Poor diet quality and food habits are related to impaired nutritional status in 13- to 18-year-old adolescents in Jeddah

Exploring university students' nutrition literacy in Saudi Arabia: a cross-sectional survey

Introduction

Improving individuals' nutrition literacy can be one way to promote healthy dietary behaviors, which lowers the incidence of non-communicable diseases. In Saudi Arabia, there is a limited information regarding nutrition literacy among students. Therefore, the purposes of this study was to investigate university students' nutrition literacy and identify its predictors in Saudi Arabia. Another objective was to assess how nutrition literacy is associated with eating habits among this sample.

Methods

This cross-sectional study was carried out among students attending the University of Jeddah and King Abdulaziz University (Jeddah City) in Saudi Arabia from June 2023 to September 2023. Using a convenience sampling approach, 570 students were enrolled in this study. An online-based structured survey tool including demographic details, a food frequency questionnaire, and a nutrition literacy scale was used to collect the data. Descriptive and multiple binary logistic regression analysis were performed.

Results

Approximately 40.4% of the participants exhibited poor nutrition literacy. Female students were less likely than male students to have poor nutrition literacy (adjusted odds ratio, AOR = 0.62; 95% confidence interval, CI = 0.42, 0.92). Underweight (AOR = 1.73; 95%CI = 1.22, 4.56) and overweight participants (AOR = 3.1; 95%CI = 2.77, 7.23) were at higher risk of having poor level of nutrition literacy as compared to those who had normal weight. Students who did not take any nutrition-related courses had a 1.3 times higher probability of having a poor level of nutrition literacy compared to their counterparts (AOR = 1.3; 95%CI = 1.05, 3.74). Moreover, poor nutrition literacy was associated with higher weekly consumption frequencies of red meat, processed foods, funk foods and sugar-sweetened beverages.

Conclusion

A higher percentage of university students had poor nutrition literacy, which was associated with gender, self-reported BMI status, nutrition-related courses and unhealthy eating habits. These findings can assist university administrators and policymakers in implementing effective measures to enhance students' nutrition literacy rates in Saudi Arabia.

The influence of gender, media, and internet usage on adolescents' fast food perception and fluid intake

BACKGROUND

Understanding the factors that influence adolescent's perception of fast food and their fluid consumption is crucial for designing effective nutrition education programs tailored to this population. This study aimed to evaluate the associations of sex and the use of media and the internet with adolescents' perception of fast foods and the amount of fluid consumption.

METHODS

A cross-sectional survey was conducted on school adolescents between the ages of 15 and 18 years in Kuwait, using a multistage stratified random sampling method (N = 706 adolescents; 343 boys and 363 girls). A pre-tested and specifically designed self-report questionnaire covering several measures such as: (a) types of foods that are considered fast foods; and (b) participant's fluid consumption. Body weight and height were measured using calibrated medical scales. Body mass index (BMI) was computed. The adolescents were stratified by sex into two groups: boys and girls, for the purpose of analysis.

RESULTS

Seven out of 14 food choices showed significant sex differences (p values ranged from 0.016 to < 0.001) in the adolescents' responses to whether they perceived such food choice as fast food or not. Although differences were found between sexes, the majority of the listed fast foods were correctly recognized as fast foods by the adolescents. In addition, there were significant differences between males and females in the amount of daily drinks (ml/week) consumed from full fat milk (males = l197.1 ± 27,652.1 and females = 1662.8 ± 2221, p = 0.013), sugar-sweetened beverage (males = 2350.8 ± 3324.3 and females = 3088.9 ± 3701.1, p = 0.004), and energy drinks (males = 429.5 ± 1117.2 and females = 267.6 ± 733.8, p = 0.037). Compared to adolescents who seldom or do not watch TV or use the internet, those who engage in these sedentary activities are less likely to classify pizza (aOR (95% CI) = 0.660 (0.440-0.990), p = 0.045), grilled meat (aOR (95% CI) = 0.674 (0.477-0.954), p = 0.026), fried egg sandwiches (aOR (95% CI) = 0.617 (0.425-0.894-0.189), p = 0.011), and rice (aOR (95% CI) = 0.598(0.409-0.875), p = 0.008) as fast foods.

CONCLUSION

The influence of TV and internet use on adolescent's ability to accurately identify fast foods has been observed. Findings indicate the need for increased fast food nutrition education programs that are tailored towards adolescents. The study recommends further research to enhance consumer awareness of foods and drinks among adolescents in the State of Kuwait.

Influence of Lifestyle Changes on Cardiovascular Diseases in Saudi Arabia: A Systematic Literature Review

In Saudi Arabia, cardiovascular disease (CVD) is one of the main causes of mortality and morbidity. The Kingdom of Saudi Arabia has undergone tremendous socio-economic development and urbanization over the past few decades, which has profoundly changed the lifestyle leading to several risk factors that contribute to the high prevalence of CVD. This systematic review identified significant lifestyle factors associated with CVD risk in order to inform effective interventions to decrease the CVD burden in Saudi Arabia. We researched all published articles and reports evaluating CVD risk factors in Saudi Arabia in the last four years from the following databases: Medline, PubMed, Google Scholar, and Embase. A total of 19 articles and 1 report were included. Physical inactivity was among 69.4% of the population, mostly among Saudi women, and was associated with 1.4-1.5 odds of CVD. Obesity prevalence was 49.6%-57% and was associated with more odds of CVD among women than men (3.3 odds vs. 2.38 odds). More than a third (34.4%) of the Saudi population studied ate unhealthy diets (rich in fat, poor in fibers, less vegetables and fruits, and ultra-processed), which was found to more than triple (almost quadruple) the CVD risks (OR=3.8). Smoking prevalence was 12.2%-26.2% and was more among men. Other factors, such as type 2 diabetes (OR=2.3) and stress (5.4%-16.9%), were also identified as factors. The prevalence of CVD lifestyle-related risk factors is still high in Saudi Arabia, especially physical inactivity, unhealthy diet, obesity, and smoking, which highlights the urgent need for lifestyle modifications and public health campaigns and collaboration among the Saudi government and its partners to effectively improve cardiovascular health in Saudi Arabia.

Change in Growth Status and Obesity Rates among Saudi Children and Adolescents Is Partially Attributed to Discrepancies in Definitions Used: A Review of Anthropometric Measurements

Anthropometric measurements are the first step in determining the health status in children and adolescents. Clinicians require standardized protocols for proper assessment and interpretation. Therefore, this study aims to review the literature of international and Saudi national guidelines and studies previously conducted in Saudi children and adolescents to provide recommendations to establish Saudi guidelines in line with the Saudi 2030 Vision. Systematic search was conducted in several databases: Medline, PubMed, Saudi Digital Library and Google Scholar from January 1990 to January 2021. Further, 167 studies measured anthropometrics in Saudi children/adolescents; 33 of these studies contributed to the establishment/adjustment of Saudi growth charts or specific cutoffs or studied the trend of growth in representative samples or adjusted the international curves to be used in Saudis. This review warrants updating growth charts and establishing the standard cutoffs of Saudi adolescent anthropometrics to avoid over/underreporting. This review provides insights and recommendations regarding the resources that can be used to establish national guidelines in anthropometric measurements for Saudi children/adolescents. This review will help policymakers and the Ministry of Health to establish standardized protocols to be used in Saudi Arabia for anthropometric measurements that may assist in detecting malnutrition.

Media use, dietary intake, and diet quality of adolescents in Saudi Arabia

BACKGROUND

Excessive media use can affect diet of adolescents, but relevant data in Saudi Arabia are lacking. The present study aimed to explore the association between media use, dietary intake, and diet quality among adolescents.

METHODS

This cross-sectional study included data of 631 adolescents (ages 11-18 years) who were randomly recruited from 16 schools located in two main cities in the Western region of Saudi Arabia (Madinah and Jeddah). Envelopes including a questionnaire were sent home to collect sociodemographic data. Students then completed the short-form food frequency questionnaire to assess diet quality. Data on media use, anthropometrics, and 24-h dietary recalls were also collected.

RESULTS

A high proportion of adolescents (86.2%) exceeded media use recommendations of ≤2 h per day. Significantly higher proportions of younger adolescents, males, and non-Saudis reported media use within the recommendation compared to their peers. Media use predicted lower diet quality score (B = -0.67 [95% CI: -1.09 to -0.28]) and lower intake of calcium, zinc, vitamin D, and vitamin C (B = -104 [95% CI: -203 to -5.24], B = -2.13 [95% CI: -4.15 to -0.11], B = -23.5 [95% CI: -41.3 to -5.65], B = -24.0 [95% CI: -45.1 to -2.96], respectively).

