Suad N. Al-Hooti

The state of health in the Arab world, 1990–2010: an analysis of the burden of diseases, injuries, and risk factors

BACKGROUND The Arab world has a set of historical, geopolitical, social, cultural, and economic characteristics and has been involved in several wars that have affected the burden of disease. Moreover, financial and human resources vary widely across the region. We aimed to examine the burden of diseases and injuries in the Arab world for 1990, 2005, and 2010 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010). METHODS We divided the 22 countries of the Arab League into three categories according to their gross national income: low-income countries (LICs; Comoros, Djibouti, Mauritania, Yemen, and Somalia), middle-income countries (MICs; Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, occupied Palestinian territory, Sudan, Syria, and Tunisia), and high-income countries (HICs; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). For the whole Arab world, each income group, and each individual country, we estimated causes of death, disability-adjusted life years (DALYs), DALY-attributable risk factors, years of life lived with disability (YLDs), years of life lost due to premature mortality (YLLs), and life expectancy by age and sex for 1990, 2005, and 2010. FINDINGS Ischaemic heart disease was the top cause of death in the Arab world in 2010 (contributing to 14·3% of deaths), replacing lower respiratory infections, which were the leading cause of death in 1990 (11·0%). Lower respiratory infections contributed to the highest proportion of DALYs overall (6·0%), and in female indivduals (6·1%), but ischaemic heart disease was the leading cause of DALYs in male individuals (6·0%). DALYs from non-communicable diseases--especially ischaemic heart disease, mental disorders such as depression and anxiety, musculoskeletal disorders including low back pain and neck pain, diabetes, and cirrhosis--increased since 1990. Major depressive disorder was ranked first as a cause of YLDs in 1990, 2005, and 2010, and lower respiratory infections remained the leading cause of YLLs in 2010 (9·2%). The burden from HIV/AIDS also increased substantially, specifically in LICs and MICs, and road injuries continued to rank highly as a cause of death and DALYs, especially in HICs. Deaths due to suboptimal breastfeeding declined from sixth place in 1990 to tenth place in 2010, and childhood underweight declined from fifth to 11th place. INTERPRETATION Since 1990, premature death and disability caused by communicable, newborn, nutritional, and maternal disorders (with the exception of HIV/AIDS) has decreased in the Arab world--although these disorders do still persist in LICs--whereas the burden of non-communicable diseases and injuries has increased. The changes in the burden of disease will challenge already stretched human and financial resources because many Arab countries are now dealing with both non-communicable and infectious diseases. A road map for health in the Arab world is urgently needed. FUNDING Bill & Melinda Gates Foundation.

Effect of adding wheat bran and germ fractions on the chemical composition of high-fiber toast bread

Abstract The effect of the type of bran, level of addition, particle size and addition of wheat germ on the chemical composition of high-fiber toast bread was investigated. The bran and germ fractions were found to be high in ash, protein, fat and total dietary fiber contents. The wheat germ had a protein content of 27.88% compared with 11.35, 12.69 and 15.76% for white flour, whole wheat flour and red fine bran, respectively. The chemical composition of high-fiber breads, in terms of minerals, protein, fat and dietary fiber contents, was found to be far superior than that of the whole wheat flour (control) bread sample. Considering these results, it can be concluded that high-fiber toast bread, with lighter crumb color and improved sensory and nutritional qualities than the whole wheat flour bread, can be produced using white flour, and equal proportions of coarse and fine bran at 20%, germ at 7.5%, and sodium stearoyl-2-lactylate at 0.5% levels.

Physicochemical characteristics of five date fruit cultivars grown in the United Arab Emirates

The physical measurements and chemical analyses of date fruits of five cultivars grown in the United Arab Emirates were measured in this study. Due to differences in seed weight, the flesh accounted for 83–92% of the total fruit. At the tamr stage, the absence of sucrose and the presence of higher concentrations of reducing sugars, especially fructose and glucose, characterized these cultivars as the soft type. On maturation from the kimri to the tamr stage, the sugar content had increased, but other constituents like moisture, crude protein, crude fat, ash, crude fiber, tannins, and pectin had decreased.

