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Alabdulkader S, Alzaben AS, Almoayad F, Mortada EM, Benajiba N, Aboul-Enein BH, Dodge E, Bernstein J, Bawazeer N. Evaluating attitudes toward soft drink consumption among adults in Saudi Arabia: Five years after selective taxation implementation. Prev Med Rep 2024; 44:102808. [PMID: 39071241 PMCID: PMC11283123 DOI: 10.1016/j.pmedr.2024.102808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Objective Saudi Arabia (SA) ranked first in soft drink consumption in the Middle East. A decrease in consumption was recorded after a selective 50% increased taxation policy in 2018. This study aimed to assess soft drinks consumption patterns among Saudi Arabian adults and examine the association between different attitudes and patterns post-taxation. Methods This cross-sectional study was conducted from October 2022 to March 2023, involving 1,935 Saudi adults aged 20-60 residing in Saudi Arabia. Participants completed online surveys using a validated questionnaire assessing sociodemographic characteristics, soft drink consumption patterns, and attitudes toward soft drinks. Chi-square and odds ratio (OR) tests were used to assess associations between sociodemographic characteristics, soft drink consumption frequency/quantity, and change in consumption patterns owing to selective taxation. Additionally, t-tests, Spearman's coefficient, and hierarchical multiple linear regression were used to measure differences in attitudes and linear relationships. Results Overall, 7.5% of the participants reported daily soft drink consumption, with 51.8% of these consuming less than one can per day and 41.2% consuming one can per day. Most (66.2%) reported no change in consumption post-taxation. Attitudes toward soft drink consumption varied significantly, with most agreeing on its health risks but also enjoying the drinks. Multiple regression analysis identified age, education, income, consumption frequency/quantity, and impact of taxation as significant predictors of overall attitudes toward soft drinks. Conclusions After taxation, 20% of participants reduced soft drink consumption, underscoring the importance of addressing taxation and intrinsic motivations to foster lasting changes in attitudes and behaviors towards soft drinks.
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Affiliation(s)
- Shahd Alabdulkader
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Abeer S Alzaben
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Fatmah Almoayad
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Eman M Mortada
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Nada Benajiba
- Unité Mixte de Recherche en Nutrition et Alimentation URAC 39 (Université Ibn Tofaïl–CNESTEN), RDC-Nutrition, Kénitra, Morocco
| | - Basil H. Aboul-Enein
- London School of Hygiene & Tropical Medicine, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | - Elizabeth Dodge
- College of Graduate & Professional Studies, University of New England, 716 Stevens Ave., Portland, ME 04103 USA
| | - Joshua Bernstein
- College of Graduate Health Studies A.T. Still University of Health Sciences, Kirksville, MO, USA
| | - Nahla Bawazeer
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
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Sleiman R, Abdelkader W, AlTannir D. Assessing the Body Composition of "Picky Eaters" Using Body Impedance Analysis: An Experience From a Tertiary Care Center. Cureus 2024; 16:e60538. [PMID: 38887328 PMCID: PMC11181006 DOI: 10.7759/cureus.60538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Picky eating might be associated with a higher risk of being underweight and poor growth. This study aimed to investigate if picky eaters aged between three and 12 years showed differences in height, weight, and body composition compared to their non-picky peers using a body impedance analysis (BIA). METHODS This cross-sectional study was conducted between March 1, 2022, and July 31, 2022, on children aged three to 12 years who presented to the outpatient pediatric clinics at Al Habib Ar Rayyan in Riyadh, Saudi Arabia. Body composition was measured using BIA after manually inserting the height, gender, and age into the machine, where body mass index (BMI), fat mass, and skeletal muscle mass were recorded. Participants were classified as under/normal/over for each body composition measurement. RESULTS A total of 2234 children were entered into the final data analysis. Our analysis showed that 1917 (85.8%) were Saudis and 1117 (50%) were males. The mean age of participants was 6.08±2.01 years and 1151 (51.5%) were in the pre-school age. The reported prevalence of picky eaters was 1684 (75.4%), of whom, 606 (27.0%) were selective eaters, 365 (16.2%) were low appetite eaters, and 723 (32.2%) were both selective and low appetite eaters. Being underweight was significantly more common among the picky eaters 487 (28.9%) compared to those non-picky eaters 55 (10.0%) (p<0.001). Significantly, 1280 (76%) picky eaters had below-average skeletal muscle mass compared to 151 non-picky eaters (27.5%) (p<0.001). The low appetite picky eater group had more under skeletal muscle mass children 277 (75.9%) compared to the selective picky eater group 412 (68.0%) (p=0.009). Additionally, the low appetite group possessed lower muscle ratios (p=0.012) and were more underweight than the selective group (p<0.001). Furthermore, the low appetite group showed a higher percentage of children below the 3rd percentile in the height for age category (p=0.003) compared to the selective group. CONCLUSION This study is the first of its kind in Saudi and globally to evaluate body composition using BIA among children. The study showed that picky eating is more associated with underweight children and low muscular mass. Despite the normal BMI, height, and weight of a picky eater, their skeletal muscle mass might be less than average, which could be associated with an increased risk of morbidity.
