Paul Amuna

Epidemiological and nutrition transition in developing countries : impact on human health and development

Whereas common infectious and parasitic diseases such as malaria and the HIV/AIDS pandemic remain major unresolved health problems in many developing countries, emerging non-communicable diseases relating to diet and lifestyle have been increasing over the last two decades, thus creating a double burden of disease and impacting negatively on already over-stretched health services in these countries. Prevalence rates for type 2 diabetes mellitus and CVD in sub-Saharan Africa have seen a 10-fold increase in the last 20 years. In the Arab Gulf current prevalence rates are between 25 and 35% for the adult population, whilst evidence of the metabolic syndrome is emerging in children and adolescents. The present review focuses on the concept of the epidemiological and nutritional transition. It looks at historical trends in socio-economic status and lifestyle and trends in nutrition-related non-communicable diseases over the last two decades, particularly in developing countries with rising income levels, as well as the other extreme of poverty, chronic hunger and coping strategies and metabolic adaptations in fetal life that predispose to non-communicable disease risk in later life. The role of preventable environmental risk factors for obesity and the metabolic syndrome in developing countries is emphasized and also these challenges are related to meeting the millennium development goals. The possible implications of these changing trends for human and economic development in poorly-resourced healthcare settings and the implications for nutrition training are also discussed.

Essential and trace elements content of commercial infant foods in the UK.

There is a paucity of data in respect of the nutritional quality of complementary foods for infants and young children aged between 6 and 12months. The primary objective of this study was to examine nutritive values of such complementary infant food on the UK market in order to ascertain their suitability relative to dietary guidelines for the 6-9months age group. Quantitative analyses were conducted on eight different products representing four popular brands (meat and vegetable based) currently on sale in the UK. Eight major mineral and trace elements, namely: calcium, copper, magnesium, iron, zinc, potassium, sodium and selenium were measured by ICP-OES and ICP-MS. The results of these studies were referenced to the Recommended Nutrient Intake (RNI) values for 6-9months old children, and a menu of entire daily intake of minerals and trace elements was composed taking into consideration the nutrient and energy intake from milk consumption. Based on these comparisons, all the food samples studied in this work contained less essential minerals than expected from the RNI values except for potassium in meat and vegetable based recipes. These results suggest that commercial complementary infant foods on the UK market may not contain the minimum levels of minerals required for the labelling declaration of micronutrient content (Commission Directive 2006/125/EC). This provides opportunities and scope for product optimisation to improve their nutritive value.

Culturally sensitive patient-centred educational programme for self-management of type 2 diabetes: A randomized controlled trial

OBJECTIVE To assess the effectiveness of a culturally sensitive, structured education programme (CSSEP) on biomedical, knowledge, attitude and practice measures among Arabs with type two diabetes. RESEARCH DESIGNS AND METHODS A total of 430 patients with type II diabetes mellitus living in Doha, Qatar were enrolled in the study. They were randomized to either intervention (n = 215) or a control group (n = 215). A baseline and one-year interval levels of biomedical variables including HbA1C, lipid profile, urine for microalbuminuria; in addition to knowledge, attitude and practice (KAP) scores were prospectively measured. The intervention was based on theory of empowerment, health belief models and was culturally sensitive in relation to language (Arabic), food habits and health beliefs. It consisted of four educational sessions for each group of patients (10-20 patients per session), lasting for 3-4 h. The first session discussed diabetes pathophysiology and complications; while the second session discussed healthy life style incorporating the Idaho plate method; and the third session dealt with exercise benefits and goal setting and the fourth session concentrated enhancing attitude and practice using counselling techniques. Outcomes were assessed at base line and 12 months after intervention. RESULTS After 12 months participation in the intervention was shown to have led to a statistically significant reduction in HbA1C in the (CSSEP) group (-0.55 mmol/L, P = 0.012), fasting blood sugar (-0.92 mmol/L, P = 0.022), body mass index (1.70, P = 0.001) and albumin/creatinine ratio (-3.09, P < 0.0001) but not in the control group. The intervention group also had improvement in Diabetes knowledge (5.9%, P < 0.0001), attitude (6.56%, P < 0.0001), and practice (6.52%, P = 0.0001). CONCLUSION This study demonstrates the effectiveness of culturally sensitive, structured, group-based diabetes education in enhancing biomedical and behavioural outcomes in Diabetic patients.

