Osman Galal

The nutrition transition in Egypt: obesity, undernutrition and the food consumption context

OBJECTIVES To describe changing food consumption patterns in Egypt over the last several decades, current levels of overweight and obesity, and current data on obesity-related morbidity. DESIGN Secondary analysis and synthesis of existing data from national-level food consumption surveys, large recent surveys of hypertension and diabetes, and documentation of historical and policy context. SETTING Arab Republic of Egypt. SUBJECTS As selected and described in primary data sources. RESULTS AND CONCLUSIONS The nutrition transition in Egypt has occurred in the context of abundant dietary energy availability, urbanisation and moderate fat intakes. The prevalence of obesity in adults is very high, particularly among women. The prevalences of diabetes mellitus and of hypertension parallel that of obesity, and both are very high. Little information is available on physical activity, but it is likely that a large proportion of the population is quite sedentary, particularly in the cities. At the same time, rates of early childhood malnutrition remain stubbornly stable and relatively high. Public awareness of the increasing prevalence of obesity and of diet-related chronic disease is increasing, and attention has turned to documenting the problem(s).

Women's autonomy and pregnancy care in rural India: A contextual analysis

Studies in low-income countries have shown that womens autonomy (i.e. the freedom of women to exercise their judgment in order to act for their own interests) influences a number of reproductive and child health outcomes, including the use of pregnancy care services. However, studies have not examined the full spectrum of pregnancy care services needed for safe motherhood and have not accounted for community context. This study analyzed data on women and their villages from the cross-sectional population-based National Family Health Survey-2 (1998-1999) of rural India to investigate whether womens autonomy (measured in the 3 dimensions of decision-making autonomy, permission to go out, and financial autonomy) was associated with the use of adequate prenatal, delivery and postnatal care. The findings indicate womens autonomy was associated with greater use of pregnancy care services, particularly prenatal and postnatal care. The effect of womens autonomy on pregnancy care use varied according to the region of India examined (North, East and South) such that it was most consistently associated with pregnancy care use in south India, which also had the highest level of self-reported womens autonomy. The results regarding village level factors suggest that public investment in rural economic development, primary health care access, social cohesion and basic infrastructure such as electrification and paved roads were associated with pregnancy care use. Improvements in womens autonomy and these village factors may improve healthier child bearing in rural India.

Breastfeeding and weaning in a poor urban neighborhood in Cairo, Egypt: maternal beliefs and perceptions.

Maternal beliefs and perceptions about breastfeeding and weaning were investigated in a series of in-depth, open-ended interviews with 20 mothers of infants aged 2-12 months in a poor neighborhood of metropolitan Cairo during July-September 1990. The traditional pattern of breastfeeding well into or through the second year of life is changing rapidly, although essentially all mothers still wish to breastfeed and do so at least initially. Beliefs and behaviors reported varied somewhat by rural/urban origins of the mother herself, but exhibited consensus on many issues. The ability to breastfeed successfully is perceived to be a blessing, and to require maturity, patience and a sense of responsibility. The quantity and quality of breast milk are believed to be influenced by a wide variety of factors including the childs age and individual characteristics, the psychological and physical state of the mother, and her diet. Mothers reported a number of behaviors that are perceived to influence the quality of breast milk including changes in their diet when the infant was ill and behaviors designed to optimize the humoral qualities (hot/cold, light/heavy) of the milk. Supplementation with sugar water beings very early, and gradual introduction of other foods generally is begun soon after 40 days of age. Mixed formula and breastfeeding is commonly perceived to increase the nutritional quality of the childs diet. Weaning is ideally related to developmental milestones (walking, complete dentition) but often occurs early due to a variety of factors including maternal illness, desire for another pregnancy, and perceptions that breast milk may be inadequate. Weaning is perceived to be a difficult and dangerous transition.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutritional Intake and Context as Predictors of Cognition and Adaptive Behaviour of Egyptian School-age Children:

