ASSIGNMENT COVER SHEET Course name: Fundamental Concepts in Food and Nutrition Course number: PHC 241 CRN: Patterns of food consumption in the Kingdom of Saudi Arabia The purpose of this assignment is to describe patterns of food consumption in the Kingdom of Saudi Arabia (KSA). Please read the attached article and write a brief summary of it by answering the following questions: Assignment title or task: (You can write a question) 1. 2. 3. 4. What are the current patterns of food consumption in the KSA? What dietary gaps can be identified by analyzing the current food situation in the KSA? Members of which age group have the healthiest diet, and why? In your opinion, what can be done to encourage better patterns of food consumption among the Saudi population? Students ID Student name: Submission date: Instructor name: Grade: …. Out of 5 Release Date: 26/9/2021 Due Date: 10/10/2021 Guidelines: • • • • • • • • Cover sheet should be attached with assignment Complete student’s information on the first page of the document. Font should be 12 Times New Roman Line spacing should be 1.5 The text color should be “Black” Maximum 500 words (Excluding references) Use proper references using APA format Do proper paraphrasing to avoid plagiarism doi:10.1017/S1368980016003141 Public Health Nutrition: 20(6), 1075–1081 Diet in Saudi Arabia: findings from a nationally representative survey Maziar Moradi-Lakeh1, Charbel El Bcheraoui1, Ashkan Afshin1, Farah Daoud1, Mohammad A AlMazroa2, Mohammad Al Saeedi2, Mohammed Basulaiman2, Ziad A Memish2, Abdullah A Al Rabeeah2 and Ali H Mokdad1,* 1 Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA: 2Ministry of Health of the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia Submitted 30 March 2016: Final revision received 8 September 2016: Accepted 10 October 2016: First published online 15 December 2016 Abstract Objective: No recent original studies on the pattern of diet are available for Saudi Arabia at the national level. The present study was performed to describe the consumption of foods and beverages by Saudi adults. Design: The Saudi Health Interview Survey (SHIS) was conducted in 2013. Data were collected through interviews and anthropometric measurements were done. A diet history questionnaire was used to determine the amount of consumption for eighteen food or beverage items in a typical week. Setting: The study was a household survey in all thirteen administrative regions of Saudi Arabia. Subjects: Participants were 10 735 individuals aged 15 years or older. Results: Mean daily consumption was 70·9 (SE 1·3) g for fruits, 111·1 (SE 2·0) g for vegetables, 11·6 (SE 0·3) g for dark fish, 13·8 (SE 0·3) g for other fish, 44·2 (SE 0·7) g for red meat, 4·8 (SE 0·2) g for processed meat, 10·9 (SE 0·3) g for nuts, 219·4 (SE 5·1) ml for milk and 115·5 (SE 2·6) ml for sugar-sweetened beverages. Dietary guideline recommendations were met by only 5·2 % of individuals for fruits, 7·5 % for vegetables, 31·4 % for nuts and 44·7 % for fish. The consumption of processed foods and sugar-sweetened beverages was high in young adults. Conclusions: Only a small percentage of the Saudi population met the dietary recommendations. Programmes to improve dietary behaviours are urgently needed to reduce the current and future burden of disease. The promotion of healthy diets should target both the general population and specific high-risk groups. Regular assessments of dietary status are needed to monitor trends and inform interventions. Dietary risks are among the most important risk factors globally and in the Kingdom of Saudi Arabia (KSA) in particular(1,2). Like many other regions of the world, the nutrition transition in the Middle East has contributed to the rising burden of non-communicable diseases(1,3). In KSA in 2013, poor diet accounted for 