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

Variations in Postprandial Blood Glucose Responses and Satiety after Intake of Three Types of Bread

Background. The magnitude and duration of postprandial blood glucose (PPG) elevations are important risk factors of diabetes and coronary heart diseases. Aim. To study PPG after ingestion of breads with and without pea fibre and rapeseed oil. Methods. After fasting overnight, 10 Pakistani immigrant women participated in three experiments having a crossover design and involving ingestion of various types of bread: regular coarse bread or fibre enriched-bread with two levels of rapeseed oil, all providing 25 g available carbohydrates (CHO). Blood glucose and satiety were determined before the meal and every 15 min over the next 2 hours. Results. Intake of an amount of pea fibre-enriched bread containing 25 g CHO attenuated, the postprandial peak glucose value, the incremental area under the glucose versus time curve during 15 to 75 min, and the glycemic profile, and increased duration of satiety (P < .05), as compared with intake of regular bread with 25 g carbohydrate. Conclusion. Pea fibre-enriched breads can reduce PPG and prolong satiety

Obesity and selected co-morbidities in an urban Palestinian population

OBJECTIVE: To assess the prevalence of obesity and central obesity in an urban Palestinian population and their associations with selected co-morbidities, including diabetes, hypertension and dyslipidaemia. DESIGN: A population-based cross-sectional survey in an urban Palestinian community. SUBJECTS: Men and women aged 30 – 65 y residing in the urban community, excluding pregnant women. MEASUREMENTS: According to WHO guidelines, obesity for men and women was defined as BMI 30 kg m72, while pre-obesity was defined as BMI 25 – 29.9 kg m72. Central obesity was defined as a waist-to-hip ratio (WHR) of > 0.90 in men and > 0.85 in women. RESULTS: The prevalence of obesity in this population was high at 41% (49% and 30% in women and men, respectively). Central obesity was more prevalent among men (59% compared to 25% in women). After adjusting for the effects of age, sex, smoking and each other, obesity and central obesity were found to be significantly associated with diabetes, low HDL- cholesterol and elevated triglycerides in separate logistic regression analyses. Central obesity was also significantly associated with hypertension (OR 2.26, 95% CI 1.30 – 3.91). CONCLUSION: Obesity and central obesity are prevalent in the urban Palestinian population. Their associations with diabetes, hypertension, and dyslipidaemia point to a potential rise in cardiovascular disease (CVD). An understanding of the reasons behind the high prevalence of obesity is essential for its prevention as well as for the prevention of the morbidities to which it may lead

The impact of dietary diversity and seasonality in food availability on the quantile distribution of birth size among pregnant women in rural Malawi – a cross-sectional study

Background: Dietary diversity scores can be used as a proxy for dietary intakes and for assessment of nutrient adequacy. Studies from low-resource settings have found maternal dietary diversity scores to be associated with neonatal birth size. We here investigated the relationship between the dietary diversity score among pregnant mothers and birth size of their offspring across quantiles of the birth size variables; birth weight, length, abdominal circumference, and head circumference. We also investigated if seasonality affects birth size across different quantiles. Methods: Dietary intake and anthropometric data were collected from 190 pregnant women and their neonates in rural Malawi through two agricultural seasons. Dietary data was collected using 24-hour recall interviews and was categorized into the 10-food group dietary diversity score proposed for women by the Food and Agriculture Organization. Neonatal anthropometrics were collected upon delivery at health facilities. Quantile regression analyses were used to investigate associations between dietary diversity scores and birth size, as well as between seasonality and birth size. Results: We found that neonatal abdominal circumference was 0.9 cm larger during the post-harvest season compared to the pre-harvest season among neonates in the 25th quantile. Birth weight was 281.4 g higher for those born during the post-harvest season in the 90th quantile. For a one-unit increase in maternal dietary diversity score, birth weight increased by 56.7 g among those in the 25th quantile and neonatal head circumference increased by 0.2 cm for those in the 70th quantile. However, these findings did not remain significant when considering the cluster effect of the neonatal anthropometric data. Conclusions: Our findings indicate that the relationship between seasonality and birth size differs across the distribution of birth size. Investigating the effect of seasonality across the distribution of birth size could be important to identify vulnerable subgroups and develop better, targeted interventions to improve maternal and child nutrition and health

Characteristics associated with organic food consumption during pregnancy; data from a large cohort of pregnant women in Norway

