Adolescents’ use of online food delivery applications and perceptions of healthy food options and food safety: a cross-sectional study in the United Arab Emirates

IntroductionThis cross-sectional study aimed to assess Online food delivery applications (OFDA) usage trends among adolescent users in the United Arab Emirates (UAE), focusing on their perceptions of healthy food options and food safety (n = 532).MethodsSociodemographic information, frequency of OFDA use, factors affecting food choices, and perceptions of healthy food and food safety were investigated. A total perception score was calculated for each participant;ResultsMost participants used OFDAs weekly (65.4%), favoring fast food (85.7%). Factors like appearance and price drove food choices (65.0%), while taste and cost hindered healthy food orders (29.7 and 28.2%). Younger and frequent users had lower scores for perceiving healthy food, while seeking healthy options was associated with higher scores (p < 0.05). Females and those seeking healthy food showed higher food safety scores (p < 0.05).DiscussionThe study suggests tailored interventions to promote healthier choices and improve food safety perceptions among adolescents using OFDAs in the UAE

Fat Intake Reduction Strategies among Children and Adults to Eliminate Obesity and Non-Communicable Diseases in the Eastern Mediterranean Region

Non-communicable diseases (NCDs) are the leading cause of mortality globally with an estimated 39.5 million deaths per year (72% of total death) in 2016, due to the four major NCDs: cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. In the Eastern Mediterranean Region (EMR), almost 68% of all deaths are attributed to NCDs commonly known as chronic or lifestyle-related diseases. Two-thirds of NCD premature deaths are linked to 4 shared modifiable behavioral risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. These unhealthy behaviours lead to 4 key metabolic/biological changes; raised blood pressure, overweight/obesity, high blood glucose levels/diabetes, and hyperlipidemia (high levels of fat in the blood), that increase the risk of NCDs. Globally, countries are already working towards agreed global goals on maternal and infant nutrition and on the prevention of NCDs. In both fields the goals include halting the increase in overweight and obesity and reducing NCD diet-related risk factors including reducing saturated fatty acids (SFAs) and trans fatty acids (TFAs) intake. The objective of this review is to present an up-to-date overview of the current fat (SFAs and TFAs) intake reduction initiatives in countries of the Eastern Mediterranean Region (EMR) by highlighting national and regional programs, strategies and activities aiming at decreasing the intakes of dietary fat (SFA and TFA). The literature review shows that the average intake of SFA is estimated to be 10.3% of the total energy intake (EI), exceeding the WHO (World Health Organization) upper limit of 10%. The average TFA intake is estimated at 1.9% EI, which also exceeds the WHO upper limit of 1% EI. The highest SFAs intake was reported from Djibouti, Kuwait, Saudi-Arabia, Lebanon and Yemen, while the highest TFAs intakes were reported from Egypt and Pakistan. If countries of the EMR receive immediate public health attention, that toll of NCD-related morbidity and mortality would be considerably decreased through the implantation of evidence-based preventive interventions. In this context, reductions in SFAs and TFAs intakes have been highlighted as cost-effectives strategies that may hamper the growth of the NCD epidemic

Meta-Analysis and Systematic Review of Micro- and Macro-Nutrient Intakes and Trajectories of Macro-Nutrient Supply in the Eastern Mediterranean Region

The Eastern Mediterranean Region (EMR) is experiencing a nutrition transition, characterized by the emergence of overnutrition and micro-nutrient deficiencies. No previous study has comparatively examined nutrient intake in adults across countries in the EMR. This review examined the adequacy of nutrients in adults living in the EMR. Moreover, it analyzed the food balance sheets (FBS) for 1961–2018 to identify the trajectory of energy supply from macro-nutrients in the EMR. A systematic search was conducted from January 2012 to September 2020. Only observational studies were retained with a random sampling design. An assessment of the methodological quality was conducted. Levels of nutrient daily intake and their adequacy compared to the daily reference intake of the Institute of Medicine were reported across the region. No studies were identified for half of the region’s countries. Although nutrient energy intake was satisfactory overall, fat and carbohydrate intake were high. Intake of vitamin D, calcium, potassium, zinc, and magnesium were below that recommended. The analysis of the FBS data allowed for the identification of four linear patterns of trajectories, with countries in the EMR best fitting the ‘high-energy-supply from carbohydrate’ group. This systematic review warrants multi-sectorial commitment to optimize nutrient intake

Anemia among children and women in the Eastern Mediterranean Region: A Technical Guide