CONCLUSION

Interventions to limit media use are urgently needed for adolescents in Saudi Arabia to improve diet quality and overall nutritional health.

IMPACT

Excessive media use can affect diet of adolescents, but relevant data are lacking in Saudi Arabia. The majority of adolescents exceed the recommendations for media use. Media use was negatively associated with diet quality and intake of calcium, zinc, vitamin D, and vitamin C. This study will inform public health entities and policy makers to draw evidence-based, culturally tailored recommendations and develop nutrition interventions to enhance diet quality and nutritional status of adolescents. Findings of this study highlight the urgency to develop intervention programs and policies that aim to limit media use among adolescents.

Psychometric properties of the Arabic version of Physical Activity Questionnaire for Adolescents (PAQ-A)

AIM

To evaluate the psychometric properties of the Arabic version of the Physical Activity Questionnaire for Adolescents (PAQ-A).

BACKGROUND

Physical inactivity is a major risk factor for becoming overweight or obese and developing chronic conditions that lead to an increase in mortality globally. Inadequate physical activity (PA) has been a problem among Arabic-speaking populations, including female adolescents in Saudi Arabia. Unfortunately, psychometrically sound measures to assess PA among female adolescents in Saudi Arabia are lacking, indicating that a reliable, valid and feasible self-report measure is urgently needed for use with this young Arabic-speaking population.

METHODS

A cross-sectional study approved by a university institutional review board was conducted with 383 Saudi female adolescents, 13-18 years of age, who were recruited from 10 all-female public schools in Jeddah, Saudi Arabia. Physical activity was measured via the PAQ-A, which assesses the level of PA engagement during the school year for 7 days. Internal consistency was estimated. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the measure's construct validity and the Pearson correlation coefficient was used to assess convergent validity.

RESULTS

Cronbach's alpha was 0.81, indicating acceptable internal consistency. Item-total correlation coefficients ranged from 0.11 to 0.61. Both EFA and CFA indicated a single-factor. The scale was significantly correlated with other cognitive and affective variables that reflected the physical activity perceptions among the female adolescents, such as enjoyment of PA, PA self-efficacy and social support for PA.

CONCLUSIONS

The Arabic version of the PAQ-A is reliable and valid measure for assessing PA among Arabic-speaking female adolescents.

The Importance of Healthy Habits to Compensate for Differences between Adolescent Males and Females in Anthropometric, Psychological and Physical Fitness Variables

Adolescence is a crucial stage in human development, and differences in psychological, physical and body composition variables between males and females have been amply demonstrated. However, the role played by certain healthy habits, such as the practice of physical activity, adherence to the Mediterranean diet (AMD) or the maintenance of an adequate weight status, in compensating for the differences found between males and females in these variables, is not well known. For this reason, the study aimed to analyze whether the practice of physical activity, optimal AMD, and adequate weight status can compensate for the differences between adolescent males and females in anthropometric variables, psychological state, and physical fitness. The sample was composed of 791 adolescents (404 males and 387 females) aged twelve to sixteen years old, whose anthropometric, psychological (autonomy, competence, relatedness, and life satisfaction), and physical fitness variables (cardiorespiratory fitness, upper strength and explosive lower limb power, hamstring and lower back flexibility, and speed) were measured. All measurements were carried out in a single day using the sports pavilion of the four participating schools. The most novel results of this research show that the practice of physical activity was determinant mainly in females, as it reduced the differences found in comparison with males in psychological (p < 0.001−0.045) and anthropometric variables (p < 0.001). Regarding weight status and AMD, these were still relevant for the adolescent population, mainly the achievement of optimal AMD, but males continued to present higher values in physical fitness tests (p < 0.001) and lower values in fat accumulation (p < 0.001), regardless of weight status or AMD. Thus, physical activity seems to be the most determining factor that compensates for the differences between adolescent boys and girls.

Fast-Food Consumption, Dietary Quality, and Dietary Intake of Adolescents in Saudi Arabia

High fast-food consumption is a common public-health concern among adolescents, due to its link to a number of non-communicable diseases. Frequent consumption of fast food may also affect diets of individuals; however, research addressing this issue is lacking in Saudi Arabia. We aimed to investigate the association between fast-food consumption, dietary quality, and dietary intake of adolescents in Saudi Arabia. This is a cross-sectional study of 617 healthy adolescents aged 11-18 years, who were recruited randomly from 16 middle- and high-schools located in Jeddah and Madinah, Saudi Arabia. Sociodemographic data were collected from parents. Dietary data, including the frequency of fast-food consumption, dietary quality (assessed using the short-form food frequency questionnaire), and dietary intake (assessed using multiple 24 h diet recalls from a subsample), were collected from the adolescents. Approximately one-third of adolescents (28.5%) reported frequent fast-food consumption (>two times a week). Results showed that a higher proportion of male adolescents frequently consumed fast-food, compared with female adolescents (32.8% vs. 24.8%, p = 0.039). Adolescents with the highest monthly family-income (≥SAR 21,000 ) reported a significantly higher frequency of fast-food consumption compared with families with a lower monthly income (p = 0.009). Frequency of fast-food consumption predicted lower dietary-quality in adolescents (Beta (B) = -0.27 [95% confidence interval (CI): -0.35 to -0.18]) and higher carbohydrate and free-sugar intake (B = 6.93 [95% CI: 0.78 to 13.1], and B = 3.93 [95% CI: 1.48 to 6.38], respectively). In conclusion, nutrition-intervention programs aiming to limit fast-food consumption and enhance the dietary quality of adolescents in Saudi Arabia, are warranted.

The prevention of gestational diabetes mellitus (The role of lifestyle): a meta-analysis

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy. The disease is on the rise worldwide with deleterious consequences on the fetus, mother, and children. The study aimed to review the role of lifestyle in the prevention of GDM. We searched PubMed, SCOPUS, Web of Science, Cochrane Library, EBSCO, and Google Scholar from the first published article up to December 2021; articles were eligible if they were controlled trials, prospective cohorts, and case-control. Out of 5559 articles retrieved, 66 full texts were screened, and 19 studies were included in the meta-analysis. (6 studies assessed the effects of diet, and 13 were on exercise). The dietary intervention showed significant positive effect on GDM, odd ratio = 0.69, 95% CI, 0.56-84, P-value for overall effect = 0.002. The DASH diet was better than Mediterranean Diet (odd ratio, 0.71, 95% CI, 68-74, P-value < 0.001). Regarding exercise, no significant prevention was evident on GDM, odd ratio, 0.77, 95% CI, 0.55-1.06, P-value = 0.11. However, a significant prevention of gestational diabetes was found when the exercise was mild-moderate (odd ratio = 0.65, 95% CI, 0.53-80, P < 0.0001) and started in the first trimester (odd ratio, 0.57, 95% CI, 0.43-0.75, P < 0.0001. No significant effect was found when the exercise was vigorous (odd ratio = 1.09, 95% CI, 0.50-2.38, P = 0.83) and started during the second trimester of pregnancy (odd ratio, 1.08, 95% CI, 0.65-1.80, P = 0.77. Diet and early mild-moderate exercise were effective in GDM prevention. Exercise during the second trimester and moderate-vigorous were not. Further studies assessing the type, duration, and frequency of physical activity are needed.

Food and nutrient intake of school-aged children in Lebanon and their adherence to dietary guidelines and recommendations

BACKGROUND

Lebanon, an Eastern Mediterranean country, is witnessing a remarkable nutrition transition, and the diets of school-aged children may be amongst those most affected. However, limited studies have examined the food consumption patterns and nutrient adequacy in this age group.

OBJECTIVES

The present study aimed to evaluate the dietary intakes of school-aged children in Lebanon and assess their adherence to nutrition guidelines and recommendations.

METHODS

This study used data for 4-13 y-old children (n = 711) from a national cross-sectional survey conducted in 2014-2015 on a representative sample of Lebanese households with children. Dietary intake was assessed using single 24-h recall method. Estimated food group and nutrient intakes were compared to dietary recommendations and age-specific dietary reference intakes (DRI), including Estimated Average Requirements (EAR) and Acceptable Macronutrient Distribution Range (AMDR). Food group, energy, macro- and micro-nutrient intakes were presented for all children in the sample and stratified by age (4-8 y and 9-13 y) and sex.

RESULTS

Mean energy intake of 4-13-year-old children was 1804 kcal/d. Almost half of the energy was provided by carbohydrates while 12% of children had protein intakes below EAR. Approximately three-quarters of children (4-13 y) exceeded the AMDR for total fat and saturated fats, and a similar proportion over consumed added sugars. The main sources of energy intake (EI) among children were the sweets, sweetened beverages and desserts followed by grains and mixed dishes. No significant differences were noted in %EI from different food groups, by sex, in either age groups. The highest adherence of children to food group recommendations was observed for the grains' food group (47.2-54.4%EI), while the lowest adherence was found for vegetables (3.1-14.1%EI). A high prevalence of vitamin and mineral inadequacies was noted amongst 4-13 y old children for key micronutrients, including vitamin D (99%), calcium (81%), and vitamin A (69.5%). Risk of inadequate micronutrient intakes was significantly increased among the older age group (p-value < 0.05).

