Nutrition and health in Arab adolescents (NaHAR) : study protocol for the determination of ethnic-specific body fat and anthropometric cut-offs to identify metabolic syndrome

The prevalence of adolescent obesity in the Middle-East is considered among the highest in the world. Obesity in adolescents is associated with several cardiometabolic abnormalities, the constellation of which is referred to as the metabolic syndrome (MetS). This multi-country cross-sectional study aims to determine the optimal cut-off values for body fat (BF); body mass index (BMI) z-score; waist circumference (WC) percentile, and mid-upper arm circumference (MUAC) for the prediction of MetS among adolescents from Kingdom of Saudi-Arabia (KSA), Kuwait, Jordan, Lebanon and Syria. A secondary objective is to examine the validity of Bioelectrical Impendence Vector Analysis (BIVA) in estimating BF against the deuterium dilution technique (DDL). In each country, a sample of 210 adolescents will be recruited. Data collection will include demographics, socioeconomic, lifestyle and dietary data using a multi-component questionnaire; anthropometric measurements will be obtained and body composition will be assessed using the DDL and BIVA; blood pressure and biochemical assessment will be performed for the identification of the MetS. Receiver operating characteristic analyses will be undertaken to determine optimal cut-off values of BMI, WC, MUAC and BF in identifying those with MetS. Odds ratios (OR) and their respective 95% confidence interval (CI) for the association of the anthropometric measurements with MetS will be computed based on multiple logistic regression analysis models. The Bland and Altman approach will be adopted to compare BIVA against the reference DDL method for the determination of body composition parameters. This study responds to the need for ethnic-specific anthropometric cut-offs for the identification of excess adiposity and associated cardiometabolic risks in the adolescent population. The adoption of the generated cut-offs may assist policy makers, public health professionals and clinical practitioners in providing ethnic-specific preventive and curative strategies tailored to adolescents in the region

Climate Change and Nutrition: Implications for the Eastern Mediterranean Region

The Eastern Mediterranean Region (EMR) is considered among the world’s most vulnerable to the dire impacts of climate change. This review paper aims at (1) characterizing climate change in countries of the EMR; (2) examining the potential effects of climate change on the nutritional and health status of the population; and (3) identifying the most vulnerable population groups. The paper explored several climate change indicators including daily temperatures, extreme temperature, daily precipitation, extreme precipitation (flooding, drought, storms, etc.), humidity, CO2 concentrations and sea surface temperature in EMR countries. Findings suggest that climate change will exert a significant adverse effect on water and food security and showed that the nutritional status of the population, which is already characterized by the triple burden of malnutrition, is likely to worsen via three main pathways mediated by climate change, namely, its impact on food security, care and health. Women, infants, children, those living in poor households and those experiencing displacement will be among the most vulnerable to the nutritional impacts of climate change. The paper concludes with a set of recommendations from the Initiative on Climate Action and Nutrition, which can support the region in tackling the critical nexus of climate change and nutrition

Dietary Glycemic Index and Glycemic Load Are Not Associated with the Metabolic Syndrome in Lebanese Healthy Adults: A Cross-Sectional Study

High dietary glycemic index (GI) and glycemic load (GL) were suggested to increase the risk of metabolic syndrome (MetS). This study aims to estimate dietary GI and GL in a sample of healthy Lebanese adults and examine their association with MetS and its individual abnormalities. The study uses data from a community-based survey of 501 Lebanese urban adults. Dietary intake was assessed using a food frequency questionnaire. Biochemical, anthropometric, and blood pressure measurements were obtained. Subjects with previous diagnosis of chronic disease, metabolic abnormalities, or with incomplete data or implausible energy intakes were excluded, yielding a sample of 283. Participants were grouped into quartiles of GI and GL. Multivariate logistic regression analyses were performed. Average dietary GI and GL were estimated at 59.9 ± 8 and 209.7 ± 100.3. Participants belonging to the highest GI quartile were at increased risk of having MetS (odds ratio (OR) = 2.251, 95% CI:1.120–4.525) but this association lost significance with further adjustments. Those belonging to the second quartile of GI had significantly lower odds of having hyperglycemia (OR: 0.380, 95% CI:0.174–0.833). No associations were detected between GL and MetS. The study contributes to the body of evidence discussing the relationship between GI, GL, and MetS, in a nutrition transition context

Nutrition and Health in Arab Adolescents (NaHAR): Study protocol for the determination of ethnic-specific body fat and anthropometric cut-offs to identify metabolic syndrome.

The prevalence of adolescent obesity in the Middle-East is considered among the highest in the world. Obesity in adolescents is associated with several cardiometabolic abnormalities, the constellation of which is referred to as the metabolic syndrome (MetS). This multi-country cross-sectional study aims to determine the optimal cut-off values for body fat (BF); body mass index (BMI) z-score; waist circumference (WC) percentile, and mid-upper arm circumference (MUAC) for the prediction of MetS among adolescents from Kingdom of Saudi-Arabia (KSA), Kuwait, Jordan, Lebanon and Syria. A secondary objective is to examine the validity of Bioelectrical Impendence Vector Analysis (BIVA) in estimating BF against the deuterium dilution technique (DDL). In each country, a sample of 210 adolescents will be recruited. Data collection will include demographics, socioeconomic, lifestyle and dietary data using a multi-component questionnaire; anthropometric measurements will be obtained and body composition will be assessed using the DDL and BIVA; blood pressure and biochemical assessment will be performed for the identification of the MetS. Receiver operating characteristic analyses will be undertaken to determine optimal cut-off values of BMI, WC, MUAC and BF in identifying those with MetS. Odds ratios (OR) and their respective 95% confidence interval (CI) for the association of the anthropometric measurements with MetS will be computed based on multiple logistic regression analysis models. The Bland and Altman approach will be adopted to compare BIVA against the reference DDL method for the determination of body composition parameters. This study responds to the need for ethnic-specific anthropometric cut-offs for the identification of excess adiposity and associated cardiometabolic risks in the adolescent population. The adoption of the generated cut-offs may assist policy makers, public health professionals and clinical practitioners in providing ethnic-specific preventive and curative strategies tailored to adolescents in the region

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