Obesity and diet-related conditions such as diabetes, hypertension, and cardiovascular diseases are on the increase in the MENA region among the general population [ 3 ] . Child obesity, an increasing global concern, is thought to be associated with genetic, socioeconomic, and environmental factors [ 30 ] . Abundant energy and fat intake, lack of physical activity, and urbanization have been reported as the top three factors associated with overweight and obesity in the region’s children and adoles- cents [ 30, 31 ] . A study published in the Eastern Mediterranean Health Journal (EMHJ) stated that the obesity rates among preschool children, school children, and adolescents in the region were 9%, 25%, and 45%, respectively; these alarming rates call for an immediate national and regional response tar- geting obesity in schools, and at the family unit level through nutrition education targeted at children and their caretakers [ 32 ] . Unlike in more developed regions of the world, obesity rates are higher among boys belonging to families of higher socioeconomic status (SES) whose parents have advanced levels of education [ 33, 34 ] . In fact, these fi ndings concur with another study’s outcomes that com- pared the relation between SES and obesity in highly developed versus developing countries; results illustrated a negative association (lower SES associated with larger body size) in highly developed countries and a positive association between SES and obesity in developing countries [ 35 ] . KSA, UAE, and Bahrain preschool and school age children obesity rates are among the highest in the world [ 32, 34, 36 ] . This stresses the importance of early detection of obesity and overweight as data show that detecting obesity in childhood by focusing on children with above-average waist circumference can lead to early intervention which protects them from developing high blood pressure and other signs of the metabolic syndrome (MS) 1 as adolescents [ 37– 39 ] ; note that MS is much higher in obese subjects than normal weight children [ 39 ] . Intervening at a young age also saves healthcare costs; a study conducted in Israel reported that obese children had more doctor visits, got hospitalized more, and used more medication than normal weight counterparts [ 39 ] . Therefore, reducing the risk for chronic diseases and lessening the load of a costly health bill are two key motives for MENA coun- tries to combat obesity. The Arab Taskforce for Obesity and Physical Activity, based in Bahrain, prepared a 5-year strategy for combating obesity and promoting physical activity in the Arab coun- tries which constitute the majority of MENA. This strategy states that action is needed in several areas. First, it addresses schools as a place for children’s education about healthy eating; second, it focuses on primary-care health clinics as centers for detecting overweight and obesity in children through regular measurement and weighing for immediate intervention; it addresses also food prepa- ration through institutions where food is served by promoting healthier cooking methods [ 40 ] .
Conclusion
The Middle East and North Africa region has the 2nd highest mean Body Mass Index (BMI) after North America and the 2nd highest mean waist-to-hip ratio after South America [ 40 ] . These two mea- sures demonstrate that the state of overweight and obesity has reached an alarming level in this part of the world [ 32 ] . On the other hand, high levels of acute and chronic malnutrition in addition to widespread micronutrient de fi ciency are still persistent in certain countries of the MENA [ 3 ] . Epidemiological and experimental research has shown that there is a causal relationship between
1 Metabolic Syndrome (MS): a syndrome marked by the presence of usually three or more of a group of factors (such as
high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to an increased risk of cardiovascular disease and type 2 diabetes—called also insulin resistance syndrome and syndrome X.
stunting (chronic malnutrition) and overweight in children [ 6 ] . Knowing that, public health agencies should tackle the multidimensional causes of malnutrition and promote healthy eating patterns and physical activity among children of the MENA countries. Incorporating well-being programs into overall health and development efforts of governments will guarantee an optimal health of its youngest and most vulnerable inhabitants [ 1 ] .
Due to the cultural, political, and socioeconomic disparities within the region, MENA is one of the most researched and least understood regions in the world [ 1 ] . The complex picture of infant and child nutrition with the superimposition of both de fi ciency on one hand and excess on the other pose a chal- lenge for policy makers and healthcare planners in setting feasible policies and programs for improving nutrition of this vulnerable group. It would be pertinent, however, to encourage few simple measures such as the following: First, pregnant women need to be educated about the great protective value of breastfeeding at their antenatal visits; informing them about the importance of EBF during the fi rst 6 months and the continuity until 1–2 years of the child’s age is imperative [ 21 ] ; second, managing overweight and obesity in preschool and school children through promoting healthy eating and physi- cal activity has the potential of slowing down the rise in childhood obesity and its negative conse- quences while contributing to the decrease in healthcare costs [ 39– 41 ] ; and fi nally, combatting undernutrition through well-planned economic and nutritional programs will contribute to the decrease of the unacceptably high rates of child morbidity and mortality in large swaths of the region [ 25 ] .
References
1. Galal O. Child feeding patterns in the Middle East. Saudi J Gastroenterol. 1995;1(3):138–44.
2. The World Bank. (2011). Middle East & North Africa: regional brief. http://web.worldbank.org/WBSITE/
EXTERNAL/COUNTRIES/MENAEXT/0, menuPK:247606~pagePK:146732~piPK:146828~theSitePK:256299,00.
html . Accessed on 12 June 2011.