Chemical composition and quality of date syrup as affected by pectinase/cellulase enzyme treatment

The date palm tree, which is native to the Mediterranean region and originated in the Arabian Gulf area, is now becoming an important commercial crop in Kuwait. Because of the tremendous efforts of the Public Authority for Agriculture and Fisheries Resources, date palm cultivation has developed quickly in Kuwait during the last decade. These newly planted date fruit trees, as well as tissue culture plants being produced and distributed by KISR, would start bearing fruit in a few years. It may not then be possible to consume all the fresh date fruit locally and, subsequently, newer avenues for turning this surplus fruit into value-added products will become a necessity and a commercially viable venture. Technology was developed on a laboratory scale for the production of date syrup from tamer fruits of two commercial varieties, Birhi and Safri, for further use in food products. Both the varieties were found to be high in total sugar contents (about 88%). Among the various extraction procedures employed for producing date syrup, the use of pectinase/cellulase enzymes gave the highest recovery of total soluble solids (68%) compared with control without these enzymes (35%). The CIE L∗a∗b∗ color values for diluted as well as concentrated date syrup of Birhi variety were found to be lower than the Safri variety, indicating lighter color for the former. The results indicate the possibility of employing pectinase/cellulase enzymes to produce concentrated date syrup from tamer fruits for use in food product development.

The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis

Objective/design We conducted a comparative risk assessment analysis to estimate the cardiometabolic disease (CMD) mortality attributable to 11 dietary and 4 metabolic risk factors in 20 countries of the Middle East by age, sex and time. The national exposure distributions were obtained from a systematic search of multiple databases. Missing exposure data were estimated using a multilevel Bayesian hierarchical model. The aetiological effect of each risk factor on disease-specific mortality was obtained from clinical trials and observational studies. The number of disease-specific deaths was obtained from the 2010 Global Burden of Disease mortality database. Mortality due to each risk factor was determined using the population attributable fraction and total number of disease-specific deaths. Setting/population Adult population in the Middle East by age, sex, country and time. Results Suboptimal diet was the leading risk factor for CMD mortality in 11 countries accounting for 48% (in Morocco) to 72% (in the United Arab Emirates) of CMD deaths. Non-optimal systolic blood pressure was the leading risk factor for CMD deaths in eight countries causing 45% (in Bahrain) to 68% (in Libya) of CMD deaths. Non-optimal body mass index and fasting plasma glucose were the third and fourth leading risk factors for CMD mortality in most countries. Among individual dietary factors, low intake of fruits accounted for 8% (in Jordan) to 21% (in Palestine) of CMD deaths and low intake of whole grains was responsible for 7% (in Palestine) to 22% (in the United Arab Emirates) of CMD deaths. Between 1990 and 2010, the CMD mortality attributable to most risk factors had decreased except for body mass index and trans-fatty acids. Conclusions Our findings highlight key similarities and differences in the impact of the dietary and metabolic risk factors on CMD mortality in the countries of the Middle East and inform priorities for policy measures to prevent CMD.

Evidence for nutrition transition in Kuwait: over-consumption of macronutrients and obesity

OBJECTIVES To describe nutrient intakes and prevalence of overweight and obesity in a nationally representative sample of Kuwaitis and to compare intakes with reference values. DESIGN Cross-sectional, multistage stratified, cluster sample. Settings National nutrition survey covering all geographical areas of the country. SUBJECTS Kuwaitis (n 1704) between 3 and 86 years of age. RESULTS Obesity was more prevalent among women than men (50 % and 70 % for females aged 19-50 years and ≥51 years, respectively, v. 29 % and 42 % for their male counterparts). Boys were more obese than girls, with the highest obesity rate among those aged 9-13 years (37 % and 24 % of males and females, respectively). Energy intake was higher than the estimated energy requirements for almost half of Kuwaiti children and one-third of adults. The Estimated Average Requirement was exceeded by 78-100 % of the recommendation for protein and carbohydrates. More than two-thirds of males aged ≥4 years exceeded the Tolerable Upper Intake Level for Na. Conversely, less than 20 % of Kuwaitis, regardless of age, consumed 100 % or more of the Estimated Average Requirement for vitamin D, vitamin E, Ca, n-3 and n-6 fatty acids. Less than 20 % of children met the recommended level for fibre. CONCLUSIONS Nutrition transition among Kuwaitis was demonstrated by the increased prevalence of obesity and overweight, increased intakes of energy and macronutrients and decreased intakes of fibre and micronutrients. Interventions to increase awareness about healthy foods combined with modifications in subsidy policies are clearly warranted to increase consumption of low-energy, nutrient-dense foods.

