Fruit and vegetable consumption and its determinants amongst Moroccan women, in the context of nutrition transition

Purpose: Morocco is undergoing a nutrition transition, characterised by increasing prevalence non-communicable diseases (NCD), including obesity. In that context, it is crucial to focus on fruit and vegetable (F&V) intake as they may have a preventive effect on weight gain and NCDs. Objectives: The objectives of the present work were: to develop an objective measure of F&V intake and to provide a holistic understanding of factors that may influence F&V consumption, such as socio-demographic and psychosocial factors. Methods: The target population was Moroccan women (20-49 years), living in the urban area of Rabat-Salé. This PhD involved three different studies: the first was based on focus groups that yielded qualitative data of women’s views of F&V; the second study involved validating a quantitative F&V Food Frequency Questionnaire (FFQ); the third a cross sectional population survey-which incorporated findings from studies 1 and 2 to assess dietary intake and the factors influencing F&V consumption. Results: Validation analyses suggested that the quantitative FFQ developed was reliable and valid to measure F&V intake. The mean F&V intake was 213g per day. Women with higher education, higher economic status and better knowledge scores ate significantly larger amounts of F&V than others. Processed food consumption was inversely associated with vegetable intakes. In terms of psychosocial factors, the strongest predictor of intention to eat fruit was control beliefs. Normative beliefs were the strongest predictor of intention to eat vegetables. Intention was the strongest predictor of both fruit and vegetable consumption. Conclusion: The data collected gave an overview of the amount of fruit and vegetables consumed by urban Moroccan women, and enabled a better understanding of the determinants of fruit and vegetable intake. As a consequence, data sheds light on possible avenues for policies and nutrition interventions to focus on in Morocco, in order to increase fruit and vegetable consumption

Fruit and vegetable consumption and its determinants amongst Moroccan women, in the context of nutrition transition

Purpose: Morocco is undergoing a nutrition transition, characterised by increasing prevalence non-communicable diseases (NCD), including obesity. In that context, it is crucial to focus on fruit and vegetable (F&V) intake as they may have a preventive effect on weight gain and NCDs. Objectives: The objectives of the present work were: to develop an objective measure of F&V intake and to provide a holistic understanding of factors that may influence F&V consumption, such as socio-demographic and psychosocial factors. Methods: The target population was Moroccan women (20-49 years), living in the urban area of Rabat-Salé. This PhD involved three different studies: the first was based on focus groups that yielded qualitative data of women’s views of F&V; the second study involved validating a quantitative F&V Food Frequency Questionnaire (FFQ); the third a cross sectional population survey-which incorporated findings from studies 1 and 2 to assess dietary intake and the factors influencing F&V consumption. Results: Validation analyses suggested that the quantitative FFQ developed was reliable and valid to measure F&V intake. The mean F&V intake was 213g per day. Women with higher education, higher economic status and better knowledge scores ate significantly larger amounts of F&V than others. Processed food consumption was inversely associated with vegetable intakes. In terms of psychosocial factors, the strongest predictor of intention to eat fruit was control beliefs. Normative beliefs were the strongest predictor of intention to eat vegetables. Intention was the strongest predictor of both fruit and vegetable consumption. Conclusion: The data collected gave an overview of the amount of fruit and vegetables consumed by urban Moroccan women, and enabled a better understanding of the determinants of fruit and vegetable intake. As a consequence, data sheds light on possible avenues for policies and nutrition interventions to focus on in Morocco, in order to increase fruit and vegetable consumption

Urban food environments in Africa: implications for policy and research.

Africa is currently experiencing rapid urbanisation impacting on people's food environments and dietary habits. Such changes are associated with higher prevalence of obesity coexisting with undernutrition. The present paper provides an overview of the healthiness of African urban food environments. We discuss the ways that food environments can be characterised and summarise the methods that can be used to investigate and intervene in the food environment. Data for Africa over a 50-year period (1961-2013) suggest an increasing availability of energy, animal products, fruit and vegetables, vegetable oils, sugar and sweeteners but a decrease in animal fats. There is a lack of evidence about how social, physical and macro-environments drive dietary habits in urban Africa, as most research has focused on the individual level. Examining how food consumption is embedded in everyday life, by investigating social environments is crucial to developing effective interventions. The informal food sector plays an important role in the retail food environment. Macro-level food price changes are an important factor influencing nutritional quality of African diets. The rapid expansion of food/beverages advertising in Africa threatens traditional food habits. Liberalisation of food trade is already impacting on the nutritional quality of food available. Improving African food environments represents a pressing public health concern and has the potential to prevent all forms of malnutrition. Hence, by conducting research into the role of urban social, physical and macro-environments, emerging interventions and policies are likely to positively impact on nutritional status, thereby enhancing social and economic development

Nutrition transition among adolescents of a south-Mediterranean country: dietary patterns, association with socio-economic factors, overweight and blood pressure. A cross-sectional study in Tunisia