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Affiliation(s)
- Rola Sleiman
- Pediatrics, Dr. Sulaiman Al Habib Medical Group, Riyadh, SAU
| | | | - Dana AlTannir
- Pediatric Medicine, Alfaisal University College of Medicine, Riyadh, SAU
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Alhazmi A, Hawash MM, Ali H, Narapureddy BR, Aziz F. Knowledge, attitudes, and practices related to dietary salt among older adults in Abha, Saudi Arabia. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:53. [PMID: 38650019 PMCID: PMC11036643 DOI: 10.1186/s41043-024-00545-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
The need to foster successful aging has intensified with the aging of the global population. This study aimed to assess the knowledge, attitudes, and practices (KAP) concerning dietary salt consumption and to investigate the correlations between sociodemographic variables and salt-related KAP. A structured interview was administered to a cohort of 200 older adults in Abha City, Saudi Arabia, recruited through a convenience sampling approach. The evaluation of salt-related KAP revealed widespread low knowledge (91.5%) as participants scored less than 3, negative attitudes (85.5%) scored less than 12, and predominantly unsatisfactory practices (69.5%) with scores less than 26. Noteworthy differences emerged between participants with poor overall KAP (81.5%) and those with good KAP (18.5%). Significantly weak negative correlations were found between age (r=-0.212), marital status (-0.236), and body mass index (-0.243) with overall KAP. Further examination revealed a significantly weak positive correlation between attitude and practice (r = 0.141). KAP scores show a highly significant positive correlation with overall KAP scores (r = 0.169, 0.352, 0.969). The uncovered correlations contribute to a valuable understanding of the complex dynamics surrounding salt-related KAP. This understanding guides the design of targeted interventions, such as health education programs, promoting successful aging and public health outcomes.
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Affiliation(s)
- Amani Alhazmi
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia.
| | - Manal Mohammed Hawash
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
- Department of Gerontological Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Haroon Ali
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Bayapa Reddy Narapureddy
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Farah Aziz
- Department of Basic Medical Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
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Aleid S, Alshahrani NZ, Alsedrah S, Carvalho AB, Lima MJ, Teixeira-Lemos E, Raposo A. The Role of Social Media Advertisement and Physical Activity on Eating Behaviors among the General Population in Saudi Arabia. Nutrients 2024; 16:1215. [PMID: 38674905 PMCID: PMC11054689 DOI: 10.3390/nu16081215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/06/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Over the past few decades, people in Saudi Arabia have become less inclined to adopt active lifestyles and healthy eating habits due to the increasing use of digital technologies such as social media. The objective of this online-based cross-sectional study was to assess the role of social media food advertisements and physical activity on eating behaviors among the general population in Saudi Arabia (n = 471). Data were collected through a structured questionnaire, which consisted of four parts: (i) sociodemographic information, (ii) attitude towards social media, (iii) eating behaviors-related information, and (iv) exposure to and engagement with social media advertisements. The study's outcome variable, eating behaviors (healthy vs. unhealthy), was assessed using the following question: "Are you on a healthy diet (such as a balanced diet, keto, or low carb)?" A multiple binary logistic regression analysis was performed to investigate the factors that influence unhealthy eating behaviors. Approximately 79.6% of the participants had unhealthy eating behaviors. Participants who were not involved in daily physical activity were more likely to have unhealthy eating behaviors compared to their counterparts (adjusted odds ratio, AOR = 4.86). Participants who watched food ads on social media channels 1-3 times a week (AOR = 2.58) or daily (AOR = 3.49) were more likely to have unhealthy eating behaviors than their counterparts. Participants whose appetite to try foods increases always (AOR = 1.42) or usually (AOR = 2.88) after viewing ads on social media were more likely to have unhealthy eating behaviors. These findings suggest that policymakers should take immediate action to regulate food advertising policy to promote a healthy food environment across the country. Saudis should be encouraged to engage in more physical activity, which could support the maintenance of healthy eating patterns and lifestyles.
