associations of the apolipoproteinA1/C3/A4/A5 gene cluster with triglyceride and HDL cholesterol levels inwomen with type 2 diabetes. Atherosclerosis 192(1):204–210

    Article  CAS  PubMed  Google Scholar 

  59. Grigorescu F (2012) New genetic approaches in understanding susceptibility for metabolic syndrome in immigrant populations around mediterranean area. Acta Endocrinol-Buch 8(1):87–98

    Google Scholar 

  60. Elouej S, Rejeb I, Attaoua R, Nagara M, Sallem OK, Kamoun I et al (2016) Gender-specific associations of genetic variants with metabolic syndrome components in the Tunisian population. Endocr Res 41(4):300–309

    Article  CAS  PubMed  Google Scholar 

  61. Elouej S, Belfki-Benali H, Nagara M, Lasram K, Attaoua R, Sallem OK et al (2016) Association of rs9939609 polymorphism with metabolic parameters and FTO risk haplotype among Tunisian Metabolic Syndrome. Metab Syndr Relat Disord 14(2):121–128

    Article  CAS  PubMed  Google Scholar 

  62. Elouej S, Nagara M, Attaoua R, Sallem OK, Rejeb I, Hsouna S et al (2016) Association of genetic variants in the FTO gene with metabolic syndrome: a case-control study in the Tunisian Population. J Diabetes Complications 30(2):206–211

    Article  PubMed  Google Scholar 

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  1. Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia

    Melek Kechida

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Kechida, M., the Tunisian Society of Internal Medicine. Cardio-metabolic risk factors in Tunisia: state of the art. Intern Emerg Med 15, 537–542 (2020). https://doi.org/10.1007/s11739-019-02164-7

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