The cost to developing countries, for current and future generations, of not eradicating hunger and poverty - in terms of recurrent conflicts and emergencies, widening inequalities, depleted resources, ill health, and premature death - is enormous. Although strategies are underway to address certain problems in Africa and the Middle East, much remains to be done. Breaking the poverty cycle in these regions demands both local and international attention. Nutrition transition is a key factor, since many countries in the region also suffer the consequences of the excessive and unbalanced diets that are typical of developed countries. This paper reviews the experiences with facing malnutrition in Sub-Saharan and North Africa and the Middle East.

The purpose of this investigation was to study body size preferences and to examine the influence of sociocultural factors on obesity among 249 Moroccan Sahraoui women. Participants rated their ideal body size and the size they thought to be "healthy," using a figural scale consisting of nine images ranging from thin to obese. They also noted which particular sociocultural influences affected their body size ratings. The results indicated that women's rating of ideal body size (4.88) was significantly larger than their rating of healthy body size (4.33). The desire to lose weight was very low even among the majority of obese women, and educational level did not affect desire to lose weight. Women not satisfied with their body size were more likely to report trying to gain weight rather than to lose it. The major factors reported to influence body size ideal were mothers, men, and traditional clothing. It is an enormous challenge for the health institutions of Morocco to prevent obesity and its complications. Prevention programs should include teenagers and key family members.

Escherichia coli O157:H7 is a pathogen strain, which causes hemorrhagic colitis, hemolytic uremic syndrome and thrombotic thrombocytopenic purpura in humans. The control of bacterial cells in foods is an important factor to reduce foodborne diseases due to E. coli O157:H7. Assays to inactivate E. coli O157:H7 were carried out by using the cinnamon oil obtained by steam distillation for 6 hours. When E. coli O157:H7 cells were incubated at 37°C for 2 hours in the presence of 0.025% of the essential oil from cinnamon, a dramatic decrease was observed in the viable counts (from 10(7) to 3.10(4) CFU/mL-1). In the presence of 0.05% of the oil, most of cells were killed after 30 min, suggesting that the antimicrobial activity of essential oil is bactericidal against E. coli. The minimal inhibitory concentration of the essential oil from cinnamon was around 625 ppm against E. coli O157:H7 and E. coli ATCC 25921, around 1250 ppm against E. coli ATCC25922 and around 2500 ppm against E. coli ATCC11105.

OBJECTIVE: To examine the associated risk factors of hypertension and the relationship between blood pressure and three anthropometric measurements for obesity (body mass index, waist circumference and waist-hip ratio) in women of the Sahraoui ethnic group. METHODS: Data were collected from a randomized sample (n = 239) of adult women aged 20 years and older, nonpregnant, who visited the public health centers during the immunization campaign of Laayoune city in South Morocco. Only individuals identified as of Sahraoui origin were eligible for this investigation. Body weight, height, blood pressure, fasting plasma glucose, triglycerides and physical activity were measured. RESULTS: The results show that high blood pressure (> 130/85 mmHg) was detected in 29.8%. All hypertensive women were at high risk of hyperglycemia (22.1% were hyperglycemic, among which 11.8% were diabetic), hypertriglyceridimia (27.8%), hypercholesterolemia (19.2%) and metabolic syndrome (44.1%). Bivariate correlation showed that age and obesity (body mass index, waist-hip ratio and waist circumference) were positively associated with blood pressure whereas education level and time spent in walking activity were negatively associated with blood pressure. Logistic regression analyses also show that education level and waist-hip ratio were independently associated with hypertension. CONCLUSION: These results indicate a high prevalence of hypertension among Sahraoui women, and that waist-hip ratio may be the best predictor for high blood pressure in the adult Moroccan Sahraoui ethnic group. A hypertension control program can detect nondiagnosed hypertensive individuals and thereby significantly reduce the cases of stroke, cardiac failure, renal failure and peripheral vascular disease.

Objective The goal of the present work was to examine the prevalence and associated risk factors of undiagnosed diabetes among urban Moroccan Sahraoui women.Design and setting Randomised sample of adult women living in the city of Laayoune in south Morocco who visited public health centres during an immunisation campaign. Body weight, height, waist and hip circumferences, blood pressure, fasting plasma glucose (FPG), triglycerides, dietary intake and physical activity were collected.Subjects Data were obtained on 249 urban women aged 15 years and older, who were not pregnant. Only subjects identified as of Sahraoui origin were eligible for this investigation.Results The prevalence of impaired fasting glucose (IFG) was 5.5% and that of undiagnosed diabetes 6.4%. Diabetes and IFG were more common among older and obese women as well as among women with hypertension or a family history of diabetes. In addition, sucrose intakes were higher in women with diabetes than in those with normal FPG. Also, physical activity estimated as the time spent in walking was negatively associated with FPG. Regression analyses showed an independent association of age, obesity, family history of diabetes and triglycerides with diabetes.Conclusion The high proportion of unknown diabetes suggests the need for increased diabetes awareness in this population. The data suggest also the involvement of obesity in diabetes and the potential importance of intervention strategies to reduce population adiposity for the prevention and management of cardiovascular risk factors.