Table 5.1 Life expectancy and under fi ve mortality rate across the region in 2009 based on data from the World Bank [ 42, 43 ]
Country
Life expectancy at birth (in years)
Under fi ve mortality rate (per 1,000 live births)
Algeria 73 32
Bahrain 76 12
Djibouti 56 94
Egypt 70 21
Iran 72 31
Iraq 68 44
Israel 82 4
Jordan 73 25
Kuwait 78 10
Lebanon 72 12
Libya 75 19
Morocco 72 38
Oman 76 12
Palestinian Territories 74 30
Qatar 76 11
Saudi Arabia 73 21
Syria 74 16
Tunisia 74 21
Turkey 72 20
United Arab Emirates 78 7
Yemen 63 66
3. World Health Organization. (2011). Nutrition situation in the Eastern Mediterranean region http://www.emro.who.
int/nutrition/nutrition_emr.htm . Accessed on 12 June 2011.
4. Middle East and North Africa Nutrition Association. (2008). Countries & institutions. http://www.menana.net/
Countries.html . Accessed on 12 June 2011.
5. UNICEF. (2007). Progress for children: a world for children statistical review (number 6). http:// www.unicef.org/
progressforchildren/2007n6 . Accessed on 12 June 2011
6. El-Taguri A, Besmar F, Abdel Monem A, Betilmal I, Ricour C, Rolland-Cachera MF. Stunting is a major risk factor for overweight: results from national surveys in 5 Arab countries. East Mediterr Health J. 2009;15(3):549–62.
7. Galal O. Nutrition-related health patterns in the Middle East. Asia Pac J Clin Nutr. 2003;12(3):337–43.
8. World Health Organization. (2010). Nutrition Landscape Information System (NLIS) country pro fi le indicators:
interpretation guide. http://www.who.int/nutrition/nlis/en . Accessed on 12 June 2011.
9. De Onis M, Blossner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children.
Am J Clin Nutr. 2010;92:1257–64.
10. Berger-Achituv S, Shohat T, Garty BZ. Breast-feeding patterns in Central Israel. Isr J Med Assoc. 2005;7:515–9.
11. World health Organization. (2009). 10 facts on breastfeeding. http://www.who.int/features/fact fi les/breastfeeding/
en/index.html . Accessed on 12 June 2011
12. Falahzadeh H, Rezvanian Z, Golestan M, Ghasemian Z. Breast-feeding history and overweight in 11 to 13-year-old children in Iran. World J Pediatr. 2009;5(1):36–41.
13. Batal M, Boulghaurjian C, Abdallah A, A fi fi R. Breast-feeding and feeding practices of infants in a developing country: a national survey in Lebanon. Public Health Nutr. 2005;13:860–8.
14. Koosha A, Hashemifesharaki R, Mousavinasab N. Breast-feeding patterns and factors determining exclusive breast-feeding. Singapore Med J. 2008;49(12):1002–6.
15. Shiva F, Nasiri M. A study of feeding patterns in young infants. J Trop Pediatr. 2003;49(2):89–92.
16. Al-Jassir M, El-Bashir B, Moizuddin SK. Surveillance of infant feeding practices in Riyadh city. Ann Saudi Med.
2004;24(2):136–40.
17. Batal M, Boulghaurjian C. Breastfeeding initiation and duration in Lebanon: are the hospitals “mother friendly”?
J Pediatr Nurs. 2005;20(1):53–9.
18. Al-Zubairi LM, Raja’a YA, Al-Saidi IA. Effect of breastfeeding on growth in Yemeni infants. Saudi Med J.
2007;28(11):1715–7.
19. Yesiltal N, et al. Breastfeeding practices in Duzce, Turkey. J Hum Lact. 2008;24(4):393–400.
20. Sharief MN, Margolis S, Townsend T. Breastfeeding patterns in Fujairah, United Arab Emirates. J Trop Pediatr.
2001;47:304–7.
21. Ergin F, Okyay P, Atasoylu G, Beşer E. Nutritional status and risk factors of chronic malnutrition in children under fi ve years of age in Aydın, a Western city of Turkey. Turk J Pediatr. 2007;49:283–9.
22. El-Mouzan MI, Al-Omar AA, Al-Salloum AA, Al-herbish AS, Qurachi MM. Trends in infant feeding in Saudi Arabia: compliance with WHO recommendations. Ann Saudi Med. 2009;29(1):20–3.
23. Alasfour D, Mohammed AJ. Implications of the use of the new WHO growth charts on the interpretation of malnutrition and obesity in infants and young children in Oman. La Revue de Santé de la Mediterranee Orientale.
2009;15(4):890–8.
