Comprehensive searches were undertaken across electronic databases (PubMed (22 March 2025; number of records = 52), Scopus (28 March 2025; number of records = 38), Google Scholar (2 April 2025; number of records = 187)) to provide a thorough understanding of the research landscape. To capture the latest trends and evidence, the search scope was restricted to papers published between January 2020 and December 2024.

Keywords used in the search strategy included nutrition-oriented non-communicable diseases NCDs, risk factors, obesity, diabetes, cardiovascular disease, diet, lifestyle, physical activity and terms specific to the countries of the Gulf Cooperation Council, such as Saudi Arabia, Kuwait, Oman, Qatar, Bahrain, and the United Arab Emirates. These keywords were combined with Boolean operators (AND, OR) to formulate the search strings.

The records retrieved from the database searches were screened in two phases: titles and abstracts screening, followed by a comprehensive review of the full texts against prespecified eligibility criteria. The main outcome of this review was to explore the dietary and lifestyle factors that contribute to the development of NCDs in the GCC region from childhood to adulthood.

This review included peer-reviewed articles encompassing original research, including observational studies published in English investigating nutrition-oriented risk factors such as dietary habits, obesity, sedentary lifestyles, and other pertinent nutritional behaviors contributing to NCDs in the GCC countries. Studies that identified dietary and lifestyle factors affecting the course of NCDs in both male and females were included. This review excluded letters, editorials, conference abstracts, unpublished data, study protocols, reviews, meta-analyses, and opinion pieces. Studies were also excluded if they did not investigate lifestyle-oriented risk factors or address NCDs, were conducted outside the GCC countries or involving non-relevant populations, or were published before 2020. This date restriction ensured the evidence reflects the recent GCC policy context and post-2020 changes, including pandemic disruptions to diet and physical activity.

The quality of the selected studies was evaluated using the Critical Appraisal Skills Programme (CASP) tool. The tool offers a systematic framework for assessing multiple dimensions of study quality, including the clarity of the research question, suitability of study design, sample size, risk of bias, and relevance of findings. Conflicts in assessment were reconciled by discussion and/or the intervention of a third review author. The quality assessment facilitated the evaluation of the research’s reliability and validity, prioritising higher-quality studies for inclusion in the final analysis.

Two independent authors extracted study characteristics, including the author, year of publication, study design, participants’ demographics, and nutrition-oriented risk factors such as dietary habits, obesity, and physical activity from the included studies using a standardized form. The extraction form was updated to capture age/age group, sex/gender, nationality/ethnicity (where reported), education, socioeconomic status (SES)/income, comorbidities/chronic conditions, exposure measurement tools, outcome definitions, and statistical methods/adjustments. Extracted variables were incorporated into Table 1 when available; where information was absent, “NR” (not reported) was recorded.

The data was analyzed thematically to determine repeating themes or patterns, such as the prevalence and impact of lifestyle-related NCDs in the GCC region [49]. The analysis identified the primary lifestyle risk variables, mainly in terms of unhealthy eating and sedentary lifestyles. Using the prevalence of the risk variables and the association with NCD outcomes, thematic categories were developed. A qualitative synthesis method was employed to encapsulate the principal findings, encompassing prevalence rates of NCDs and the link lifestyle-associated risk variables. The results were structured to emphasise trends, deficiencies, and implications for public health interventions in the GCC region.

The total number of records identified in the databases was 277. Thirteen duplicates and 99 records published before 2020 were removed. One hundred sixty-five records were screened, after which 84 were excluded following title and abstract screening. Eighty-one full-text articles were retrieved and meticulously screened. Twenty-two studies did not focus on risk factors, 13 studies encompassing additional nations alongside the GCC countries, and 26 studies that concentrated solely on awareness and attitude were excluded. Twenty research articles that met the eligibility criteria were included in this analysis (Figure 1).