CONCLUSION

Nutrient intakes of school-aged children in Lebanon reflect suboptimal nutrition. Educational and public health interventions are needed to promote healthier diets among children and prevent micronutrient deficiencies during this critical phase.

Determinants of Sugar-Sweetened Beverage Consumption Among the Saudi Adults: Findings From a Nationally Representative Survey

Background

Saudi Arabia is the fifth largest consumer of calories from sugar-sweetened beverages (SSBs) in the world. However, there is a knowledge gap to understand factors that could potentially impact SSB consumption in Saudi Arabia. This study is aimed to examine the determinants of SSBs in Saudi Arabia.

Methods

The participants of this study were from the Saudi Health Interview Survey (SHIS) of 2013, recruited from all regions of Saudi Arabia. Data of a total of 10,118 survey respondents were utilized in this study who were aged 15 years and older. Our study used two binary outcome variables: weekly SSB consumption (no vs. any amount) and daily SSB consumption (non-daily vs. daily). After adjusting for survey weights, multivariate logistic regression models were applied to assess the association of SSB consumption and study variables.

Results

About 71% of the respondents consumed SSB at least one time weekly. The higher likelihood of SSB consumption was reported among men, young age group (25–34 years), people with lower income (<3,000 SR), current smokers, frequent fast-food consumers, and individuals watching television for longer hours (≥4 h). Daily vegetable intake reduced the likelihood of SSB consumption by more than one-third.

Conclusions

Three out of four individuals aged 15 years and over in Saudi Arabia consume SSB at least one time weekly. A better understanding of the relationship between SSB consumption and demographic, socioeconomic, and behavioral factors is necessary for the reduction of SSB consumption. The findings of this study have established essential population-based evidence to inform public health efforts to adopt effective strategies to reduce the consumption of SSB in Saudi Arabia. Interventions directed toward education on the adverse health effect associated with SSB intake are needed.

Dietary Determinants of Dental Caries Prevalence and Experience in Saudi Schoolchildren: Frequency versus Quantity

Background

Sugar-added diet has been associated with increased risk of developing dental caries.

Objective

To investigate the dietary determinants of caries prevalence and experience based on the frequency versus the quantity of consumption among Saudi schoolchildren.

Methods

This is a cross-sectional study that invited 12- to 15-year-old intermediate school students (N = 3000) in four cities in the Eastern Province of Saudi Arabia. Data collection comprised a pretested questionnaire and clinical examination. Caries was diagnosed based on the World Health Organization (WHO) criteria and was recorded as a decayed, missing, filled tooth (DMFT). The questionnaire included questions regarding the consumption of different quantities and frequencies of multiple sugar-containing food items. Multiple logistic and linear regression models were used to assess the influence of sugar-containing food on the dental caries experience (DMFT) and prevalence of decayed teeth. SPSS version 20.0 was used to analyze the data at 5% significance level.

Results

Of 3000 invited students, 2262 participated with a participation rate of 75.4%. Our study found that the frequency of soft drink consumption was significantly associated with increased caries prevalence (adjusted OR = 1.33, 95% CI 1.07–1.65) and experience (adjusted B = 0.46, 95% CI 0.16–0.76). The frequency of consumption of fruit juice was statistically significantly associated with increased caries experience (adjusted B = 0.48, 95% CI 0.16–0.79). The interaction terms between the frequency and the quantity of consumption of energy drinks, soft drinks, and sweetened milk were statistically significantly related to caries experience and prevalence.

Conclusion

Although the frequency of consumption of sugar-containing drinks was more associated with caries experience and prevalence, the interaction between frequency and quantity was highly related to the prevalence and experience of dental caries.

The Association Between Dietary Patterns and Socio-Demographic and Lifestyle Characteristics: A Sample of Saudi Arabia

Dietary intake is an important risk factor that contributes to the development or prevention of many health conditions. The objective of the current study was to identify different dietary patterns and its relation to socio-demographic and life-style characteristics. A cross-sectional study of 299 Saudi adults, aged between 35-65 years without any significant health problems. Participants were interviewed individually and completed a pre-designed questionnaire with close-ended questions including socio-demographic and lifestyle characteristics. Dietary intake was assessed using food frequency questionnaire. Anthropometric measurements were obtained by a trained nurse in the clinic. Factor analysis technique was used to derive different food patterns. Five dietary patterns were identified, namely: sweet & starch, date & coffee, healthy, traditional, and protein patterns. Following sweet & starch pattern was significantly correlated to male gender, frequently visiting fast food restaurants and breakfast consumption behavior. Adherence to healthy pattern was associated with male gender, higher education with high income, older adults, breakfast consumption behavior and high levels of physical activity. Traditional pattern was correlated with married subjects and male gender, whereas compliance to date & coffee pattern was related to reduced number of meals and snacks. The protein pattern was significantly associated with younger age and breakfast consumption behavior. Dietary patterns were influenced by socio-demographic characteristic (age, gender, marital status, education level, income) and other lifestyle factors (breakfast consumption, number of meals, physical activity). A national cohort study is needed to assess the association between dietary patterns with the risk of cardiometabolic dysregulation.

Childhood obesity and its relation with dietary habits among children in Aseer region, Southern Saudi Arabia

BACKGROUND

The rate of obesity in children is rising and it has become a growing epidemic worldwide; Childhood obesity is related to the high risk of obesity later in adult life. In the last 30 years the prevalence childhood obesity more than tripled. Overweight in paediatric population is suggested to be related to many cardio-metabolic risk factors such as metabolic syndrome, type 2 diabetes, hypertension, insulin resistance. Metabolic syndrome and dyslipidaemia and 70% obese children had first cardiovascular disease risk factor and 30% had second or more.

AIM

To estimate the prevalence and correlates of obesity among children in Aseer region.

METHODOLOGY

A descriptive cross-sectional survey was conducted in the schools of Abha and Khamis Mushayet Cities; Aseer region during the period from January to December 2019. The respondents were any of the parents of the child. After having permission from the school authority, self-administered questionnaires were distributed to a total of 300 children, with explanations about the questionnaire by the principal investigator and class teacher.

RESULTS

The study included 300 students with ages that ranged from 1 year up to 17 years and mean age was 8.6 years old. Exact of 55.3% of the students were males and 32% were at preschool age while 43.7% were at the primary level of education. Students' body mass index (BMI) distribution demonstrated that more than half of the children had overweight or obesity and 16.7% were with underweight. There was a significant relation between obesity among the children and some of their dietary habits including sweets, chocolate and fast food.

CONCLUSIONS AND RECOMMENDATIONS

In conclusion, the study revealed that nearly one-third of the children in the study group were overweight or obese with obesity more prevalent. Obesity was more recorded among old-aged children who frequently had unhealthy food. Improving the children lifestyle and dietary habits is mandatory to work against weight gain.

Dietary Behavior of Adolescents in the Qassim Region, Saudi Arabia: A Comparison between Cities with and without the Healthy Cities Program

This study reports dietary behaviors of adolescents in the Qassim region, Saudi Arabia, and comparison of these behaviors between cities with and without the Healthy Cities Program (HCP). We surveyed 1133 school-attending adolescents aged 15–19, using a multi-staged cluster sampling with probability proportionate to size. Prevalence of daily breakfast consumption was 27.7% among the adolescents. Prevalence of daily vegetables, fruits and milk or milk products consumption was 35.9%, 28.6% and 51.1%, respectively. Meanwhile, the prevalence of daily consumption of fast-food and carbonated drinks was 7.5% and 37.1%, respectively. There was no significant association between living in the healthy cities and daily intake of breakfast (OR: 1.15, 95% CI: 0.87–1.53), fruits (OR: 1.02; 95% CI: 0.77–1.36), vegetables (OR: 1.27; 95% CI: 0.98–1.67), or milk/milk products (OR: 1.0; 95% CI: 0.77–1.29); and the daily intake of fast-food (OR: 0.81; 95% CI: 0.49–1.35) or carbonated drinks (OR: 0.80; 95% CI: 0.60–1.05). These findings warrant further in-depth evaluation of the HCP in the Qassim region of Saudi Arabia.

