Adherence to the Mediterranean diet in two Moroccan populations living at different distances from the Mediterranean Sea

Background

There is growing strong scientific evidence over the past few decades that the Mediterranean diet (MD) has protective effects on cardiometabolic health.

Objective

This study aimed to assess MD adherence and its association with sociodemographic and lifestyle factors among women living in two Moroccan provinces, El Jadida and Tetouan, located at different distances from the Mediterranean Sea.

Material and methods

It is a cross-sectional study involved 355 subjects of which 55.8% reside in the province of El Jadida, and data on socio-demographic characteristics, lifestyle, cardiovascular risks, medical history and of food frequency consumption were collected. Compliance with the MD was assessed with a simplified MD adherence score based on the weekly frequency of consumption of eight food groups.

Results

The overall mean Simplified Mediterranean Diet Score was 4.37 ± 1.47 with inadequate compliance in 55.2% of the sample. No significant association was found between adherence to MD and geographic, socio-demographic, lifestyle or the major cardiovascular risk factors. However, the participants do not comply with half of the recommendations based on the Mediterranean diet pyramid. The lowest level of compliance was observed for olive oil, followed by sweets, eggs, potatoes, fruits, red meat, vegetables, legumes, olives, nuts and seeds. The increased contribution of sugars, dairy products and meat to the overall food intake is significant in the category with high adherence to MD.

Conclusion

The study data indicate that Mediterranean Diet is far from being a global pattern in this Moroccan population. The study draws attention to the need for a promoting intervention to maintain this pattern as the original diet in the region.

Food purchasing habits at traditional and modern markets and consumption of natural and processed foods in Moroccan households

Background

The locations of food purchase have an impact on the quality of food consumed.

Objective

To examine food purchasing habits at traditional and modern markets, their associated factors, and their effects on consuming natural and processed foods.

Material and methods

This work used a validated conceptual and methodological framework of a study conducted among 507 households in the Rabat-Salé-Kenitra region in Morocco. Data on sociodemographic and economic characteristics and the frequency of food purchasing were collected from household representatives through a population survey. The food frequency questionnaire was used to collect frequency of consumption of 20 foods, including 10 natural and 10 processed. The associations between the variables were studied by the Chi-square test with a level of significance of p <0.05.

Results

Among the households 70% were urban, 62% have nuclear families, 51.5% a size of 5 to 12 members, 41% middle standard of living, 87% frequented markets and souks (MS), and 19% frequented large and medium-sized stores (LMS) at least once a week. The households have in majority a frequency of natural foods consumption ≥ 3 times/week, including fresh vegetables (91%), olive oil (85%), and fresh fruit (84%); and processed foods, such as refined flours (68%), industrial cheese (65%) and industrial yoghurt (52%). MS and LMS frequentation were associated with environment (p<0.001), family type (p=0.01 and p=0.002, respectively), household size (p=0.04 and p=0.002 respectively) and standard of living (p<0.001). Foods whose consumption was associated with both MS and LMS frequentation included fresh vegetables (p<0.001) as natural foods and baked goods as processed foods (respectively, p=0.01 and p=0.04).

Conclusion

The results of this study argue for implementing a nutrition education strategy based on the choice of food purchase locations as well as the consumption of natural or processed foods as part of a sustainable Mediterranean diet.

Meal intake in an adult Moroccan population: determinants and implications for weight status

Background

In recent decades, the Moroccan population has changed its dietary practices, particularly those related to meal-taking. It is about irregular meal schedules, reduced frequency and shorter time of meal taking times, as well as a decrease in family meal-taking. All these factors are likely to influence its nutritional status.

Objective

The aim is to study meal-taking practices, their determinants and their implications on weight status. In this study, meal-taking practices are defined by the regularity of the schedule, the frequency and the duration of the meals as well as the family commensality.

Material and Methods

This work data are part of a study conducted among 507 households in the region of Rabat-SaléKenitra in Morocco, with a validated conceptual and methodological framework. The questionnaire was completed with one member of each household and the body mass index (BMI) was determined by an impedance meter.

Results

The main results indicate that the majority of the surveyed population was aged 35 years (59%), female (52%), urban (70%), with a BMI ≥25 kg/m2 (51%), took usually three meals a day (89%), spent less than 90 minutes a day in meals and snacks (60%), had irregular meal schedule (69%), and usually eat at least two meals or snacks a day with family (49%). The univariate analysis showed that urban area was a factor favoring variations of meal times, the male sex was a factor favoring three meals a day, the level of higher education was a factor penalizing the daily duration of meals, and that marital status "married" was a factor favoring family commensality. In addition, variable meal times were revealed as a factor contributing to overweight/obesity, and meal times ≥90 min were revealed as a protective factor of overweight/obesity.

