Review Article

The Epidemiology and Economic Burden of Obesity and Related Cardiometabolic Disorders in the United Arab Emirates: A Systematic Review and Qualitative Synthesis

Table 2

Epidemiology of cardiometabolic diseases in the United Arab Emirates and risk of bias in the included studies.

Author and yearPrevalence of cardiometabolic disease(s)Risk factors (multivariate analysis)

Obesity in childrenAl Hourani et al. (2003) [21]At risk for overweight: 14%
Overweight: 9% (at risk for overweight and obesity: Abu Dhabi: 21%; Sharjah: 24%; Dubai: 27%; Ras Al Khaimah: 22%; Fujairah: 30%)
Not assessed
Al-Haddad et al. (2005) [22]Overweight: 18.6% (calculated) (boys: 17.1%; girls: 20.1%)
Obesity: 7.4% (calculated) (boys: 7.7%; girls: 7.1%)
Not assessed
Malik and Bakir (2007) [15]Overweight: girls: 19.8%, 95% CI: 18.3–21.6; boys: 19.2%, 95% CI: 17.6–20.9
Obesity: girls: 12.4%, 95% CI: 11.1–13.8; boys: 13.1%, 95% CI: 11.6–14.5
Emirati:
Overweight: girls: 17.6%, 95% CI: 15–20.2; boys: 17.3%, 95% CI: 15.3–19.9
Obesity: girls: 14.3%, 95% CI: 11.5–16.7; boys: 12.7%, 95% CI: 10.4–14.6
Others:
Overweight: girls: 25%, 95% CI: 22.8–27.5; boys: 20.5%, 95% CI: 18.6–22.5
Obesity: girls: 13.5%, 95% CI: 11.8–15.4; boys: 14.6%, 95% CI: 12.5–16.7
Obesity:
Predictors:
Non-Emirati boys (OR = 1.783, CI 1.499–2.121)
Non-Emirati girls (OR = 1.767, CI 1.48–2.102)
Birth outside the UAE (OR = 1.173, CI 1.015–1.306)
Girls living in rural areas (OR = 1.614, CI 1.348–2.001)
Protective factors:
Boys living in rural areas (OR = 0.732, CI 0.591–0.912)
Overweight:
Protective factors:
Non-Emirati boys (OR = 0.662, CI 0.572–0.769)
Non-Emirati girls (OR = 0.569, CI 0.461–0.703)
Boys living in rural areas (OR = 0.785, CI 0.629–0.974)
Abdulrazzaq et al. (2011) [16]Under 5 years:
Overweight: boys: 13.45%; girls: 12.98%
Obesity: boys: 6.06%; girls: 6.54%
At age 13–17:
Overweight: boys: 14.16%; girls: 15.16%
Obesity: boys: 6.08%; girls: 9.94% 
At age 18:
Overweight: boys: 25%; girls: 30%
Obesity: boys: 7%; girls: 10%
Not assessed
Al-Haddad et al. (2000) [14]Overweight: 9.0% (boys: 8.5%; girls: 9.3%)
Obesity: 7.9% (boys: 7.9%; girls: 7.9%)
Not assessed
Al Blooshi et al. (2016) [23]Emirati:
Overweight: CDC: 17%; IOTF: 16%; WHO: 4.5%
Obesity: CDC: 20%; IOTF: 14%; WHO: 30.3%
Residents:
Overweight: CDC: 14% (calculated figure)
Obesity: CDC: 18% (calculated figure)
Age and gender: prevalence of overweight, obesity, and extreme obesity increased linearly with age in children 3–12 y (3.89% per year, R2 ≥ 0.962); a rate 28% higher in boys than in girls
Bin Zaal et al. (2009) [24]Overweight: girls: 13.1%; boys: 18.5%
Obesity: girls: 20.5%; boys: 22.2%
Protective factors:
Girls: always eating breakfast (OR = 0.5; 95% CI 0.2–1.0); eating breakfast at school (OR = 3.4; 95% CI 1.6–7.4); frequently snacking in between breakfast and lunch (OR = 0.5; 95% CI 0.3–0.9); meat consumption ≥4 times/week (OR = 0.1; 95% CI 0.02–1.0); chocolates and sweets consumption ≥4 times/week (OR = 0.5; 95% CI 0.3–0.8); soft drinks consumption ≥4 times/week (OR = 0.5; 95% CI 0.3–0.8); fast foods consumption ≥4 times/week (OR = 0.5; 95% CI 0.3–0.8)
Boys: fruit consumption: ≥4 times/week (OR = 0.6; 95% CI 0.4–1.0)
Predictors:
Boys: eating breakfast at school (OR = 3.0; 95% CI 1.1–8.3)
Al Junaibi et al. (2013) [25]Overweight: 14.7% (boys: 11.7%; girls: 17.6%)
Obesity: 18.9% (boys: 20.7%; girls: 17.0%)
Emirati nationals:
Overweight: 14.2% (boys: 11.6%; girls: 16.7%)
Obesity: 19.8% (boys: 21.4%; girls: 18.1%)
Positive correlation between child’s BMI percentiles and parental BMI (for every kg/m2 of parental BMI, the child’s BMI percentile increased by 2.34 percentile points)
Negative correlation between child’s BMI percentiles and dairy consumption (each additional daily dairy consumption was associated with a reduction in BMI by 2.52 percentile points; )
Musaiger et al. (2012) [26]IOTF:
Overweight: 15.24% (boys: 16.8%; girls: 13.6%)
Obesity: 13.07% (boys: 19.1%; girls: 6.6%) 
CDC:
Overweight: boys: 11.1%; girls: 11.5%
Obesity: boys: 22.5%; girls: 7%
Not assessed

