Malek Batal

Processed and Ultra-processed Food Products: Consumption Trends in Canada from 1938 to 2011

PURPOSE A classification of foods based on the nature, extent, and purpose of industrial food processing was used to assess changes in household food expenditures and dietary energy availability between 1938 and 2011 in Canada. METHODS Food acquisitions from six household food budget surveys (1938/1939 , 1953, 1969, 1984, 2001, and 2011) were classified into unprocessed or minimally processed foods, processed culinary ingredients, and ready-to-consume processed or ultra-processed products. Contributions of each group to household food expenditures, and to dietary energy availability (kcal per capita) were calculated. RESULTS During the period studied, household expenditures and dietary energy availability fell for both unprocessed or minimally processed foods and culinary ingredients, and rose for ready-to-consume products. The caloric share of foods fell from 34.3% to 25.6% and from 37% to 12.7% for culinary ingredients. The share of ready-to-consume products rose from 28.7% to 61.7%, and the increase was especially noteworthy for those that were ultra-processed. CONCLUSIONS The most important factor that has driven changes in Canadian dietary patterns between 1938 and 2011 is the replacement of unprocessed or minimally processed foods and culinary ingredients used in the preparation of dishes and meals; these have been displaced by ready-to-consume ultra-processed products. Nutrition research and practice should incorporate information about food processing into dietary assessments.

Acculturation and Nutritional Health of Immigrants in Canada: A Scoping Review

Although recent immigrants to Canada are healthier than Canadian born (i.e., the Healthy Immigrant Effect), they experience a deterioration in their health status which is partly due to transitions in dietary habits. Since pathways to these transitions are under-documented, this scoping review aims to identify knowledge gaps and research priorities related to immigrant nutritional health. A total of 49 articles were retrieved and reviewed using electronic databases and a stakeholder consultation was undertaken to consolidate findings. Overall, research tends to confirm the Healthy Immigrant Effect and suggests that significant knowledge gaps in nutritional health persist, thereby creating a barrier to the advancement of health promotion and the achievement of maximum health equity. Five research priorities were identified including (1) risks and benefits associated with traditional/ethnic foods; (2) access and outreach to immigrants; (3) mechanisms and coping strategies for food security; (4) mechanisms of food choice in immigrant families; and (5) health promotion strategies that work for immigrant populations.

A Mediterranean diet pattern with low consumption of liquid sweets and refined cereals is negatively associated with adiposity in adults from rural Lebanon

Background:The beneficial impact of the traditional Mediterranean diet pattern on adiposity is still under debate, and this has never been assessed in a developing Mediterranean country.Objectives:To assess the relationships between adherence to a traditional Mediterranean diet and adiposity indexes, that is, body mass index (BMI) and waist circumference (WC), in a sample from rural Lebanon.Design:A sample of 798 adults, aged 40–60 years, was selected in continental rural areas of Lebanon for a cross-sectional study. The questionnaire included socio-demographic, anthropometric and dietary sections. The daily consumption frequencies of selected food groups, categorized as positive or negative components, were calculated based on a food frequency questionnaire. Adherence to the Mediterranean diet was assessed using six a priori scores; including the widely used Mediterranean diet score (MDS). Associations between diet scores and BMI and WC were assessed.Results:Overall, the diet of the study sample only partially matched the traditional Mediterranean diet. A total of 17.0% of men and 33.7% women were obese. The MDS was negatively associated (P<0.05) with WC, but not BMI, in men and women. The constructed composite Mediterranean score combining positive components of the diet (whole cereals, vegetables, legumes and fruit, olive oil and fish) and negative components adapted to this sample (refined cereals and pastries, and liquid sweets) was consistently and negatively associated with both BMI and WC for men and women in multivariate models. A 2-point increase in that score was associated with a decrease in BMI of 0.51 and 0.78 kg m–2 and a decrease in WC of 2.77 and 4.76 cm in men and women, respectively.Conclusion:The results demonstrate that a Mediterranean diet is negatively associated with obesity and visceral adiposity in a rural population of a developing Mediterranean country.