Conclusion

The study identified factors associated with meal times, frequency and duration. The results obtained will serve as a basis for the development of educational actions for a change in behavior conducive to health.

Dietary behavior of pregnant women in the province of El Jadida and impact of low birth weight on the anthropometric status of newborns. Case-control study

Background

Low birth weight (LBW) is a major health problem responsible for neonatal mortality and morbidity such as diabetes, obesity and cardiovascular disease in adulthood.

Objective

This case-control study aims to compare data on the intake of energy, macro and micronutrient in two groups of pregnant women, who gave birth to low birth weight (LBW) babies named cases and those who gave birth to babies of normal weight (NW) called controls.

Material and methods

The collection of information was done using an established questionnaire for 400 pregnant women, allowing the collection of data on socio-demographic and obstetrical factors. Nutritional intake was obtained by recording food consumption using the 24-hour recall method. Anthropometric measurements of parturient and fundal height (FH) were measured before delivery.

Results

The mean FH of the cases was 25.69±0.13 and that of the controls was 31.83±0.06. The gestational age of the cases was on average 31.65±0.21 week of amenorrhea (WA) against 38.04±0.08 WA for the controls. 37% of LBW newborns had an Apgar score < 7 (p< 0.001) and 71% were hospitalized in neonatal intensive care (p<0.001). Micronutrient deficiency was raised and concerned calcium 34.02% vs 60.65%, folates 48.32% vs 68.01% and iron 50.85% vs 66% in cases and controls respectively. Newborns from NW had a weight of 3395.5±15.99 against 1957.25±30.72 for those from LBW.

Conclusion

This study shows that the nutritional intake did not cover all the nutrient needs of the pregnant women studied and that newborns with LBW are associated with an altered anthropometric status. Improving the living conditions of mothers, good monitoring of pregnancy, and good nutritional education can significantly improve the nutritional status with the same food intake and should be integrated into the nutritional intervention strategies.

Assessment of diet quality in children and adolescents with type 1 diabetes

Background

Micronutrient malnutrition is a serious public health problem in most developing countries, including Morocco, due to poor and therefore lower quality diets that lack dietary diversity.

Objective

The present study aimed to assess dietary diversity and variety and their relationship with micronutrient adequacy in children and adolescents with type 1 diabetes (T1D).

Materials and methods

A cross-sectional study was carried among 240 children and adolescents with T1D. Weight and height were measured and BMI was calculated. Dietary intake data were obtained from two 24-h recalls. A Dietary diversity (DDS) and dietary variety scores (DVS) and mean adequacy ratio (MAR) and nutritional adequacy ratios (NARs) were calculated and compared according to sociodemographic/anthropometric categories.

Results

52.1% of the patients were female. The mean age of the patients was 8.49 ± 4.1 years. The mean BMI was 19.44 ± 5.24 kg/m2; the mean DDS was 4.62±1.20 and the mean MAR was 0.66 ± 0.11. Older children living in rural areas have a low DDS/DVS. Parental education and income level are associated with DDS/DVS. General and central obesity were significantly elevated in children with high DDS. In addition, a high intake of vegetables, eggs, fiber and micronutrients (Magnesium, Calcium, Potassium, Zinc, Phosphorus and Vit B1) is associated with a high DDS; however, high DVS is associated with high consumption of dairy products, carbohydrates and low intake of protein and fat. There are also positive correlations between DDS/DVS and NARs for various nutrients.

Conclusion

The quality of the respondents' diets are moderately diversified. DDS or DVS can be used as indicators of micronutrient adequacy in Moroccan T1D children. Nutritional education needs to be strengthened to improve dietary diversity in children, especially in rural areas.

Food quality and nutritional status of school-going adolescents in the province of El Jadida in Morocco

Background

Dietary diversity and variety scores represent tools for measuring the overall quality of diets. In children, they are good indicators of their nutritional status and growth.

Objective

The aim of this study was to assess the consumption and eating habits as well as the lifestyle of Moroccan adolescents attending school in the city of El Jadida.