10·4 % (95 % CI 8·9, 12·2 %) of disability-adjusted life years and 22·1 % (95 % CI 18·7, 24·5 %) of deaths(3,4). FAO data show an overall increase in food supply (1961–2007) in KSA, with an increase in the supply of sugar, meat, animal fat, offal (organ meats), eggs and milk, and a levelling trend in the vegetable and fruit supply(5). A similar trend was reported earlier in 2000(6). Khan and Al Kanhal reported a rapidly increasing surplus of energy and protein availability in KSA after 1975, compared with the recommended daily allowances(7). Keyword Diet Foods Beverages Nutrition epidemiology Saudi Arabia Previous reports have shown the dietary patterns or energy/nutrient intakes in specific population subgroups or regions of KSA(8). However, nationally representative diet data from KSA are limited to food availability. Food availability data (such as FAO data) do not represent intake, as they do not account for wastage and other uses. Moreover, they do not provide information on diet by age, sex and socio-economic status. In 2012, the KSA Ministry of Health published dietary guidelines on the amount and composition of recommended foods to promote a healthy diet among the population(9). However, there are not enough data on the success of the guidelines’ implementation, the population’s current dietary status and the potential impacts of the guidelines. Therefore, the aims of the present study *Corresponding author: Email [email protected] Downloaded from https://ift.tt/2crPgHn. 15 Sep 2021 at 21:29:35, subject to the Cambridge Core terms of use. © The Authors 2016 1076 were to describe the amount of consumption of different types of foods and beverages in KSA; to describe dietary consumption by age, sex, socio-economic status and subnational administrative regions; and to assess the degree to which Saudis’ diets met the dietary guidelines. Methods Performed between April and June 2013, the Saudi Health Interview Survey (SHIS) was a national multistage survey of individuals aged 15 years or older. For this survey, KSA was divided into thirteen regions. Each region was divided into sub-regions and blocks. All regions were included in the survey. A probability-proportional-to-size method was used to randomly select sub-regions and blocks. Households were then randomly selected from each block. A roster of household members was conducted and an adult aged 15 years or older was randomly selected to be surveyed from each selected household. If the randomly selected adult was not present, our surveyors made an appointment to return. A total of three visits were attempted before the household was considered as a nonresponse. More details about the study are available in previous publications(10–13). The Saudi Ministry of Health and its institutional review board (IRB) approved the study protocol. The University of Washington IRB deemed the study IRB-exempt, since the Institute for Health Metrics and Evaluation received deidentified data for the present analysis. All respondents had the opportunity to consent and agree to participate in the study. The survey included forty-two questions on diet (a diet history questionnaire), as well as questions on socioeconomic status (educational and household monthly income levels) and other aspects of health. Respondents were asked to report the number of days that they consumed eighteen food or beverage items in a typical week over the last year. The food and beverage items included in the survey were: fruits; pure (100 %) fruit juices; vegetables; dark meat fish; other fish; shrimp; red meat; poultry meat; processed meat (meats preserved by smoking, curing or salting, or by the addition of preservatives, such as in the case of pastrami, salami, bologna, other packaged lunch meats or deli meats, sausages, bratwursts, frankfurters and hot dogs); other processed foods (such as fast foods, canned foods, packaged entrées or packaged soup); eggs; nuts; milk; yoghurt; laban (a beverage of yoghurt mixed with salt, which is also known as ayran or doogh); labneh (strained yoghurt); cheese; and sugar-sweetened beverages (SSB). For each type of food/beverage that the respondents reported at least one day of consumption per typical week, the respondents were asked: ‘How many servings of [this food/beverage] do you usually consume/eat/drink on one of those days?’ The interviewers used specific pictures that M Moradi-Lakeh et al. represented the serving size of each type of food/beverage. Moreover, respondents were asked about the type of oil or fat most often used for meal preparation, and the usual type of dairy products (full-fat, low-fat, non-fat) and bread in the household. There were insufficient data to calculate total energy consumption directly. Supplemental File 1 (see online supplementary material) shows the method for indirect estimation of energy intake and the energy-adjusted daily food/beverage consumption estimates. Although not an ideal method for energy adjustment, it can provide more comparability with other studies for interested readers. An energy adjustment is also necessary to compare the status with the dietary guideline recommendations. Average numbers of daily servings – and their equivalent weight (grams) for foods, or volume (millilitres) for beverages – were calculated. In cases where the weight of a serving size had not been clarified in the survey manuals (fruits, vegetables, processed meat, processed foods and eggs), we matched our visual manual as closely as possible to phrases in the guidelines of the US Department of Agriculture to assign an average weight(14). For fruits and vegetables, we used the weighted average weight of one serving of the most common types of fruits and vegetables based on the most recent food supply data of FAO in KSA(15). The 99th percentiles of consumption were used as cut-off points to identify and exclude implausibly high levels of intake. The statistical software package Stata 13.1 for Windows was used for the analyses and to account for the complex sampling design. Results A total of 12 000 households were contacted and 10 735 participants (5253 men and 5482 women) completed the SHIS, for a response rate of 89·4 %. Table 1 demonstrates the average daily consumption of different food and beverage items. Table 2 shows the food and beverage consumption of men and women. Non-adjusted consumption of fruit, red meat, other processed foods, eggs and SSB was statistically higher in men than women, while yoghurt and cheese consumption was higher in women than men. Daily consumption of fruits and vegetables was reported by 10·8 (SE 0·4) % and 25·9 (SE 0·6) %, respectively, and 27·0 (SE 0·7) % reported daily drinking of SSB. Mean consumption of processed meat, other processed foods and SSB was clearly higher in younger age groups (Table 3), while laban consumption was higher in older age groups. Consumption of fruit, shrimp, labneh and cheese had an increasing pattern with higher education (Table 4). As demonstrated in Table 5, consumption of some of the food items (fruit, shrimp, red meat and labneh) was higher in individuals with higher household Downloaded from https://ift.tt/2crPgHn. 