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Affiliation(s)
- Sara Aleid
- Preventive Medicine Division, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia; (S.A.); (S.A.)
| | - Najim Z. Alshahrani
- Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah 21589, Saudi Arabia
| | - Safa Alsedrah
- Preventive Medicine Division, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia; (S.A.); (S.A.)
| | - Ana Branca Carvalho
- ESTGL & CISeD—Research Centre in Digital Services, Polytechnic University of Viseu, 3504-510 Viseu, Portugal;
| | - Maria João Lima
- CERNAS-IPV Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal; (M.J.L.); (E.T.-L.)
| | - Edite Teixeira-Lemos
- CERNAS-IPV Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal; (M.J.L.); (E.T.-L.)
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
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Alangari AS. Restaurants' compliance with calorie labeling policies in food delivery applications. Front Nutr 2023; 10:1281293. [PMID: 38162518 PMCID: PMC10757599 DOI: 10.3389/fnut.2023.1281293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Background To encourage consumers to make healthier choices, the Saudi Food and Drug Authority (SFDA) released the Saudi Arabia Nutrition Labeling Policy, which requires restaurants to present caloric information clearly on their menus. Food delivery applications are also mandated to present caloric information on their platforms. The aim of this study is to explore how restaurants on food delivery applications comply with the calorie labeling policy. Methods Data were extracted from a widely used food delivery application in Saudi Arabia to include a sample of 120 "healthy food" restaurants. The restaurants were checked for compliance on both the application and the website. Descriptive and logistic regression analyses were performed to examine the distribution and association of relevant factors. Results A substantial proportion (43.3%) of healthy foods on delivery applications (n = 120) do not comply with the SFDA calorie labeling policies. Among these restaurants, 56.5% presented the calorie labeling on their menu item. Of those who provided calorie information on their websites (n = 62), 54.8% provided appropriate calorie labeling based on the SFDA policy. There was an association between compliance and the number of restaurant categories but no associations for website calorie labeling, rating, and appropriateness. Conclusion This study provides important findings for policymakers that will enable them to reinforce food calorie policies on food delivery platforms, restaurant websites, social media, and marketing campaigns. Not all restaurants comply with the SFDA calorie labeling policies. Suggestions to present the calorie-related words in Arabic and offer more information to help the consumer make the appropriate food selection decision. Further studies are needed to explore the reasons for and barriers to posting nutritional information on menu items.
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Affiliation(s)
- Abdulaziz S. Alangari
- Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Rabiee Khan F, Abdelraheim Titi M, Frankowska N, Kowalczyk K, Alziedan R, Yin-Kei Lau C, Biernat K, Brown KG. The Impact of the First Wave of the COVID-19 Pandemic on University Staff Dietary Behaviours, Sleeping Patterns, and Well-Being: An International Comparison Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6941. [PMID: 37887679 PMCID: PMC10606338 DOI: 10.3390/ijerph20206941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Abstract
This study assessed the impact of the first wave of the COVID-19 pandemic on well-being by measuring the changes to food security, dietary behaviour, and sleeping patterns of university staff in England, Poland, Saudi Arabia, and China. Using a cross-sectional study design, participants in four universities in the respective countries were surveyed between June and July 2020. The mean age of the 902 participants was 42 years old and 67% were female. The findings indicate a reduction in emotionally driven food behaviour [t (901.00) = -20.87, p < 0.001], food acquisition location [t (901.00) = -51.55, p < 0.001], skipping meals [t (901.00) = -24, p < 0.001], and consumption of canned fruit and vegetables [t (901.00) = -10.18, p < 0.001]. However, home cooking [t (901.00) = 36.61, p < 0.001] and the food shopping experience [t (901.00) = 4.53, p < 0.001] markedly increased during lockdown. The participants had higher levels of well-being during the pandemic and experienced a significant increase in sleeping hours (p < 0.001). Increased age and sleeping hours were positively associated with overall well-being. Conversely, emotionally driven food behaviour (i.e., buying and eating more food out of boredom/fear or anxiety) and skipping meals decreased the overall well-being. Lockdown had beneficial effects on dietary behaviours, sleeping patterns, and well-being, but there were variations between countries.