Material and methods

A sample of 463 children of both sexes, aged 9 to 17, attending four schools in the city of El Jadida was studied. Eating habits and information on socioeconomic level are assessed using questionnaires and weight and height were measured on participants.

Results

According to the dietary diversity score (DDS) classes, 2.4% of the children surveyed were with low DDS, 55.7% moderate and 41.9%, with high DDS. The mean DDS was 5.67 ± 1.03 in underweight children and 5.53 ± 1.5 in those with overweight (obesity included) and the food variety scores (DVS) were of 12.94±3.24 food items and 10.81±3.25 in the 2 groups respectively. In addition, data analyzes show that children from parents with a low level of education had higher averages of DDS and DVS (DDS: 5.54 ± 0.84; SVA: 10.65 ± 2.32) compared to those of parents with medium education level (DDS: 5.31±0.96; DVS: 9.72±2.62) or high level (DDS: 5.17±0.93; DVS: 9.36 ±2.42). In addition, children from parents of high economic level had a lower averages of DDS and DVS (DDS: 5.24 ± 0.88; DVS: 8.84 ± 2.10) compared to those of parents of low economic level (DDS: 5.36±1.00; DVS: 10.14±2.85). The sugary products were consumed by 56.3% of underweiht children, 75% of normal-weight children and 67% of overweight children (including obese). The estimated total energy intake (TEI) was higher than the Recommended Daily Allowances (RDA) in underweight 2933 Kcal/d and in overweight (including obese) children 3061.75 Kcal/d, while the mean daily intakes of folate, calcium, iron, potassium and zinc were lower than the (RDA). The food groups consumed by the majority of children were cereals (98.5%), fruits and vegetables (87.7%), and sweet products (69.8%) while oilseed products and fat were less consumed (9.7% and 7.8% respectively).

Conclusion

The study data show that the adolescents diet were moderately diverse, little varied and poor in certain nutrients essential for their nutritional status and growth. The study draws attention to the need for parents to be aware of the benefits of improving the diet quality and weight status of adolescents.

Mediterranean diet pyramid of an adult Moroccan population: comparison with the recommendations of the updated Mediterranean diet pyramid

One of the illustrations selected for the presentation of the nutritional recommendations of the Mediterranean diet (DM) is the food pyramid (FP). The aim of this work was to design a food pyramid illustrating the dietary pattern of an adult Moroccan population and compare it to the recommendations of the Mediterranean diet pyramid (MDP) updated in 2020 by a group of experts. The study was carried out over the period of 2018 to 2022, on 507 adults from the Rabat-Salé-Kenitra region in Morocco. Socio-demographic data, usability, and toxic habits were collected using a questionnaire. Physical activity was assessed by the Marshal questionnaire. Food intake and food diversity have been determined by food history and food variety by food frequency questionnaires. The majority of the study population was over 34 years old (59%), resides in urban areas (70%), of which women (52%), sufficiently active (57%) and without any toxic habits (99.9%). A proportion of 31% still participate in meal preparation within the household, and 48.9% have at least two meals with the family daily. The population’s energy and protein intakes are higher (p<0.001) while their dietary fiber and water intakes are lower than the recommended intakes (p<0.001). The FP constructed according to the population’s food consumption comprises, from the bottom to the top, 1) water, 2) cereals and starchy foods, 3) sugars and sweet products, 4) fruits and vegetables, 5) dairy products, 6) olive oil, and 7) pulses, dried fruits, red meat, fish, chicken, eggs, and olives. The hierarchy and frequency of the consumption of certain foods and food groups differ from the recommendations of the updated MDP, reflecting a shift from sustainable diet.

Weight status and its determinants among Moroccan adolescents in the province of El Jadida

Background

Despite the efforts of health systems, the prevalence of malnutrition reflected by weight status still poses challenges for many countries around the world. In fact, with the decrease in undernutrition, excess weight and obesity are gradually increasing in parallel with that of chronic diseases. Among school-going adolescents, however, weight status is less studied, particularly in developing countries.

Objective

The objective of this research is to examine the situation and the determinants of the weight status of adolescents in the province of El Jadida in Morocco.

Material and methods

The study was carried out on a sample of 463 students from the province of El Jadida of which 58.1% are boys and 41.9% girls, ages 9 and 17. Nutritional status was assessed by anthropometric measurements including height, weight and waist and hip circumference. Body mass index (BMI) was calculated to determine underweight, overweight and general obesity and waist circumference and the waist circumference to hip circumference ratio were used to determine abdominal obesity.