This review included 19 cross-sectional studies, and one descriptive study. The majority of included studies employed cross-sectional designs (n = 18, 90%), reflecting the predominance of observational epidemiological evidence in the region. These studies were conducted in different GCC countries and focused on various risk factors for NCDS, dietary habits, and lifestyle factors. These studies employed secondary data, national surveys, and self-reported questionnaires. Sample sizes varied from 100 to more than 180,000 participants, with an approximate mean sample size of ∼11,800 participants, reflecting the inclusion of several large national surveys. Most studies included large population samples, which helped reduce the role of random error. Among the included studies, most were conducted among adult populations (n = 12, 60%), while fewer studies focused on children or adolescents (n = 3, 15%), patients with specific conditions such as diabetes (n = 2, 10%), or migrant populations (n = 1, 5%). Regarding health outcomes, obesity and overweight were the most frequently investigated conditions (n = 8, 40%), followed by cardiometabolic risk factors including hypertension and cardiovascular disease (n = 4, 20%), while type 2 diabetes was specifically addressed in two studies (10%). The studies examined significant risk factors associated with NCDs, including obesity, hypertension, tobacco consumption, lack of physical activity, and dietary habits. In addition, the connections between these factors and various socio-demographic characteristics, such as age, gender, education, and income levels, were analyzed (Tables 1, 2).

All 20 studies included in the appraisal demonstrated high methodological quality and relevance to the research objectives. Each study addressed a clearly focused issue and employed an appropriate methodology to answer the research question. The recruitment processes were acceptable across all studies, and measures were applied accurately to reduce potential bias. Regarding recruitment strategies, probability-based sampling methods were used in 5 studies (25%), including national surveys and stratified sampling approaches [29, 37, 40, 50, 51]. Convenience sampling was employed in 7 studies (35%) [30, 32, 34, 39, 43, 52, 53], while cluster or institutional sampling (e.g., schools, hospitals, or health centers) was used in 4 studies (20%) [32, 33, 36, 38]. The remaining 4 studies (20%) relied on secondary national datasets or surveillance systems [29, 35, 42, 45]. Data collection methods were well-aligned with the research aims, and all studies had an adequate sample size to minimise the role of chance. Data analysis was conducted with sufficient rigor, and every study provided a clear statement of findings. In terms of analytical rigor, multivariable or adjusted regression models were used in 9 studies (45%) to control for potential confounders [29, 30, 33, 36, 40, 42, 50, 51, 53]. Descriptive and prevalence-based analyses were reported in 8 studies (40%) [32, 37–39, 43–45, 52], while comparative risk modelling or advanced epidemiological modelling approaches were used in 1 study (5%) [35]. Additionally, subgroup analyses based on demographic factors such as sex, age, nationality, or socioeconomic status were conducted in 6 studies (30%), further strengthening the interpretability of the findings. Moreover, the results from all studies were deemed applicable to the local population and were considered highly valuable in informing practice and policy (Table 3). Overall, the appraisal revealed a consistent pattern of methodological robustness and practical significance across the reviewed literature.

Many included studies underscore the significant prevalence of obesity and associated risk factors within the GCC nations. There was a considerable prevalence of various risk factors, including tobacco use (12.1%), inadequate fruit and vegetable consumption (87%), insufficient physical activity (94.9%), overweight and obesity (65.1%), and hypertension (37.5%) [29]. In addition, there were socioeconomic associations with overweight/obesity and hypertension, encompassing variables such as gender, employment type, income, and educational attainment. Moreover, there was a general prevalence of non-communicable diseases (NCDs) in Saudi Arabia (32.15%), with elevated rates observed among women and elders, highlighting the necessity for focused interventions aimed at risk populations [29]. In another study, 38.5% of adults were classified as obese, with significant contributors identified as education level, dietary habits, and lack of physical activity [42]. Another study documented similar results in Dubai, indicating that 39.8% of adults were classified as overweight and obesity associated with various sociodemographic determinants such as age, sex, and occupation [43].

The influence of socioeconomic factors is substantial in the prevalence of obesity and various risk factors associated with NCDs. High educational levels correlated with physical activity that reduced obesity prevalence in Kuwait and Oman [33, 40]. In addition, obesity was prevalent, particularly among women, indicating that 47% of Omani women aged 30–49 years were classified as obese. Socio-demographic factors, such as marital status, income, and family structure, correlated with the behaviours related to meal timing and meal skipping in Kuwait [35]. These behaviours are consequently associated with an elevated risk of obesity and metabolic syndrome [33, 40].

The increasing incidence of childhood obesity presents a significant concern within the GCC region. Dietary consumption patterns and anthropometric measurements revealed that 28% of the children in the UAE were classified as overweight or obese. In addition, there were reported inadequacies in critical nutrients, including vitamins D and A [45]. Similarly, 42.3% of schoolchildren in Qatar were classified as overweight or obese, noting a greater prevalence among male students [44].

