BackgroundIn a context of nutrition transition and major shifts in lifestyle and diet, the Middle East and North Africa features a marked gender excess adiposity gap detrimental to women. In this setting, where gender issues are especially acute, we investigated gender differences in dietary intake with a focus on diet quality, and how the differences varied with the area of residence and socio-demographic characteristics.MethodsThe study was conducted in 2009–2010 in the Greater Tunis region (Tunisia), as a case study of an advanced nutrition transition context in the region. A cross-sectional survey used a random, stratified, clustered sample of households: 1689 women and 930 men aged 20–49 years were analyzed. Dietary intake was assessed using a 3-day food record. Nutrient content was derived from a specific Tunisian food composition database. We analysed the Diet Quality Index-International (DQI-I) and sub-scores (variety, adequacy, moderation and balance). A score of DQI-I > 60 defined good diet quality. Inequality measures were women vs. men differences in means for interval variables and odds-ratios (OR) for DQI-I > 60. Their variation with socio-demographic characteristics was estimated using models featuring gender x covariate interactions.ResultsMean energy intake/day was 2300 ± 15 kcal for women vs. 2859 ± 32 kcal for men. By 1000 g/kcal/d women consumed more fruits and sweets but less red meat and soft drinks than men. Women had a higher mean moderation sub-score than men (+ 1.8[1.4, 2.2], P < 0.0001) but lower variety (− 2.0[− 2.3, − 1.6], P < 0.0001) and adequacy (− 1.8[− 2.0, − 1.5], P < 0.0001). Thus, the overall mean DQI-I was lower among women than men (58.6 ± 0.3 vs. 60.4 ± 0.3, − 1.8[− 2.6, − 1.0], P < 0.0001) as was the proportion of DQI-I > 60 (45.2% vs. 55.7%, OR = 0.7[0.5, 0.8], P < 0.0001). Adjusted gender differences in DQI-I decreased with age but were higher in larger households and extreme categories of education (no-schooling and university) vs. the middle categories.ConclusionIn this nutrition transition context with only average diet quality, it was somewhat lower for women. Socioeconomic patterning of gender contrasts was mild. Beyond, that women had lower adequacy and variety scores but better moderation is a possible pathway for gender specific prevention messages.Electronic supplementary materialThe online version of this article (10.1186/s12937-019-0442-6) contains supplementary material, which is available to authorized users.

Objective: The nutrition transition has exacerbated the gender gap in health in the Middle East and North Africa region as the increase in excess adiposity has been much higher among women than men. This is not exclusive of the persistence of anaemia, generally also more prevalent among women. We assessed the magnitude and sociodemographic factors associated with gender inequality vis-à-vis the double burden of excess adiposity and anaemia. Design: Cross-sectional study, stratified two-stage cluster sample. BMI (= weight/ height 2 ) ≥25·0 kg/m 2 defined overweight and BMI ≥ 30·0 kg/m 2 obesity. Anaemia was defined as Hb <120 g/l for women, <130 g/l for men. Gender inequalities vis-à-vis the within-subject coexistence of excess adiposity and anaemia were assessed by women v. men relative prevalence ratios (RPR). Their variation with sociodemographic characteristics used models including gender × covariate interactions. Setting: Greater Tunis area in 2009-2010. Subjects: Adults aged 20-49 years (women, n 1689; men, n 930). Results: Gender inequalities in excess adiposity were high (e.g. overweight: women 64·9 % v. men 48·4 %; RPR = 2·1; 95 % CI 1·6, 2·7) and much higher for anaemia (women 38·0 % v. men 7·2 %; RPR = 8·2; 95 % CI 5·5, 12·4). They were striking for overweight and anaemia (women 24·1 % v. men 3·4 %; RPR = 16·2; 95 % CI 10·3, 25·4). Gender inequalities in overweight adjusted for covariates increased with age but decreased with professional activity and household wealth score; gender inequality in anaemia or overweight and anaemia was more uniformly distributed. Conclusions: Women were much more at risk than men, from both over-and undernutrition perspectives. Both the underlying gender-related and sex-linked biological determinants of this remarkable double burden of malnutrition inequality must be addressed to promote gender equity in health.