<p>Abstract</p> <p>Background</p> <p>Little is known about the use of organic food during pregnancy. The aim of this study was to describe characteristics associated with the use of organic food among pregnant women participating in the Norwegian Mother and Child Cohort Study (MoBa).</p> <p>Methods</p> <p>The present study includes 63,561 women who during the years 2002-2007 answered two questionnaires, a general health questionnaire at gestational week 15 and a food frequency questionnaire at weeks 17-22. We used linear binomial regression with frequent versus rare use of organic food as outcome variable and characteristics of the respondent as independent variables. The outcome variable was derived from self-reported frequency of organic food use in six main food groups (milk/dairy, bread/cereal, eggs, vegetables, fruit and meat).</p> <p>Results</p> <p>Organic eggs and vegetables were the food items which were most frequently reported to be used "often" or "mostly". The proportion of women reporting frequent intake of organic food was 9.1% (n = 5754). This group included more women in the lower (<25 years) and higher (>40 years) age-groups, with normal or low body mass index, who were vegetarians, exercised regularly (3+times weekly), consumed alcohol and smoked cigarettes during pregnancy (p < 0.001 for all, except alcohol: p=0.044). Further, participants with frequent organic consumption included more women in the lower (≤12 years) or higher (17 years +) category of educational attainment, women who were students or had a partner being a student, who belonged to the lowest household income group (both respondent and her partner earned <300 000 NOK), who entered the study 2005-2007, and who lived in an urban area (p < 0.001 for all).</p> <p>Conclusions</p> <p>The socio-economic characteristics of pregnant Norwegian women with frequent organic consumption did not unambiguously follow those typically associated with better health, such as higher levels of education and income. Rather, lower household income, and both lowest and highest levels of education were associated with a higher prevalence of frequent organic consumption. The results indicate that personal and socio-economic characteristics are important covariates and need to be included in future studies of potential health outcomes related to organic food consumption during pregnancy.</p

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

Diminished mental- and physical function and lack of social support are associated with shorter survival in community dwelling older persons of Botswana

<p>Abstract</p> <p>Background</p> <p>Mortality rates for older persons in Botswana have been unavailable and little is known of predictors of mortality in old age. This study may serve as a precursor for more detailed assessments.</p> <p>The objective was to assess diminished function and lack of social support as indicators of short term risk of death.</p> <p>Methods</p> <p>A national population based prospective survey was undertaken in Botswana; twelve rural areas and three urban centers were included.</p> <p>372 community-dwelling persons aged sixty years and over, were included; 265 were followed-up. Sixteen subjects were deceased at follow-up.</p> <p>Subjects were interviewed and clinically assessed at home. Measures of cognitive function, depression and physical function and sociodemographic information were collected. Subjects were followed-up at average 6.8 months after baseline.</p> <p>Results</p> <p>Overall mortality rate was 10.9 per 100 person years. Age-adjusted odds ratios (OR) for death during follow-up were; 4.2 (CI 1.4–12.5) and 3.6 (CI 1.0–12.7) for those with diminished physical- and cognitive function, respectively.</p> <p>Indicators of limited social support; household with only 1 or 2 persons and eating alone, yielded age adjusted ORs of 4.3 (CI 1.5–12.5) and 6.7 (CI 2.2–20), respectively, for death during follow-up.</p> <p>Conclusion</p> <p>Older community dwelling persons with diminished cognitive- or physical function, solitary daily meals and living in a small household have a significantly increased risk of rapid deterioration and death.</p> <p>Health policy should include measures to strengthen informal support and expand formal service provisions to older persons with poor function and limited social networks in order to prevent premature deaths.</p

Sociodemographic correlates of food habits among school adolescents (12–15 year) in north Gaza Strip

Background: There is little information about meal patterns and food consumption of adolescents in Palestine. The objective of this study was to describe the association between sociodemographic factors and food intake, and meal patterns among Palestinian school adolescents (12–15 year) in North Gaza Strip. Methods: A cross-sectional study was conducted in 2002 comprising 944 subjects in 10 schools in Gaza city, Jabalia village and Jabalia refugee camp. Self-administered questionnaires were filled in by students and parents to obtain data on frequency of meals, food intake and sociodemographic characteristics. Results: High household socioeconomic status (SES) was associated with the increased number of meals and the increased intakes of many nutritious foods such as; animal food items, fruits and vegetables and dairy foods. The percentage of adolescents having breakfast daily of high and low SES was 74.5% vs 55% in boys and 65.6% vs 45% in girls. The percentage of girls with refugee status who had lunch was higher (90.2%) compared to the local citizen girls (83.9%), (p = 0.03). Girls were less likely to skip daily lunch (OR = 0.55, 95% CI = 0.36–0.87, p = 0.01) compared to boys. Risk of skipping lunch was three times higher among adolescents living in the village compared to Gaza well-off area (OR = 3.3, 95% CI = 1.72–6.31, p < 0.001). Adolescents who were having lunch daily were less likely to skip breakfast or dinner. Only 11.6% of boys and 16.2% of girls consumed fruits daily. In multivariate analysis, SES was positively associated with food frequency intake scores in both genders. Boys from the refugee camp and the village had a significant higher consumption of fruits and vegetables than boys from high and low income area in Gaza City, while it was the opposite in girls. Conclusion: Meal skipping is common, particularly among those of low SES and the intakes of many nutritious foods such as animal food items, fruits and vegetables and dairy foods seem to be low among adolescents of low SES. The results of this study could be used as an important baseline for future monitoring of the nutritional situation of adolescents.Abdallah H Abudayya, Hein Stigum, Zumin Shi, Yehia Abed and Gerd Holmboe-Ottese