Relations between nutrition, cognition, and adaptive behaviour measures were assessed for 110 Egyptian pre-adolescents (47% male), ranging in age from 7 to 10 years. Using a combination of oral recall and weighing of food portions, the level of dietary intake was obtained for 19 specific nutrients, including measures of energy (kilocalories), macronutrients (protein, fat, carbohydrates), and micronutrients (vitamins, trace minerals). Children were tested on six subscales from the Egyptian version of the WISC-R plus the Ravens coloured matrices. Based on repeated naturalistic observations we also obtained measures of the childrens behaviour in the school classroom, social interactions with peers and adults, activity level, and affect. Teacher ratings of the childrens classroom behaviour were also obtained. The results indicated that specific nutritional indices were significantly related to male classroom behaviour and activity level, and to female verbal ability and classroom involvement. Although a diverse group of nutrients predicted developmental outcomes, common to many of these nutrients was the fact that they were derived from intake of animal source foods. The results further indicated that relations between nutrition and childrens cognition and behaviour were mediated by contextual factors, such as social class and cultural expectations about the appropriateness of given behaviours.

Relations between nutrition and cognitive performance in Egyptian toddlers.

Two relatively unexplored questions--which specific components of chronic mild child malnutrition are associated with specific behavioral and cognitive deficits and do psychosocial child rearing factors moderate the nutrition-development relationship?--were investigated in a longitudinal study involving 153 toddlers from the Egyptian village of Kalama. Beginning at study entry at age 18 months and continuing until 30 months, food intake information was obtained for 2 consecutive days each month. During the same period, researchers visited the homes twice a month to observe both toddler behavior and caregiver styles. Finally, standardized infant development tests were administered at 24 months and 30 minutes and the capacity for exploratory, symbolic play was assessed. Specific components of nutritional intake at 18-23 months of age were confirmed to be uniquely related to specific developmental outcomes at 24 months of age. Changes in toddler intake from 18-30 months also predicted 30-month cognitive performance. At 24 months, general mental competence was associated positively with fat intake, total kilocalories, and total protein intake while symbolic play capacity was related only to total protein intake. Significant increases in predictive variance occurred when the model was expanded to encompass caregiver behaviors as well as nutritional factors. For example, when nonverbal response to child vocalizations was used as the environmental measure, there was evidence of both coactive and synergistic interactions for comparisons involving cognitive development indicators. For symbolic play, an increase in predictive variance was found when the model included the multiplicative interaction of animal kilocalories by nonverbal response to vocalizations. Also observed was a buffering effect against poor psychosocial rearing conditions given the presence of adequate nutritional intake. These findings suggest the feasibility of multidimensional risk profiles, the provision of specific nutrients targeted at specific deficits, and multidisciplinary interventions.

Obesity among schoolchildren in developing countries.

The threat of worldwide obesity in children is a reality and has become pandemic. Previously a concern of only developed countries, rapid, escalating rates of overweight children now dominate the public health concerns of middle-and low-income nations as well. There are, of course, many influences that have literally shaped the global population, but there is also a recent observable pattern that is shared by those developing countries with increasingly obese children: a grand structural shift in diet and activity levels on every continent and in every region has occurred in the last quarter century, accompanied by rising rates of obesity. Two central public health concerns drive the need for effective interventions: the immediate health of children and the imminently crushing blow that is coming to health care systems and developing economies due to high rates of chronic disease. In developed nations, the role of gatekeeper has shifted to childcare providers, media, and schools, but in the developing world the traditional role of the mother as home manager has remained intact. Accepting the mother as the primary care provider within the childs nuclear environment places the mother as the guardian of the familys resources, which may be a viable alternative to the types of health-promotion efforts found in past ineffective models.

Urban Environment and Health: Food Security

The authors examine the impact of urbanization on food security and human health in the Middle East. Within-urban-population disparities in food security represent one of the most dramatic indicators of economic and health disparities. These disparities are reflected in a double burden of health outcomes: increasing levels of chronic disease as well as growing numbers of undernourished among the urban poor. These require further comprehensive solutions. Some of the factors leading to food insecurity are an overdependence on purchased food commodities, lack of sufficient livelihoods, rapid reductions in peripheral agricultural land, and adverse impacts of climate change. The Food and Agriculture Organization of the United Nations (FAO) Food Security Framework is used to examine and compare 2 cities in the Middle East: Amman, Jordan, and Manama, Bahrain.

