Kathleen Abu-Saad

Adult-onset diabetes among Arabs and Jews in Israel: a population-based study.

Diabet. Med. 29, 748–754 (2012)

Jews and Arabs in the Same Region in Israel Exhibit Major Differences in Dietary Patterns

The Jewish majority and Arab minority populations in Israel exhibit disparities in nutrition-related chronic diseases, but comparative, population-based dietary studies are lacking. We evaluated ethnic differences in dietary patterns in a population-based, cross-sectional study of Arab and Jewish urban adults (n = 1104; age 25-74 y). Dietary intake was assessed with an interviewer-administered, quantified FFQ. We used principal-component analysis to identify 4 major dietary patterns: Ethnic, Healthy, Fish and Meat Dishes, and Middle Eastern Snacks and Fast Food. The Ethnic and Healthy patterns exhibited major ethnic differences. Participants in the top Ethnic intake tertile (97% Arab) had modified Mediterranean-style Arabic dietary habits, whereas those in the bottom Ethnic tertile (98% Jewish) had central/northern European-style dietary habits. The Arab participants with less strongly ethnicity-associated dietary habits were younger [OR for 10-y decrease = 1.42 (95% CI: 1.21-1.68)] and male [OR = 2.23 (95% CI: 1.53-3.25)]. Jews with less strongly ethnicity-associated dietary habits were less recent immigrants [OR = 8.97 (95% CI: 5.05-15.92)], older [OR for 10-y decrease = 0.80 (95% CI: 0.69-0.92)], had post-secondary education [OR = 2.04 (95% CI: 1.06-3.94)], and reported other healthy lifestyle behaviors. In relation to the Healthy pattern, Arabs were less likely than Jews to be in the top intake tertile, but the magnitude of the difference was less in diabetic participants. Participants reporting other healthy lifestyle behaviors were more likely to have a high intake of the Healthy pattern. Substantial differences were found between Arabs and Jews in dietary patterns and suggest a need for culturally congruent dietary interventions to address nutrition-related chronic disease disparities.

Bread type intake is associated with lifestyle and diet quality transition among Bedouin Arab adults.

The traditionally semi-nomadic Bedouin Arabs in Israel are undergoing urbanisation with concurrent lifestyle changes, including a shift to using unfortified white-flour bread instead of wholewheat bread as the main dietary staple. We explored associations between the transition from wholewheat to white-flour bread and (1) lifestyle factors, (2) overall diet quality, and (3) health status. We conducted a nutrition survey among 451 Bedouin adults, using a modified 24 h recall questionnaire. Bread intake accounted for 32.7 % of the total energy intake. Those consuming predominantly white bread (PWB) (n 327) were more likely to be urban (OR 2.79; 95 % CI 1.70, 4.58), eating store-bought rather than homemade bread (OR 8.18; 95 % CI 4.34, 15.41) and currently dieting (OR 4.67; 95 % CI 1.28, 17.11) than those consuming predominantly wholewheat bread (PWWB) (n 124). PWB consumption was associated with a lower intake of dietary fibre (23.3 (se 0.6) v. 41.8 (se 1.0) g/d; P < or = 0.001), a higher intake of saturated fats (26.9 v. 24.6 % of total fat; P = 0.013) and lower intakes of Fe (11.0 (se 0.3) v. 16.7 (se 0.4) mg/d), Mg (262.2 (se 5.9) v. 490.3 (se 9.8) mg/d), vitamin E (6.5 (se 0.2) v. 8.6 (se 0.3) mg/d) and most B vitamins than PWWB consumption (P < 0.001 for all), after adjusting for total energy intake. Among those aged > or = 40 years, PWB consumption was associated with a 9.85-fold risk (95 % CI 2.64, 36.71; P = 0.001) of having one or more chronic conditions, as compared with PWWB consumption, after controlling for other risk factors. White bread intake was associated with a less traditional lifestyle and poorer diet quality, and may constitute a useful marker for at-risk subgroups to target for nutritional interventions.

