Abstract
Background:
Metabolic disorders significantly contribute to global morbidity and mortality. However, data on these trends in the Arab region remain limited despite rising obesity rates and declining metabolic health.
Objectives:
This study aims to investigate the trends and burdens of metabolic diseases, including diabetes mellitus, cardiovascular disease (CVD), chronic kidney disease (CKD), metabolic dysfunction-associated fatty liver disease (MAFLD), and ischemic stroke and related risk factors in the Arab region.
Design:
A retrospective analysis of metabolic diseases based on the Global Burden of Disease 2021 database.
Methods:
We analyzed age-standardized rates of disease prevalence, incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021, using data from the Global Burden of Disease Study 2021.
Results:
In 2021, the Arab region faced a substantial burden: 34.6 million with diabetes, 30.8 million with CVD, 32 million with CKD, 109.4 million with MAFLD, and 3 million with stroke. Mortality and DALYs for these diseases often exceeded global averages.
Conclusion:
The Arab region faces a significant public health challenge due to increasing metabolic disease burdens and inconsistent mortality reduction. A comprehensive approach addressing lifestyle factors and improving healthcare access is crucial to improving health outcomes and managing this growing burden.
Plain language summary
This study examined how common metabolic diseases like diabetes, heart disease, fatty liver disease, and stroke have changed in Arab countries over the past 30 years (from 1990 to 2021). We used data from a large global study to see how many people are affected by these conditions and how they impact people’s health and lives. We found that metabolic diseases are becoming more common in the Arab region. More people are being diagnosed with these conditions, leading to increased disease and death. While some countries have made progress in lowering deaths from certain diseases, overall, the rates remain high. There are also significant differences between countries, with some performing much better than others. Our findings highlight the importance of better prevention and treatment of metabolic diseases in the Arab region. This involves promoting healthier lifestyles, improving access to healthcare, and tackling the factors that increase risk. By taking action now, we can help reduce the burden of these diseases and improve the health and well-being of people across the region. The data reveal that countries affected by war face additional challenges. This emphasises the negative effects of political and economic instability on health and highlights the need for regional cooperation to address health inequalities and improve overall well-being.
Introduction
Non-communicable diseases (NCDs), especially metabolic diseases, are a leading cause of disability. They account for approximately 75% of total deaths and impose significant economic burdens. 1 Metabolic risk factors are responsible for nearly one-third of global deaths and over 460 million disability-adjusted life years (DALYs). 2
The rise of obesity and decline in metabolic health are associated with various clinical consequences, including increased rates of diabetes mellitus, hypertension, hyperlipidemia, metabolic dysfunction-associated fatty liver disease (MAFLD), cardiovascular diseases (CVD), and chronic kidney disease (CKD), making metabolic diseases a significant global health challenge.3,4 These interconnected metabolic diseases often occur together, sharing common environmental and genetic risk factors. This increases the likelihood of disability, cancer, and premature death. 5
The Arab region, which includes 22 countries and approximately 500 million people living in diverse social and economic conditions, faces serious challenges due to rising obesity rates and declining metabolic health. 6 Yet, consistent and updated data on metabolic risk factor exposure and burden in this region are lacking. While some previous studies have investigated the prevalence of a single metabolic risk factor or disease at a country level within the region,7–9 updated and comprehensive assessments of the metabolic disease burden that spans the entire region are still lacking. 6
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 data, released on May 16, 2024, systematically collect mortality statistics and provide age, sex, and location-specific estimates of mortality rates worldwide. This data can be used to understand the evolving burden of metabolic diseases over time and inform about the efficacy of the implemented health policies. 10
Thus, this study aims to comprehensively portray the current burden of metabolic diseases—specifically diabetes mellitus, CVD, CKD, MAFLD, ischemic stroke, hypercholesterolemia, hypertension, and obesity—using GBD data. It will also compare these trends with global levels and highlight differences across various countries in the region from 1990 to 2021.
Methods
Data source
The GBD study models 371 diseases and injuries on global and regional scales, including subnational analyses in select countries. 10 The latest iteration assessed these diseases and 88 risk factors across 204 countries and territories from 1990 to 2021. Data are reported by super-region, region, and country, utilizing a Bayesian meta-regression tool, DisMod-MR 2.1. This tool refines estimates at the regional and country levels using global data, with mortality figures obtained from vital registration systems and other surveillance methods.
