Dietary habits of Palestinian adolescents in three major governorates in the West Bank: a cross-sectional survey

The Palestinian society is undergoing changes in their dietary habits and in the prevalence of obesity and overweight. Palestinian adolescents (aged 10–19 years) make up 24% of the population. Their dietary habits are important, yet understudied. The 2004 survey of health behaviour in school-aged children in the West Bank and Gaza Strip identified missing of breakfast and low intake of milk, fruits, and vegetables as the main problems. We investigated food habits in Palestinian adolescents in three main governorates (administrative divisions) in the West Bank (Ramallah, Nablus, and Hebron) and the relation between food habits and sociodemographic factors (region, sex, urban or rural residence, standard of living index, and parents’ education). Methods We undertook a cross-sectional survey in the three governorates between March 19 and May 8, 2005, in 96 school classes (34 in Ramallah, 31 in Hebron, and 31 in Nablus) that were selected to be representative of the eighth and ninth grade classes (students aged 13–15 years). A list including the number of students per classroom in 2004–05 was provided by the Palestinian Ministry of Education and Higher Education. The classes were divided into nine strata by sex (boys, girls, and coeducational) and school type (public, UN Relief and Works Agency [UNRWA], and private). The sample was selected with the single-stage probability proportional-to-size sampling procedure, from each of the nine strata within each governorate, with the class as the primary sampling unit. All students in the selected classes were invited to participate in the study. Self-administered questionnaires for students and their parents were used. The students’ questionnaire contained questions about age, residence, household amenities, meal patterns, and a food frequency list of 42 items without portion sizes. The parents’ questionnaire gathered household information, including family size and parents’ education. Both questionnaires were piloted and adjusted before the survey. Data analysis was done with Stata (version 10.1) and adjusted for design effect. The sample was weighted according to sample and population size in each governorate (inverse of sampling probability; percentages are weighted and numbers are unweighted), and the analysis was adjusted for possible dependencies due to cluster design. We used χ² tests to compare frequencies, and t tests or ANOVA to compare means. We did multivariate linear regression analysis to model the association between food scores and sociodemographic factors. Findings Of the 3271 students invited, 3071 (94%) consented to participate. 2952 students (1364 boys and 1588 girls) aged 13–15 years were included in the analysis, excluding 119 who were older or younger than this age group. Only 765 (26%) students had three meals daily; 382 (26%) boys and 814 (51%) girls had breakfast only once or twice per week or less (p<0·0001). As few as 758 (25%) drank milk daily (462 [33%] boys vs 296 [18%] girls; p<0·0001). Around three-quarters ate vegetables daily (984 [73%] boys vs 1174 [74%] girls; p=0·67). Daily fruit consumption was equally common in boys and girls (841 [59%] vs 915 [55%]; p=0·27). Daily intake of salty snacks was more common in girls than in boys (1022 [62%] vs 716 [50%]; p=0·0016) whereas daily intake of regular soft drinks was more common in boys (575 [40%] vs 464 [28%]; p=0·0001). Daily intake of sweets was more common in girls than in boys (816 [49%] vs 609 [42%]; p=0·0634). Results of multivariate regression analysis showed that residence in Hebron and low standard of living (based on 16 household amenities) were negatively associated with frequency of intake of animal foods, foods commonly eaten in highly industrialised countries, dairy products, fruits and vegetables, and sweets and salty snacks, after adjustment for other sociodemographic factors such as age, sex, parents’ education, and family size. Interpretation Irregular meal patterns and a low intake of fruits, vegetables, and milk were common in Palestinian adolescents, especially in groups with low standard of living and those in Hebron. Effective interventions are needed to establish healthy dietary habits, with an emphasis on vulnerable groups. The full text of this article has been published in Public Health Nutr (in press). Reproduced with permission from Cambridge University Press.Norwegian Programme for Development, Research and Education (pro X1 50/2002

Prevalence and sociodemographic correlates of stunting, underweight, and overweight among Palestinian school adolescents (13-15 years) in two major governorates in the West Bank