Maternal weight misperceptions and smoking are associated with overweight and obesity in low SES preschoolers

Objectives:To identify modifiable risk factors for obesity among low socioeconomic status (LSES) children.Methods:Cross-sectional data were obtained from 238 4–7-year-old children and 224 mothers from LSES preschools. Anthropometric measurements were obtained; mothers were interviewed about sociodemographic characteristics, health behaviors, perceptions and beliefs.Results:The combined prevalence of overweight and obesity (OWOB) among children was 29.8% based on the new World Health Organization (WHO) growth standard. Prevalence of OWOB (body mass index ⩾25) among mothers was 51.8%. Mean age, sleeping hours, gender distribution and poverty level were similar between normal and OWOB children. Over 82% of mothers underestimated their childs weight status. Of the 62 OWOB children, 74.2% were perceived by their mothers as having ‘normal weight’ (NW) and 8% were perceived as ‘thin’. Mothers perceived 67 out of 158 NW children (42.4%) as ‘thin’ (P<0.001). Mediation analysis indicated that 10% of the effect of maternal underestimation on childs OWOB may be mediated through childs daily sedentary hours (P=0.06). In a multivariable logistic-regression analysis controlling for maternal obesity, knowledge regarding breakfasts importance and childs daily sedentary hours, maternal underestimation of the childs weight status (odds ratio=7.33; 95% confidence interval (CI):2.41–22.37; P<0.0001) and parental smoking (odds ratio=3.25; 95% CI: 1.26–8.40; P=0.015) were the only significant factors associated with OWOB in LSES children.Conclusions:Maternal perception of childs weight status and parental smoking are associated with childhood OWOB among LSES children. These parameters can help identify children at risk for obesity. Maternal perception may be amenable to intervention.

Importance of ethnic foods as predictors of and contributors to nutrient intake levels in a minority population

Objectives:To evaluate the role of ethnic foods as predictors of intake levels of selected nutrients that are important during pregnancy among the Bedouin Arab minority population in southern Israel, and to compare the main food predictors for Bedouin intakes of the selected nutrients with those for the regions Jewish majority population.Subjects/Methods:Ethnic foods/recipes (n=122) reported in the Bedouin Nutrition Study (BNS) were added to a preexisting, validated Israeli food composition table using European Food Information Resource standard criteria. Food items reported by the 519 BNS participants were combined into146 food groups that distinguished between existing foods and new ethnic recipes and were entered into a stepwise multiple regression model to identify the main predictors of intake levels of the selected nutrients. The results were compared with those of an identical analysis for the selected nutrients using 24 h recall data from the majority Jewish population.Results:Over 80% of the BNS between-person variability in the intake of all selected nutrients was explained by 34 food groups, of which 13 (38.2%) were ethnic foods. Homemade whole wheat bread was a main predictor of intake levels for five of the eight selected nutrients, and other ethnic foods/recipes (for example, za’atar, leafy dark green vegetables and camel milk) emerged as predictors of iron, folate, calcium and ω-3 fatty acid intakes. Breads explained 60 and 44% of the between-person variation, and 38 and 36% of the total intakes of iron and zinc intakes in the BNS sample, respectively, whereas for the Jewish population, animal sources and fortified foods predominated as main predictors and contributors of these nutrients.Conclusions:The addition of ethnic foods to food composition databases is important, as some of these foods are main predictors of nutrient intake levels in ethnic minority populations. In turn, this should facilitate the development of more sensitive dietary assessment tools and more effective diet-based health interventions for ethnic minorities.

Assessing individual dietary intake from common-plate meals: a new tool for an enduring practice.

OBJECTIVE The purposes of the present study were to estimate individual intake from common-plate meals among Bedouin Arabs using a modified 24 h recall questionnaire, and to evaluate reported energy intake (EI) by comparison with estimated energy requirement (EER). DESIGN Weighed records were used to develop a method of quantifying intake from common plates. Reported EI and nutrient intakes were obtained from administration of the modified 24 h recall. The relative standard error (RSE) was used to evaluate the reliability of reported nutrient intakes. The FAO/WHO/United Nations University and Oxford equations and reported physical activity levels were used to compute ratios of reported EI to BMR and EER. SETTING Population centres of traditionally semi-nomadic Bedouin Arabs undergoing sedentarization/urbanization in southern Israel. SUBJECTS A convenience sample of 451 adults (aged 19-82 years). RESULTS Mean (se) energy intake was 9648 (276) kJ/d (2306 (66) kcal/d) for men and 8230 (172) kJ/d (1967 (41) kcal/d) for women, of which carbohydrates accounted for 63-64 %. The nutrient intakes evaluated had RSE ratios of less than 25 %. EI:EER ratios ranged from 0.86 to 0.89, and from 0.87 to 0.93 among non-dieters who ate the usual amount on the recall day. CONCLUSIONS The modified 24 h recall produced plausible estimates of energy and nutrient intakes, comparable to those obtained with the 24 h recall in other populations. The modified questionnaire makes an important contribution to facilitating large-scale nutritional surveillance in the Bedouin population, and may serve as a model for modifying dietary instruments to quantify individual intake in other populations that practise common-plate eating.