In the GBD, estimates of incidence, prevalence, DALYs, and mortality are given for each disease (T2DM, CVD, CKD, MAFLD, and ischemic stroke), and estimates of DALYs and mortality are also provided for each risk factor (hypercholesterolemia, hypertension, and obesity); we analyzed all the above data, including all age groups and both sexes. These estimates were derived using ICD-10 codes, ensuring that data for overlapping conditions are not combined. In the GBD study, DALYs represent the total healthy life years lost due to illness, which combines years of life lost (YLL) from premature death and years lived with disability (YLD). YLLs are calculated by multiplying age–sex–location–year-specific deaths by life expectancy at the age of death, while YLDs are based on prevalent counts of non-fatal disease outcomes and corresponding disability weights. We analyzed DALYs and mortality for each metabolic disease and risk factor to ensure consistent indicators across our research.
Statistical analysis
We utilized incidence, prevalence, mortality, and DALYs along with age-standardized rates to characterize the burden of metabolic diseases, presented per 100,000 population with 95% uncertainty intervals (95% UIs) using the GBD algorithm. DALYs, which comprise YLL and YLDs, were calculated with uncertainty propagated through 500 draws, forming UIs from the 2.5th and 97.5th percentiles. Visual data results are available at https://vizhub.healthdata.org/gbd-compare/, while all data results are available in tabular form on https://vizhub.healthdata.org/gbd-results/. The analyses followed GBD rules, guidelines, and procedures.
This manuscript was prepared in accordance with the Standardized Reporting of Burden of Disease studies (STROBOD) statement reporting guideline for cross-sectional studies. 11 A completed checklist based on the reporting recommendations for the burden of disease study is included as Supplemental Material.
Results
Summary of findings
In 2021, an estimated 525.6 million cases of T2DM (95% UI: 490.9–565.4) were reported globally, with approximately 34.6 million individuals affected in the Arab region, representing 6.6% of global cases. CVD impacted 612 million people worldwide in 2021, with 30.8 million cases in the Arab region (5% of global cases). Globally, 673.7 million people were affected by CKD in 2021, including 32 million in the Arab region (4.7%). MAFLD affected 1267.8 million people worldwide, including 109.4 million cases in the Arab region (8.6%). Ischemic stroke impacted 69.9 million people globally, with 3 million cases in the Arab region (4.3%).
Diabetes mellitus
In 2021, diabetes affected approximately 34.6 million individuals in the Arab region. Qatar and Iraq experienced the highest burden in 2021, with prevalence rates of 15,316.1 and 15,261.8 per 100,000, respectively (Figure 1(a)).
Rates of prevalence in 22 Arab countries, 2021. (a) Diabetes mellitus, (b) CVD, (c) CKD, (d) MAFLD, and (e) ischemic stroke.
Diabetes prevalence exhibited a significant upward trend across the Arab region, with Egypt experiencing the highest annual increase in prevalence rate at 4.4% since 1990. No Arab country reported a decrease in diabetes prevalence, while Mauritania recorded the lowest annual change at 1.6%.
The highest incidence rates are reported in Qatar (788) and Bahrain (774.7), while Mauritania and Somalia report the lowest incidence rates (189.1 and 191.7; Figure 2(a)) and prevalence rates (3432.7 and 3163.6) among Arab countries. However, both of their mortality rates remain significantly higher than the global average (37.3 and 54.9 compared to 19.6).
Rates of incidence in 22 Arab countries, 2021. (a) Diabetes mellitus, (b) CVD, (c) CKD, (d) MAFLD, and (e) ischemic stroke.
Bahrain had the highest mortality rate at 126.7 and DALYs of 3437.4, significantly exceeding the global averages of 19.6 and 916.2, respectively (Table 1). Yemen recorded the lowest mortality rate in the Arab region at 14.9, and it was the only Arab country with lower DALYs than the global level (794.6 compared to 916.3). Morocco experienced the highest annual increase in mortality at 2.2% and DALYs at 2.8%. Jordan reported the greatest annual decrease in mortality at −1.2% and also had the lowest annual change in DALYs at 0.1%.
Arab countries of ASIR, ASPR, ASMR, and DALYs (per 100,000) of patients with T2DM in 2021, and the annual change from 1990 to 2021.
ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; ASR, age-standardized rate; DALYs, disability-adjusted life years; UI, uncertainty interval.
Cardiovascular disease
In 2021, CVD impacted approximately 30.8 million individuals in the Arab region, with the United Arab Emirates and Oman reporting the highest prevalence rates of 11,066.8 and 10,991.9 per 100,000, respectively (Figure 1(b)). Somalia had the lowest prevalence rate at 6695.4 per 100,000. Syria and the United Arab Emirates recorded the highest incidence rates for 2021 at 1480.4 and 1464.5 per 100,000, while Comoros reported the lowest incidence rate of 751.5 per 100,000 (Figure 2(b)).
Saudi Arabia experienced the largest annual prevalence increase at 0.4%, while Mauritania saw the most significant decrease at −0.1%. The highest annual incidence rate change occurred in Libya at 0.2%, whereas Algeria reported the largest decrease at −0.6%.
Mauritania and Egypt reported the highest mortality rates in 2021, at 763.9 and 612.1 per 100,000, respectively, which exceeds the global level of 235.2 per 100,000 by over 150%. Egypt and Yemen showed the highest DALYs, with figures of 12,208 and 10,703.2 per 100,000, doubling the global rate of 5055.9. Lebanon recorded the lowest figures for both mortality rate and DALYs, at 164.5 and 3323.3 per 100,000, respectively. In addition, Lebanon experienced the most significant annual decline in both mortality rate and DALYs, at −3.2% and −3.3%. By contrast, Libya saw the highest annual increases in mortality, at 0.2%, and DALYs, at 0.1%. Qatar reported the most substantial decreases in both mortality and DALYs, at −3.5% and −3.5%, respectively (Table 2).
Arab countries of ASIR, ASPR, ASMR, and DALYs (per 100,000) of patients with CVD in 2021, and the annual change from 1990 to 2021.
CVD, cardiovascular disease; DALYs, disability-adjusted life years; UI, uncertainty interval; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; ASR, age-standardized rate.
Chronic kidney disease
In 2021, CKD affected approximately 32 million individuals in the Arab region, with the United Arab Emirates having the highest prevalence (9512.7 per 100,000; Figure 1(c)) and Djibouti having the lowest prevalence rate (5776.9 per 100,000).
Saudi Arabia recorded the highest incidence (495.8 per 100,000; Figure 2(c)), mortality rates (79.3 per 100,000), and DALYs (1762.8 per 100,000) in 2021 (Supplemental Table 1). This sharply contrasts with Somalia, which reported the lowest incidence (113 per 100,000) but still faced a high mortality rate (47.9 per 100,000).
Oman showed the highest annual increase in prevalence at 0.2%, while Kuwait experienced the largest decrease at −0.1%. Oman also had the highest annual change in ASMR, recording 1.9%. By contrast, Kuwait noted a decrease in the annual change of ASMR of −2.1%. Following Saudi Arabia’s increase of 1.5%, Libya recorded a rise of 1.4%, while Oman followed closely with an increase of 1.3%.
Metabolic dysfunction-associated fatty liver disease
In 2021, MAFLD affected approximately 109.4 million individuals in the Arab region, with Kuwait and Egypt reporting the highest prevalence rates that year (32,312.2 and 31,668.8 per 100,000, respectively; Figure 1(d)). Saudi Arabia and Kuwait had the highest incidence rates in 2021 (1333.3 and 1321.5, respectively; Figure 2(d)). Only in Djibouti were the incidence and prevalence rates lower than the global averages (546.6 vs 592.8; 14,379.3 vs 15,017.5; Table 3).
Arab countries of ASIR, ASPR, ASMR, and DALYs (per 100,000) of patients with MAFLD in 2021, and the annual change from 1990 to 2021.
DALYs, disability-adjusted life years; MAFLD, metabolic dysfunction-associated fatty liver disease; UI, uncertainty interval; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; ASR, age-standardized rate.
In addition, Egypt and Qatar exhibited the highest mortality rates (9.4 and 6.91 per 100,000, respectively), while Yemen recorded the lowest mortality rate (0.9 per 100,000). Although Somalia also reported one of the lowest prevalence rates in 2021 (15,069.6 per 100,000), it still demonstrated significantly higher mortality than the global average (3.3 vs 1.1). Egypt reported the highest rate of DALYs at 196.5, while Yemen had the lowest at 20.2.