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Affiliation(s)
- Fatemeh Rabiee Khan
- College of Life Sciences, Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham B15 3TN, UK
| | - Maher Abdelraheim Titi
- Quality Management Department, King Saud University Medical City, Riyadh P.O. Box 7805, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh P.O. Box 7805, Saudi Arabia
| | - Natalia Frankowska
- SWPS University of Social Sciences and Humanities, 03-815 Warsaw, Poland;
| | | | - Rasmieh Alziedan
- Cardiology Department, Medical College, King Fuad University, Riyadh P.O. Box 7805, Saudi Arabia;
| | - Christine Yin-Kei Lau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China;
| | - Karolina Biernat
- Solihull Metropolitan Borough Council, Public Health Department, Council House, Solihull B91 9QS, UK;
| | - Kyle Gavin Brown
- College of Psychology, Faculty of Business, Law and Social Sciences, Birmingham City University, Birmingham B4 7BD, UK;
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Alothmani NM, Almoraie NM. Understanding the Knowledge, Attitudes, and Practices Concerning Sugar-Sweetened Beverages and Beverage Taxation among Saudi University Students. Nutrients 2023; 15:4151. [PMID: 37836435 PMCID: PMC10574237 DOI: 10.3390/nu15194151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
University students should be informed about sugar-sweetened beverages (SSBs). Given the high consumption level of SSBs in Saudi Arabia, this study aims to examine the knowledge, attitudes, and practices related to SSBs and taxes. This cross-sectional study was conducted on 380 students at King Abdulaziz University in Jeddah between September 2022 and March 2023. The data were collected using an online self-administered questionnaire. The results reveal that 93% of the students had high knowledge scores, 99% have positive attitudes, and 37% present good practices toward SSBs. Moreover, 73% of students have high knowledge scores, 83% have positive attitudes, and 32% present good practices regarding SSB taxes. Each of these variables, college education, smoking, family income, body mass index, activities, and sports, showed statistically significant differences between gender with regard to the scores for knowledge, attitudes, and practice towards SSBs and their taxes. Thus, a high percentage of university students present sufficient knowledge of and good attitudes towards SSBs and taxation, unlike the practical results. Policymakers should develop strategic approaches and education campaigns to improve practices towards SSBs.
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Affiliation(s)
| | - Noha M. Almoraie
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah 3270, Saudi Arabia;
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Abstract
Obesity is an alarming public health concern and needs to be addressed promptly in the Kingdom of Saudi Arabia. Sedentary lifestyle, changes in dietary intake and choice, culture, gender, climatic conditions and, lately, COVID-19 have contributed to obesity as a near epidemic in the Kingdom of Saudi Arabia. Interventions targeting obesity includes lifestyle management, pharmacotherapy, and surgery. Lifestyle interventions qualify as first-line therapies. Diets include a low-fat diet, low-calorie diet, low-carbohydrate diet, high-protein diet, and low-glycemic-index diet. Diet and exercise interventions can have a huge impact on weight loss. Pharmacotherapy is considered a treatment option at a later stage. Surgery is only for severely obese individuals. Above all, the government has to intervene and implement regulations and policies that can curb the incidence of obesity. This review aims to address obesity in the Kingdom of Saudi Arabia, interventions to curb it, and the impact of COVID-19 on obesity.
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Affiliation(s)
- Aljohrah Aldubikhi
- From the Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Kingdom of Saudi Arabia.
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Alshamrani KA. The cranial capacity of the Saudi population measured using 3D computed tomography scans. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2023; 28:184-189. [PMID: 37482378 PMCID: PMC10519656 DOI: 10.17712/nsj.2023.3.20230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 01/15/2023] [Accepted: 06/26/2019] [Indexed: 07/25/2023]
Abstract
OBJECTIVES To measure the cranial capacity of members of the Saudi adult population across ages and genders. METHODS This was a retrospective cross-sectional study that used 488 Computed Tomography (CT) scans of heads (of which 275 males) to measure cranial volume. The CT slices 0.625 mm thick were uploaded using the freely available software "3D-Slicer", which then reconstructed the images and built a 3D module. RESULTS The mean (±SD) cranial capacity of the males was 1481.6 (±110) cm3 (range: 1241-1723 cm3), whereas the cranial capacity of the females was 1375.4 (±104) cm3 (range: 1203-1678 cm3). This study showed that the males had a mean cranial capacity that was 7% greater than that of the females in this study. The average cranial capacity of the males between the ages of 31 and 40 years was statistically significantly larger to that of the males aged 61-80 (p<0.05). CONCLUSION This study demonstrated that the average cranial capacity of the males was larger than that of the females. These study results can help to determine the normal cranial capacity of adults in Saudi Arabia. Further work should be carried out to aid in establishing reference data for the Saudi population.