15 Sep 2021 at 21:29:35, subject to the Cambridge Core terms of use. Diet in Saudi Arabia 1077 Table 1 Average daily food and beverage consumption of Saudi adults, 2013 Weight/volume units Food/beverage item Fruits (g) Vegetables (g) Pure (100 %) fruit juices (ml) Dark meat fish (g) Other fish (g) Shrimp (g) Red meat (g) Poultry meat (g) Processed meat (g) Other processed foods (g) Eggs (g) Nuts (g) Yoghurt (g) Milk (ml) Laban (ml) Labneh (g) Cheese (g) SSB (ml) Serving size Serving size N Mean SE Mean SE 103 g* 105 g* 125 ml 75 g 75 g 75 g 75 g 75 g 69 g* 399 g* 92 g* 40 g 175 g 250 ml 175 g 175 g 50 g 125 ml 10 187 10 334 10 066 10 096 10 082 9801 10 223 10 336 9667 9664 10 219 9768 10 257 10 326 10 269 9866 10 113 9967 70·9 111·1 31·9 11·6 13·8 2·4 44·2 103·0 4·8 97·5 46·0 10·9 75·4 219·4 116·8 28·9 43·7 115·5 1·3 2·0 0·8 0·3 0·3 0·1 0·7 1·8 0·2 2·7 0·7 0·3 2·0 5·1 2·8 0·8 0·9 2·6 0·675 1·078 0·269 0·137 0·159 0·028 0·521 1·304 0·070 0·244 0·500 0·274 0·431 0·885 0·667 0·165 0·874 0·924 0·013 0·019 0·007 0·003 0·003 0·001 0·009 0·022 0·003 0·007 0·007 0·007 0·012 0·021 0·016 0·004 0·018 0·021 Meet the recommendations % SE 5·2† 7·5† 0·3 0·4 44·7‡ 0·7 85·7§ 0·5 80·2§ 0·6 31·4† 26·2† 0·7 0·7 78·6‡ 0·6 SSB, sugar-sweetened beverages. *Estimated through matching of pictures in the survey manual with the descriptions of the US Department of Agriculture guideline(14). Reference dietary guidelines: †Dietary Guidelines for Americans(25); ‡American Heart Association(24); §American Institute for Cancer Research(23). Table 2 Daily food and beverage consumption of Saudi male and female adults, 2013 Male (N 5253) Weight/volume units Female (N 5482) Serving size Weight/volume units Serving size Food/beverage item Mean SE Mean SE Mean SE Mean SE Fruits (g) Vegetables (g) Pure (100 %) fruit juices (ml) Dark meat fish (g) Other fish (g) Shrimp (g) Red meat (g) Poultry meat (g) Processed meat (g) Other processed foods (g) Eggs (g) Nuts (g) Yoghurt (g) Milk (ml) Laban (ml) Labneh (g) Cheese (g) SSB (ml) 75·7 105·4 34·0 11·5 14·3 2·5 52·4 106·6 5·0 108·4 49·8 11·2 67·1 217·5 122·2 27·5 40·5 131·4 1·9 2·3 1·2 0·4 0·4 0·1 1·2 2·4 0·3 4·3 1·0 0·4 1·9 6·4 3·9 1·0 1·2 3·5 0·620 0·904 0·241 0·123 0·153 0·026 0·590 1·195 0·064 0·239 0·496 0·269 0·349 0·712 0·580 0·149 0·672 0·972 0·016 0·020 0·010 0·005 0·005 0·002 0·014 0·027 0·004 0·009 0·011 0·011 0·010 0·019 0·017 0·006 0·016 0·028 65·9 117·0 29·7 11·7 13·3 2·3 35·7 99·3 4·7 86·0 42·0 10·7 84·2 221·4 111·2 30·4 47·0 98·8 1·9 3·3 1·1 0·4 0·4 0·1 0·9 2·7 0·3 3·2 0·9 0·4 3·6 8·1 3·9 1·2 1·4 3·8 0·547 1·032 0·214 0·123 0·144 0·023 0·403 1·131 0·068 0·194 0·414 0·243 0·420 0·796 0·568 0·164 0·779 0·699 0·017 0·034 0·010 0·004 0·006 0·002 0·012 0·033 0·004 0·008 0·009 0·009 0·020 0·033 0·023 0·007 0·023 0·030 SSB, sugar-sweetened beverages. incomes. Consumption of SSB was statistically higher in individuals with lower household incomes (Table 5). Fruit/beverage consumption in different administrative regions can be found in Supplemental File 2 (see online supplementary material). Vegetable oils were the most common type of oil/fat used for preparation of food (84·5 (SE 0·5) %). Olive oil and butter/margarine were reported by 5·3 (SE 0·3) % and 4·8 (SE 0·3) %, respectively. Most of the respondents reported use of full-fat dairy products (77·6 (SE 0·6) %), followed by low-fat (15·0 (SE 0·5) %) and non-fat (1·3 (SE 0·1) %); others had no preference. The most common type of bread was white bread (79·1 (SE 0·5) %); brown bread and Saudispecific traditional breads were reported by 20·1 (SE 0·5) % and 0·8 (SE 0·1) %, respectively, as the usual kind of bread. Discussion The present study is the first to describe dietary patterns in a nationally representative sample of adults in KSA. It Downloaded from https://ift.tt/2crPgHn. 