Folate deficiency is associated with nutritional anaemia in lebanese women of childbearing age

OBJECTIVE The objective of this study was to identify the determinants of anaemia in Lebanese women of childbearing age attending health centres in Lebanon. DESIGN Cross-sectional study carried out between May and December 2003. Anthropometric measurements as well as sociodemographic, health and dietary intake data were collected using a questionnaire. Haemoglobin (Hb), plasma ferritin, plasma folate and vitamin B12 were assessed using standard laboratory methods. SETTING Governmental health centres in Lebanon. SUBJECTS Four hundred and seventy non-pregnant Lebanese women aged 15-45 years. RESULTS Anaemia (Hb <12 g dl(-1)) and iron deficiency (ferritin <15 microg l(-1)) were prevalent in 16.0 and 27.2% of the study sample, respectively. Of the total sample, 7.7% had iron-deficiency anaemia. The percentage of women with either Hb or ferritin deficiency or both was 35.6%. Plasma folate and vitamin B12 deficiency was reported in 25.1 and 39.4%, respectively, and 12.6% of the women had both folate and vitamin B12 deficiencies. Of the anaemic group, 48.0% of the women had iron deficiency. The intake of iron was lower in iron-deficient than in non-deficient women and a positive relationship was shown between folate intake and its corresponding serum levels. Regression analysis showed that ferritin, plasma folate and family history of anaemia were significant determinants of the anaemia in the sample of women. CONCLUSIONS Anaemia not related to iron deficiency was partly explained by plasma folate deficiency. Measures to control folate and iron deficiency should be considered.

Consumption of ultra-processed foods predicts diet quality in Canada

This study describes food consumption patterns in Canada according to the types of food processing using the Nova classification and investigates the association between consumption of ultra-processed foods and the nutrient profile of the diet. Dietary intakes of 33,694 individuals from the 2004 Canadian Community Health Survey aged 2 years and above were analyzed. Food and drinks were classified using Nova into unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods. Average consumption (total daily energy intake) and relative consumption (% of total energy intake) provided by each of the food groups were calculated. Consumption of ultra-processed foods according to sex, age, education, residential location and relative family revenue was assessed. Mean nutrient content of ultra-processed foods and non-ultra-processed foods were compared, and the average nutrient content of the overall diet across quintiles of dietary share of ultra-processed foods was measured. In 2004, 48% of calories consumed by Canadians came from ultra-processed foods. Consumption of such foods was high amongst all socioeconomic groups, and particularly in children and adolescents. As a group, ultra-processed foods were grossly nutritionally inferior to non-ultra-processed foods. After adjusting for covariates, a significant and positive relationship was found between the dietary share of ultra-processed foods and the content in carbohydrates, free sugars, total and saturated fats and energy density, while an inverse relationship was observed with the dietary content in protein, fiber, vitamins A, C, D, B6 and B12, niacin, thiamine, riboflavin, as well as zinc, iron, magnesium, calcium, phosphorus and potassium. Lowering the dietary share of ultra-processed foods and raising consumption of hand-made meals from unprocessed or minimally processed foods would substantially improve the diet quality of Canadian.

Obesity and type 2 diabetes in Northern Canada's remote First Nations communities: the dietary dilemma.

First Nations populations in Northwestern Ontario have undergone profound dietary and lifestyle transformations in less than 50 years, which have contributed to the alarming rise in obesity and obesity-related diseases, in particular type 2 diabetes mellitus. Even though the genetic background of First Nations peoples differs from that of the Caucasians, genetics alone cannot explain such a high prevalence in obesity and type 2 diabetes. Modifications in lifestyle and diet are major contributors for the high prevalence of chronic diseases. What remains constant in the literature is the persistent view that locally harvested and prepared foods are of tremendous value to First Nations peoples providing important health and cultural benefits that are increasingly being undermined by western-based food habits. However, the complexities of maintaining a traditional diet require a multifaceted approach, which acknowledges the relationship between benefits, risks and viability that cannot be achieved using purely conventional medical and biological approaches. This brief review explores the biological predispositions and potential environmental factors that contribute to the development of the high incidence of obesity and obesity-related diseases in First Nations communities in Northern Canada. It also highlights some of the complexities of establishing exact physiological causes and providing effective solutions.

Estimation of traditional food intake in indigenous communities in Denendeh and the Yukon

Abstract Objectives. Chronic non-communicable diseases related to excessive or unbalanced dietary intakes are on the rise among some Indigenous populations in Canada. Nutritional problems of Indigenous peoples arise in the transition from a traditional diet to a market diet characterized by highly processed foods with reduced nutrient density. This study aimed at assessing traditional food intake of Indigenous people in 18 communities. Study design. This study was cross-sectional with a sample size of 1,356. Methods. This study used food frequency and 24-hour recall questionnaires to quantify traditional food intake in 18 communities in the McKenzie basin of the Northwest Territories (Denendeh and the Yukon). Results. Typical daily intakes of groups of traditional food items were generated and intake of an extensive list of traditional food detailed for adult men and women. Per capita intake of traditional food items was also calculated. Conclusion. Reliance on traditional food intake is still high in Denendeh, as well as in the Yukon. The detailed description of the traditional food system presented here allows an accurate identification of the contribution of traditional food items to nutrient and contaminant intake by Indigenous people for future studies. (Int J Circumpolar Health 2005; 64(1):46–54)