Indigenous data matter: spotlight on Negev Bedouin Arabs

www.thelancet.com Vol 388 October 22, 2016 1983 population-based samples because, by government mandate, the homes in their communities do not have landline telephone services and street addresses, among other modern amenities. As a result, they are excluded from most of the national population, health, and welfare statistics. Furthermore, since 2012, the entire Negev Bedouin population, both in government-planned and unrecognised localities, has been excluded from national food security surveys and the household income and expenditure surveys that provide the source for national employment or labour force and poverty statistics. Most of the data that have been collected for the Negev Bedouin people (primarily for those living in recognised localities) are not separate from the larger Arab or Israeli populations. Special projects that analysed disaggregated, crude data collected before 2012 showed that Negev Bedouin people had lower labour force participation (28%) compared with the total Arab (48%) and Jewish (67%) averages, and lower average monthly salaries (ILS 4644 [US

Cardiovascular health among two ethnic groups living in the same region: A population-based study

1229]) than the total Arab (ILS 5126 [

Health disparities monitoring in the U.S.: lessons for monitoring efforts in Israel and other countries

1356]), and Israeli populations (ILS 8971 [

Dietary Acculturation and Diet Quality Among the Arab Minority Population in Israel

2373]). These socioeconomic disparities will further exacerbate existing health disparities. Moreover, the complete exclusion of the Negev Bedouin from ongoing national household and labour force data collection frameworks will severely cripple eff orts to assess the social determinants of health in this population; as well as efforts to implement effective strategies for eradicating health and social disparities. The status of this marginalised Indigenous population (which holds Israeli citizenship) might seem inconsequential to Israeli society as a whole. However, the problems faced by the Negev Bedouin population in terms of health, service provision, and inclusion in national socioeconomic frameworks, are from a traditional, seminomadic lifestyle to government-directed urbanisation, without any preparation for such a radical change. Horton raised a number of the critical health consequences of this transition. In follow-up, I would like to touch on the type of data issues that Anderson and colleagues discussed. Negev Bedouin Arabs are one of the youngest population groups in Israel, with a median age of 15·9 years, compared with 22·2 years among all Arabic people in Israel, and 31·8 years among Jewish people. Their total fertility rate is 5·45 children, compared with the larger Arab (3·17) and Jewish (3·07) populations, respectively, while their infant mortality rate is 11·0 per 1000 live births, compared with 6·3 for all Arabic people and 2·4 for Jewish people. Turning to social indicators, school dropouts in the Bedouin population in the 2013–14 academic year were 36·2%, compared with 19·7% in the Arabic population and 5·6% in the Jewish population. Although 13·8% of all people aged 20–29 years in Israel were enrolled in universities or academic colleges in 2013–14, the rates were 8·4% for the total Arab population, and 4·1% for the Negev Bedouin population. Obtaining additional socioeconomic data on this subpopulation is problematic. As Horton noted, half the Negev Bedouin Arabs l ive in government-planned townships, while the remainder live in unrecognised villages. The illegal status of these villages is a result of the long-standing conflict between the government and the Bedouin over their land ownership claims, which pre-date the 1948 establishment of the state of Israel. The ongoing stalemate complicates not only the provision of health-care and other services that aff ect health (eg, education and infrastructure), but also the collection of data on key social determinants. The Negev Bedouin group is hard to include in a corruption-free health system. We believe that his interest to serve people in Nepal is a message that should be shared in our global health community.