15 Sep 2021 at 21:29:35, subject to the Cambridge Core terms of use. 5·5 13·5 2·9 0·9 1·1 0·5 5·3 6·1 0·3 4·0 2·4 1·1 19·6 27·7 14·5 3·1 3·0 3·6 SSB, sugar-sweetened beverages. SE Mean 60·1 112·5 24·3 5·9 7·7 1·0 36·8 78·0 0·9 29·8 26·8 5·4 108·0 247·1 129·0 21·3 28·7 21·6 4·4 5·0 2·2 1·0 1·3 0·3 3·1 4·5 0·7 4·7 2·1 0·8 5·0 11·2 7·7 2·5 1·5 3·5 SE Mean 68·8 91·5 20·8 7·2 12·4 1·3 54·2 79·8 1·4 32·1 32·6 5·3 67·0 205·0 113·5 19·8 23·0 30·4 3·7 5·2 2·0 0·6 0·9 0·2 1·9 3·9 0·4 4·1 1·4 0·7 6·0 9·4 6·5 2·2 1·4 3·1 SE Mean 65·5 109·2 25·3 8·7 12·5 1·5 37·9 83·1 2·7 54·1 37·0 8·8 80·5 187·4 112·6 29·4 33·1 42·5 3·5 3·5 2·1 0·6 0·7 0·2 1·8 2·9 0·3 5·1 1·7 0·6 3·2 7·4 4·2 2·1 1·3 4·3 SE Mean 77·9 105·8 30·9 8·8 13·9 2·2 49·2 83·2 2·4 69·6 44·2 9·2 64·2 170·1 102·0 31·0 31·1 64·9 3·6 4·5 1·4 0·7 0·8 0·3 1·4 4·1 0·5 4·8 1·5 0·7 5·9 9·5 7·0 1·5 1·5 4·9 SE Mean 65·1 104·8 26·5 12·8 14·6 2·7 34·8 87·2 5·7 84·4 44·1 10·3 72·7 191·3 99·4 27·6 40·5 84·3 2·4 7·4 2·4 0·7 0·9 0·3 1·8 5·5 0·6 6·5 1·4 0·6 6·4 18·0 7·2 2·6 2·5 8·0 46·2 104·8 24·8 10·4 11·7 1·9 31·2 96·4 5·8 93·5 35·8 10·4 64·9 201·3 87·0 30·2 42·9 127·3 SE SE 2·9 3·8 2·3 0·8 0·8 0·2 2·4 3·9 0·7 7·8 1·8 0·8 3·4 9·1 5·8 2·0 1·7 6·6 SE 56·5 83·0 26·2 11·0 12·8 1·7 51·4 101·1 6·3 121·6 48·4 12·9 57·8 183·0 97·2 23·1 36·9 172·2 2·7 3·4 1·8 0·7 0·7 0·3 1·8 4·0 0·4 5·3 1·6 0·7 3·1 6·9 4·7 1·7 1·1 6·0 Mean Mean Mean Food/beverage item Fruits (g) Vegetables (g) Pure (100 %) fruit juices (ml) Dark meat fish (g) Other fish (g) Shrimp (g) Red meat (g) Poultry meat (g) Processed meat (g) Other processed foods (g) Eggs (g) Nuts (g) Yoghurt (g) Milk (ml) Laban (ml) Labneh (g) Cheese (g) SSB (ml) 66·0 98·2 32·5 12·1 13·9 3·4 47·9 98·1 4·2 96·2 46·6 10·4 61·8 163·6 104·3 28·4 33·7 119·2 Male (N 1857) Female (N 1193) Female (N 2169) Male (N 1495) Female (N 1575) Male (N 712) Female (N 545) M Moradi-Lakeh et al. Male (N 1189) 25–39 years 15–24 years Table 3 Daily food and beverage consumption of Saudi adults by sex and age group, 2013 40–59 years 60 years or more 1078 showed poor dietary practices in the Kingdom. Saudis’ dietary behaviours met dietary recommendations in only a small percentage of the population, especially for fruit and vegetable consumption, dairy products, nuts and fish meat. Young adults (15–24 years old) had a concerning pattern of high consumption of SSB, processed meat and other processed foods, as well as low intake of fruits and vegetables. Other studies on schoolchildren show that these unhealthy dietary behaviours start even sooner(16). This evidence calls for a comprehensive programme to improve the dietary situation of Saudis. The programme should include all age ranges, considering the different needs and different dietary challenges of each age group. A cluster of dietary risk factors is the leading risk factor for non-optimal health, with 11·3 million attributed deaths and 241·4 million attributed disability-adjusted life years per annum around the world(1). The Global Burden of Diseases, Injuries, and Risk Factors (GBD) study showed that in Saudi Arabia, the average levels of consumption of fruits, vegetables, nuts, whole grains, PUFA and seafood n-3 fatty acids were far less than optimum, and the average levels of consumption of processed meats, red meats, total fatty acids, SSB and sodium were higher than optimal(3). In the report of the WHO 2005 STEPwise survey, there was limited dietary information on the consumption of fruits, vegetables and oils. During the time between the STEPwise survey and our current study (2005 to 2013), the percentage of individuals consuming at least five daily servings of fruits or vegetables increased slightly, from 5·5 to 7·3 %(11). However, based on food supply data, fruit and vegetable availability in KSA (about 475 g/d in 2010)(17) is more than twice the average consumption in our study (less than 200 g/d). The difference might be related to using fruits as pure juices (about 32 ml/d) or sweetened juices, as well as the higher potential of decay in fruits/ vegetables compared with other food items. Further details on consumption of fruits and vegetables by Saudi adults have been reported elsewhere(11). Consumption of olive oil has increased from 1·7 % in the Saudi STEPwise survey to 5·3 %(18); since higher…

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