Anemia, a condition defined by deficiency in the size or number of red blood cells (RBCs), or a lower-than-normal level of hemoglobin within the RBCs, is a multifactorial condition whereby numerous factors may contribute to its development. The main factors include inadequate nutrition, poor nutrient absorption, deficiencies in essential micronutrients, nutritional interactions, infections, inflammation, chronic diseases, gynecological factors, heavy menstrual cycles, hemorrhage, pregnancy complications, family history of anemia and inherited disorders affecting RBCs. Anemia remains a significant public health concern, with the most vulnerable being children under five, specifically infants and young children below the age of 2 years, adolescent girls, women of reproductive age (WRA) and pregnant women. While symptoms of anemia vary depending on its severity, common symptoms include fatigue, dizziness, shortness of breath, chills at the extremities (hands and feet), headache, palpitations, decreased physical endurance, inadequate nutrition, and reduced productivity. Anemia predominantly affects low-income and middle-income countries with the heaviest burden, specifically populations residing in rural areas, economically disadvantaged households, and those lacking formal education. In 2019, the World Health Organization (WHO) estimated that approximately 40% of under five children, 37% of pregnant women, and 30% of WRA (15–49 years of age) worldwide are anemic. In the Eastern Mediterranean Region (EMR), the prevalence among under five children ranged between 11.9% and 79.5%. Among WRA, the prevalence ranged from 23.7% to 61.5%, while the prevalence among pregnant women was estimated between 19.1% and 57.5% in countries of the region. When the prevalence was assessed based on income, data from the region showed that in general, as income increased, the prevalence of anemia, and subsequently its severity, decreased, even though some exceptions were present in few countries. When the severity of anemia was assessed, the majority of EMR countries fell into the moderate category for anemia, with a prevalence rate ranging between 20% and 39.9% among under five children, WRA and pregnant women. The majority of EMR countries are therefore off track when compared with the World Health Assembly (WHA) global target of reducing anemia by 50% among WRA in 2025. The management and prevention of anemia should be specific in targeting the underlying nutritional and non-nutritional causes of anemia. This includes following a healthy, nutritious and diversified diet; improving infant feeding practices and promoting exclusive breastfeeding; considering supplementation if necessary; implementing food fortification policies; implementing nutrition education and awareness programs; enforcing food security and ensuring adequate access to a healthy, nutritious and diversified diet, across the population; targeting non-nutritional causes of anemia through specific programs pertinent to malaria, HIV, tuberculosis, soil-transmitted parasitic worms, genetic blood disorders, water, sanitation and hygiene (WASH), environmental and social aspects, delayed cord clamping, birth spacing, and menstrual bleeding and hemorrhage. Therefore, multifaceted, holistic and comprehensive approaches to address the key contributors to anemia are a must, along with frequent monitoring, evaluating and impact assessment. Key recommendations highlighted in the regional expert consultation 2023, on prevention and management of anemia in the EMR, focused on the following: defining a holistic approach; advocacy, coordination and communication; nutrition, dietary habits and preferences; nutrition education; providing support; school-based approaches; data collection, assessment, revision and monitoring; data quality/reporting and analysis; and coverage of interventions

Epidemiology of Phenylketonuria Disease in Jordan: Medical and Nutritional Challenges

Background: Phenylketonuria (PKU) is the most frequent inborn error in amino acid metabolism caused by a deficiency of the phenylalanine hydroxylase enzyme (PAH). If PKU is left untreated, high concentrations of phenylalanine (Phe) accumulate in the blood, leading to severe brain dysfunction, neurodevelopmental, behavioral and psychological problems. Data concerning the epidemiology of PKU in Jordan are limited. The main objectives of our study were to determine the prevalence of PKU in Jordan, analyze the PKU phenotypes, and identify major challenges in providing dietary management to PKU patients. Methods: Data were collected utilizing the medical records of PKU patients attending the PKU clinic at the Ministry of Health in Amman, Jordan, between 2008 and 2021. Results: The total number of patients diagnosed with PKU was 294. The prevalence of PKU was estimated to be 1/5263. Most patients were Jordanians (90.8%), and 9.2% were non-Jordanians. More than half of the patients (56%) were diagnosed through the national newborn screening (NBS) program. Regarding the phenotypes of PKU, 46.6% had moderate PKU, whereas 42.9% had the classic type of PKU and only 8 (2.7%) had cofactor Tetrahydrobiopterin (BH4) deficiency (atypical PKU). According to the age of diagnosis, 66% of patients were diagnosed more than 30 days post-birth. Consanguinity was found in 87.4% of patients, and the majority of patients, 218 (74.2%), had first-degree consanguinity. The most common complication was mental retardation (31%). Most patients were committed to dietary management (83%) and developed fewer complications. Conclusion: In our study, we demonstrated the importance of the NBS program in the early identification and diagnosis of new PKU cases which allows the initiation of treatment and dietary management to prevent severe complications of PKU in Jordan