Habiba I. Ali

The prevalence and trends of overweight, obesity and nutrition‐related non‐communicable diseases in the Arabian Gulf States

This paper reviews studies on the prevalence of overweight, obesity and related nutrition‐related non‐communicable diseases in Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and the UAE. Obesity is common among women; while men have an equal or higher overweight prevalence. Among adults, overweight plus obesity rates are especially high in Kuwait, Qatar and Saudi Arabia, and especially among 30–60 year olds (70–85% among men; 75–88% among women), with lower levels among younger and elderly adults. The rate of increase in obesity was pronounced in Saudi Arabia and Kuwait. Prevalence of obesity is high among Kuwaiti and Saudi pre‐schoolers (8–9%), while adolescent overweight and obesity are among the highest in the world, with Kuwait having the worst estimates (40–46%); however, comparison of child data is difficult because of differing standards. Among nutrition‐related non‐communicable diseases, hypertension and diabetes levels are very high and increase with age, with the UAE performing the worst because of a rapid rate of increase between 1995 and 2000. Additional monitoring of the prevalence of metabolic syndrome and cancers is necessary. Nationally representative longitudinal surveys with individual, household and community‐level information are needed to determine the importance of various factors that contribute to these troubling trends.

Nutrition transition in the United Arab Emirates

Background/Objectives:The United Arab Emirates has undergone remarkable economic and social transformations over the past few decades. We present findings on the prevalence of overweight and obesity, dietary and activity patterns among Emiratis in 2009/10, and explore associated urbanization and wealth factors.Subjects/Methods:A cross-sectional study was conducted in 628 randomly selected households in all seven emirates. Sociodemographics, 24-h dietary recalls, physical activity and anthropometric data were collected from adult females (⩾19 years), adolescents (11–18 years) and children (6–10 years) in each family via in-person interviews using validated questionnaires.Results:In 2009/10, 65% of adult women, 28% of male adolescents and 40% of female adolescents, 25% of male children and 41% of female children were overweight or obese. 43% of girls and 38% of boys (6–10 years) consumed more calories than their estimated energy requirements. Snacking represents a major source of Emirati caloric intake (>20%) of total calories. In addition, caloric beverages account for 8–14% of total calories. Meanwhile, physical activity levels are low, especially among females Emiratis and those living in urban areas.Conclusions:These trends represent the potential risk for severe cardiometabolic problems in the United Arab Emirates. The significant gender differentials among children and adolescents are driven by diet and activity differences. More attention should be paid to educate the public on nutrition (for example, limit the consumption of sugared sodas, fruit drinks and whole milk, promote water and low-fat/skim milk consumption instead) and encourage physical activity from a young age, especially among females. Built environments and social support for improved lifestyle choices by individuals are needed.

Barriers and facilitators of weight management: perspectives of Arab women at risk for type 2 diabetes.

Obesity and associated chronic diseases, such as type 2 diabetes, are highly prevalent in the United Arab Emirates (UAE). This qualitative study explored weight management behaviours and perceptions of women who are at increased risk for type 2 diabetes through focus group interviews. A total of 75 Emirati national women (age, 20-60 years) considered high risk for type 2 diabetes participated in eight focus groups. Purposive sampling was used to recruit women from primary healthcare centres (PHCs) in Al Ain, UAE. Qualitative research methodology involving a modified approach to grounded theory was used to guide data collection and analysis. Focus group interviews transcripts were thematically analyzed using NVivo software. A number of personal, social and physical environmental themes emerged as both barriers and enablers that are consistent with the social ecological model of health promotion. Low motivation, lack of social support, competing demands, lack of culturally-sensitive exercise facilities and sociocultural norms that restrict outdoor physical activities were the main barriers cited by the participants. On the other hand, social support, such as having other women to walk with, helped them stay physically active. Suggestions from the participants included enhancing social support for women, greater access to dietitians and nutrition information, and increasing availability of culturally-sensitive exercise facilities. This study provides valuable information in the development of culturally congruent healthy weight promotion programmes for women at risk for type 2 diabetes in the UAE and has implications for obesity intervention programmes for women in other Arabian Gulf countries.