Obesity in university studentsAmine and Samy (1996) [27]Overweight: 10.8%; obesity: 30.6%
Abu Dhabi: overweight: 12.3%; obesity: 31.6%
Dubai: overweight: 4%; obesity: 31.3%
Sharjah: overweight: 10.1%; obesity: 28.4%
Ras Al Khaimah: overweight: 15.2%; obesity: 29.1%
Others: overweight: 11.8%; obesity: 31.4%
Significant association (bivariate analysis) between obesity and:
Obesity during childhood
Obesity among parents (both or mother or father only)
Eating between meals (regularly or occasionally)
Al Mukhtar (2000) [19]Overweight: 24.0% (<20 years: 27.3%; ≥20 years: 21.9%)
Obese: 7.5% (<20 years: 6.5%; ≥20 years: 8.2%)
Not assessed
Badr and El-Sabban (2008) [28]Overweight and obesity: 13.3%
Female: overweight and obesity: 8.1%
Male: overweight and obesity: 22.2%
Positive correlation between BMI of males and their fathers’ BMI (r = 0.51; )
Musaiger et al. (2003) [29]Obesity: 35.7%Predictors:
Family history of obesity (RR = 1.88); not practicing sport (RR = 1.77)
Sheikh-Ismail et al. (2009) [30]Overweight: 27% (age group: 20–<30: 21%; 30–<60: 33%; >60: 15%)
Obesity: 16% (age group: 20–<30: 8%; 30–<60: 24%; >60: 14%)
Not assessed
Kerkadi (2003) [31]Obesity: 6.7%
Overweight: 19.4%
Reported hypertension: 2.8%
Reported diabetes: 1.4%
Significant association in bivariate analysis between obesity and higher consumption of cereals and fruits ()
Musaiger and Radwan (1995) [32]Overweight: 19%
Obesity: 9.8%
No statistical significance was found for any of the assessed risk factors
Papandreou et al. (2015) [33]Overweight and obesity: 28.4%Not assessed