24. Radi S, Abou Murad T, Papandreou C. Nutritional status of Palestinian children attending primary health care centers in Gaza. Indian J Pediatr. 2009;76:163–6.
25. El-Taguri A, Brtilmal I, Mahmud SM, Ahmed AM, Goulet O, Galan P, et al. Risk factors for stunting among under- fi ves in Libya. Public Health Nutr. 2008;12(8):1141–9.
26. El-Mouzan MI, Foster PJ, Al Herbish AS, Al Salloum AA, Al Omar AA, Qurachi MM. Prevalence of malnutrition in Saudi children: a community-based study. Ann Saudi Med. 2010;30(5):381–5.
27. Khatab K. Childhood malnutrition in Egypt using geoadditive Gaussian and latent variable models. Am J Trop Med Hyg. 2010;82(4):653–63.
28. Khatib I, Elmadfa E. Poor nutritional health of Bedouin preschool children in Jordan: the irony of urbanization.
Ann Nutr Metab. 2009;54:301–9.
29. Malekafzali H, Abdollahi Z, Ma fi A, Naghavi M. Community-based nutritional intervention for reducing malnutrition among children under 5 years of age in the Islamic Republic of Iran. East Mediterr Health J. 2000;6(2–3):238–45.
30. Al-Otheiman AL, Al-Nozha M, Osman K. Obesity: an emerging problem in Saudi Arabia. Analysis of data from the National Nutritional Survey. East Mediterr Health J. 2007;13(2):441–8.
31. Hwalla N, Sibai A, Adra N. Adolescent obesity and physical activity. World Rev Nutr Diet. 2005;94:42–50.
32. Musaiger AO. Overweight and obesity in the Eastern Mediterranean Region: can we control it? East Mediterr Health J. 2004;10(6):789–93.
33. Nasreddine L, Sibai AM, Mrayati M, Adra N, Hwalla N. Adolescent obesity in Syria: prevalence and associated factors. Child Care Health Dev. 2009;36(3):404–13.
34. Al-Dossary SS, Sarkis PE, Hassan A, Ezz El Regal M, Fouda AE. Obesity in Saudi children: a dangerous reality.
East Mediterr Health J. 2010;16(9):1003–8.
35. McLaren L. Socioeconomic status and obesity. Epidemiol Rev. 2007;29(1):29–48.
36. Al- Haddad F, Little BB, Abdul Ghafour AG. Childhood obesity in United Arab Emirates schoolchildren: a national study. Ann Hum Biol. 2005;32(1):72–9.
37. Medline Plus. (2010). Medical Dictionary. http://www.nlm.nih.gov/medlineplus/mplusdictionary.html . Accessed on 10 July 2011.
38. Al-Sendi AM, Shetty P, Musaiger AO, Myatt M. Relationship between body composition and blood pressure in Bahraini adolescents. Br J Nutr. 2003;90:837–44.
39. Hering E, Pritsker I, Gonchar L, Pillar G. Obesity in children is associated with increased health care use. Clin Pediatr. 2009;48:812–8.
40. Musaiger AO, Al-Hazzaa MA, Al-Qahtany A, Elati J, Ramadan J, AboulElla NA, et al. Strategy to combat obesity and to promote physical activity in Arab countries. Diabetes, Metab Syndr Obes. 2011;4:89–97.
41. Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case–control study. Lancet. 2005;366:1540–649.
42. The World Bank. (2010). Mortality rate—under 5 (per 1000). http://data.worldbank.org/indicator/SH.DYN.
MORT/countries/DZ-XQ-XT . Accessed on 13 June 2011.
43. The World Bank. (2010). Countries and Economies. http://data.worldbank.org/country?display=graph . Accessed on 12 June 2011
75 R.R. Watson et al. (eds.), Nutrition in Infancy: Volume 1, Nutrition and Health,
DOI 10.1007/978-1-62703-224-7_6, © Springer Science+Business Media New York 2013 P. O. Uvere, Ph.D. (*)
Department of Food Science and Technology , University of Nigeria , Nsukka 410001 , Nigeria e-mail: [email protected]
H. N. Ene-Obong
Department of Biochemistry (Nutrition Unit) , University of Calabar, Calabar , Nigeria e-mail: [email protected]
Key Points
The emphasis on complementary feeding over the years is a re fl ection of the advantages that adequate
•
feeding within the 6–23 month window of life confers on the overall development of the child and the larger community.
This attention on infant feeding dates back to prehistoric times and explains why a lot of development
•
has taken place in the complementary food world.
These developments have not trickled down to the rural and urban poor in much of the developing
•
world in order to improve the locally available complementary foods for infants.
This chapter therefore considers developing world complementary foods, their processing and how
•
the nutritional quality and feeding practices may be improved in addition to some strategies to dis- seminate the new technologies to the rural and urban poor.
Keywords Developing countries • Infants • Local complementary foods • Improvement • Technology dissemination