Saudi Arabia experienced the highest annual increase in prevalence rate at 1%, while Oman recorded the highest annual increase in incidence rate at 0.9%. Conversely, Somalia reported the lowest increases in both prevalence rate (0.2%) and incidence rate (0.1%). The United Arab Emirates topped the charts in annual increases in both mortality (1.8%) and DALYs (1.3%), whereas Palestine saw the largest declines in mortality (−1.2%) and DALYs (−1.3%).
Ischemic stroke
In 2021, ischemic stroke affected approximately 3 million individuals in the Arab region. Djibouti and the United Arab Emirates reported the highest prevalence rates in 2021, with 1225.6 and 1201.6 cases per 100,000, respectively (Figure 1(e)). Iraq and Egypt had the highest incidence rates, reporting 139 and 132.1 cases per 100,000, respectively (Figure 2(e)). The lowest prevalence rate was found in Bahrain, at 540.4 cases per 100,000, while the lowest incidence rate was recorded in the United Arab Emirates, at 56.3 cases per 100,000.
The highest mortality and DALY rates were reported in Egypt and Iraq, at 139.8 and 123.1 per 100,000, and 2462.6 and 2163.9 per 100,000, respectively. By contrast, Kuwait had the lowest mortality rate at 25.7 per 100,000 and the lowest DALY rate at 526.3 (Supplemental Table 2).
Egypt experienced both the highest annual increase in prevalence rate (0.6%) and the highest annual increase in incidence rate (0.5%). Conversely, Qatar reported the largest decrease in both prevalence rate (−1.6%) and incidence rate (−1.4%). Libya stood out as the only Arab country indicating an increase in annual mortality (0.3%) and DALYs (0.4%), while Lebanon reported the largest decrease in both mortality and DALYs (−3.2% and −2.9%, respectively).
Hypercholesterolemia
In 2021, 3.6 million people died due to high LDL cholesterol, with 237,624 cases occurring in the Arab region, accounting for 6.5% of global cases. Egypt reported the highest DALYs (3151.31 per 100,000) and mortality (139.26 per 100,000) among Arab countries, both significantly higher than global levels (1023.1 and 43.7). Meanwhile, Comoros had the lowest DALYs (730.3) and mortality (31.1).
The most notable improvement occurred in Bahrain, where DALYs decreased by 63% (from 3528.3 to 1303.5), and mortality dropped by 60% (from 167.3 to 66.9) between 1990 and 2021. Oman and Algeria followed with declines of 45% and 35% in DALYs, respectively. However, the DALYs for Libya and Djibouti rose by 18% (from 1464.9 to 1724.1) and 17% (from 630.4 to 738.3; Supplemental Table 3), respectively.
Hypertension
In 2021, 10.8 million people died from hypertension, with 578,185 cases in the Arab region, representing 5.3% of global cases. Egypt had the highest rates for high blood pressure in 2021, reporting the highest DALYs (7093.8) and mortality (370.5). By contrast, Jordan reported the lowest DALYs (2575.3) and mortality (137.9).
Bahrain exhibited the largest reduction in DALYs (from 6510.4 to 2960.3, a 54.5% decrease) and mortality (from 361.8 to 178.4, a 51% reduction). Likewise, Lebanon and Kuwait observed a 60% and 50% decline in DALYs, respectively. By contrast, Libya experienced a 14.9% increase in DALYs (from 3646.5 to 4190.7) and a 13.3% rise in mortality (from 180.8 to 204.8), marking the most adverse trend (Supplemental Table 4).
Obesity
In 2021, 3.7 million people died due to obesity, with 314,703 cases occurring in the Arab region, which accounted for 8.5% of global cases. Saudi Arabia reported the highest obesity-related DALYs (4588.4) and mortality (158.9) in 2021, while Somalia reported the lowest DALYs (1607.4) and mortality (53.1).