Association of Healthy Eating Index and the Alternative Healthy Eating Index with the cell blood count indices

OBJECTIVES

There is an association between diet quality and markers of inflammation. We aimed to investigate the relationship between diet quality with cell blood count (CBC) and inflammatory indices such as red cell distribution width (RDW) and white blood cell count (WBC).

STUDY DESIGN

A total of 367 male subjects aged 20-69 yrs, who were employees of Shahid Hasheminejad Gas Processing Company (SGPC) completed the study.

METHODS

All participants completed a questionnaire that contained questions about demography. Standard protocols were used for measuring anthropometric indices in all subjects. Blood samples were collected after a 12 hrs fast from all participants. Biochemical parameters were determined in all participants using an auto-analyzer (Eppendorf, Germany). Systolic and diastolic blood pressure were measured using a standard mercury sphygmomanometer. CBC was measured using the Sysmex auto analyser system (KX-21 N). The HEI/AHEI scores extracted from a validated food frequency questionnaire (FFQ) to evaluate the diet quality. Data analyses were performed using SPSS 16 (SPSS Inc., IL, and USA).

RESULTS

A total of 674 men (aged 43.68±9.09 yrs) completed the study. The CBC indices were not significantly different between the HEI/AHEI classifications among the Iranian men (p-value >0.05 for all variables). Moreover, there was no association between HEI/ AHEI with the CBC indices in our population (p-value >0.05 for all variables).

CONCLUSIONS

In summary, there was no association between the diet quality with the cell blood count parameters among Iranian men.

Exploration of changes in health-related behaviours among Saudi Arabian undergraduates in the UK

This project is an exploratory survey of the ways in which living in the UK has affected the health-related behaviours of Saudi Arabian undergraduate students. The study identifies changes in exercise behaviours, dietary and smoking habits and experiences of stress after their move to the UK. In addition, it identifies what the students perceive to be the drivers of these changes. To achieve this, an online questionnaire was developed collecting quantitative data. This was distributed via Facebook groups specifically for Saudi students in the UK. The results demonstrate that a majority of Saudi Arabian undergraduates felt that their behaviours had become healthier since their move to the UK, mainly as a result of a more active lifestyle, derived from reduced reliance on cars, increased daily walking, and a heightened focus on health promoted by their independence, the availability of healthy foods and exposure to a more health-promoting culture. Although these results are based on a relatively small sample, they are surprising since they contradict previous studies on international students, which have generally found negative lifestyle changes during their studies, including increased stress, poorer dietary habits and a decline in physical activity. Although the exploratory nature of the study means that concrete recommendations cannot be made, it nonetheless offers an impetus for further research into how Saudi Arabian students may be encouraged to adopt healthier lifestyles while studying in the UK.

Dietary pattern and nutritional status of female adolescents in Amai Secondary School, Delta State, Nigeria

Introduction

there is an existing variability in eating patterns between adolescents and children. Consequently, with the adoption of westernised way of life, this translates to a change in eating habits and food choices. This study was designed to investigate the dietary patterns and nutritional status of the female adolescents in Amai Secondary Commercial School, Delta State, Nigeria.

Methods

a cross-sectional study was conducted among 201 adolescent female students (12-18 years) using simple random sampling techniques. A self-administered questionnaire was used to obtain the information while anthropometric measurement was carried out to obtain the height and weight of the respondents. Data generated were analysed using SPSS version 22.0.

Results

majority of the respondents 129 (64.20%) were between the ages of 16-18 years. Measurement of nutritional status confirmed that 46.80% and 31.80% of the respondents were underweight and healthy weight respectively. In addition, the dietary pattern of the respondents demonstrated that they consumed proteinous, carbohydrate, and snacks occasionally. Factors that motivated respondents for good food choices include; nutritional status 71 (35.30%), taste 54 (26.90%), and popularity 15 (7.50%).

Conclusion

under nutrition remains a challenge among rural adolescent girls in Amai community. Therefore sustained strategic nutritional campaigns should be carried out among female adolescents in Amai community in order to improve their nutritional status.

Malnutrition in School-Going Adolescents in Dessie Town, South Wollo, Ethiopia

Background

Malnutrition among adolescents is a global public health problem. Nutrient intake is a proxy measure of nutritional status, but studies in developing countries describing the actual nutrient intake condition associated with nutrition in the adolescents are limited. On top of this, there is inconsistent finding on the extent of malnutrition among adolescents. Hence, the aim of this study was to assess malnutrition and the associated factors among adolescents at Dessie high school.

Methods

A school-based cross-sectional study was conducted among 365 randomly selected high school adolescents. The data were collected using a structured questionnaire adapted from previous literature studies. Nutrient intakes were estimated by ESHA food processor software from a 24-hour recall, and anthropometric indices were calculated from weight, height, age, and sex. The data analysis was managed by SPSS version 23. Binary logistic regression and multinomial logistic regression were used to report the associated factors of malnutrition. Adjusted odds ratio with 95% CI was used to reveal the presence of statistical association.

Results

The percentage of being stunted, underweight, and overweight/obese was 15.7%, 6.3%, and 8.2%, respectively. Snack consumption (AOR = 0.38, 95% CI: 0.20, 0.71) was negatively associated with stunting, while MAR <1 (AOR = 3.36, 95% CI: 1.15, 7.82) was positively associated with stunting. Being a male (AOR = 2.76, 95% CI: 1.03, 7.44) and meal consumption <3 times per day (AOR = 4.21, 95% CI: 1.35, 13.11) were factors positively associated with being underweight/thin. Dietary diversity score <5 (AOR = 0.35, 95% CI: 0.13, 0.89) was negatively associated with overweight/obesity, while MAR < 1 (AOR = 3.14, 95% CI: 1.09, 9.09) was positively associated with overweight/obesity.

Conclusion

The percent of overweight/obesity among adolescents in the study area was higher compared with the national and regional prevalence, and this was found to be a public health concern. Therefore, increasing snack consumption, sex consideration, increasing meal consumption, and intake of diversified foods should be included in the prevention strategies of malnutrition among adolescents.

Sex Differences in Oral Health and the Consumption of Sugary Diets in a Saudi Arabian Population

BACKGROUND AND PURPOSE

Adolescence is a crucial period for developing healthy lifestyle and dietary habits. The growing consumption of high-sugar foods and beverages constitutes a serious public health concern. The aim of this study was to evaluate sex differences in the consumption of a sugary diet and oral health among Saudi adolescents.

SUBJECTS AND METHODS

This cross-sectional study was conducted in the Eastern Province of the Kingdom of Saudi Arabia between January and February 2019. A multistage sampling technique was used to recruit 2265 middle-school children aged 12-16 years. Data were collected via the Food Frequency Questionnaire and via an oral health examination, using the WHO criteria. The chi-squared test, Student's t-test, and Mann-Whitney U-test were used to investigate the associations between the study variables.

RESULTS

The most consumed foods and beverages reported were water, juices, and biscuits (90%), while the least consumed were energy drinks and jams. A significant difference was found between males and females in the frequency of consumed sugary foods (P=0.01) and the quantity of consumed sugary beverages (P=0.000); males over all consumption were greater than their counterpart. However, no differences were found between sexes in the frequency of sugary drink consumption (P=0.2). The decayed-missing-filled index score was significantly higher in females (4.29 ± 3.44) than in males (3.61 ± 3.14; P=0.001). The mean plaque index among males and females was 1.72 (±0.79) and 1.20 (±0.78), respectively, while the mean gingival index was 1.31 (±0.77) in males and 0.69 (±0.73) in females-a statistically significant difference (P=0.001).

CONCLUSION

Sex differences were found in sugary diet consumption and oral health status. Thus, policy makers are encouraged to consider sex-based differences when planning preventative programs and initiatives. Nevertheless, further research is needed on the dietary intake patterns of young adults.

Prevalence and social determinants of overweight and obesity in adolescents in Saudi Arabia: A systematic review

Obesity in adolescents has a serious impact later in life in the form of disturbances in health and wellbeing. We aimed to evaluate the prevalence of overweight and obesity (Ow/Ob) in Saudi adolescents and to construct an ecological model of social determinants (SDs) of Ow/Ob and evaluate current evidence of their effect on Saudi adolescents. A systematic review of literature reported up until 31 December 2018 on Ow/Ob and factors that can influence them in Saudi adolescents was conducted. Fifty-one studies with n = 97 666 adolescents (55.6% males) were reviewed. The prevalence of Ow/Ob started off high and continued to increase over time. Most of the 49 reviewed SDs reports, from 19 studies, showed positive association between SDs constructed ecological model and Ow/Ob in Saudi adolescents. The prevalence of Ow/Ob among adolescents is a major public health problem in Saudi Arabia, is growing at an alarming rate and SDs play a significant role in this problem, and should be considered in all strategies targeting it. The constructed ecological model for SDs of Ow/Ob in adolescents can serve as a useful exploratory tool that helps investigating the multi-faceted aetiology of adolescent Ow/Ob and facilitates the development of effective intervention and prevention programmes.