Objective: To develop a child-and adolescent-appropriate physical activity frequency questionnaire (PAFQ) in Tunisia, North Africa. Design: A PAFQ was developed from a physical activity (PA) inventory that comprised major activity components (at home, preparing meals, school time, transport, non-sport leisure, sports, prayer and sleeping time). Then, type and duration of each activity undertaken during the past week were estimated. Total energy expenditure (TEE) estimated by the PAFQ was compared with data derived from two criterion methods: heart-rate monitoring (HRM) and a 24 h PA recall (24h-R), both collected during a 3 d period including one weekday and two weekend days. Setting: Two elementary schools and two high schools of the most developed and urbanized area, Greater Tunis. Conclusions: This PAFQ could be useful in the description and surveillance of PA patterns or for the evaluation of population-based interventions directed at promoting PA in Tunisian children and adolescents.

ObjectiveIn the Middle East and North Africa region, the nutrition transition has resulted in drastic increases in excess adiposity, particularly among women, while some types of undernutrition remain prevalent, especially among pre-school children. We assessed the magnitude, nature and associated factors of the within-household co-occurrence of anaemia in children and excess adiposity in mothers.DesignCross-sectional survey using stratified two-stage random cluster sampling to survey households with women aged 20–49 years. BMI≥25·0 kg/m2 defined overweight and BMI≥30·0 kg/m2 obesity, while anaemia for children was defined as Hb<110 g/l. The associations between child anaemia and mother excess adiposity, and sociodemographic and lifestyle factors were estimated by multinomial regression.SettingGreater Tunis area, Tunisia, in 2009–2010.SubjectsChildren aged 6–59 months living with their 20–49-year-old mothers (437 child–mother pairs).ResultsThe most prevalent double burden of malnutrition in child–mother pairs by far was the anaemic child and overweight mother (24·4 %; 95 % CI 20·1, 29·3 %). A significant proportion of pairs were anaemic child and obese mother (14·4 %; 95 % CI 11·0, 18·5 %). The co-occurrence of anaemia in child and excess adiposity in mother was neither synergetic nor antagonistic (P=0·59 and 0·40 for anaemia–overweight and anaemia–obesity, respectively). This double burden was more frequent among child–mother pairs with younger children, with mothers of higher parity and higher energy intakes.ConclusionsThe high prevalence of anaemic child and overweight or obese mother requires special attention e.g. through interventions which simultaneously target both types of malnutrition within the same household.

The prevention and management of hypertension are untimely associated with a lowering of sodium intake. The present study aimed to evaluate the sodium and potassium intake levels of Tunisian population through measurement of 24‐hr urinary sodium excretions. A randomly, multistage, cross‐sectional study was conducted in an urban region (Bizerte) in Tunisia during 2015. The target population involved adults aged from 25 to 64 years. Sodium, potassium, and creatinine concentrations were determined in each urine sample using indirect potentiometric method. From the 420 selected participants, only 194 gave urine samples complying completeness criteria. A multivariate regression model was used to assess the variables related to sodium and potassium excretion. The daily mean excretion of sodium and potassium was 138.3 ± 46.5 mmol/d (corresponding to 8.1 ± 2.7 g/d of salt intake) and 61.0 ± 22.7 mmol/d, respectively. More than 87.1% of the participants (89.8% for men vs. 84.9% for women; p = .31) exceeded the WHO recommendation of 5 g/d. The upper limit of 10 g salt intake per day was still exceeded by 26.3%. After adjusted analysis, sex (for women, coef = −1.6; (95% CI: −2.4, −0.7)), level of instruction (≥30 kg/m2, coef = +1.1; (95% IC: 0.4–2.0)), and body mass index (≥30 kg/m2, coef = +1.1; (95% CI: 0.1, 2.0)) were associated with the sodium excretion. High sodium intake and inadequate potassium intake were found among participants. This consumption profile complies with the diet westernization context occurring in Tunisia. The initiated strategy focused on the downward of sodium in bread (the main source of salt intake) seems to be promising.