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The excessive consumption of refined sugars mainly fructose is linked to metabolic dysfunction. The early introduction of refined sugars in the diets of children has resulted in an increased incidence of childhood metabolic dysfunction. There are conflicting reports on the gender susceptibility to developing metabolic dysfunction. Natural honey (NH) has been shown to have health benefits when included in the diet. The neonate is sensitive to dietary manipulations which can have long lasting effects. The short and long term effects of inclusion of NH in the diets of neonates were investigated in rat models. This was with a view to determine whether NH can substitute refined sugars such as cane syrup (GS), without adverse effects, and whether there were any gender differences in response to the dietary modification. In the long term study, 59 suckling Sprague-Dawley (SD) rats were fed with either NHor GS-supplemented diets from age 7 (neonate) to 91 (adulthood) days. For the short term study to investigate the effects of NH in neonates, 69 SD pups were gavaged with NH or GS twice daily at 12-hour intervals and allowed to nurse freely in between from age 7 to 20 days. The rats in all groups were weighed daily during the period when they were gavaged and then twice weekly thereafter to assess body weight gain (BWG) over the study periods. The adult rats were subjected to an oral glucose tolerance test (OGTT) at 13 weeks of age before termination. The rats’ growth was determined through their BWG and linear growth was assessed by measurements on the bones (femur and tibia) weight, length and density. Blood was collected for the assessment of clinical biochemistry and plasma markers of general health including the circulating metabolic substrates (glucose, triglycerides (TGs), free fatty acids (FFAs)); hormones (insulin, leptin); liver and renal functions were also obtained. Morphometric measurements (weight, lengths and histology) were also done on the abdominal viscera. Hepatic storage of metabolic substrates (glycogen and lipids) was determined. The analysis of the proximate composition of the NH and GS as well as the diets was performed with the Student’s t-test. A repeated measures two-way analysis of variance (ANOVA) with Bonferonni’s post hoc test was used to analyse the BWG and OGTT, while the other parameters were analysed by one-way ANOVA with Neuman-Keul’s post hoc test, and level of significance was set at p < 0.05. The matched diets were found to be isonitrogenous and isocalorific. Following the long term study, the NH fed rats showed tolerance to an oral glucose load. GS increased fasting blood glucose (FBG), TGs (p < 0.05), FFAs (p < 0.0001), visceral fat weight (p < 0.0001), and caused hypercholesterolemia, hyperinsulinemia, hepatomegaly and fatty liver in the males. NH increased intestinal villi growth and preserved the liver integrity in both males and females. Although, the GS-fed female rats did not suffer multiple risks of metabolic syndrome (MetS), there were high FBG concentration and hypercholesterolemia induced at low dose and metabolic dyslipidemia shown as high TG levels at high dose. These findings were contrary to the notion about the females having a lower susceptibility to developing metabolic syndrome than males. Some traditional rites include the feeding of honey to infants at birth, and there is evidence of the dietary inclusion of sugars in infant formulations. The need to evaluate the safety of honey consumption vis-à-vis refined sugars in children becomes imperative. Thus, after inducing metabolic syndrome in the rats through 12-week GS feeding, the effects of both diets on neonates were studied. In the neonates, there was no difference in all the parameters measured except the higher circulating non fasting FFAs (p < 0.0001) and hepatic storage of lipids (p < 0.001) in GS-fed than the NH-fed pups. Metabolic syndrome did not develop within the short term. NH was thus found to be a healthy source of dietary sugars, improved glycaemic control and metabolic profiles. The study underscored the differential effects of dietary treatments in male and female rodents. This pointed to the advantages of gender based comparative studies in biomedical research. The study confirmed the nutraceutical value of NH, and advocated for its consumption as a healthy substitute to refined sugars. The consumption of refined sugars by infants should be discouraged, and females should also be cautious in excessive sugar intake, as they can also be susceptible to the metabolic adverse health effects of artificial sweeteners.

Over the last 30 years Bahrain has witnessed remarkable economic growth and social development. This has resulted in tremendous changes in the dietary habits and lifestyle of the population and consequently increased levels of obesity. A cross-sectional study involving a representative sample of 506 Bahraini adolescents (249 males and 257 females), aged 12 to 17 years, was carried out to estimate the prevalence of obesity, its contributing factors and relationship to the risk of developing high blood pressure. The sample was selected, using a multi-stage random sampling technique, from intermediate and secondary schools in Bahrain. Data was collected using anthropometric measurements, blood pressure measurement and a self-administered questionnaire. A separate case control study, which included a sample of obese and non-obese adolescents, was carried out to investigate the relationship between adolescents' obesity and the family environment. Twenty one percent of the male and 35% of the female participants were obese using the WHO criteria for obesity in adolescents. A distinct sexual dimorphism in the accumulation of body fat during adolescence was observed. Thirty two percent of the boys and 60% of the girls had a percentage body fat at or exceeding the high-risk threshold for fatness, according to the currently accepted criteria. Systolic blood pressure, waist circumference and waist-hip ratio were all positively associated with body fatness. Multivariate analysis showed that higher levels of mother's education, frequent snacking and distress eating were all independent factors associated with an increased risk of obesity. Factors associated with a reduced risk of obesity included playing sport outside school, walking or cycling to school and eating meals with the family. Among the family environment variables, parental obesity and history of diabetes; mother's lifestyle variables, namely physical exercise and hours of television viewing, were all found to be independently related to risk of obesity in the Bahraini teenagers. Mother's degree of control over child's eating was strongly and indirectly related to risk of obesity in the adolescents. Breastfeeding, birthweight and availability and accessibility of high calorie foods in the house did not appear to be associated with adolescents' obesity. Eighteen percent of boys and 10% of girls had high blood pressure. BMI, percent body fat and waist circumference were all significantly and positively associated with a risk of having elevated blood pressure. Approximately 30% of the adolescents underestimated their current weight and about 40% thought that their parents/peers would consider them to be leaner than they actually were. More than half of the girls and about one third of the boys expressed discontent with their current body weight. Lifestyle changes and nutrition transition associated with economic development in Bahrain has increased risk of obesity among adolescents, a characteristic now evident in most countries in the Arab Gulf Region. This study provides an insight into the various determinants of this epidemic and will help to initiate public health strategies to deal with this increasing burden on health in the region.