When Professor Jumana Saleh moved to Oman in 2004, obesity simply wasn’t a public health issue in the sultanate. “You could hardly find anyone who was even just overweight, never mind obese,” she told The Brilliant.
It’s a very different story now.
Just like many other Gulf states, Oman has become much wealthier in the last 20 years. In 2000, its gross domestic product was valued at $19bn (US dollars), a figure which swelled to $80bn by 2014, according to the World Bank. With this prosperity came sweeping lifestyle changes. Giant air-conditioned shopping malls, for example, suddenly began to spring up. These new shopping centres host luxury boutiques and western-style eateries, offering everything from burritos and fried chicken to pizza. Fast-food culture arrived in Oman for the first time, causing waistlines to bulge and making obesity a significant challenge.
“We’re seeing more and more overweight people and it’s not just older people, it’s in children and young adults too. It’s a really big problem and I’m trying to direct more attention to it because people are now accumulating these health risks so early in their lives,” says Saleh, a professor of biochemistry at Sultan Qaboos University in Muscat, who studies metabolic disorders and lipid biochemistry.
It was Saleh’s father who first got her interested in science. He was an organic chemist at the University of Bristol. He’d often pick her up from primary school and take her back to the laboratory where she’d sit and watch him finish the day’s experiments. “All these colourful substances in beakers sparked my interest. It made research look so exciting,” she recalls. Her family moved from the United Kingdom to Yemen when she was aged seven, and then later to Jordan where Saleh took her undergraduate degree in medical technology and her master’s degree in biological sciences at the Jordan University of Science and Technology.
It was during her PhD studies at McGill University in Canada that she first began to work on fat storage and its relation to metabolic diseases and cardiology – all of which makes her the perfect candidate to study the rise of obesity faced by Oman and several other Arab countries such as Qatar and the United Arab Emirates.
The increased wealth enjoyed by many Middle Eastern countries in the last few decades has resulted in a reduction of deaths from infectious diseases such as malaria by 23% between 2000 and 2015. However, the number of deaths from non-communicable diseases including heart attacks and diabetes has risen by 38% in the same time frame.
Filling knowledge gaps for female patients
Saleh is studying the rising rates of “cardiovascular disease” in the region, which is a catch-all phrase that encompasses several different maladies including coronary heart disease and strokes. She’s looking how these disorders specifically affect women because much of what we know in terms how to tackle cardiovascular disease is tailored to male patients. That’s because until roughly 25 years ago, it was rare to include women as participants in medical trials and even now the male to female ratio in studies frequently falls short of 50:50. Yet diseases often behave differently depending on the sex of a patient. Women, for example, are more likely to suffer from inflammatory diseases such as rheumatoid arthritis, possibly because testosterone has anti-inflammatory properties. The biochemical differences between the sexes are so profound that some experts even say pharmaceutical companies should focus on producing male and female versions of their drugs.
Cardiovascular disease is a major cause of death in post-menopausal women – according to the American Heart Foundation, it’s responsible for roughly one third of women’s deaths globally – and one reason for such a high rate could be that the symptoms and risk factors of cardiovascular diseases in women differ from those in men, says Saleh. If that is the case, then doctors could be inadvertently ignoring the warning signs for their female patients who present with symptoms and risk factors not deemed typical of cardiovascular disease.
Body mass index (BMI), which uses a person’s height and weight to determine whether they’re a healthy weight or not, is currently used as one of the principal ways to assess a person’s risk of developing metabolic and cardiovascular disease. But that’s only part of the story, says Saleh. Studies have already shown that where fat is distributed is just as important as how much total fat a person has.
Visceral fat, which is fat that surrounds internal abdominal organs, is linked to higher levels of cholesterol production. It’s not obvious to the naked eye who does and doesn’t have large visceral fat deposits. “As women get older, they tend to have higher visceral fat, particularly during menopause” says Saleh. “The problem is that measuring a person’s visceral fat isn’t routine practice. You need specialist equipment that isn’t widely available, so I’m looking for biomarkers in the blood that might coincide with high visceral fat.”
Saleh has been gathering data from women of different age groups. She measures their visceral fat using specialised machines and also takes blood samples, looking to see if there are any substances in the blood that are common amongst women with high visceral fat. “We have recently found that a specific retinal binding protein is correlated with how much visceral fat a person has,” she says. These findings were presented during the latest International Symposium on Atherosclerosis held in Japan.
Findings like this could help to identify more women who are unwittingly at risk of cardiovascular disease and offer them the chance to introduce lifestyle changes to lessen that threat. “We also have to look at symptoms. A lot of importance is given to symptoms such as chest pain, which is important in men, but women can present with different symptoms such as nausea and back pain. This needs to be looked at too,” says Saleh.
Through research like this, Saleh is working towards her greater ambition of ensuring that women are better studied in the future. “The aim is broader than just finding particular risk factors,” she says. “It’s to modify the way we approach women in research.”
Article by Benj Plackett
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