Some studies examine dietary patterns and their correlation with risk factors associated with cardiovascular disease (CVD). Kuwait showed three distinct dietary patterns, including the predominance of vegetables, the consumption of fast food, and a reliance on refined grains and poultry. Fast food consumption positively correlated with elevated BMI, increased waist circumference, and heightened blood pressure [32]. The consumption of refined grains and poultry was correlated with increased glucose levels. Similarly, inadequate dietary practices, characterised by a diminished consumption of nuts and seeds, excessive sodium intake, and insufficient fruit and vegetable intake, were responsible for 64.7% of cardiometabolic fatalities in Kuwait [34].

Physical activity is a critical modifiable factor influencing high NCD risk in the GCC. Evidence from several studies shows that there is an inverse relationship between disease burden and physical activity levels. For instance [31], reported that, among elders, those with greater physical activity engagement presented with fewer NCDs, even after statistical adjustment for other variables. Population-based data also show that inactivity is widespread: in Saudi Arabia, almost 95% of adults were classified as insufficiently active [29, 33] while findings from Kuwait reveal that more active individuals were less likely to have obesity or central obesity [29, 33]. Physical inactivity in the region has been associated with high prevalence of NCDs such as hypertension, dyslipidemia, and type 2 diabetes [29, 33]. Barriers to regular activity include cultural norms, sedentary occupations, and environmental constraints such as high temperatures [30].

Several studies examine the deficiencies of micronutrients and their implications for the risk of NCDs. About 23.8% of children in Oman were found to be anaemic, while 59.2% of women were classified as overweight or obese [39]. The prevalence of anaemia, iron deficiency, and micronutrient deficiency in Oman underscores the necessity for focused nutritional interventions [39]. Moreover, vitamin D deficiency was reported 67% among females in Al-Ain UAE [46]. Similarly, Bahrain was characterized by a low intake of fruits and vegetables alongside a high consumption of processed meats and sugary beverages. This dietary pattern is associated with nutritional deficiencies and a heightened prevalence of NCDs, including cardiovascular conditions [36].

The correlation between meal timing and the incidence of NCDs has been examined across various nations within the GCC. There were distinct timing and frequency patterns in Kuwait, with 54% of Kuwaiti adults consuming food after 10 pm, while 29% skipped breakfast, noting a higher propensity for meal skipping among women in comparison to men [35]. The behaviours are associated with an elevated risk of obesity and may play a role in the development of additional metabolic disorders. Engaging in late-night eating and the practice of skipping meals have been recognized as notable behavioural risk factors for NCDs, especially in nations such as Kuwait and Bahrain, where the prevalence of unhealthy dietary habits was considerable [35]. During Ramadan, Muslims follow a unique eating schedule, with a mealtime shift to Suhoor and Iftar. The change in meal timing can significantly affect sleep patterns [50]. Better sleep quality is significantly related to adequate physical activity and adequate intake of vegetables, fruits, dates, and plant-based proteins. Conversely, consuming foods at night and smoking can disrupt sleep. This underscores how dietary choices during Ramadan can significantly affect overall health [50].

Enhancing public health awareness concerning NCDs is essential for addressing the associated risk factors. About 70.6% of the Bahraini population possessed knowledge regarding Type 2 diabetes, with a notable increase in awareness among individuals diagnosed with the condition in contrast to those without diabetes [37]. The research advocated for educational initiatives to augment awareness and prevention strategies for Type 2 diabetes, highlighting the potential of social media as a tool for health communication [37]. In addition, enhanced education regarding nutrition, physical activity, and lifestyle modifications is critical to effectively manage obesity and improve diabetes outcomes [38, 43].

In individuals with NCDs, there is an association between nutritional quality and mental health in the GCC. In Oman [38], reported a significant negative correlation between nutrition quality of life (NQOL) scores and symptoms of mental health, such as anxiety and depression, among individuals with type 2 diabetes, with 71.1% of participants indicating poor glycaemic control. The results show that (NQOL) influences metabolic outcomes and may also play a role in mental health prevalence. Related findings from other studies in the region support the interconnected nature of nutrition, physical health, and mental wellbeing [39]. Reported a high prevalence of overweight and obesity among Omani women (59.2%), while [40] found that socio-demographic factors such as income and marital status were significantly associated with obesity. These factors are recognised in the literature as potential influences on both quality of life and mental health. Together, these results underscore the need for integrated care approaches in NCD management that address nutrition, metabolic control, and psychological support simultaneously.