Food Consumption Patterns and Nutrient Intakes of Children and Adolescents in the Eastern Mediterranean Region: A Call for Policy Action

The Eastern Mediterranean Region (EMR) has witnessed significant social and economic changes that may have influenced the diet of children and adolescents, and increased the risk for obesity and malnutrition in this age group. This review aims to characterize and assess food consumption patterns and nutrient intakes amongst school-aged children (5-10 years) and adolescents (10-19 years) in countries of the EMR. Electronic databases (MedLine, PubMed, Scopus, and Google Scholar) were searched for relevant articles published between 2005 and 2020; international organizations and governmental websites were also searched. Available studies documented low intakes of fruits, vegetables and fiber, inadequate consumption of water, milk and dairy products, coupled with high intakes of fat, saturated fat, and sugar sweetened beverages, as well as a frequent consumption of energy-dense, nutrient poor foods such as sweet and savory snacks. Micronutrient inadequacies were also observed, particularly for calcium, iron, zinc and vitamins A, D, C, and folate. Acknowledging the impact that nutrition may have on building societies and transforming the lives of children, adolescents and their families, there is a crucial need for a food system approach in developing and implementing national and regional policies and interventions aimed at improving the diet of children and adolescents.

Impact of Taste on Food Choices in Adolescence-Systematic Review and Meta-Analysis

Studies of adults report that perceived taste affects food choices and intake, which in turn may have an impact on health. However, corresponding evidence on adolescents is limited.  Our aim was to summarize current evidence of the impact of taste perception on food choice preferences or dietary intakes among adolescents (mean age 10-19.9 years). Systematic searches identified 13 papers, 12 cross-sectional and one cohort study published between 1 January 2000 to 20 February 2020 assessing the impact of taste (using phenotypic and/or genotypic markers) on food choices in adolescents without any disease conditions. Qualitative assessment in the current review indicated that individuals sensitive to bitter tastes often have a lower preference of bitter-tasting food and higher preference for sweet-tasting food. A meta-analysis of three studies on bitter-taste sensitivity revealed no difference in preference for bitter-tasting vegetables between bitter tasters and non-tasters (standardized mean difference (SMD) = 0.04; 95% CI: -0.18, 0.26; p = 0.72). Overall, a limited number of studies were available for review. As a result, we report no clear relationship between taste perception and food choices or intake in adolescents. More studies are needed to evaluate the link between adolescents' taste perceptions and dietary intake.

A study on binge eating behavior in urban adolescents

AIM

The study was aimed at studying binge eating behavior in urban adolescents. This was in keeping with the increasing prevalence of obesity and lifestyle disorders amongst Indian population especially in adolescent groups.

METHODS

2000 adolescents English speaking schools in Mumbai were administered the Binge Eating Scale and the Eating Behaviors and Pattern Questionnaire after assent and parental consent. The prevalence of Binge eating behavior was estimated along with the socio-demographic data and other data from scale which was analyzed using the Chi square test and ANOVA where appropriate.

RESULTS

The mean age of the total sample was 15.05 ± 1.65 years. Females reported higher Binge eating behavior than males and majority of the sample belonging to upper and lower middle- class families reported high binge eating behavior. The prevalence of Binge eating behavior was high with 1002 (50.1 %) adolescents reporting moderate binge eating while 736 (36.8 %) reporting severe binge eating. Significantly greater adolescents in the binge eating group reported irregular menses and being overweight and obese. There was a significantly greater proportion of adolescents in the binge eating group that ate out weekly and ate more fried food.

CONCLUSION

There is an increasing trend of obesity and lifestyle disorders in adolescent population that can be linked to Binge eating behavior however, the role of binge eating in context of one of the potential cause of lifestyle disorders and obesity has not been studied in Indian adolescents despite the prevalence of Binge eating and overweight being high in this population, we need further larger studies to corroborate the findings of this study.

Influence of various environmental factors on the growth of children and adolescents in Jeddah, Kingdom of Saudi Arabia

Objectives:

To evaluate the association between various environmental factors and the anthropometric measurements of children and adolescents.

Methods:

This retrospective studywasperformed from September 2017 to April 2018 and included 393 children aged 2-18 years. Data were extracted through patient and/or parentinterviews and from medical records of endocrine ambulatory clinics.

Results:

Among underweight children, the proportion of mixed-fed children was the highest, and among normal weight children, most were either bottle-fed or mixed-fed. Most overweight children were mixed-fed, and most obese children were breastfed. Underweight status was noted most commonly in children playing videogames for <2 hours/day, followed by those playing>4 and 2-4 hours/day. Normal weight was noted most commonly in those playing for >4 hours/day, followed by those playing <2 and 2-4 hours/day. Overweight status was noted most commonly in those playing videogames for >4 hours/day, followed by those playing 2-4 and <2 hours/day. Most children playing videogames for <2 hours/day were obese. Mean BMIs were the highest in those who exercised 1-2 times/week. P-values for the association between passive smoking indoors and BMI, weight, and height were 0.045, 0.150, and 0.854, respectively. Regarding socioeconomic status, log BMI values were 1.22, 1.23, and 1.26 in low-, medium-, and high-income families, respectively (P-value, 0.001).

Conclusion:

Children who were bottle-fed in their first year of life, played video games >2 hours/day, did not exercise regularly, were exposed to indoor passive smoking, and had a high socioeconomic status had a higher BMI and weight than their counterparts. (www.actabiomedica.it)

Overweight and Obesity Coexist with Thinness among Lao's Urban Area Adolescents

INTRODUCTION

In recent decades, the developing countries of Southeast Asia, including the Lao People's Democratic Republic (Lao PDR), have experienced a rapid growth of their urban population. Partly as a result of that, issues of undernutrition and overnutrition became a significant public health problem.

OBJECTIVE

To examine the prevalence of overweight and obesity and their related factors, among the school-attending adolescents in the Lao capital of Vientiane.

METHODS

A cross-sectional data on 300 adolescents aged 15-19 were collected during the months of March, April, and May 2018 by means of a self-administrated questionnaire. Anthropometric measurements were used to obtain data on height and weight. Pearson's chi-squared test, Fisher exact tests, and univariable and multivariable logistic regressions were applied in the course of the statistical analysis.

RESULTS

The study found a high prevalence of overweight/obesity (23.3%) and thinness (10.3%). Poor eating habits were noted in 67.0% of adolescents, even though 78.0% of them had a good knowledge of nutrition. Factors significantly associated with the overweight/obesity were low physical activities (aOR = 18.3; 95% CI: 5.51-60.66) and adolescents living with their guardians (aOR = 0.25; 95% CI: 0.08-0.79). Results also indicated that, in 47.3% of the cases, teachers, acting as a source of health and nutrition information, can prevent the risk of adolescents' overweight/obesity (aOR = 2.05, 95% CI = 1.11-3.80) but not their thinness (aOR = 0.4, 95% CI = 0.17-0.88).

CONCLUSIONS

Laotian adolescents are facing the spectrum of malnutrition in urban areas. To improve adolescents' nutritional status, there is a need for a collaborative approach of public health agencies that would address the issues of an effective food and nutrition policy. The school curricula should also include programs on nutrition and physical education.

The Influence of Parents and Schools on Adolescents' Perceived Diet and Exercise Self-Efficacy: A School-Based Sample From the United Arab Emirates

Introduction: In the United Arab Emirates, an alarming rate of 19% obesity among adolescents, associated with poor lifestyle, is apparent. Diet and exercise self-efficacy could influence adolescents' engagement in healthy behaviors. This study evaluates adolescents' perceptions of diet and exercise self-efficacy and explores the impact of parents and schools on self-efficacy. Method: A cluster sampling approach in cross-sectional design was used to recruit 610 school adolescents (Grades 7-12) over a 6-month period. Information on sociodemographics, lifestyle, parents, and schools was explored. Self-efficacy was assessed using The Eating Habits and Exercise Confidence Survey. Results: Participants reported moderate diet and exercise self-efficacy. Diet self-efficacy was predicted by parental support, eating breakfast and meals regularly at home, and prohibiting soft drinks. School support and frequency of weekly exercise classes predicted exercise self-efficacy; p values ≤.05. Discussion: Cultural knowledge and collaboration are essential to promote self-efficacy in multiethnic adolescents in the United Arab Emirates.

Saudi Arabian university students’ perceptions of health risk behaviours

Purpose

The purpose of this paper is to investigate how and why Saudi Arabian students engage in specific health risk behaviours (HRBs), and if there are gender differences.