Diet and Carbohydrate Food Knowledge of Multi-Ethnic Women: A Comparative Analysis of Pregnant Women with and without Gestational Diabetes Mellitus

Background Diet therapy is the cornerstone for the management of gestational diabetes mellitus (GDM). Carbohydrate is the primary nutrient affecting postprandial blood glucose levels. Hence, knowledge of food containing carbohydrates can assist women with GDM optimize glycemic control. Despite that, there is a paucity of research on carbohydrate-related knowledge of women with GDM. The United Arab Emirates (UAE) has one of the highest prevalence of diabetes (19.2%) in the world. This study compared diet and knowledge of carbohydrate-containing foods among pregnant women with and without GDM in the UAE. Methods The sample consisted of multi-ethnic women with GDM (n = 94) and a control group of healthy pregnant women (n = 90) attending prenatal clinics in three hospitals in Al Ain, UAE. Data were collected using a questionnaire and a 24-hour recall. Knowledge of food sources of carbohydrate, dietary patterns, and nutrient intakes of the two groups were compared. Results There were no significant differences in the mean knowledge score of food sources of carbohydrate between women with GDM and that of pregnant women without GDM. Similarly, there were no significant differences in energy and nutrient intakes between the two groups with the exception of percent energy from protein. Women with GDM reported significantly lower intake of fruits and fruit juices (P = 0.012) and higher consumption of milk and yogurt (P = 0.004) compared to that of women without GDM. Twenty-two percent of women with GDM indicated they never visited a dietitian for counseling while 65% reported they visited a dietitian only once or twice during the pregnancy. Predictors of carbohydrate knowledge score were perceived knowledge of diet and GDM and parity among women with GDM and parity and educational level among those without GDM. Conclusion The results of the study highlight the urgent need to provide nutrition education for women with GDM in the UAE.

High proportion of 6 to 18-year-old children and adolescents in the United Arab Emirates are not meeting dietary recommendations.

In the United Arab Emirates (UAE), overweight, obesity, and associated chronic diseases have recently emerged as major public health concerns among all age groups, including children and adolescents. We hypothesized that although energy needs might be met by the majority of Emirati children and adolescents, their diet quality and intakes of certain micronutrients may not meet recommendations. A cross-sectional design was used to assess dietary intakes of 253 children (6-10 years of age) and 276 adolescents (11-18 years of age) in the UAE. Trained dietitians collected a 24-hour food recall in the homes of the participants. Nutrient intakes were compared with the Dietary Reference Intakes, and food group consumption was compared with MyPyramid recommendations. Results showed that 9 to 13-year-old females consumed 206 kcal/d from candy and sweets and nearly 264 cal/d from sugar-sweetened beverages. The proportion of participants with percentage energy from saturated fat greater than the recommendation ranged from 27.6% (males 9-13 years) to 45.9% (males 6-8 years). Mean intakes of vitamins A, D, and E were lower than the Estimated Average Requirements for all the subgroups. Mean calcium intake was lower than recommendations for all age and sex subgroups. The proportions of participants whose intakes were less than the recommended number of servings from the food groups were substantial: more than 90% of each of the 6 subgroups for the milk group and 100% among 9 to 18-year-old males for vegetables. In conclusion, the results of this study indicate the need for interventions targeting 6 to 18-year-old children and adolescents in the UAE to improve their diet quality.

Conducting Environmental Health Research in the Arabian Middle East: Lessons Learned and Opportunities

Background: The Arabian Gulf nations are undergoing rapid economic development, leading to major shifts in both the traditional lifestyle and the environment. Although the pace of change is brisk, there is a dearth of environmental health research in this region. Objective: We describe challenges and successes of conducting an environmental epidemiologic study in the United Arab Emirates (UAE), a Gulf nation in the Middle East, with an inter-disciplinary team that includes in-country academic and government collaborators as well as U.S. academic collaborators. Discussion: We present several issues, including study and data collection design, exposure assessment, scheduling and time coordination, quality assurance and quality control, and institutional review board protocols. These topics are considered in a cultural context. Benefits of this research included building linkages among multinational, interdisciplinary team members, generating data for local environmental decision making, and developing local epidemiologic research capacity. The Middle Eastern culture of hospitality greatly benefited the project team. Conclusion: Cultural differences impact multiple aspects of epidemiologic research and should be respectfully addressed. Conducting international population-based environmental research poses many challenges; these challenges can be met successfully with careful planning, cultural knowledge, and flexibility. Lessons learned are applicable to interdisciplinary research all over the world. The research conducted will benefit the environmental and public health agencies of the UAE and provide the nation’s leadership with country-specific environmental health data that can be used to protect the public’s health in a rapidly changing environment.

