H. Aounallah-Skhiri

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

BackgroundThe 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.MethodsCross-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) ≥85th and 95th percentile defined overweight and obesity. Waist Circumference (WC) assessed abdominal fat. High blood pressure was systolic (SBP) or diastolic blood pressure (DBP) ≥90th of the international reference for 15-17 y., and SBP/DBP ≥120/80 mm Hg for 18-19 y.ResultsEnergy 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 (2nd vs. 1st tertile: Prevalence Odds-Ratio (POR) = 4.0[1.7-9.3], 3rd 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 (2nd vs. 1st tertile: POR = 0.5[0.3-0.8], 3rd vs. 1st tertile: POR = 0.4[0.2-0.8]).ConclusionThe 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.

Blood pressure and associated factors in a North African adolescent population. a national cross-sectional study in Tunisia.

BackgroundIn southern and eastern Mediterranean countries, changes in lifestyle and the increasing prevalence of excess weight in childhood are risk factors for high blood pressure (BP) during adolescence and adulthood. The aim of this study was to evaluate the BP status of Tunisian adolescents and to identify associated factors.MethodsA cross-sectional study in 2005, based on a national, stratified, random cluster sample of 1294 boys and 1576 girls aged 15-19 surveyed in home visits. The socio-economic and behavioral characteristics of the adolescents were recorded. Overweight/obesity were assessed by Body Mass Index (BMI) from measured height and weight (WHO, 2007), abdominal obesity by waist circumference (WC). BP was measured twice during the same visit. Elevated BP was systolic (SBP) or diastolic blood pressure (DBP) ≥ 90th of the international reference or ≥ 120/80 mm Hg for 15-17 y., and SBP/DBP ≥ 120/80 mm Hg for 18-19 y.; hypertension was SBP/DBP ≥ 95th for 15-17 y. and ≥ 140/90 mm Hg for 18-19 y. Adjusted associations were assessed by logistic regression.ResultsThe prevalence of elevated BP was 35.1%[32.9-37.4]: higher among boys (46.1% vs. 33.3%; P < 0.0001); 4.7%[3.8-5.9] of adolescents had hypertension. Associations adjusted for all covariates showed independent relationships with BMI and WC: - obesity vs. no excess weight increased elevated BP (boys OR = 2.1[1.0-4.2], girls OR = 2.3[1.3-3.9]) and hypertension (boys OR = 3.5[1.4-8.9], girls OR = 5.4[2.2-13.4]), - abdominal obesity (WC) was also associated with elevated BP in both genders (for boys: 2nd vs. 1st tertile OR = 1.7[1.3-2.3], 3rd vs.1st tertile OR = 2.8[1.9-4.2]; for girls: 2nd vs. 1st tertile OR = 1.6[1.2-2.1], 3rd vs.1st tertile OR = 2.1[1.5-3.0]) but only among boys for hypertension. Associations with other covariates were weaker: for boys, hypertension increased somewhat with sedentary lifestyle, while elevated BP was slightly more prevalent among urban girls and those not attending school.ConclusionWithin the limits of BP measurement on one visit only, these results suggest that Tunisian adolescents of both genders are likely not spared from early elevated BP. Though further assessment is likely needed, the strong association with overweight/obesity observed suggests that interventions aimed at changing lifestyles to reduce this main risk factor may also be appropriate for the prevention of elevated BP.

La modernisation de l’alimentation des adolescents diminue-t-elle sa qualité ?

Introduction Dans un contexte de changements socio-economiques et de transition nutritionnelle, les adolescents sont prompts a adopter des comportements percus comme modernes, notamment concernant leur alimentation. On etudie la relation entre un score de modernisation et un indice de qualite de l’alimentation chez les adolescents Tunisiens. Sujets et Methodes Etude transversale (2005)xa0; 1019xa0sujets, 15–19xa0ans, echantillon stratifie, aleatoire en grappes. Consommation alimentaire par questionnaire de frequence (134xa0items), semi-quantitatif et validexa0; score d’alimentation «xa0modernexa0» derive par analyse factorielle. Qualitexa0: «xa0Diet Quality Index Internationalxa0» (DQI-I) (/100) et ses composantes variete, adequation, moderation et equilibrexa0; bonne qualite definie par DQI-Ixa0≥xa060. Resultats Seulement 38xa0% [33,8–42,3] des sujets avaient une bonne qualite d’alimentation. Le gradient transversal de modernisation (score «xa0modernexa0») etait caracterise par une augmentation de la consommation de pain blanc, laitages, sucreries, sodas, graisses ajoutees et fruits et diminution de celle de legumes, couscous, pâtes, legumineuses et epices. La proportion de sujets avec DQI-Ixa0≥xa060xa0augmentait du 1er au 3e quintile du score moderne (21,3xa0% a 52,3xa0%) pour decroitre a 36,4xa0% au 5e quintile (pxa0 Conclusion Dans ce contexte de transition nutritionnelle, la modernisation de l’alimentation peut en ameliorer la qualite (en accroissant la variete et l’adequation), jusqu’a un maximum au-dela duquel la qualite decroit. Mais faut-il donc systematiquement diaboliser la «xa0modernisationxa0» de l’alimentation versus une alimentation «xa0traditionnellexa0» idealiseexa0?

Motifs du recours aux services d’urgence des principaux hôpitaux du Grand Tunis

Tunisia, similar to many countries, has a problem of overcrowding of the emergency departments (ED). This study aimed to analyse the reasons for using EDs, and to describe the seriousness of the attendees’ condition and their itinerary before their arrival at ED. This cross-sectional study in 2009 was conducted in ED of 4 hospitals in Greater Tunis and targeted 1058 patients of both sexes, aged ≥ 18 years, with stratification according to time of day of presentation to ED (morning, afternoon and evening). Information was recorded on the sociodemographic characteristics of the study participants, reasons for choosing ED, time of and reason for consultation, diagnosis and severity of illness. Over half the patients (52.5%) were male and the mean age was 46.0 (SD 18.1) years. The main reasons for choosing the ED were: speed (54.0%) and ease of access (47.7%) of ER and occurrence of an acute episode (26.4%). Patients with serious illness accounted for only 6.3% of those interviewed. Implementation of good practices and better coordination between public and private services and the ED are needed to reduce unnecessary visits to ED. طسوتلما قشرل ةيحصلا ةلجلما شرع نماثلا دلجلما لولأا ددعلا