Animal source foods have a positive impact on the primary school test scores of Kenyan schoolchildren in a cluster-randomised, controlled feeding intervention trial

Micronutrient deficiencies and suboptimal energy intake are widespread in rural Kenya, with detrimental effects on child growth and development. Sporadic school feeding programmes rarely include animal source foods (ASF). In the present study, a cluster-randomised feeding trial was undertaken to determine the impact of snacks containing ASF on district-wide, end-term standardised school test scores and nutrient intake. A total of twelve primary schools were randomly assigned to one of three isoenergetic feeding groups (a local plant-based stew (githeri) with meat, githeri plus whole milk or githeri with added oil) or a control group receiving no intervention feeding. After the initial term that served as baseline, children were fed at school for five consecutive terms over two school years from 1999 to 2001. Longitudinal analysis was used controlling for average energy intake, school attendance, and baseline socio-economic status, age, sex and maternal literacy. Children in the Meat group showed significantly greater improvements in test scores than those in all the other groups, and the Milk group showed significantly greater improvements in test scores than the Plain Githeri (githeri+oil) and Control groups. Compared with the Control group, the Meat group showed significant improvements in test scores in Arithmetic, English, Kiembu, Kiswahili and Geography. The Milk group showed significant improvements compared with the Control group in test scores in English, Kiswahili, Geography and Science. Folate, Fe, available Fe, energy per body weight, vitamin B₁₂, Zn and riboflavin intake were significant contributors to the change in test scores. The greater improvements in test scores of children receiving ASF indicate improved academic performance, which can result in greater academic achievement.

Cognitive performance of Egyptian adults as a function of nutritional intake and sociodemographic factors

Abstract This study was designed to investigate whether variability in adult cognitive performance was associated with variability in dietary energy intake or with variability in dietary intake quality, as defined by intake of animal source foods. In addition, we also investigated whether the impact of nutrition was amplified by covarying nonnutrient risk factors. Participants were 54 Egyptian male adults and 101 Egyptian female adults. Using a combination of oral recall and weighing of food portions, the level of individual dietary intake was established for 22 specific nutrients, including measures of energy (kilocalories), macronutrients (fat, protein), and micronutrients (vitamins, trace minerals). Adults were mildly deficient in specific trace minerals and vitamins, but were not clinically malnourished. Participants were tested on four subscales from the Egyptian version of the WAIS-R and the Ravens Progressive Matrices. In addition we also obtained measures of family SES, individual education level, and adult height as a proxy for prior nutritional status. Results indicated that male cognitive performance was primarily associated with intake of animal source foods, with a small contribution of socioeconomic status. Female cognitive performance was primarily associated with level of education, with a small contribution from animal source foods. The results emphasize the salience of nutritional intake for adult cognition, even with populations that are not clinically malnourished. The results also emphasize the importance of studying nutritional influences as part of a larger system of multiple determinants of human behavior.

Prevalence and functional correlates of obesity in an Egyptian village

The objective of this analysis was to investigate obesity and its correlates in 147 men and 286 women 15 to 74 years from the Egyptian project of the Nutrition Collaborative Research Support Program (CRSP). According to National Center for Health Statistics (NCHS, 1983) standards for body mass index (BMI), nearly twice the proportion of women (25.1 and 10.1%) were overweight or obese compared to men (12.9 and 6.8%), using body mass index (BMI). Although not for men, women reporting heart disease or diabetes had higher BMI and were older. High maternal pre‐pregnant BMI was also related to adverse pregnancy outcome, i.e., multiple births and complicated deliveries, and higher infant birthweights. Given that the likelihood of a lighter weight infant was greater for leaner women and that women regardless of their pre‐pregnancy weight had low pregnancy weight gains, one could suggest that women in this community are vulnerable to the risks of low pregnancy weight gains and that high pre‐pregnancy relative weig...