Design/methodology/approach

In order to find out the situation regarding university students in Saudi Arabia, quantitative data were collected by administering questionnaires to 722 respondents, and qualitative data were collected using a series of interviews with 17 students.

Findings

The findings of this mixed methods sequential explanatory study suggest that lifestyle and personal factors, as well as economic, social, policy and other aspects of the environment played a significant role in influencing students’ HRBs. Recommendations for mitigating HRBs among these students and other youth in the Saudi Arabian context are provided.

Originality/value

This paper addresses an important gap in the research on HRBs among university students from the perspectives of students.

An Analysis of Overweight and Obesity Status among Childhood Cancer Survivors in Saudi Arabia: A Single Center Study

Overweight and obesity in the pediatric population remains a growing worldwide health burden. The extent to which this trend extends to childhood cancer survivors (CCS) remains less well explored. We conducted a retrospective observational study from a single institution in Saudi Arabia to estimate the prevalence of overweight and obese status among CCS over a five-year period. A total of 91 CCS patients were identified, 63 of whom had complete weight data from their treatment to the time of the study. Of these patients, 29 (46.0%) were found to be overweight or obese [body mass index (BMI) ≥85th percentile] at the time of the study. Of these patients, this rate was particularly high for patients who were female, older at the time of diagnosis (>6 years) (72.8%) and among pubescent patients (Tanner 3-5 at diagnosis). The rate of overweight and obesity increased from 31.7% immediately after the end of treatment (average age of 7.1 years) to 36.5% one year after. Thereafter, these percentages increased to approximately 38% over the 5-year follow-up period and increased beyond that up to 46%. A high prevalence of overweight and obesity among CCS was found at the end of their treatment with an observed increasing trend towards overweight and obesity in the following years, suggesting the need for early and continuous intensive intervention and frequent dietary evaluation.

Childhood Overweight and Obesity is Increasing in Gulf Cooperation Council Countries: A Review of the Literature

Introduction: A review was conducted to examine the prevalence and risk factors of developing overweight and obesity in children residing in Gulf Cooperation Council (GCC) countries. Method: PubMed, Medline, and Google Scholar databases using PRISMA guidelines were searched from January 1, 2007, to January 1, 2017. The inclusion criteria were (a) studies written in English, (b) clinical trials that examined risk factors of childhood overweight or obesity, (c) studies involving children 5 to 10 years of age, and (d) studies conducted in GCC countries. Results: Three main types of childhood obesity risk factors were identified (individual, familial, and lifestyle behavioral factors). The dietary, physical activity, and screen time lifestyle behavior risk factor findings were inconclusive. Discussion: Childhood obesity is increasing in GCC countries. Lifestyle behavior risk factors are still unclear. Researchers need to use instruments that have been psychometric tested and culturally acceptable. A follow-up review should be conducted.

Prevalence, severity and explanatory factors of tooth wear in Arab populations

OBJECTIVES

The aim of this study was to assess the prevalence and severity of tooth wear and related risk indicators in six Arab countries.

METHODS

This multicenter, multinational cross-sectional study was conducted among 2924 participants between the ages of 18-35 years old from six Arab countries. Calibrated dentists assessed tooth wear using the Basic Erosive Wear Examination Index (BEWE). Participants were also asked to complete a questionnaire that assessed their dietary and oral health habits. Each participant was identified by the sextant with the highest BEWE score in the upper and lower jaws.

RESULTS

Odds ratios were estimated for correlates of tooth wear anterior and posterior regions. Oman had the highest prevalence of BEWE score 3 (N = 255 (60.2%)). Overall, the highest BEWE score 3 was observed on the incisal edge of the upper anterior teeth (N = 602 (20.6%)) and in the lower left posterior region (sextant 6) on the occlusal surface (N = 466 (15.9%)). Correlates of severe tooth wear in both regions were eating or drinking more than six times per day, age and education. Drinking soft drinks "once a day" was significantly associated with severe tooth wear in the posterior region (OR: 1.3, 95% CI:1.05, 1.6). Brushing teeth more than twice a day was inversely associated with tooth wear in the anterior region (OR:0.75, 95% CI: 0.57,0.97).

CONCLUSION

The prevalence of tooth wear in Arab populations is relatively high, specific preventive and therapeutic measures should be developed to target people at higher risk of this condition.

CLINICAL SIGNIFICANCE

Tooth wear is now regarded as a significant oral health problems, dentists should advise their patients about dietary and oral health habits that can lead to severe tooth wear.

Development of a Saudi Food Frequency Questionnaire and testing its reliability and validity

OBJECTIVES

To create a food frequency questionnaire specifically designed to capture the dietary habits of Saudis and test its validity and reliability. Methods: This investigation is a longitudinal, test-retest study conducted in King Saud University, Riyadh, Kingdom of Saudi Arabia between December 2015 and March 2016. A list of 140 food items was included in the questionnaire where a closed-ended and open-ended approach was used. Regarding past   year food frequency consumption and 24 hours dietary recall, body weight and height were collected. Internal consistency, test-retest reliability, completeness of the food list, and criterion validity were assessed. Results: One-hundred and thirty eight participants were interviewed to complete the 24 hours dietary recall and the constructed questionnaire. Approximately 85% of the food items reported in the dietary recall were covered in the food frequency questionnaire. The association of body mass index with meats (regression coefficients: 2.28) and dairy products consumption frequency was statistically significant (regression coefficients: 2.31). A high overall reproducibility rate of the questionnaire was detected (Pearsons' correlation coefficient: 0.78 p less than 0.001).  Conclusion: The developed questionnaire has a high reliability and reasonable validity, and suitable for use in nutritional epidemiological investigations in Saudi Arabia.

Jordanian adolescents' health behaviour and school climate

Aim

This study was conducted to assess the occurrence of physical activity, nutritional habits, tooth brushing and seat belt use behaviour among adolescent school students in Jordan, and to examine the effect of psychosocial aspects of school on these behaviours.

Method

A cross-sectional descriptive correlational design was used to draw a sample of in-school adolescents aged between 11 and 15 years. The final sample included 1166 adolescents from five public and two private schools. Study participants filled in a translated version of the health behaviour in school aged children questionnaire. Descriptive statistics, correlational (point biserial), and bivariate analyses (chi-square tests) were used to analyse the data.

Results

Among the study sample 34.5% of the adolescents practised exercise outside school hours once a week or less frequently, and only 53.1% of them brushed their teeth more than once a day. Regarding seat belt use, 44.7% of the adolescents used them rarely or never. Concerning carbonated sugary drinks and sweets consumption, about 64% and 83.3% of the adolescents, respectively, consumed them once a day or more often. The percentages of adolescents who never drank low fat or whole fat milk were 43.1% and 38.2%, respectively.

Conclusions

The study concluded that school adolescents do engage in unhealthy behaviour. Psychosocial aspect of schools were associated with students' physical activity, nutritional habits, tooth brushing and seat belt use behaviours.

Diets Rich in Fruits and Vegetables Are Associated with Lower Cardiovascular Disease Risk in Adolescents

Obesity and cardiovascular disease (CVD) risk are public health concerns in adolescents, yet few studies have examined the association of their diet to CVD risk factors. This study investigated associations between diet, body mass index (BMI), waist circumference (WC), blood pressure (BP), and blood lipids in 163 16-17 year olds. Diet recall data were converted into Healthy Eating Index-2010 (HEI) to assess diet quality. Differences in diet between groups with normal or obese BMI, normal or hypertensive BP, and normal or altered lipids were determined. Associations between diet and BMI, WC, BP, and lipids, controlling for race, gender, and socioeconomic status, were examined. Mean HEI was 49.2 (±12.0), with no differences observed between groups. HEI was not associated with any CVD risk. Sweetened beverage consumption was higher in obese adolescents, and positively related to total cholesterol (TC). Fruit intake was negatively related to BMI and diastolic BP. Total vegetable intake was negatively related to systolic BP. Greens and beans were negatively related to TC and LDL. Whole grains were negatively related to HDL. This research suggests a cardioprotective effect of diets rich in fruits and vegetables, as well as low in sweetened beverages in adolescents.

Effect of price and information on the food choices of women university students in Saudi Arabia: An experimental study

OBJECTIVE

To explore the impact of price manipulation and healthy eating information on intended food choices.

DESIGN

Health information was provided to a random half of subjects (vs. information on Saudi agriculture). Each subject chose from the same lunch menu, containing two healthy and two unhealthy entrees, deserts and beverages, on five occasions. Reference case prices were 5, 3 and 2 Saudi Arabian Reals (SARs). Prices of healthy and unhealthy items were manipulated up (taxed) and down (subsidized) by 1 SAR in four menu variations (random order); subjects were given a budget enabling full choice within any menu. The number of healthy food choices were compared with different price combinations, and between information groups. Linear regression modelling explored the effect of relative prices of healthy/unhealthy options and information on number of healthy choices controlling for dietary behaviours and hunger levels.