Results

The results indicate that only 59.6% of students had normal weight status, 40.4% had abnormal BMI values corresponding to thinness in 18.8% and overweight (overweight and obesity) in 21.6%. A significant difference in the prevalence of abnormal weight status by sex and level of physical activity was found. The results of the present study reveal an abnormal weight status in a large proportion of adolescents linked in addition to the peculiarities of the puberty phase to the sedentary lifestyle in the study population.

Conclusions

The results obtained revealed the coexistence of over-nutrition and undernutrition which require a prevention policy based on regular monitoring of weight status as well as on nutritional education and the promotion of physical activity for children and parents.

Study of the association of the nutritional profile of pregnant women with the birth weight of newborns in Morocco

Background

Low birth weight (LBW) is an important predictor of neonatal morbidity and mortality. It reflects the nutritional status of the mother and the quality of health care services during pregnancy.

Objective

The objective of this study is to determine the factors associated with low birth weight of children born to Moroccan pregnant women in the province of El Jadida.

Material and Methods

This cross-sectional case-control study was carried out in the maternity ward of El Jadida provincial hospital on 344 parturient women, half of whom had given birth to children with an LBW and the other half of children with normal weight (NW) at birth. Information on maternal gestational and socioeconomic characteristics as well as eating habits was collected using a questionnaire and anthropometric measurements were taken on the newborns.

Results

The study identified 172 parturient who gave birth to newborns with LBW and 172 parturient who gave birth to newborns of NW. The proportions of LBW are greater in first-time mothers (50.6%) and professionally inactive (86.6%). The mean weight of LBW newborns is 2013.95 ± 372.95g compared to 3380 ± 217.59g for NW newborns. The determined factors associated with LBW are the low socio-economic level (OR = 3.18; 95% CI: 1.09-9.23), insufficient monitoring of prenatal consultation (OR = 2.91; 95% CI: 1, 71-4.95), origin from rural areas (OR = 0.52; 95% CI: 0.30-0.91) and lack of nutritional education (OR = 0.17; 95% CI: 0, 09-0.34). The daily calcium intake in mothers of newborns with LBW is 33.82% of the recommended daily allowance (RDA), the daily iron requirement coverage was 50%, folates 66, 16% and zinc 87.72% of the RDA.

Conclusions

Well-targeted and coordinated education and awareness-raising actions on early pregnancy and feeding pregnant women could have a positive impact on improving the birth rate of children with a weight deficit.

Nutritional status of Moroccan pregnant women and the birth weight of their newborn: a case-control study in the province of El Jadida

<abstract><sec> <title>Background</title> <p>Maternal malnutrition is a global concern whose consequences for newborns are intrauterine growth retardation, fetal hypotrophy and exposure to risks of pathologies in adulthood.</p> </sec><sec> <title>Objective</title> <p>The aim of this study was to assess and compare the diet quality and nutritional status of pregnant women at the time of childbirth while assessing their newborn's weight at birth.</p> </sec><sec> <title>Materials and methods</title> <p>The study involved 400 parturient, divided into two groups of 200 each, the controls who have just given birth to newborns of normal weight and the cases who have just given birth to babies of low birth weight (LBW). Information on food intakes and dietary habits were collected using questionnaires and anthropometric parameters were measured.</p> </sec><sec> <title>Results</title> <p>The mean body mass index (BMI) of the cases was 25.93 ± 2.64 kg/m² vs. 28.25 ± 2.75 kg/m² in the controls. The dietary diversity and variety scores were higher in the controls than in the cases. Indeed means were 6.87 ± 1.30 vs. 8.88 ± 1.35 food groups for the diversity scores and 11.77 ± 1.57 vs. 15.90 ± 2.09 food items for the variety scores in the cases and the controls respectively. The average daily intakes of folates, calcium, iron and zinc were lower than the Recommended Daily Allowances (RDA) for both groups. The daily calcium intake represents only 1/5th of the RDI for the cases and 1/3 for the controls. Average dietary iron intake was insufficient at only 49% of the daily requirement for cases vs. 66.88% for controls while folates accounts for 64.33% of the RDA for the cases.</p> </sec><sec> <title>Conclusion</title> <p>Data from this study shows that the diets of women who have given birth to low birth weight infants are poorly diversified, poorly varied, and poor in certain nutrients essential for a successful pregnancy and childbirth.</p> </sec></abstract>