Efficacy of wheat-based biscuits fortified with microcapsules containing ferrous sulfate and potassium iodate or a new hydrogen-reduced elemental iron: a randomised, double-blind, controlled trial in Kuwaiti women

Adverse sensory changes prevent the addition of highly bioavailable ferrous sulfate (FeSO4) to most wheat flours. Poorly absorbable reduced Fe powders are commonly used. Encapsulation of FeSO4 can overcome these sensory changes, but the particle size of commercial compounds is too large to be used by flour mills. The first objective of the study was to measure the efficacy in wheat flour of two newly developed Fe compounds, an H-reduced Fe powder (NutraFine RS; North America Höganäs High Alloys LLC, Johnstown, PA, USA) and small particle-sized (40 microm) encapsulated FeSO4. As a second objective, the microcapsules were evaluated as a vehicle for iodine fortification. A randomised, double-blind controlled intervention trial was conducted in Kuwaiti women (n 279; aged 18-35 years) with low body Fe stores (serum ferritin (SF) < 25 microg/l) randomly assigned to one of three groups (20 mg Fe as NutraFine RS, 10 mg Fe as encapsulated FeSO4 and 150 microg iodine, or no fortification Fe) who consumed wheat-based biscuits 5 d per week. At baseline and 22 weeks, Hb, SF, transferrin receptor, urinary iodine and body Fe stores were measured. Relative to control, mean SF in the encapsulated FeSO4 group increased by 88 % (P < 0.001) and body Fe stores increased from - 0.96 to 2.24 mg/kg body weight (P < 0.001), while NutraFine RS did not significantly increase SF or body Fe stores. The median urinary iodine concentration increased from 140 to 213 microg/l (P < 0.01). NutraFine RS added at double the amount of Fe as FeSO4 was not efficacious in improving Fe status. The newly developed microcapsules were highly efficacious in improving both Fe stores and iodine status.

Date bars fortified with almonds, sesame seeds, oat flakes and skim mik powder

Fortified date bars were prepared from some of the commonly grown date cultivars in the United Arab Emirates. The average ash, fat and protein contents in the control date bar sample were 1.78, 6.09 and 7.83%, respectively. The ash and protein contents increased, but the fat content decreased slightly with the inclusion of skim milk powder in the remaining date bar formulations. All the date bar samples were found to be free from Enterobacteriaceae and coliforms. Date fruit, which usually supplies only calories, can thus be turned into a product having significant amounts of other valuable nutrients.

Developing Functional Foods Using Red Palm Olein: Objective Color and Instrumental Texture

Abstract Edible red palm olein (RPOL) has been newly developed by the Malaysian Palm Oil Board for use in food products to enhance their nutritional value. The results of the effect of RPOL and red palm shortening (RPS) on the objective color and instrumental texture of these functional foods are presented. The results indicate that using up to 100% RPS in the test bread samples did not have any adverse effect on the textural quality of the samples, with the results being comparable with the respective control breads. However, increasing the level of RPOL caused a simultaneous increase in compression force with the values being highest at the 100% replacement level. Replacement with RPOL in bread formulations at the 100% level increased the compression force to 15.2 N for whole-wheat bread, 7.5 N for white bread, and 11.7 N for 20% bran (0.2 kg bran/kg flour) bread over that of control whole-wheat bread (8.3 N), control white bread (3.3 N), and control 20% bran bread (4.2 N). This indicates that RPOL does not perform as well in pan bread as compared with RPS. Using 0.5% diacetyl tartaric acid esters of monoglycerides (DATEM) in bread formulations produced a decrease in compression force values at all combination levels of RPS and RPOL, thus producing a softer product. As RPOL and RPL are extremely rich in carotene pigments (727 ppm), the major changes in crumb color were observed in the yellowness values (b*). The results indicate that increasing the level of RPS or RPOL in test bread samples caused a similar increase in crumb color yellowness values (b*), with a higher increase observed due to increased levels of RPOL.

Characterisation of quality and safety of tomatoes sold in the state of Kuwait

This study determined the microbiological quality and safety of locally produced and imported tomatoes at selected points of the food chain. To accomplish this objective, a survey was conducted to obtain necessary information on the various links in the food chain for tomatoes. The food chain operational links for local and imported tomatoes were then prepared. Microbiological assessment of tomatoes was then carried out by collecting samples from local farms, retail and wholesale outlets. Microbiological analyses included aerobic plate count (APC), yeast and moulds, Streptococcus faecal, Staphylococcus aureus, Listeria monocytogenes and detection of Salmonella spp. All samples collected at the farms and the outlets had APC counts less than 107 CFU g−1. Local samples collected from the farms exceeded the microbiological recommendations set for yeast and moulds (10%), faecal Streptococcus (0.7%) and L. monocytogenes (0.7%). Similarly, local tomato samples collected at the outlets exceeded the microbiological recommendations set for yeast and moulds (7.6%) and L. monocytogenes (1.3%). For imported tomatoes, samples exceeded the microbiological recommendations for yeast and moulds (10%), faecal Streptococcus (2.5%) and L. monocytogenes (1.3%). The pathogen, Salmonella spp. was not detected in any of the samples analysed.