Inventory on the dietary assessment tools available and needed in africa: a prerequisite for setting up a common methodological research infrastructure for nutritional surveillance, research, and prevention of diet-related non-communicable diseases

abstract Objective: To carry out an inventory on the availability, challenges, and needs of dietary assessment (DA) methods in Africa as a pre-requisite to provide evidence, and set directions (strategies) for implementing common dietary methods and support web-research infrastructure across countries. Methods: The inventory was performed within the framework of the “Africas Study on Physical Activity and Dietary Assessment Methods” (AS-PADAM) project. It involves international institutional and African networks. An inventory questionnaire was developed and disseminated through the networks. Eighteen countries responded to the dietary inventory questionnaire. Results: Various DA tools were reported in Africa; 24-Hour Dietary Recall and Food Frequency Questionnaire were the most commonly used tools. Few tools were validated and tested for reliability. Face-to-face interview was the common method of administration. No computerized software or other new (web) technologies were reported. No tools were standardized across countries. Conclusions: The lack of comparable DA methods across represented countries is a major obstacle to implement comprehensive and joint nutrition-related programmes for surveillance, programme evaluation, research, and prevention. There is a need to develop new or adapt existing DA methods across countries by employing related research infrastructure that has been validated and standardized in other settings, with the view to standardizing methods for wider use.

The role of traditional cereal/legume/fruit‐based multimixes in weaning in developing countries

The weaning period is a crucial stage in the growth and development of the infant and child. The timing of weaning, the choice of foods, their methods of preparation, and how weanlings are fed, all affect the outcome. The commercial preparation of weaning foods and the fortification of some traditional foods are seen by some as the most sustainable and cost‐effective means of alleviating micronutrient deficiencies among infants and children. This may be true in industrialized countries, but the same cannot necessarily be said of poor, developing countries. Demonstrates that, even in poor communities, it is possible to combine scant food resources in a cost‐effective way to formulate multimixes which would meet energy, protein and micronutrient needs, without fortification. Proposes that such approaches can be used in community nutrition education programmes to help reduce childhood malnutrition and in emergency feeding programmes.

Building systemic capacity for Nutrition: Training towards a professionalised workforce for Africa.

The fundamental role played by good nutrition in enabling personal, social and economic development is now widely recognised as presenting a fundamental global challenge that has to be addressed if major national and international problems are to be resolved in the coming decades. The recent focus provided by the Millennium Development Goals and the Scaling-Up-Nutrition (SUN) movement has been towards reducing the extent of nutrition-related malnutrition in high-burden countries. This has served to emphasise that there is a problem of inadequate professional capacity in nutrition that is sufficiently widespread to severely limit all attempts at the effective delivery and sustainability of nutrition-related and nutrition-enabling interventions that have impact at scale. Many high-burden countries are in sub-Saharan Africa where there is a high dependency on external technical support to address nutrition-related problems. We have sought to explore the nature and magnitude of the capacity needs with a particular focus on achieving levels of competency within standardised professional pre-service training which is fit-for-purpose to meet the objectives within the SUN movement in Africa. We review our experience of engaging with stakeholders through workshops, a gap analysis of the extent of the problem to be addressed, and a review of current efforts in Africa to move the agenda forward. We conclude that there are high aspirations but severely limited human resource and capacity for training that is fit-for-purpose at all skill levels in nutrition-related subjects in Africa. There are no structured or collaborative plans within professional groups to address the wide gap between what is currently available, the ongoing needs and the future expectations for meeting local technical and professional capability. Programmatic initiatives encouraged by agencies and other external players, will need to be matched by improved local capabilities to address the serious efforts required to meet the needs for sustained improvements related to SUN in high-burden countries. Importantly, there are pockets of effort which need to be encouraged within a context in which experience can be shared and mutual support provided.