Perceived health and medicinal properties of six species of wild edible plants in north-east Lebanon

OBJECTIVES Wild edible plants (WEP) play the dual role of securing food diversity and promoting health in traditional societies. Current simplified dietary habits contribute to increasing population health risks. Since WEP are integral to the diet of traditional communities, identifying their significance as foods to people provides further evidence to conserve them and promote their consumption. Six species of WEP were identified as integral to the diet of rural Lebanese communities. We investigated their patterns of consumption and knowledge regarding their health and medicinal properties. DESIGN An ethnobotanical survey, employing a qualitative questionnaire, was conducted among thirty informants. The identified species were Cichorium intybus, Eryngium creticum, Foeniculum vulgare, Malva sylvestris, Thymus syriacus and Gundelia tournifortii. RESULTS Most informants consumed the six plants as a regular part of their diet. Seasonal variability in consumption was evident. C. intybus was renowned for its digestive and blood strengthening properties. F. vulgare was used as a digestive stimulant. M. sylvestris was distinguished for its anti-inflammatory qualities. T. syriacus was popular for its digestive and anti-poisonous properties. E. creticum was attributed less pronounced health benefits. G. tournifortii was considered a nutritious food. CONCLUSIONS All six species were popular for their edible uses as well as their health and/or medicinal benefits. These properties are supported by scientific evidence. Our results highlight the importance of these plants for local people and support efforts for their conservation. However, we noticed a decline in indigenous knowledge. We encourage efforts to record it for other plants and in other communities.

The nutrient profile of traditional Lebanese composite dishes: comparison with composite dishes consumed in France

Primary objective: To estimate the overall nutritional quality of traditional Lebanese dishes by calculating their nutrient profile. Methods: Fifty traditional Lebanese composite dishes (LD) were compared with 50 composite dishes consumed in France (FD), based on the SAIN (score of nutritional adequacy of individual foods) and LIM (score of nutrients to be limited) nutrient profiling system. Each dish was attributed to one of four nutrient profiling classes based on their SAIN and LIM values. The dishes’ distributions within the four classes and their content in selected nutrients and ingredient groups were compared. Results: LD had a better nutrient profile than FD (P <0.001). LD were richer in vitamin C and contained less proteins, saturated fatty acids, and sodium. They contained more vegetables and unrefined starches and less cheese and refined starches than FD. Conclusions: Nutrient profiles may help identify those composite dishes whose consumption should be encouraged to promote healthy eating in Lebanon.

Specific cut-off points for waist circumference and waist-to-height ratio as predictors of cardiometabolic risk in Black subjects: a cross-sectional study in Benin and Haiti

Purpose Waist circumference (WC) and waist-to-height ratio (WHtR) are widely used as indicators of abdominal adiposity and the cut-off values have been validated primarily in Caucasians. In this study we identified the WC and WHtR cut-off points that best predicted cardiometabolic risk (CMR) in groups of African (Benin) and African ancestry (Haiti) Black subjects. Methods This cross-sectional study included 452 apparently healthy subjects from Cotonou (Benin) and Port-au-Prince (Haiti), 217 women and 235 men from 25 to 60 years. CMR biomarkers were the metabolic syndrome components. Additional CMR biomarkers were a high atherogenicity index (total serum cholesterol/high density lipoprotein cholesterol ≥4 in women and ≥5 in men); insulin resistance set at the 75th percentile of the calculated Homeostasis Model Assessment index (HOMA-IR); and inflammation defined as high-sensitivity C-reactive protein (hsCRP) concentrations between 3 and 10 mg/L. WC and WHtR were tested as predictors of two out of the three most prevalent CMR biomarkers. Receiver operating characteristic (ROC) curves, Youden’s index, and likelihood ratios were used to assess the performance of specific WC and WHtR cut-offs. Results High atherogenicity index (59.5%), high blood pressure (23.2%), and insulin resistance (25% by definition) were the most prevalent CMR biomarkers in the study groups. WC and WHtR were equally valid as predictors of CMR. Optimal WC cut-offs were 80 cm and 94 cm in men and women, respectively, which is exactly the reverse of the generic cut-offs. The standard 0.50 cut-off of WHtR appeared valid for men, but it had to be increased to 0.59 in women. Conclusion CMR was widespread in these population groups. The present study suggests that in order to identify Africans with high CMR, WC thresholds will have to be increased in women and lowered in men. Data on larger samples are needed.