Libya exhibited the largest increase in DALYs at 102.5% (from 1853.6 to 3754.5) and a surge in mortality of 98.2% (from 61.9 to 122.7). Jordan and Qatar were the only two Arab countries to show a decrease in DALYs (from 3458.5 to 3226.9 and from 3656.3 to 3590.9, respectively), but these levels are still substantially higher than the global average (which increased from 1189.7 to 1493.2). The highest decrease in mortality was reported in Lebanon, where figures dropped from 91.5 to 70.1. Djibouti was the only Arab country with both DALY rates and mortality lower than the global averages (from 686.3 to 1006.5 vs 1189.7 to 1493.2 and from 25.5 to 35.7 vs 40.9 to 44.2; Supplemental Table 5).
Discussion
This study provides a comprehensive overview of metabolic disease burden in Arab countries and examines trends over the past three decades. While global GBD reports provide valuable insights into worldwide health trends, our analysis offers a unique and culturally relevant perspective on the specific challenges facing the Arab region. Alarmingly, the prevalence and incidence of nearly all metabolic diseases have increased across the Arab region, with very few countries reporting a decline in only one or two of these diseases. Moreover, mortality rates and DALYs associated with metabolic diseases have generally stagnated or increased in most Arab countries, often exceeding the global average. These trends underscore the dual challenges of a rising disease burden and inconsistent progress in reducing mortality rates. Significant variation in the burden of metabolic diseases was observed across different countries. There is also a notable discrepancy between disease prevalence and related mortality rates, which is more pronounced in countries with lower to middle socioeconomic status compared to wealthier nations. This difference may indicate better early diagnosis and management practices in affluent countries.
To date, there is a paucity of studies that address the burden of metabolic diseases in the Arab region, and none have used the updated GBD 2021.7–9 Furthermore, existing research has often focused on individual metabolic diseases or countries in isolation. However, metabolic diseases are frequently interconnected through shared pathogenic pathways and genetic risk variants.12,13 An expert panel has recently called for a comprehensive framework for managing metabolic diseases, emphasizing the prevalent multimorbidity and the synergy of metabolic traits that contribute to end-organ damage, disabilities, cancers, and premature deaths. 3 Recognizing the common drivers of metabolic diseases is essential for developing effective public health measures to mitigate their impact. Instead of viewing these metabolic risk factors as separate entities, consolidating them into a global integrative approach highlights the need for upstream solutions to tackle the combined challenges posed by these diseases. 14 Thus, this work aligns with the expert panel’s call for a more integrated approach.
Looking at the individual metabolic risk factors, obesity remains the primary contributor to the metabolic disease burden in the Arab region, highlighting the necessity for policymakers to address upstream health determinants within our current obesogenic environment. 15 This strategy should also account for disparities related to sex, geography, and socioeconomic factors, as a one-size-fits-all approach is unlikely to yield effective results.
In addition, the region exhibits a higher prevalence of hypertension compared to the global average. Although regional efforts are underway to improve access to anti-hypertensive treatment and increase awareness of reducing salt intake. 16 Our results suggest that in conflict-affected countries such as Libya, Syria, and Yemen, there has been an increase in DALYs due to hypertension. This trend likely suggests significant challenges in the implementation and adoption of effective hypertension control policies in these settings.
Diabetes also continues to pose a significant threat in the region, although the growth rate of diabetes-related deaths has declined in some countries since 1990, such as Qatar, Jordan, and Kuwait, paralleling advancements in diabetes management and successful implementation of lifestyle and education initiatives. 17 More efforts are still required in other countries like Morocco, Saudi Arabia, and Egypt, where a significant gap remains in diabetes management and care quality, to help turn around the diabetes-related death curve. Ongoing efforts to tackle these metabolic risk factors are crucial for improving health outcomes in the region.