The present review included recent studies published between 2020 and 2024, providing up-to-date evidence on nutrition-related risk factors, including unhealthy dietary patterns, socioeconomic determinants, lack of physical activity, and behavioural risk factors, influencing the increasing prevalence of NCDs. This date range is a strength, as it synthesizes the most recent evidence reflecting the current GCC policy context and the post-2020 period, including pandemic-related disruptions to diet and physical activity. In addition, the countries within the GCC present comparable fast rates of economic development, urbanization, and shared public health problems and nutritional behaviours. This enables the applicability of the findings within the broader GCC and other population groups, including adults, children, and migrants, to inform the targeting of public health strategies.

However, most included studies employed cross-sectional designs, which preclude the establishment of causal relationships between nutritional risk factors and NCDs. The absence of longitudinal data limits understanding of risk factor exposure and disease development temporal sequence. In addition, many studies utilized self-reported questionnaires for data collection, particularly regarding dietary habits and physical activity levels. These may introduce recall and social desirability biases, potentially leading to underreporting unhealthy behaviors and overreporting healthy practices. Moreover, the variability in the instruments used to assess dietary patterns, physical activity, and anthropometric measurements across studies limits direct comparability and may have influenced prevalence estimates of risk factors.

Future research should evaluate the effectiveness of specific intervention programs aimed at reducing nutrition- and lifestyle-related risk factors for NCDs in GCC countries. For example, school-based nutrition and physical activity programs targeting adolescents and adults could improve dietary habits, increase physical activity levels, and reduce overweight and obesity prevalence. Similarly, community-based lifestyle modification programs for adults such as structured weight-management initiatives, dietary counselling, and physical activity promotion may help reduce cardiometabolic risk factors including obesity, hypertension, and type 2 diabetes.

At the policy level, regulatory authorities in GCC countries could implement population-level strategies, such as taxation on sugar-sweetened beverages, front-of-package nutrition labeling, and restrictions on marketing unhealthy foods. These measures may help reduce the consumption of ultra-processed foods and sugary beverages while encouraging healthier dietary choices. Additionally, workplace wellness programs promoting regular physical activity, healthy food environments, and routine health screenings could contribute to early detection and prevention of NCDs among working-age adults.

Healthcare systems should also strengthen preventive services, including routine screening for obesity, hypertension, and diabetes in primary healthcare settings, coupled with lifestyle counselling and referral to nutrition or lifestyle medicine programs. Integrating multisectoral strategies involving health, education, and urban planning sectors such as improving access to recreational spaces and promoting active transport could further support healthier lifestyles.

Future studies should also employ longitudinal designs to assess the long-term impact of lifestyle interventions on NCD prevention in GCC populations, while exploring how socioeconomic, cultural, and environmental factors influence dietary behaviours and health outcomes. Such evidence would provide policymakers with clearer guidance for implementing targeted and effective public health interventions.

This review provides evidence of the substaintial burden of lifestyle-related NCDs across the GCC region. Dietary practices, physical inactivity, and socioeconomic factors influence the prevalence of obesity, cardiovascular diseases, and type 2 diabetes in these countries. In addition, the nutritional landscape of the GCC region is characterized by concerning dietary patterns that include excessive consumption of fast foods, refined grains, and sugar-sweetened beverages, coupled with inadequate intake of fruits, vegetables, and whole grains. These patterns, alongside widespread physical inactivity, promote the development and progression of NCDs. Furthermore, the identified socioeconomic gradients in NCDs prevalence, with higher burdens among less educated and lower-income groups, especially women, underscore the need for equity-focused approaches to health promotion. The high prevalence of childhood obesity across the region highlights an impending crisis that will likely translate into even higher adult NCD rates in the coming decades. Early intervention programs focusing on school-based nutrition education, mandatory physical education, and creating supportive environments for healthy behaviors are critical to addressing the issue. Public health policy should focus on nutrition, health improvement, physical activity promotion, and socioeconomic inequality. Strengthening public education, dietary guideline adherence, and physical exercise promotion to minimize NCDs in the GCC is also essential.