Background: The increase in the burden of chronic diseases linked to the nutrition transition and associated dietary and lifestyle changes is of growing concern in south and east Mediterranean countries and adolescents are at the forefront of these changes. This study assessed dietary intake and association with socio-economic factors and health outcomes among adolescents in Tunisia. Methods: Cross-sectional survey (year 2005); 1019 subjects 15-19 y. from a clustered random sample. Dietary intake was assessed by a validated semi-quantitative frequency questionnaire (134 items) as was physical activity; the Diet Quality Index International measured diet quality; dietary patterns were derived by multiple correspondence analysis from intakes of 43 food groups. Body Mass Index (BMI) >= 85(th) and 95(th) percentile defined overweight and obesity. Waist Circumference (WC) assessed abdominal fat. High blood pressure was systolic (SBP) or diastolic blood pressure (DBP) >= 90(th) of the international reference for 15-17 y., and SBP/DBP >= 120/80 mm Hg for 18-19 y. Results: Energy intake levels were quite high, especially for females. The macro-nutrient structure was close to recommendations but only 38% had a satisfactory diet quality. A main traditional to modern dietary gradient, linked to urbanisation and increased economic level, featured an increasing consumption of white bread, dairy products, sugars, added fats and fruits and decreasing consumption of oils, grains, legumes and vegetables; regarding nutrients this modern diet score featured a decreasing relationship with total fat and an increase of calcium intake, but with an increase of energy, sugars and saturated fat, while vitamin C, potassium and fibre decreased. Adjusted for age, energy and physical activity, this modern pattern was associated with increased overweight in males (2(nd) vs. 1(st) tertile: Prevalence Odds-Ratio (POR) = 4.0[1.7-9.3], 3(rd) vs. 1st: POR = 3.3[1.3-8.7]) and a higher WC. Adjusting also for BMI and WC, among females, it was associated with decreased prevalence of high blood pressure (2(nd) vs. 1(st) tertile: POR = 0.5[0.3-0.8], 3(rd) vs. 1(st) tertile: POR = 0.4[0.2-0.8]). Conclusion: The dietary intake contrasts among Tunisian adolescents, linked to socio-economic differentials are characteristic of a nutrition transition situation. The observed gradient of modernisation of dietary intake features associations with several nutrients involving a higher risk of chronic diseases but might have not only negative characteristics regarding health outcomes

Consumption of food away from home in low- and middle-income countries: a systematic scoping review

Consumption of food away from home represents an increasing share of people’s food consumption worldwide, although the percentage of food intake that is consumed away from home varies among countries and among individuals. Previous systematic reviews have reported that, overall, consumption away from home negatively affects an individual’s diet and nutritional status. However, these reviews have mainly focused on high-income countries, leaving a gap in knowledge and data for people in low- and middle-income countries (LMICs). The present review aimed to describe trends in the consumption of food away from home in an apparently healthy population in low- and middle-income countries (LMICs) and to investigate any associations between this behavior and diet quality, nutritional status, and health outcomes

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Les mesures de la consommation alimentaire individuelle : des méthodes en fonction des objectifs visés

International audienceLes trois méthodes de mesure de la consommation alimentaire présentées permettent d'évaluer la qualité de l'alimentation ou d'identifier des modèles alimentaires dans une population donnée. Ces méthodes quantitatives reposent sur un travail important de préparation de la collecte et de gestion des données qu'il est fondamental de ne pas sous-estimer

Socio-economic and behavioural determinants of fruit and vegetable intake in Moroccan women

Objective: To estimate daily fruit and vegetable intakes and to investigate socioeconomic and behavioural differences in fruit and vegetable consumption among urban Moroccan women. Design: A cross-sectional survey. Fruit and vegetable intake was measured with a single 24 h recall. Settings: A representative population-based survey conducted in the area of Rabat-Sale. Subjects: Women (n 894) of child-bearing age (20-49 years). Results: Mean fruit and vegetable intake was 331 g/d (155 g/d for fruit and 176 g/d for vegetables). Only one-third (32.1 %) of women consumed >= 400 g/d and half the sample (50.6 %) were considered as low consumers, i.e. <280 g/d. Women of higher economic status ate significantly more fruit (P<0.05) and more fruit and vegetables combined (P < 0.05). Women ate significantly less vegetables if they ate out of home more often or skipped at least one main meal (breakfast, lunch or dinner) or ate more processed foods (P < 0.05, P<0.01 and P < 0.001, respectively). Fruit and vegetable diversity was not associated with any of the factors investigated. Conclusions: In this population, fruit and vegetable intakes are driven by different determinants. Indeed, while vegetable consumption was related only to behavioural determinants, fruit consumption was influenced only by economic status. Therefore, programmes promoting fruit and vegetable intake would be more effective if they account for these specific determinants in their design