Students’ perspectives on promoting healthful food choices from campus vending machines: a qualitative interview study

BackgroundIncreasing the healthfulness of campus food environments is an important step in promoting healthful food choices among college students. This study explored university students’ suggestions on promoting healthful food choices from campus vending machines. It also examined factors influencing students’ food choices from vending machines.MethodsPeer-led semi-structured individual interviews were conducted with 43 undergraduate students (33 females and 10 males) recruited from students enrolled in an introductory nutrition course in a large national university in the United Arab Emirates. Interviews were audiotaped, transcribed, and coded to generate themes using N-Vivo software.ResultsAccessibility, peer influence, and busy schedules were the main factors influencing students’ food choices from campus vending machines. Participants expressed the need to improve the nutritional quality of the food items sold in the campus vending machines. Recommendations for students’ nutrition educational activities included placing nutrition tips on or beside the vending machines and using active learning methods, such as competitions on nutrition knowledge.ConclusionsThe results of this study have useful applications in improving the campus food environment and nutrition education opportunities at the university to assist students in making healthful food choices.

Nutritional Value of 10 Traditional Dishes of the United Arab Emirates

In the present study, 10 traditional dishes commonly consumed in the United Arab Emirates (U.A.E.) were chemically analyzed for proximate composition and mineral content. In addition, exchange lists for meal planning were developed for those dishes. Significant variations in nutritional value were found among the dishes. Protein content was lowest in chicken harese (3.33%) and highest in maleh (23.57%). The fat content ranged from 1.19% in ragag bread to15.47% in legemat (a sweet dish) while carbohydrate levels ranged from traces in maleh to 76.83% in ragag bread. Significant variations were also observed in major elements and trace elements among the dishes. Data from this study will be useful in calculating nutrient contributions from common traditional dishes in the U.A.E. as well as in planning normal and therapeutic diets. Further studies on the nutritional contributions of other traditional dishes in the U.A.E. are needed.

Determinants of diabetes and hypertension control in ambulatory healthcare in Al ain, United arab emirates.

OBJECTIVES This study aims to study determinants for the control of diabetes and hypertension in Al Ain Ambulatory Healthcare patients. METHOD This is a cross sectional observational study of patients attending ambulatory healthcare centers in Al Ain, United Arab Emirates in 2009. From a yearly audit evaluating the care of patients with diabetes and hypertension, the determinants for improved diabetes and hypertension outcomes were identified from a total of 512 patients and its association with glycemic and blood pressure control were studied. RESULTS From all variables studied, only the clinic where the patient was treated helped predict both improved blood sugar and blood pressure control. For patients with diabetes, poor control the year before (p<0.001), the number of chronic disease clinic visits (p=0.042) and triglyceride levels (p=0.007) predicted worse control of diabetes. A predictor of poor control of blood pressure (p<0.001) for patients with hypertension was poor control of blood pressure in the year before. CONCLUSION In this population, the healthcare system and the team played major roles as determinants in the control of patients diabetes and blood pressure more than any of the other factors examined.

Dietary fat reducing behaviours of Arab women with type 2 diabetes mellitus

To identify dietary fat reducing behaviours of Emirati women with type 2 diabetes, based on 5 eating patterns (subscales) associated with a low fat diet. Responses from a cross-sectional questionnaire survey of 172 women were used to calculate means for the 5 subscales and summary scores. A low score indicated a desirable behaviour. Multiple regression analysis was used to determine the predictors of the subscale and summary scores. Based on a 5-point scale, the mean scores (s.d.) of the subscales were as follows: substituting for lower fat milk products 3.70 (1.53), modifying meats 1.46 (0.70), avoiding frying 2.63 (0.88), replacing high-fat foods with lower fat foods 3.14 (1.09) and avoiding fat as flavouring or spread 2.62 (0.68). The values for the summary and mean scores were 2.64 (0.60) and 2.52 (0.55), respectively. Nutrition education programs should focus on dietary fat behaviours these women were less successful in changing.