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Affiliation(s)
- Khalaf A. Alshamrani
- From the Department of Radiological sciences, Faculty of Applied Medical Science, and from Health Research Centre, Najran University, Najran, Kingdom of Saudi Arabia
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Shin S, Alqunaibet AM, Alsukait RF, Alruwaily A, Alfawaz RA, Algwizani A, Herbst CH, Shekar M, Finkelstein EA. A Randomized Controlled Study to Test Front-of-Pack (FOP) Nutrition Labels in the Kingdom of Saudi Arabia. Nutrients 2023; 15:2904. [PMID: 37447230 DOI: 10.3390/nu15132904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
One common strategy for governments to tackle the non-communicable disease (NCD) epidemic is front-of-package (FOP) nutrition labeling. The Kingdom of Saudi Arabia (KSA) is considering implementing a new FOP label that is based on either France's Nutri-Score (NS), which labels all foods (A = healthiest to E = least healthy) based on overall nutritional quality, or the Chilean warning label (WL) approach, which identifies foods to avoid based on select nutritional characteristics. Using a fully functional online grocery store, this study aimed to test these two promising FOP strategies by randomizing 656 KSA adults into one of the three versions of the store to complete a hypothetical grocery shop: no-label (control), NS, and WL. The NS was modified with a sugar percentage tag given that reducing sugar consumption is one of KSA's public health goals. We found that both modified NS labels and Chilean warning labels positively influenced food and beverage choices among KSA participants, but there were differential effects across the two labels. Relative to the control, NS improved the overall diet quality of the shopping baskets, measured by the weighted (by the number of servings) average NS point (ranging from 0, least healthy, to 55, healthiest), by 2.5 points [95% CI: 1.7, 3.4; p < 0.001], whereas results for WL were not statistically significant (0.6 points [95% CI: -0.2,1.5]). With respect to each nutritional attribute, we found that NS reduced sugar intake per serving, whereas WL was effective at decreasing energy and saturated fat intake per serving from food and beverages purchased. Our results suggest that the NS approach that identifies the healthiness of all foods using a holistic approach appears preferable if the purpose of the label is to improve overall diet quality as opposed to addressing select nutrients to avoid.
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Affiliation(s)
- Soye Shin
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | | | - Reem F Alsukait
- Department of Community Health Sciences, King Saud University, Riyadh 11362, Saudi Arabia
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC 20433, USA
| | | | | | | | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC 20433, USA
| | - Meera Shekar
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC 20433, USA
| | - Eric A Finkelstein
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
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Sugar Reduction Initiatives in the Eastern Mediterranean Region: A Systematic Review. Nutrients 2022; 15:nu15010055. [PMID: 36615712 PMCID: PMC9823488 DOI: 10.3390/nu15010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
This systematic review aims to identify and characterize existing national sugar reduction initiatives and strategies in the Eastern Mediterranean Region. For this purpose, a systematic review of published and grey literature was performed. A comprehensive list of search terms in the title/abstract/keyword fields was used to cover the four following concepts (1) sugar, (2) reduction OR intake, (3) policy and (4) EMR countries. A total of 162 peer-reviewed documents were identified, until the 2nd of August 2022. The key characteristics of the identified national strategies/initiatives included the average sugar intake of each country's population; sugar levels in food products/beverages; implementation strategies (taxation; elimination of subsidies; marketing regulation; reformulation; consumer education; labeling; interventions in public institution settings), as well as monitoring and evaluation of program impact. Twenty-one countries (95%) implemented at least one type of sugar reduction initiatives, the most common of which was consumer education (71%). The implemented fiscal policies included sugar subsidies' elimination (fourteen countries; 67%) and taxation (thirteen countries 62%). Thirteen countries (62%) have implemented interventions in public institution settings, compared to twelve and ten countries that implemented food product reformulation and marketing regulation initiatives, respectively. Food labeling was the least implemented sugar reduction initiative (nine countries). Monitoring activities were conducted by four countries only and impact evaluations were identified in only Iran and Kingdom of Saudi Arabia (KSA). Further action is needed to ensure that countries of the region strengthen their regulatory capacities and compliance monitoring of sugar reduction policy actions.