There are significant disparities in the burden of metabolic diseases, and considerable heterogeneity in trends has been observed among the countries in the Arab region. Notably, low- and middle-income countries experience the highest mortality rates from T2DM, hypertension, and MAFLD. Our analysis reveals a clear disparity in metabolic disease burden across the Arab region, correlating with the Sociodemographic Index. Wealthier nations, such as Qatar, tend to exhibit lower mortality rates and better disease management outcomes compared to lower-income countries like Somalia, likely reflecting differences in healthcare infrastructure, access to specialized care, and the implementation of preventative health policies. War-torn nations like Syria and Yemen are seeing rising DALY rates, in contrast to wealthier Gulf States, which show declines; this underscores the negative impact of political and economic instability on health. Indeed, regional instability and conflict have had a devastating impact on healthcare systems and disease prevalence in countries such as Libya, where disrupted access to essential medicines, displacement of populations, and the breakdown of public health infrastructure have contributed to a surge in metabolic disease burden, exacerbating existing health challenges. These factors highlight the need for regional cooperation to address health inequities and improve overall well-being. 18
To reduce future metabolic disease burdens, therapies should focus on upstream factors through policy interventions aimed at behavioral change. Modifications in the food environment and physical activity may alleviate the metabolic burden across various risk factors. Modifiable lifestyle factors, such as smoking and sedentary behavior, contribute significantly to the metabolic disease burden. 19 The decline in mortality related to some studied metabolic diseases, despite an increase in their prevalence, exemplifies the benefits of improving overall metabolic health.20,21 Pharmacological treatments should aim to enhance overall metabolic health. Strategies targeting high systolic blood pressure and cholesterol have effectively decreased disease burden, but it remains uncertain whether newer T2DM medications, like sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, will similarly reduce T2DM-related mortality. 22
Limitations
This study has several notable limitations. First, the accuracy of the GBD estimates depends on the quality of vital registration systems in each country, and data quality gaps in certain countries within the Arab region may introduce uncertainty. When reliable data are unavailable, estimates rely on models and trends from neighboring countries, which can introduce potential biases. The GBD has enhanced data collection by collaborating with in-country partners to improve data quality. Second, while evidence suggests that clustering of metabolic dysfunction conditions may elevate cardiovascular and MAFLD risk,23–25 we focused solely on individual metabolic diseases due to the lack of detailed patient data in the GBD database. Future research should aim to explore the combined effects of these disorders. Finally, although we used ICD-10 codes, our estimates did not account for factors that might influence disease prevalence, such as evolving definitions of metabolic diseases and heightened health awareness. Related to this, the evolving definition of fatty liver disease (from nonalcoholic fatty liver disease (NAFLD) to MAFLD) may affect the comparability of data over time, as different sources may have used different diagnostic criteria. This study evaluates the burden of four metabolic risk factors, high systolic blood pressure, high fasting plasma glucose, high body mass index, and high low-density lipoprotein, over the past 30 years, but excludes metrics like waist circumference and triglycerides due to data limitations. Finally, while this study provides valuable insights into the trends of metabolic diseases in the Arab region, it is important to acknowledge a key limitation: the GBD dataset lacks detailed pathogenesis data. This prevents us from directly assessing the causal relationships between specific risk factors and disease development. However, our analysis shows a clear parallel increase in obesity, hypercholesterolemia, and hypertension alongside the rising burden of metabolic diseases, suggesting that the observed trends are, at least in part, linked to the increase in these risk factors.
Conclusion
In conclusion, the increasing prevalence of metabolic diseases across the Arab region presents a significant public health challenge. Although there have been some promising indicators, such as declining mortality rates from conditions such as hypertension and high LDL cholesterol in some of the countries of the region, these improvements suggest better treatment, awareness, and diagnostic recognition. However, the mortality rates associated with several metabolic diseases, including diabetes mellitus, CKD, and MAFLD, have not declined over the past two decades. This persistent trend highlights the need for more robust intervention strategies. A comprehensive approach that addresses lifestyle risk factors, improves healthcare accessibility, and views metabolic diseases as interconnected is crucial for reversing these trends and enhancing overall health outcomes.
Supplemental Material
sj-doc-1-tae-10.1177_20420188251406531 – Supplemental material for The burden of metabolic diseases in the Arab region, 1990–2021
Supplemental material, sj-doc-1-tae-10.1177_20420188251406531 for The burden of metabolic diseases in the Arab region, 1990–2021 by Ziyan Pan, Yasser Fouad, Faisal Abaalkhail, Abdulla Al Hassani, Munira Y. Altarrah, Moutaz Derbala, Maheeba Abdulla, Mohamed Tahiri, Said A. Al-Busafi, Nawal Alkhalidi, Bilal Hotayt, Sameer Al-Awadhi, Riham Soliman, Gamal Shiha, Faisal M. Sanai and Mohammed Eslam in Therapeutic Advances in Endocrinology and Metabolism
Footnotes
References
Supplementary Material
Please find the following supplemental material available below.
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