Obesity in communityNg et al. (2011) [3]Adult female: overweight: 31.4%; obesity: 34.2%; elevated WC: 53.2%
Adolescent female: overweight: 20.5%; obesity: 19.7%
Adolescent male: overweight: 16.2%; obesity: 11.7%
Children (girls): overweight: 23.6%; obesity: 17.1%
Children (boys): overweight: 9.1%; obesity: 15.9%
Not assessed
Carter et al. (2004) [34]Overweight: 27%
Obesity: 35%
Age (OR = 1.05; 95% CI 1.04–1.07)

Metabolic syndromeMehairi et al. (2013) [35]Metabolic syndrome: 13% (boys: 22%; girls: 4%)
Elevated WC: boys: 22%; girls: 4%
IFG: boys: 13%; girls: 6%
Low HDL: boys: 88%; girls: 74%
Elevated TG: boys: 5%; girls: 1%
Hypertension: boys: 5%; girls: 8%
Overweight or obesity: 34.6% (boys: 39%; girls: 30%)
Predictors of metabolic syndrome:
Boys: screen time (aOR: 1.08, 95% CI: 1–1.17); BMI (aOR: 1.26, 95% CI: 1.2–1.33)
Girls: BMI (aOR: 1.22, 95% CI: 1.2–1.33)
Al Dhaheri et al. (2016) [36]Metabolic syndrome: 6.8% (95% CI: 5–9%)
(reduced HDL-C: 48.8%; elevated WC: 18.2%; elevated FBG: 9.7%; elevated BP: 5.4%; hypertriglyceridemia: 1.4%)
(At least 1 component: 38.4%; 2 components: 11.2%; 3 components: 4.9%; 4 components: 1.8%; 5 components: 0.2%)
Overweight (aOR = 3.8, 95% CI: 1.15–12.52)
Obesity (aOR = 11.2, 95% CI: 3.1–40.9)
WHR >0.8 (aOR = 3.04, 95% CI: 1.10–8.44)
HbA1c 5.6–6.4% (aOR = 8.92; 95% CI: 3.39–23.48)
HbA1c>6.5% (aOR = 22.5, 95% CI: 6.37–79.42)
Malik and Razig (2008) [17]Metabolic syndrome:
NCEP definition: 38.4% (36.9–39.9) (male: 32.4% (30–34.3); female: 47.0% (44.6–49.3))
IDF definition: 40.5% (39–42) (male: 32.9% (30.7–35.2); female: 45.9% (43.9–47.9))
Abdominal obesity:
NCEP definition: 44.8% (43.3–46.3) (male: 25.3% (23.3–27.4); female: 60% (58–62))
IDF definition: 69.9% (68.5–71.3) (male: 63.4% (61.1–65.7); female: 74.6% (72.7–76.2))
High BP: 38.4% (36.9–39.9) (male: 47% (44.6–49.3); female: 32.4% (30–34.3))
High fasting plasma glucose: 50.7% (male: 46.4% (44.1–48.8); female: 53.7% (51.7–55.6))
High plasma TG: 33.5% (32.1–34.9) (male: 43.6% (41.2–46); female: 26.4% (24.7–28.2))
Low HDL-C: 53.9% (52.3–55.4) (male: 43.4% (41.1–45.8); female: 61.2% (59.3–63.1))
Emirati:
Metabolic syndrome:
NCEP definition: 42.9% (40.1–44.8) (male: 31% (27.1–38.9); female: 51.2% (48.1–54.1))
IDF definition: 41.8% (39.5–44.1) (male: 37.1% (33–41.5); female: 44.3% (41.5–47.1))
Predictors of metabolic syndrome for both definitions:
Increasing age (≥40 years), female gender, and family history of diabetes

DyslipidemiaAgarwal et al. (1995) [37]Dyslipidemia (total cholesterol)
UAE nationals: borderline: 33.3%; high: 19.8%
Arabs (non-UAE): borderline: 29.5%; high: 19.6%
Non-Arabs: borderline: 31%; high: 11.4%
Female: borderline: 34.2%; high: 15.1%
Male: borderline: 29.9%; high: 18.1%
<51 years: borderline: 36.3%; high: 16.5%
>51 years: borderline: 34.7%; high: 22.6%
Not assessed