SETTING

University campus, Saudi Arabia, 2013.

SUBJECTS

99 women students.

RESULTS

In the reference case, 49.5% of choices were for healthy items. When the price of healthy items was reduced, 58.5% of selections were healthy; 57.2% when the price of unhealthy items rose. In regression modelling, reducing the price of healthy items and increasing the price of unhealthy items increased the number of healthy choices by 5% and 6% respectively. Students reporting a less healthy usual diet selected significantly fewer healthy items. Providing healthy eating information was not a significant influence.

CONCLUSION

Price manipulation offers potential for altering behaviours to combat rising youth obesity in Saudi Arabia.

Prevalence of dietary supplement use and associated factors among female college students in Saudi Arabia

Background

The economic boom in Saudi Arabia indirectly prompted the use of dietary supplements in the last two decades. Our aim is to investigate the prevalence of dietary supplement use and its association with sociodemographic/lifestyle characteristics among Saudi female students.

Methods

In this cross-sectional study, 534 female participants (≥19 years of age) completed a self-administered questionnaire that include sociodemographic and lifestyle characteristics, perceived health status, dietary supplement use, general awareness, attitudes and behavior.

Results

In all participants, the prevalence of dietary supplement use was 76.6% (n = 409). High level of education (p = 0.002) and more physical activity (p = 0.008) exhibited a significant positive association with users than to non-users. The frequency showed that beta-carotene (54.2%), chamomile (54.2%), and glucosamine (53.8%) were the most preferred diet supplements under the category “when needed”. Cod liver oil (71.3%), omega 3 (68.3%), multi-vitamins (61.5%), ginseng (60%), and vitamin A (60%), were mostly used “from time to time”. Multi-minerals (34.4%) were the preferred choice when it comes to daily use. The main reasons for supplement use were to “maintain healthy hair” and “injury and illness” (both 26.2%). About 38.4% were not aware and 30.3% disagree on differences taking supplements with or without consulting a medical professional. About 36.7% lack information about side effects while, 35.0% were unaware about any health effect of dietary supplements.

Conclusion

The prevalence of dietary supplement use was high in Saudi female students and was significantly associated with sociodemographic and lifestyle factors.

Exploration of the Risk Factors of Generalized and Central Obesity among Adolescents in North Lebanon

Adolescents' obesity is an emerging public health problem globally and in the Arab countries. Alarming rates of overweight/obesity have been rising progressively in Lebanon. However, the risk factors for the development of adolescents' obesity have not yet been thoroughly explored in North Lebanon. To determine the dietary and lifestyle risk factors associated with generalized and central obesity among adolescents living in Tripoli, a cross-sectional survey was conducted including a representative sample of 311 students aged 11–16 years from both sexes chosen from public and private schools in Tripoli. Data were collected using a standardized questionnaire to determine sociodemographic characteristics, dietary patterns, and physical activity and sedentary behaviors. Body mass index (BMI) was evaluated using the Center for Disease Control BMI for age percentiles. Central obesity was assessed using both waist-to-height ratio and gender-specific waist circumference for age indices. Multiple logistic regression analysis revealed that skipping breakfast and physical inactivity were the most significant independent risk factors associated with both generalized and central obesity. In addition, higher screen time and male gender were associated with increased risk for generalized and central obesity, respectively. Intervention strategies to prevent the development of obesity should be implemented among adolescent students to encourage regular breakfast intake and adopting healthy dietary and lifestyle behaviors.

Selected nutritional habits of teenagers associated with overweight and obesity

INTRODUCTION

A balanced diet is at the heart of healthy growth and development of children and youth, whereas inappropriate eating habits considerably influence the incidence of disorders connected with nutrition, including overweight and obesity. This paper aims at studying nutritional factors of 18-year-old secondary school youth in the urban environment and their effect on the incidence of overweight and obesity.

MATERIALS AND METHODS

The survey was conducted among 1,999 secondary school students chosen at random. The research tool consisted an original survey questionnaire. The measurements of respondents' height and body mass provided data for calculating the body mass index.

RESULTS AND CONCLUSION

The percentage of youth with deficient body mass was estimated at 8.4%. The percentage of normal weight students in the surveyed group was estimated at 77.6%. Overweight and obesity characterized 14.0% of the total number. As many as 21.8% of overweight and obese respondents would eat one or two meals as opposed to 16.8% of normal weight students. Three-fourths of the surveyed students would eat breakfast regardless of their nutritional habits. Lunch is eaten by 52.9% of normal weight 18-year-olds and 46.1% of overweight and obese students. The analysis of mealtimes suggests that overweight and obese students would have their breakfast and dinner at later hours than the rest of the surveyed. More than half of the participating students failed to eat lunch (53.9%), and one in four students within this group resigned from supper. Girls would eat fruit and vegetables more frequently than boys several times a day. The percentage of persons in the surveyed groups who would eat fast foods on a daily basis was similar regardless of their nutritional status. Sweetened carbonated beverages would be drunk more often by overweight and obese boys (81.2%) as compared with boys with proper body mass (75.8%). The same type of beverages would be popular with two-thirds of girls, and this result was similar regardless of their nutritional status. About 44.2% of overweight and obese girls and 20% of girls with proper body mass attempted to lose weight, and 5.7% of boys tried to go on a diet. Eating limitations were declared by 16.5% of overweight and obese boys and ca. 3% of normal weight boys.

CONCLUSION

Within the surveyed group of youth, it was possible to indicate eating errors primarily consisting in irregular eating, too low a number of meals during the day, particularly skipping breakfast, which took place more frequently among overweight and obese students rather than normal weight ones. The survey points to the insufficient intake of vegetables and fruit as opposed to salty and sweet meals. It is essential to convey the knowledge on the causes of overweight and obesity as well as rules of a healthy diet as factors preventing civilization diseases.

Factors associated with dietary supplement use in Saudi pregnant women

Background

The aim was to investigate the prevalence of dietary supplement use among pregnant Saudi women and its associations between various demographics.

Methods

In this cross-sectional study, a total of 137 pregnant women attending prenatal care from King Salman Hospital completed a self-administered questionnaire including socio-demographic characteristics, general awareness, attitude and behavior towards use of dietary supplements during pregnancy.

Results

Dietary supplement use among Saudi women in pregnancy was high (71.5%) and was significantly associated with level of education (p = 0.005), family income (p = 0.039) and number of children (p = 0.007). No significant association was observed between neonatal health outcomes and dietary supplement use during pregnancy. In all participants, 81.6% believed that supplement use is important for nutritional status and more favorable neonatal outcomes. For the majority of participants, the primary source of information for dietary supplement use was a doctor’s advice. The majority of the participants [65.7% (n = 90)] responded that dietary supplement use is safe. Folic acid was found to be the most common type of dietary supplement used (95.9%; n = 94); however, 53.1% (n = 52) did not take folic acid supplements 3 months prior to pregnancy. Other common supplements used were iron, calcium and vitamin D (88.8, 81.6, and 41%, respectively).

Conclusions

This study provided new information on dietary supplement use and its correlates in Saudi pregnant women. The prevalence of dietary supplement use was high in this group and was associated with socio-demographic and lifestyle characteristics.

The Influence of Sweet Taste Perception on Dietary Intake in Relation to Dental Caries and BMI in Saudi Arabian Schoolchildren

Objectives

The aim of the study was to evaluate the influence of sweet taste perception on dietary habits in Saudi schoolchildren. In addition, the relationship between dietary habits and both caries and BMI was studied.

Methods

A cross-sectional observational study comprising 225 schoolchildren aged 13–15 years from Jeddah, Saudi Arabia, was conducted. The consumption frequency of certain food items was analysed from a beverage and snack questionnaire and a three-day estimated dietary record was obtained. The sweet taste perception level was determined as sweet taste threshold (TT) and sweet taste preference (TP). Children were grouped into low, medium, and high, according to their sweet taste perception level. ICDAS and DMFS indices were used for caries registration and anthropometric measurements using BMI were collected.

Results

Sweet taste perception was found to be negatively correlated to the number of main meals and positively correlated to both snack and sweet intake occasions. Statistically significant differences were found between the TT and TP groups with regard to the number of main meals and sweet intake (p ≤ 0.01). No significant correlation between the dietary variables and caries or BMI was found.

Conclusions

The dietary habits and sweet intake were found to be influenced by the sweet taste perception level, while the relation between the dietary habits and the caries and BMI was found insignificant.