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Salem V, AlHusseini N, Abdul Razack HI, Naoum A, Sims OT, Alqahtani SA. Prevalence, risk factors, and interventions for obesity in Saudi Arabia: A systematic review. Obes Rev 2022; 23:e13448. [PMID: 35338558 PMCID: PMC9287009 DOI: 10.1111/obr.13448] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 12/12/2022]
Abstract
Saudi Arabia (SA) has a reported obesity prevalence greater than the global average. Here, we systematically review firstly the prevalence and associated factors (59 studies) and secondly the pharmacological, lifestyle, and surgical interventions for obesity (body mass index, >30 kg/m2 ) in SA (29 studies) between December 2020 and March 2021 in PubMed, Medline, Embase, PsycINFO, and Cochrane. Peer-reviewed articles in Arabic and English on human adults (aged >18 years) were searched. Among the eight largest studies with sample sizes over 10,000 people, the maximum-reported obesity prevalence was 35.6%, with notable variations in gender and geographic region. Diet, specifically the move towards Western diet and heavy consumption of sugary beverages, and high levels of inactivity are major contributing factors to obesity. The reported obesity-risk polymorphisms are not specific. Bariatric surgery is underrepresented, and in general, there is a lack of nationally coordinated studies on weight loss interventions. In particular, the systematic review did not find a body of research on psychological interventions. There is no trial data for the use of GLP-1 analogs in SA, despite their widespread use. These findings can help policymakers, and practitioners prioritize future research efforts to reduce obesity prevalence in SA.
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Affiliation(s)
- Victoria Salem
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Habeeb Ibrahim Abdul Razack
- College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | | | - Omar T Sims
- College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.,School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.,School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Saleh A Alqahtani
- Liver Transplant Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.,Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA
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13
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Al-Jawaldeh A, Jabbour J. Marketing of Food and Beverages to Children in the Eastern Mediterranean Region: A Situational Analysis of the Regulatory Framework. Front Nutr 2022; 9:868937. [PMID: 35662943 PMCID: PMC9158545 DOI: 10.3389/fnut.2022.868937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/26/2022] [Indexed: 12/12/2022] Open
Abstract
Marketing of food items high in added saturated and/or trans-fat, sugar, or sodium (HFSS) negatively affect consumption patterns of young children. The World Health Organization (WHO) advised countries to regulate the marketing of foods and non-alcoholic beverages to young populations. The aim of this manuscript is to provide a situational analysis of the regulatory framework of food marketing policies targeting children in the Eastern Mediterranean Region (EMR). A semi structured questionnaire was shared with the focal points of EMR member states inquiring about the reforms and monitoring initiatives in place. Electronic databases were searched for relevant publications between 2005 and 2021. Results revealed that even though 68% of countries discussed the recommendations, progress toward the WHO set goals has been slow with only 14% of countries implementing any kind of restrictions and none executing a comprehensive approach. Reforms have focused on local television and radio marketing and left out several loopholes related to marketing on the internet, mobile applications, and cross border marketing. Recent monitoring initiatives revealed a slight improvement in the content of advertised material. Yet, unhealthy products are the most promoted in the region. This review identified the need to intensify the efforts to legislate comprehensive food marketing policies within and across EMR countries.