<p>Abstract</p> <p>Background</p> <p>There is little information about height and weight status of Palestinian adolescents. The objective of this paper was to assess the prevalence of stunting, underweight, and overweight/obesity among Palestinian school adolescents (13-15 years) and associated sociodemographic factors in 2 major governorates in the West Bank.</p> <p>Methods</p> <p>A Cross-sectional survey was conducted in 2005 comprising 1942 students in 65 schools in Ramallah and Hebron governorates. Data was collected through self-administered questionnaires from students and parents. Weights and heights were measured. Overweight and obesity were assessed using the 2000 Centers for Disease Control and Prevention (CDC) reference and the International Obesity Task Force (IOTF) criteria. Stunting and underweight were assessed using the 2000 CDC reference.</p> <p>Results</p> <p>Overweight/obesity was more prevalent in Ramallah than in Hebron and affected more girls than boys. Using the 2000 CDC reference, the prevalence of overweight and obesity in Ramallah among boys was 9.6% and 8.2%, respectively versus 15.6% and 6.0% among girls (P < 0.01). In Hebron, the corresponding figures were 8.5% and 4.9% for boys and 13.5% and 3.4% for girls (P < 0.01). Using the IOTF criteria, the prevalence of overweight and obesity among boys in Ramallah was 13.3% and 5.2%, respectively versus 18.9% and 3.3% for girls. The prevalence of overweight and obesity among boys in Hebron was 10.9% and 2.2%, respectively versus 14.9% and 2.0% for girls. Overweight/obesity was associated with high standard of living (STL) among boys and with the onset of puberty among girls. More boys were underweight than girls, and the prevalence was higher in Hebron (12.9% and 6.0% in boys and girls, respectively (P < 0.01)) than in Ramallah (9.7% and 3.1% in boys and girls, respectively (p < 0.01)). The prevalence of stunting was similar in both governorates, and was higher among boys (9.2% and 9.4% in Ramallah and Hebron, respectively) than among girls (5.9% and 4.2% in Ramallah and Hebron, respectively). Stunting was negatively associated with father's education among boys and with urban residence, medium STL and onset of puberty among girls.</p> <p>Conclusion</p> <p>Under- and overnutrition co-exist among Palestinian adolescents, with differences between sexes. Region, residence, STL, and onset of puberty were associated factors.</p

Contrasting cardiovascular mortality trends in Eastern Mediterranean populations: contributions from risk factor changes and treatments

Background Middle income countries are facing an epidemic of non-communicable diseases, especially coronary heart disease (CHD). We used a validated CHD mortality model (IMPACT) to explain recent trends in Tunisia, Syria, the occupied Palestinian territory (oPt) and Turkey. Methods Data on populations, mortality, patient numbers, treatments and risk factor trends from national and local surveys in each country were collated over two time points (1995–97; 2006–09); integrated and analysed using the IMPACT model. Results Risk factor trends: Smoking prevalence was high in men, persisting in Syria but decreasing in Tunisia, oPt and Turkey. BMI rose by 1–2 kg/m2 and diabetes prevalence increased by 40%–50%. Mean systolic blood pressure and cholesterol levels increased in Tunisia and Syria. Mortality trends: Age-standardised CHD mortality rates rose by 20% in Tunisia and 62% in Syria. Much of this increase (79% and 72% respectively) was attributed to adverse trends in major risk factors, occurring despite some improvements in treatment uptake. CHD mortality rates fell by 17% in oPt and by 25% in Turkey, with risk factor changes accounting for around 46% and 30% of this reduction respectively. Increased uptake of community treatments (drug treatments for chronic angina, heart failure, hypertension and secondary prevention after a cardiac event) accounted for most of the remainder. Discussion CHD death rates are rising in Tunisia and Syria, whilst oPt and Turkey demonstrate clear falls, reflecting improvements in major risk factors with contributions from medical treatments. However, smoking prevalence remains very high in men; obesity and diabetes levels are rising dramatically

Quality of life of type 2 diabetes mellitus patients in Ramallah and al-Bireh Governorate-Palestine : a part of the Palestinian diabetes complications and control study (PDCCS)

Purpose Type 2 diabetes mellitus (T2DM) is a considerable impact on physical health as well as on emotional and social wellbeing. This study aimed to investigate the quality of life and its associated factors among Palestinians with T2DM. Methods A cross-sectional study including 517 patients (68% female) was conducted in eleven primary health care clinics located in Ramallah and al-Bireh governorate of the West Bank. To assess socio-demographic data, risk factors and diabetes control, interviews, physical examinations, anthropometric measurements, and blood and urine tests were performed. The validated Arabic version of the Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire was carried out on all patients to measure Quality of Life (QoL). A multivariable regression analysis was performed. Results The average weighted impact (AWI) score was -3.38 (95% CI: -3.55 to -3.21, range: -9.00 to 0.12). This indicates that diabetes was perceived as having a considerable negative impact on the quality of life. The life domains 'freedom to eat', 'physical activities', and 'work-life' were the most negatively impacted. Males and individuals living with diabetes for a prolonged time were associated with a more significant negative impact on quality of life. Conclusion The study showed that diabetes generally had a negative impact on QoL and identified the demand for diabetes management programs tailored to patient needs and different patient groups, as well as health policies that put patients in the center of diabetes care