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Objectives: To describe changing food consumption patterns in Egypt over the last several decades, current levels of overweight and obesity, and current data on obesity-related morbidity. Design: Secondary analysis and synthesis of existing data from national-level food consumption surveys, large recent surveys of hypertension and diabetes, and documentation of historical and policy context. Setting: Arab Republic of Egypt. Subjects: As selected and described in primary data sources. Results and conclusions: The nutrition transition in Egypt has occurred in the context of abundant dietary energy availability, urbanisation and moderate fat intakes. The prevalence of obesity in adults is very high, particularly among women. The prevalences of diabetes mellitus and of hypertension parallel that of obesity, and both are very high. Little information is available on physical activity, but it is likely that a large proportion of the population is quite sedentary, particularly in the cities. At the same time, rates of early childhood malnutrition remain stubbornly stable and relatively high. Public awareness of the increasing prevalence of obesity and of diet-related chronic disease is increasing, and attention has turned to documenting the problem(s). Keywords Nutrition transition Egypt Food consumptionThis paper will attempt to describe the current situation in Egypt with regard to the emergence of obesity and dietrelated chronic diseases and their relation to changes in the food supply, food habits and related variables. In addition to the usual food balance sheet and household budget/expenditure surveys, Egypt has very valuable and specific information on food consumption and dietary patterns spanning a considerable time period. Egypt was one of the earliest countries to follow the recommendations of the Health Section of the League of Nations in 1939 and publish a food composition table of local foods in order to undertake dietary surveys. When World War II intervened, it was not until 1959 that sporadic activities resumed. Since then there have been three major national food consumption surveys: (1) one in 1981; (2) a second in 1998 that was essentially a repeat of first; and (3) the third is planned as a continuous monitoring system that began in 1994, with a second round in 1999. Nutritional status surveys at the national level have focused mostly on preschool children. Morbidity data on national samples are relatively recent but provide an overview of current trends in relative body weight for adolescents and adults, and the prevalence of obesity-related morbidities.

Micronutrient deficiencies and suboptimal energy intake are widespread in rural Kenya, with detrimental effects on child growth and development. Sporadic school feeding programmes rarely include animal source foods (ASF). In the present study, a cluster-randomised feeding trial was undertaken to determine the impact of snacks containing ASF on district-wide, end-term standardised school test scores and nutrient intake. A total of twelve primary schools were randomly assigned to one of three isoenergetic feeding groups (a local plantbased stew (githeri) with meat, githeri plus whole milk or githeri with added oil) or a control group receiving no intervention feeding. After the initial term that served as baseline, children were fed at school for five consecutive terms over two school years from 1999 to 2001. Longitudinal analysis was used controlling for average energy intake, school attendance, and baseline socio-economic status, age, sex and maternal literacy. Children in the Meat group showed significantly greater improvements in test scores than those in all the other groups, and the Milk group showed significantly greater improvements in test scores than the Plain Githeri (githeri þ oil) and Control groups. Compared with the Control group, the Meat group showed significant improvements in test scores in Arithmetic, English, Kiembu, Kiswahili and Geography. The Milk group showed significant improvements compared with the Control group in test scores in English, Kiswahili, Geography and Science. Folate, Fe, available Fe, energy per body weight, vitamin B 12 , Zn and riboflavin intake were significant contributors to the change in test scores. The greater improvements in test scores of children receiving ASF indicate improved academic performance, which can result in greater academic achievement.

Zinc nutriture of women living in a periurban Egyptian village was examined over the last 6 mo of pregnancy and the first 6 mo of lactation as one of several potential determinants of pregnancy outcome and infant development. Estimated bioavailable zinc intake was approximately 2 mg/d from diets high in phytate and fiber. Among numerous variables analyzed by multiple regression, early pregnancy weight (3 mo) and plasma zinc concentrations in the second trimester formed the best predictor model of birth weight, accounting for 39% of the variance. Bioavailable zinc intake during pregnancy was part of a profile of micronutrient intakes related to neonatal habituation behavior, a measure of early information processing. Performance on the Bayley motor test at 6 mo of age was negatively related to maternal intakes of plant zinc, phytate, and fiber, suggesting that zinc bioavailability was involved. Maternal dietary intake explained most of the variance observed in infant motor performance; however, predictive variance was amplified by the psychosocial context.

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Underreporting of dietary intake has been observed consistently in food consumption surveys in affluent societies and in clinical studies in a variety of settings. Almost one third of quantitative 24-h recalls provided by adults in U.S. surveys appear to result in estimates that are biologically implausible. Underreporting has been linked to obesity in both the U.S. and Europe, with heavier individuals underreporting to a greater degree than lean persons. A relative dearth of data exists from developing countries and those in transition to address the question whether such underreporting is universal. We present the first data from a large survey of women in a rapidly urbanizing developing country to address this question. More than 4500 adult women in Egypt provided quantitative 24-h recalls of food intake on the previous day in 1993-1994, and weights and heights were measured. We compared the data, in terms of the ratio of reported energy intake to estimated basal metabolic rate, to data from 3010 women in the 1994-1996 U.S. Continuing Survey of Food Intake by Individuals, on whom quantitative 24-h recalls were also conducted. The Egyptian women reported food intakes consistent with FAO/WHO recommendations for energy intakes for women of comparable activity levels, whereas the data for U.S. women showed underreporting consistent with other U.S. surveys. Only 10% of Egyptian women reported energy intakes below accepted criteria for plausibility, compared with one third of American women. We discuss possible reasons for this difference, including cultural and food supply differences, and methodological differences between the two surveys.

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Effects of stage of lactation, nutrient intake, and cultural differences on the composition of human milk were examined during the first 6 mo of lactation in American and Egyptian women. In both population groups zinc levels in milk decreased from 1 to 6 months of lactation. American women supplemented with Zn had higher levels of Zn in their milk than did unsupplemented American or Egyptian women. Concentrations of calcium and magnesium were not significantly different in milk of American and Egyptian women except at month 6 of lactation. Ca levels in milk of both population groups increased from 1 to 2-3 mo of lactation and then decreased at 6 mo; Mg concentrations increased from 1 to 3 mo and then reached a plateau. Similarities in the longitudinal decrease observed in Zn levels of milk in Zn supplemented and unsupplemented subjects suggested physiological regulation.