HypertensionAbdulle et al. (2014) [38]Prehypertension: 10.9% (male: 10.5%; female: 11.4%)
Hypertension: 16.5% (male: 15.4%; female: 17.8%)
Systolic hypertension: 14.6% (male: 14.4%; female: 14.8%)
Diastolic hypertension: 4.9% (male: 2.5%; female: 7.4%)
Predictors of systolic BP Z-scores:
Age (B(SE) = –0.010 (0.005)); BMI CDC percentile (B(SE) = 0.006 (0.001))
Predictors of diastolic BP Z-scores:
BMI CDC percentile (B(SE) = 0.002 (0.0003)); sex (B(SE) = –0.113 (0.025))
Positive relationship between BP Z-scores and weight status in all age groups and both sexes
El-Shahat et al. (1999) [39]Hypertension: 36.6% (calculated according to census in Sharjah: 31.6%)
Stage I: 32%; stage II: 4%; stage III: 0.05%
Female: 33.7% (stage I: 28.3%; stage II: 4.8%; stage III: 0.05%)
Male: 40.3% (stage I: 36.7%; stage II: 2.9%; stage III: 0.6%)
Not assessed

DiabetesEl Mugamer et al. (1995) [40](Age-adjusted prevalence)
Diabetes: 6% (male: 5.8%; female: 6.1%; Shamsi: 18.7%; others: 4.2%; rural: 4.0%; urban: 9.2%)
Obesity: male: 10.7%; female: 27.4%; Shamsi: 16.1%; others: 21.8%; rural: 17.9%; urban: 26.7%
Elevated SBP: male: 23.0%; female: 19.7%; Shamsi: 12.9%; others: 22.2%; rural: 19.2%; urban: 24.9%
Elevated DBP: male: 17.9%; female: 12.8%; Shamsi: 16.1%; others: 14.7%; rural: 12.1%; urban: 18.3%
Predictors of higher FBG:
Age 40–59: B = 1.59, SE = 0.4; ≥60 y: B = 1.01, SE = 0.43; tribe (Shamsi): B = 2.07, SE = 0.60; residence (urban): B = 1.56, SE = 0.37
Predictors of higher BMI:
Age 40–59: B = 1.85, SE = 0.62; gender (female): B = 1.93, SE = 0.54; tribe (Shamsi): B = −2.18, SE = 0.94; residence (urban): B = 1.82, SE = 0.59
Predictors of higher SBP:
Age 40–59: B = 11.5, SE = 2.7; ≥60 y: B = 21.2, SE = 2.9
Predictors of higher DBP:
Age 40–59: B = 7.9, SE = 1.5; ≥60 y: B = 6.5, SE = 1.7; gender (female): B = −3.0, SE = 1.3
Saadi et al. (2007) [41]Reported:
Diabetes: 10.2% (male: 9.4%; female: 11.1%)
Segi-standardized rates among 30- to 64-year-olds: 20.6% (male: 17.7%; female: 22.1%)
Measured:
Diabetes: 25.9% (diagnosed: 15.3%; undiagnosed: 10.7%); male: 27.1% (diagnosed: 18.9%; undiagnosed: 8.2%); female: 25.5% (diagnosed: 13.5%; undiagnosed: 12.0%)
Prediabetes: 22.8% (male: 19.7%; female: 24.3%)
Adjusted for the probability of inclusion in the study:
Diabetes: 17.1% (diagnosed: 10.5%; undiagnosed: 6.6%)
Prediabetes: 20.2%
Age-standardized rates among 30- to 64-year-olds:
Diabetes: 29.0% (diagnosed: 15.0%; undiagnosed: 14.0%)
Prediabetes: 24.2%
Predictors of undiagnosed diabetes:
BMI: B = 0.088; age: B = 0.059

