Socioeconomic status and lifestyle (including dietary habits) have dramatically changed in Saudi Arabia (SA) over the last few decades. SA suffers from a high burden of non-communicable diseases (NCDs) such as cardiovascular diseases and hypertension. There is no data on habitual salt intake in SA apart from one study in the Eastern region 8·1 g/day, not representative for the general population. Food frequency questionnaires (FFQ) are practical for epidemiological studies, but need to be developed and validated for specific populations because foods are culture-dependent (1) . To our knowledge, there is no validated Saudi specific FFQ, apart from one semi-quantitative FFQ for the assessment of vitamin A intake only (2) . We aimed to develop a culture-specific FFQ and evaluate its validity in estimating the intake of salt in Saudi Arabian population.A quantitative FFQ was developed using a food list of common foods and composite dishes consumed by Saudi adults from previously collected 24-hour dietary recall (3) . The FFQ was pretested and finalized with 133 food items. A specific question was included regarding table salt use. The FFQ was validated against repeated multiple pass 24-Hour dietary recalls (MP24-HR) and urinary biomarkers for a sub-sample of the population. Participants (aged 19-60) were recruited from the community in Riyadh City, Kingdom of Saudi Arabia in 2013. Informed consent was collected and blood pressure and anthropometrics measurements taken. Participants received verbal and written instructions on how to collect the urine samples for 24 hours. The mean daily intake of salt (NaCl), were estimated from measured urinary sodium (Na) using WHO equation (1 g of NaCl = 393·4 mg of Na).A total of 601 participants were recruited (265 males, 336 females, median age 29, IQR 24-38). All completed the FFQ and repeated MP24-HR. A sub-sample of 71 subjects (24 males, 47 females, median age 38, IQR 25-45) provided urine samples, 49 of which (18 males, 31 females) provided complete 24-h urine collections (creatinine index falling inside the range of 11-20 and 14-26 mg/ kg body weight/day for women and men respectively). The median urinary sodium output was 3457 mg/24 h (IQR 2298-4696), equivalent to 8·7 g salt/24 h (IQR 5·8-11·9), higher than the recommended level of <5 g/d for salt (4) . Around 60 % of the population always adding salt while cooking and 73 % never add it while eating The correlation between FFQ and food recall was weak (r s = 0·376, p < 0·001), and moderate for FFQ and urinary excretion (r s = 0·502, p < 0·001). The biases between FFQ and food recall, and FFQ and urinary excretion were relatively small (3·4 and 2·3 g salt/day, respectively, Fig.1&2), although with wide limits of agreement (−5·4 and 12·2 g salt/day, and −10·1 and 5·5 g salt/day, respectively). Therefore, we can conclude that the newly developed FFQ deemed a valid and practical tool to assess sodium and salt intake in the Saudi adult population.
Objective: Mandatory menu energy-labelling policy in restaurants has received increasing attention worldwide as a useful tool for promoting balanced energy intake and encouraging healthier food selection to reduce obesity prevalence. Therefore, we aimed to evaluate the knowledge, views and observations of the public and restaurant owners towards the mandatory menu energy-labelling policy (introduced in August 2018) in restaurants in Saudi Arabia. Design: In February 2019, we conducted a cross-sectional study using an electronic questionnaire. Setting: Saudi Arabia. Participants: Saudi individuals (n 1228) aged 18–80 years and forty-one restaurant owners. Results: Most participants identified the correct daily energetic requirements for moderately active men (51 %) and women (69 %), but not for inactive adults (36 %). Although 40 % reported adequate knowledge to select low-energetic meals and 55 % perceived the policy as useful, 51 % reported they would be less likely to eat at restaurants displaying energy. Most participants (76 %) mentioned they would choose lower-energetic meals, and 79 % would feel guilty after consuming high-energetic meals. Moreover, 62 % of participants reported that the new labelling policy affected their food selections, prompting them to order different food items, eat less, change restaurants or eat at restaurants less frequently. Among restaurant owners, half were aware of the reason for the implementation of this policy and supported this measure. However, they did not consider modifying recipes to reduce energy. Sales of low- and high-energetic meals increased and decreased in 44 % and 39 % of restaurants, respectively. Conclusions: This policy may be an effective public health tool for promoting balanced energy intake and encouraging healthier food selection in Saudi Arabia.
This study aims at identifying national salt reduction initiatives in countries of the Eastern Mediterranean Region and describing their progress towards the global salt reduction target. A systematic review of published and grey literature was conducted. Key characteristics of strategies were extracted and classified according to a pre-defined framework: salt intake assessments; leadership and strategic approach; implementation strategies; monitoring and evaluation of program impact. Salt intake levels were estimated in 15 out of the 22 countries (68%), while national salt reduction initiatives were identified in 13 (59%). The majority of countries were found to implement multifaceted reduction interventions, characterized by a combination of two or more implementation strategies. The least common implementation strategy was taxation, while the most common was reformulation (100%), followed by consumer education (77%), initiatives in specific settings (54%), and front of pack labelling (46%). Monitoring activities were conducted by few countries (27%), while impact evaluations were lacking. Despite the ongoing salt reduction efforts in several countries of the region, more action is needed to initiate reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluations of ongoing programs. Such efforts are vital for the achievement of the targeted 30% reduction in salt intake.
Background: Maternal depression and anxiety are significant public health concerns that play an important role in the health and well-being of mothers and children. The COVID-19 pandemic, the consequential lockdowns and related safety restrictions worldwide negatively affected the mental health of pregnant and postpartum women. Methods: This regional study aimed to develop a machine learning (ML) model for the prediction of maternal depression and anxiety. The study used a dataset collected from five Arab countries during the COVID-19 pandemic between July to December 2020. The population sample included 3569 women (1939 pregnant and 1630 postpartum) from five countries (Jordan, Palestine, Lebanon, Saudi Arabia, and Bahrain). The performance of seven machine learning algorithms was assessed for the prediction of depression and anxiety symptoms. Results: The Gradient Boosting (GB) and Random Forest (RF) models outperformed other studied ML algorithms with accuracy values of 83.3% and 83.2% for depression, respectively, and values of 82.9% and 81.3% for anxiety, respectively. The Mathew’s Correlation Coefficient was evaluated for the ML models; the Naïve Bayes (NB) and GB models presented the highest performance measures (0.63 and 0.59) for depression and (0.74 and 0.73) for anxiety, respectively. The features’ importance ranking was evaluated, the results showed that stress during pregnancy, family support, financial issues, income, and social support were the most significant values in predicting anxiety and depression. Conclusion: Overall, the study evidenced the power of ML models in predicting maternal depression and anxiety and proved to be an efficient tool for identifying and predicting the associated risk factors that influence maternal mental health. The deployment of machine learning models for screening and early detection of depression and anxiety among pregnant and postpartum women might facilitate the development of health prevention and intervention programs that will enhance maternal and child health in low- and middle-income countries.
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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