Dietary sources of energy and nutrient intake among children and adolescents with chronic kidney disease

BACKGROUND

Our purpose was to identify the main food contributors to energy and nutrient intake in children with chronic kidney disease (CKD).

METHODS

In this cross-sectional study of dietary intake assessed using Food Frequency Questionnaires (FFQ) in the Chronic Kidney Disease in Children (CKiD) cohort study, we estimated energy and nutrient intake and identified the primary contributing foods within this population.

RESULTS

Completed FFQs were available for 658 children. Of those, 69.9% were boys, median age 12 (interquartile range (IQR) 8-15 years). The average daily energy intake was 1968 kcal (IQR 1523-2574 kcal). Milk was the largest contributor to total energy, protein, potassium, and phosphorus intake. Fast foods were the largest contributors to fat and sodium intake, the second largest contributors to energy intake, and the third largest contributors to potassium and phosphorus intake. Fruit contributed 12.0%, 8.7%, and 6.7% to potassium intake for children aged 2-5, 6-13, and 14-18 years old, respectively.

CONCLUSIONS

Children with CKD consumed more sodium, protein, and calories but less potassium than recommended by the National Kidney Foundation (NKF) guidelines for pediatric CKD. Energy, protein, and sodium intake is heavily driven by consumption of milk and fast foods. Limiting contribution of fast foods in patients with good appetite may be particularly important for maintaining recommended energy and sodium intake, as overconsumption can increase the risk of obesity and cardiovascular complications in that population.

Methodology and Early Findings of the Fifth Survey of Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable Disease: The CASPIAN-V Study

Background:

This paper presents the methodology and early findings of the fifth survey of a school-based surveillance program in Iran.

Methods:

This nationwide study was conducted in 2015 as the fifth survey of a surveillance program entitled “Childhood and Adolescence Surveillance and PreventIon of Adult Non- communicable disease” (CASPIAN-V) study. The protocol was mainly based on the World Health Organization-Global School student Health Survey. We studied 14400 students, aged 7-18 years, and their parents living in 30 provinces in Iran. Fasting blood was obtained from a sub-sample of 4200 randomly selected students.

Results:

The participation rate for the whole study and for blood sampling were 99% and 91.5%, respectively. The mean (SD) age of participants was 12.3 (3.2) years, consisting of 49.4% girls and 71.4% urban residents. Overall, 16.1% were underweight (17.4% of boys and 14.8% of girls), and 20.8% had excess weight consisting of 9.4% (8.7% of boys and 10.2% of girls) of overweight and 11.4% (12.5% of boys and 10.3% of girls) of obesity. Abdominal obesity was documented in 21.1% of students (21.6% of boys and 20.5% of girls). Low HDL-C was the most prevalent abnormality of the lipid profile (29.5%) followed by high serum triglycerides (27.7%). Of students, 59.9% consumed whole wheat bread; and 57% reported that they never or rarely added salt to table. The reported daily consumption of fresh fruits, vegetables, and milk was about 60%, 32% and 40%, respectively. 13.7% of participants had at least 30-min daily leisure-time physical activity.

Conclusions:

The current findings provide an overview of the current health status and lifestyle habits of children and adolescents. This surveillance program would help planning preventive programs at individual and community levels.

Assessment of the environmental and genetic factors influencing prevalence of metabolic syndrome in Saudi Arabia

Metabolic syndrome (MS) is a combination of factors that increases the risk of cardiovascular atherosclerotic diseases including diabetes, obesity, dyslipidemia, and high blood pressure. Cardiovascular diseases are one of the leading causes of death in the adult Saudi population where the increase in cardiovascular-related mortality is augmented by the rise in the prevalence of MS. Metabolic syndrome is a multi-factorial disorder influenced by interactions between genetic and environmental components. This review aims to provide a comprehensive assessment of studied environmental and genetic factors explaining the prevalence of MS in the Kingdom of Saudi Arabia. Additionally, this review aims to illustrate factors related to the population genetics of Saudi Arabia, which might explain a proportion of the prevalence of MS.

The Child Obesity Epidemic in Saudi Arabia: A Review of the Literature

PURPOSE

To examine prevalence, nutrition and activity, and overweight and obesity prevention and management in Saudi Arabia.

DESIGN

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria, PubMed, Web of Science, PyschINFO, Global Health, Family Studies Worldwide, Middle Eastern Studies, and Sociological Abstracts was searched from January 1, 2003 to January 31, 2016. Inclusion criteria included peer-reviewed articles published in Arabic and English that focused on prevalence, overweight or obesity in children 2 to 20 years of age, body mass index percentile, and interventions.

FINDINGS

Three themes were identified: epidemiological features, where the eastern region had the highest prevalence of overweight and obesity, risk factors, which included higher parental education, and lifestyle factors, which included increased consumption of calorie-dense food and a sedentary lifestyle.

CONCLUSION

Childhood obesity is increasing in Saudi Arabia at an alarming rate.

IMPLICATIONS FOR PRACTICE

Practitioners need to consider the cultural influences of the increasing obesity epidemic in Saudi Arabia.

Gut microbiome and dietary patterns in different Saudi populations and monkeys

Host genetics, environment, lifestyle and proximity between hosts strongly influence the composition of the gut microbiome. To investigate the association of dietary variables with the gut microbiota, we used 16S rDNA sequencing to test the fecal microbiome of Bedouins and urban Saudis and we compared it to the gut microbiome of baboons living in close contact with Bedouins and eating their leftovers. We also analyzed fermented dairy products commonly consumed by Bedouins in order to investigate their impact on the gut microbiome of this population. We found that the gut microbiomes of westernized urban Saudis had significantly lower richness and biodiversity than the traditional Bedouin population. The gut microbiomes of baboons were more similar to that of Bedouins compared to urban Saudis, probably due the dietary overlap between baboons and Bedouins. Moreover, we found clusters that were compositionally similar to clusters identified in humans and baboons, characterized by differences in Acinetobacter, Turicibacter and Collinsella. The fermented food presented significantly more bacteria genera common to the gut microbiome of Bedouins compared to urban Saudis. These results support the hypothesis that dietary habits influence the composition of the gut microbiome.

Do healthier foods cost more in Saudi Arabia than less healthier options?

Objectives:

To investigate whether healthy foods in Saudi Arabia cost more compared with less healthy options.

Method:

This is a cross-sectional study conducted in Riyadh, Saudi Arabia during June and July 2015. The study targeted well-known market chains in the city of Riyadh. The selection of food items was purposive to include healthy and less healthy food items in each category. Price, caloric value, salt, fat, sugar, and fiber contents for each food item were collected. To test for the correlation between nutritional contents and average price, Spearman’s correlation coefficients were calculated. The Mann-Whitney U test was used to test for the presence of average price difference between healthy and less healthy food items.

Results:

A total of 162 food items were collected. Sixty-six food items were classified as healthy compared with 96 less healthier options. The calculated correlation coefficients indicate an association between increased cost of food with increased caloric values (0.649 p=0.0000001), increased fat content (0.610 p=0.0000003), and increased salt contents (0.273 p=0.001). Prices of food items with higher fiber contents showed a weaker association (0.191 p=0.015). The overall average cost of healthy food was approximately 10 Saudi riyals cheaper than less healthy food (p=0.000001).

Conclusion:

The findings of the study suggest that the cost of healthy food is lower than that of less healthy items in the Saudi market.

The health of Saudi youths: current challenges and future opportunities

Background

The health status of the young people is an important indicator for future health and health care needs of the next generation. In order to understand the health risk factors of Saudi youth, we analyzed data from a large national survey in the Kingdom of Saudi Arabia.

Methods

The Saudi Health Information Survey sample included 2382 youths aged 15 to 24 years old. The questionnaire included information on socio-demographic characteristics, risk factors, risky behaviors, chronic conditions, functional status, health care utilization, and anthropometric and blood pressure measurements.

Results

Only 45.9 % of men and 48.4 % of women had normal body mass index (BMI). Men were more likely than women to smoke cigarettes or shisha. The prevalence of daily consumption of at least five servings of fruits and vegetables was 6.6 %. The prevalence of no or insufficient physical activity was 41.8 % in men and 75.6 % in women (P < 0.001). Around 40 % of men and 25 % of women had abnormal blood pressure. Mean BMI and prevalence of insufficient physical activity, current smoking, and hypertension was higher in 20-to 24-year-olds than younger ages. Women were more likely to report that they never use seatbelts (82.2 % vs. 65.4 %).

Conclusions

The prevalence of modifiable risk factors and risky driving behaviors is very high among Saudi youth. If these current behaviors are not reversed during this crucial age period, the burden of disease and injuries will rise in the future. Our findings call for developing health prevention programs for youths in Saudi Arabia.