Multiple risk factorsMalik et al. (2005) [18]Diabetes:
Crude: 20.2% (male: 21.5% (including newly diagnosed: 35.6%); female: 19.2% (including newly diagnosed: 44.9%))
Age-standardized rates (95% CI): 21.4% (20.4–22.4) (male: 20.4% (18.8–22); female: 22.3% (20.9–23.7))
IFG:
Crude: 6.5% (male: 4.5%; female: 8%)
Age-standardized rates (95% CI): 6.6% (6–7.2) (male: 4.5% (3.7–5.3); female: 7.2% (6.3–8.1))
Overweight: crude: 40%
Obesity: crude: 33%
Emirati:
Diabetes: crude: 24.5%; age-adjusted rate: 25.1%
IFG: crude: 8.8%; age-adjusted rate: 8.5%
Obesity: crude: 37%
Predictors of diabetes:
WHR: OR = 1.73, 95% CI: 1.18–2.55; age: OR = 1.06, 95% CI: 1.05–1.07; SBP: OR = 1.01, 95% CI: 1.001–1.01; BMI: OR = 1.04, 95% CI: 1.02–1.05
Protective factors for diabetes:
Nationality: Shwam: OR = 0.45, 95% CI: 0.36–0.57; Egypt/North Africa: OR = 0.7, 95% CI: 0.55–0.9; Sudan/East Africa: OR = 0.6, 95% CI: 0.45–0.8
Yusufali et al. (2015) [42]Mean 10-year Framingham CVD Risk Score: 5.3 (7.1) (male: 5.5 (7.3); female: 4.7 (6.0)) (Emirati: 7.2)
Diabetes: 31.6% (Emirati: 46.2%; other Arabs: 29.3%; South Asians: 31.7%; other Asians: 22.1%; others: 23.2%)
Hypertension: 30.6% (Emirati: 30.2%; other Arabs: 22.9%; South Asians: 31.5%; other Asians: 39%; others: 24.2%)
Dyslipidemia: 68.5% (Emirati: 666.2%; other Arabs: 69.3%; South Asians: 71%; other Asians: 53.2%; others: 47.9%)
Overweight: 41.9% (Emirati: 34.3%; other Arabs: 41.9%; South Asians: 43.1%; other Asians: 40.4%; others: 35.8%)
Obesity: 19.6% (Emirati: 46.6%; other Arabs: 40.9%; South Asians: 14.1%; other Asians: 16%; others: 25.5%)
Central obesity: 24% (Emirati: 55.8%; other Arabs: 43.5%; South Asians: 18.5%; other Asians: 27.9%; others: 33%)
Predictors of risk factors:
Male gender (OR: 3.441; 95% CI: 2.930 to 4.042)
Protective factor:
Age (per 10 years) (OR: 0.834; 95% CI: 0.784 to 0.886)
Baynouna et al. (2008) [43]Diabetes: 23.3% (self-reported: 19.5%; additionally measured: 3.8%) (female: 18.4%; male: 10.4%)
Prehypertension: 7.3%
Hypertension: 20.8% (self-reported: 20%; additionally measured: 0.8%) (female: 19.8%; male: 21.8%);
Obesity: 37.3% (female: 46.5%; male: 28.3%)
Central obesity: 39% (female: 59.9%; male: 37.2%)
Metabolic syndrome: 22.7% (female: 24.2%; male: 21.3%)
Dyslipidemia: 58.9% (female: 53.9%; male: 64%)
Not assessed
Hajat and Harrison (2010) [44]Overweight: 32%
Obesity: 35%
Central obesity: 57%
Either prediabetes or diabetes: 44%
Framingham CVD Risk Score:
>10%: male: 20.32%; female: 9.51%; overall: 14.22%
>20%: male: 7.59%; female: 2.56%; overall: 4.75%
Not assessed
Hajat et al. (2012) [20]Obesity: crude: 35.4% (female: 38.3%; male: 31.6%); ASR: 41.1% (40.7; 41.5)
Morbid obesity: 5% (female: 6%; male: 4%)
Overweight: crude: 31.9% (female: 28.8%; male: 36.1%); ASR: 34% (33.6; 34.4)
Central obesity: crude: 54.8% (female: 51.9%; male: 58.6%); ASR: 62.4% (61.9; 62.8)
Dyslipidemia: crude: 44.2% (female: 33.9%; male: 57.7%); ASR: 50.7% (50.3; 51.2)
Hypertension: crude: 23.1% (female: 20.9%; male: 26%); ASR: 29.2% (28.8; 29.6)
Prediabetes: crude: 27.1% (female: 26.5%; male: 27.8%); ASR: 29.5% (29.1; 29.9)
Diabetes: crude: 17.6% (female: 17.9%; male: 17.4%); ASR: 24.6% (24.2; 25) (newly diagnosed: 35%; self-reported history: 65%)
Not assessed