Human and economic development in developing countries: a public health dimension employing the food multimix concept

Over the last three decades, efforts to boost economic development in Sub-Saharan Africa (SSA) have met with mixed outcomes. The gap between rich and poor in developing countries has widened following the removal of government subsidies on health, agriculture and education partly as a consequence of structural adjustment programmes. More alarming, nine out of the top ten poorest countries are located in SSA with an average GNI per capita of US

Applying the Food Multimix concept for sustainable and nutritious diets

251 (95% CI 192.9-309.6), an average life expectancy of 43.9 (95% CI 41.8-51.9) years, the latter of which is projected to fall further if present trends continue especially combined with the HIV/AIDS pandemic. Poor education, food insecurity, limited access to affordable and good quality healthcare will lead to a weakened workforce and ultimately, impact negatively on productivity and economic development. We have previously reported the use of traditional Food Multimixes (FMM) to meet nutritional needs for different population groups. The focus of this paper was to demonstrate the processes involved in the development of a suitable FMM and how such products can provide sufficient nutrients in the daily composite diets of poor, food-insecure communities in SSA. We suggest that an integrated approach including community-based and community supported food-based interventions, education with an in-built nutrition and health component as well as information, learning and leadership strategies will contribute to human and economic development efforts in SSA.

Evaluation of the international standardized 24-h dietary recall methodology (GloboDiet) for potential application in research and surveillance within African settings

Despite a rich and diverse ecosystem, and biodiversity, worldwide, more than 2 billion people suffer from micronutrient malnutrition or hidden hunger. Of major concern are a degradation of our ecosystems and agricultural systems which are thought to be unsustainable thereby posing a challenge for the future food and nutrition security. Despite these challenges, nutrition security and ensuring well balanced diets depend on sound knowledge and appropriate food choices in a complex world of plenty and want. We have previously reported on how the food multimix (FMM) concept, a food-based and dietary diversification approach can be applied to meet energy and micronutrient needs of vulnerable groups through an empirical process. Our objective in this paper is to examine how the concept can be applied to improve nutrition in a sustainable way in otherwise poor and hard-to-reach communities. We have reviewed over 100 FMM food recipes formulated from combinations of commonly consumed traditional candidate food ingredients; on average five per recipe, and packaged as per 100 g powders from different countries including Ghana, Kenya, Botswana, Zimbabawe and Southern Africa, India, Mexico, Malaysia and the UK; and for different age groups and conditions such as older infants and young children, pregnant women, HIV patients, diabetes and for nutrition rehabilitation. Candidate foods were examined for their nutrient strengths and nutrient content and nutrient density of recipes per 100 g were compared with reference nutrient intakes for the different population groups. We report on the nutrient profiles from our analysis of the pooled and age-matched data as well as sensory analysis and conclude that locally produced FMM foods can complement local diets and contribute significantly to meet nutrient needs among vulnerable groups in food-insecure environments.

Potential Nutrigenomic Approaches to Reduce the High Incidence of Obesity in Qatar

BackgroundCollection of reliable and comparable individual food consumption data is of primary importance to better understand, control and monitor malnutrition and its related comorbidities in low- and middle-income countries (LMICs), including in Africa. The lack of standardised dietary tools and their related research support infrastructure remains a major obstacle to implement concerted and region-specific research and action plans worldwide. Citing the magnitude and importance of this challenge, the International Agency for Research on Cancer (IARC/WHO) launched the “Global Nutrition Surveillance initiative” to pilot test the use of a standardized 24-h dietary recall research tool (GloboDiet), validated in Europe, in other regions. In this regard, the development of the GloboDiet-Africa can be optimised by better understanding of the local specific methodological needs, barriers and opportunities. The study aimed to evaluate the standardized 24-h dietary recall research tool (GloboDiet) as a possible common methodology for research and surveillance across Africa.MethodsA consultative panel of African and international experts in dietary assessment participated in six e-workshop sessions. They completed an in-depth e-questionnaire to evaluate the GloboDiet dietary methodology before and after participating in the e-workshop.ResultsThe 29 experts expressed their satisfaction on the potential of the software to address local specific needs when evaluating the main structure of the software, the stepwise approach for data collection and standardisation concept. Nevertheless, additional information to better describe local foods and recipes, as well as particular culinary patterns (e.g. mortar pounding), were proposed. Furthermore, food quantification in shared-plates and -bowls eating situations and interviewing of populations with low literacy skills, especially in rural settings, were acknowledged as requiring further specific considerations and appropriate solutions.ConclusionsAn overall positive evaluation of the GloboDiet methodology by both African and international experts, supports the flexibility and potential applicability of this tool in diverse African settings and sets a positive platform for improved dietary monitoring and surveillance. Following this evaluation, prerequisite for future implementation and/or adaptation of GloboDiet in Africa, rigorous and robust capacity building as well as knowledge transfer will be required to roadmap a stepwise approach to implement this methodology across pilot African countries/regions.