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Affiliation(s)
- Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Jana Jabbour
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
- Department of Nutrition, School of Health Sciences, Modern University for Business and Sciences, Beirut, Lebanon
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14
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Al-Jawaldeh A, Taktouk M, Chatila A, Naalbandian S, Abdollahi Z, Ajlan B, Al Hamad N, Alkhalaf MM, Almamary S, Alobaid R, Alyafei SA, Azizi MH, Baqadir NM, Barham R, Binsunaid FF, El Ammari L, El Ati J, Hoteit M, Massad H, Nejad MS, Nasreddine L. A Systematic Review of Trans Fat Reduction Initiatives in the Eastern Mediterranean Region. Front Nutr 2021; 8:771492. [PMID: 34901118 PMCID: PMC8662545 DOI: 10.3389/fnut.2021.771492] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/27/2021] [Indexed: 12/04/2022] Open
Abstract
High intakes of trans fatty acids (TFA), particularly industrially-produced TFA, are implicated in the etiology of cardiovascular diseases, which represent the leading cause of mortality in the Eastern Mediterranean Region (EMR). This systematic review aims to document existing national TFA reduction strategies in the EMR, providing an overview of initiatives that are implemented by countries of the region, and tracking progress toward the elimination of industrially-produced TFA. A systematic review of published and gray literature was conducted using a predefined search strategy. A total of 136 peer-reviewed articles, gray literature documents, websites and references from country contacts were obtained, up until 2 August 2021. Randomized-control trials, case-control studies, and studies targeting unhealthy population groups were excluded. Only articles published after 1995, in English, Arabic or French, were included. Key characteristics of strategies were extracted and classified according to a pre-developed framework, which includes TFA intake assessment; determination of TFA levels in foods; strategic approach; implementation strategies (TFA bans/limits; consumer education, labeling, interventions in public institution settings, taxation), as well as monitoring and evaluation of program impact. Thirteen out of the 22 countries of the EMR (59%) have estimated TFA intake levels, 9 have determined TFA levels in foods (41%), and 14 (63.6%) have national TFA reduction initiatives. These initiatives were mainly led by governments, or by national multi-sectoral committees. The most common TFA reduction initiatives were based on TFA limits or bans (14/14 countries), with a mandatory approach being adopted by 8 countries (Bahrain, Iran, Jordan, KSA, Kuwait, Morocco, Oman and Palestine). Complementary approaches were implemented in several countries, including consumer education (10/14), food labeling (9/14) and interventions in specific settings (7/14). Monitoring activities were conducted by few countries (5/14), and impact evaluations were identified in only Iran and the UAE. The robustness of the studies, in terms of methodology and quality of assessment, as well as the lack of sufficient data in the EMR, remain a limitation that needs to be highlighted. Further action is needed to initiate TFA reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluation of ongoing programs.
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Affiliation(s)
- Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo, Egypt
| | - Mandy Taktouk
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Aya Chatila
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Sally Naalbandian
- Science and Agriculture Library, American University of Beirut, Beirut, Lebanon
| | - Zahra Abdollahi
- Nutrition Department, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Nawal Al Hamad
- The Public Authority for Food and Nutrition, Kuwait City, Kuwait
| | - Majid M. Alkhalaf
- National Nutrition Committee, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | | | - Rawan Alobaid
- Senior Regulations and Standards, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Salah Abdulla Alyafei
- Health Promotion and Non Communicable Disease (NCD) Division, Public Health Department, Ministry of Public Health, Doha, Qatar
| | - Mohammad Hosein Azizi
- Food and Beverage Office, Iran Food and Drug Administration (IFDA), Ministry of Health and Education, Tehran, Iran
| | - Nimah M. Baqadir
- National Nutrition Committee, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | | | - Faisal F. Binsunaid
- Healthy Food Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | | | - Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, Tunis, Tunisia
| | - Maha Hoteit
- PHENOL Research Group (Public Health Nutrition Program-Lebanon), Faculty of Public Health, Lebanon University, Beirut, Lebanon
| | - Hanan Massad
- Nutrition Department, Ministry of Health, Amman, Jordan
| | | | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
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15
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Analysis of Fat Content with Special Emphasis on Trans Isomers in Frequently Consumed Food Products in Egypt: The First Steps in the Trans Fatty Acid Elimination Roadmap. Nutrients 2021; 13:nu13093087. [PMID: 34578964 PMCID: PMC8470785 DOI: 10.3390/nu13093087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Trans Fatty Acid (TFA) intake is a risk factor for coronary heart diseases and cancer. Egypt, considered among the highest TFA consumers in the world, lacks proper dietary analysis of TFAs. This cross-sectional study aimed to analyze TFAs in traditional and frequently consumed food products. A market survey was conducted to identify products and brands that are mostly consumed in major governorates in Egypt. Laboratory analysis allowed for the profiling of TFAs, and saturated and unsaturated fatty acids. Products having more than 2 g of TFA/100 g of fat were considered to have an elevated TFA content. Commonly consumed food items (n = 208) in the Egyptian market were identified. On average, 34% of the products exceeded the TFA limit. Sambosk meat, a traditional meat item, had the highest TFA content of 5.2%, followed by foods fried with used oils. Oriental sweets had a TFA content three times higher than that of doughnuts. The fast-food group had the largest proportion of TFA-rich products, followed by the canned and frozen item groups and confectionaries. This study revealed that around one third of products in the Egyptian market have a high TFA content. This calls for urgent legislative action to regulate composition.
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