WorkersHossain and Malik (1998) [45]IGT: 18%
Diabetes: 10%
Obesity (defined by BMI): 68%, and obesity (defined by WHR): 31%
Elevated blood cholesterol: 74%
Predictors of obesity (elevated BMI):
Peninsular Arab: aOR: 3.06 (1.44–6.54); Shwam: aOR: 4.14 (1.96–8.75); Egyptian: aOR: 4.64 (1.4–15.21); WHR >1: aOR: 3.31 (1.77–6.18)
Predictor of obesity (elevated WHR):
BMI >25: aOR: 3.57 (1.89–6.73)
Predictor of elevated total cholesterol:
age 45–49: aOR: 2.8 (1.47–5.32)
Protective factors of abnormal glucose tolerance:
Shwam: aOR: 0.37 (0.17–0.78); Egyptian: aOR: 0.31 (0.1–0.96)
Protective factors of obesity (elevated WHR):
Afro-Arab: aOR: 0.14 (0.03–0.64); European: aOR: 0.15 (0.03–0.72); medium physical activity: aOR: 0.4 (0.19–0.83); heavy physical activity: aOR: 0.27 (0.09–0.8)
Newson-Smith (2010) [46]Preemployment assessment:
Obesity: 16.6% (Emiratis: 31.9%; Pakistanis: 16.6%; Filipinos: 5.9%; Indians: 2.4%)
Diabetes: 2.5% (Emiratis: 3.6%; Pakistanis: 0%; Filipinos: 2.9%; Indians: 1.6%)
Hypertension: 15.5% (Emiratis: 0%; Pakistanis: 16%; Filipinos: 32.4%; Indians: 28.4%)
At periodic health evaluation:
Obesity: 8.6% (Emiratis: 29%; Pakistanis: 43%; Filipinos: 8%; Indians: 7%)
Diabetes: 11.3% (Emiratis: 0%; Pakistanis: 21.4%; Filipinos: 9.5%; Indians: 11.6%)
Hypertension: 37% (Emiratis: 12.5%; Pakistanis: 50%; Filipinos: 47.6%; Indians: 37.3%)
Not assessed

IncidenceSreedharan et al. (2015) [13]Overall incidence in ≥20 years: 4.8/1,000 PY
Gender-specific incidence rate: male: 3.3/1,000 PY; female: 6.3/1,000 PY
Highest incidence rate for both genders: age group: 55–59 (male: 23.4/1,000 PY; female: 32.4/1,000 PY)
ASR in male and female was almost similar until the age of 39 years; then, females ≥40 years showed a higher incidence rate than males

CI: confidence interval; OR: odds ratio; UAE: United Arab Emirates; CDC: Centers for Disease Control and Prevention; IOTF: International Obesity Task Force; WHO: World Health Organization; BMI: body mass index; aOR: adjusted odds ratio; HDL-C: high-density lipoprotein cholesterol; WC: waist circumference; FBG: fasting blood glucose; BP: blood pressure; HbA1c: Hemoglobin A1c; NCEP: National Cholesterol Education Program; IDF: International Diabetes Federation; TG: triglycerides; SE: standard error; IFG: impaired fasting glucose; WHR: waist-to-hip ratio; CVD: cardiovascular disease; ASR: age-standardized rate; IGT: impaired glucose tolerance; PY: person-years.