This study aimed to assess dietary intake and nutrient adequacy in pregnant women selected from an agricultural region of Morocco. On a sample of 172 pregnant women from rural and urban area, data on socio-demographic characteristics and dietary habits by a quantified food frequency were collected using questionnaires. Mean daily intakes of energy and nutrients were estimated and compared to reference nutrient intakes (RNI).The results show that the mean daily intakes of energy (3110.9 kcal in urban; 2707.5 kcal in rural) and some nutrients were adequate. However, iron, folate, zinc and calcium intakes were inadequate for the majority of women and more markedly in rural area. Education level appeared to affect nutrient intakes while no differences were registered across pregnancy stages or according to household size. The study suggests that an education program should be conducted to improve dietary intakes in order to prevent risks for pregnancy outcome in this population.

Factors related to metabolic syndrome were investigated in a sample of 249 Moroccan Sahraoui women, ages 15 years and older. Body weight, height, waist and hip circumference, total cholesterol, triglycerides, fasting blood glucose, and blood pressure were measured. The results indicate that central obesity was the most common comorbid factor (75%) followed by hypertension (28.6%), hypertriglyceridemia (22.4%), hyperglycemia (11.9%), and hypercholesterolemia (11.6%). The overall prevalence of metabolic syndrome was 16.3%, and it was more prevalent in obese, older, married, and women without education than nonobese, younger, single, and educated women. Also, the prevalence of all metabolic syndrome components decreased with physical activity. The results suggest that prevention of obesity, particularly central obesity, could be the most direct route to prevention of this syndrome and its complications.

Objective: To determine the prevalence of obesity and body fat distribution of Moroccan women of childbearing age, using a panel of anthropometric measurements.Design and setting: A cross-sectional survey conducted in 1995 in an agricultural community, El Jadida province of Morocco. Weight, height, waist and hip circumferences and triceps, biceps, subscapular and supra-iliac skinfold thicknesses were measured. Body mass index (BMI), waist/hip ratio (WHR), sum of all and sum of trunk skinfold thicknesses were determined.Subjects: In total, 1269 women aged 15-49 years from urban and rural areas were surveyed.Results: The means of all anthropometric measurements including body fat were higher in urban than in rural women and increased with age. Trunk fat contributed 50% of total fat. Globally, 4.7% of women were underweight (BMI<18.5 kg m(-2)), 35.2% were overweight or obese (BMI>/=25 kg m(-2)), 10.1% were obese (BMI>/=30 kg m(-2)) and 16.8% had central obesity (WHR>0.85). The prevalence of overweight and obesity was higher in the urban than in the rural area. Underweight prevalence decreased with age, whereas that of overweight and obesity increased. All anthropometric parameters adjusted for age increased with the increase of BMI and WHR.Conclusions: Although undernutrition is still prevalent, there is an alarming prevalence of overweight and obesity in Moroccan women of childbearing age. The results indicate a shift in this country from the problem of dietary deficiency to the problem of dietary excess, and alert one to the necessity of establishing an intervention to prevent obesity-related diseases. It is necessary to address which of the anthropometric variables studied here is the best predictor of obesity-related diseases in this population.

Background: Vitamin A deficiency alters iron status leading to an iron overload in tissues; however, the mechanism of this interaction is poorly understood. The present study aimed to assess the effect of vitamin A deficiency on iron bioavailability and utilization in rats. Methods: Animals were divided into three groups of six rats each that were fed AIN-93G diet (control group), a vitamin A deficient diet and an iron and vitamin A deficient diet, respectively, for 57 days. The concentrations of hepatic and splenic iron, haemoglobin, red and white cells as well as iron utilization and its bioavailability were evaluated in the three groups. Results: Vitamin A deficiency increased the concentration of red blood cells, haemoglobin concentration (Hb), and splenic iron as well as iron utilization. However, the iron bioavailability observed in vitamin A deficient rats was not significantly different compared to the control group, while in the iron/vitamin A deficient rats, it was higher (p = 0.0056). With regard to iron absorption, no difference was observed among the three groups. Conclusion: Increase of haemoglobin, red blood cells and splenic iron concentration observed in vitamin A deficiency suggests that vitamin A may affect the iron mobilization from tissues rather than iron absorption.

In the study presented, an in vitro digestion/Caco-2 cell culture model was used to assess the amount of bioavailable iron from a modified Tanzanian complementary food formulation. The main objective of the study was to determine whether a change from red beans to white beans in the complementary food recipe would improve iron bioavailability from the mixture, as recent studies had indicated that iron bioavailability in white beans is significantly higher compared to that in the colored beans. The white beans had a significantly higher (p<0.0001) amount of ferritin formation (13.54 ng/mg) when compared to all other porridge ingredients including the red beans (2.3 ng/mg), and it is plausible that the complementary food formulated with the white beans may be superior to that formulated with the red beans, with reference to iron bioavailability. The results are important as they suggest that substitution of complementary food ingredients with high anti-nutrient concentrations with those that have lower anti-nutrient concentrations may improve iron bioavailability from complementary food home-recipes.

OBJECTIVE: To determine the impact of an intervention that combined an increase in dietary and bioavailable iron intakes and an improvement in hygiene behaviors on the iron status of preschool children from Burkina Faso. METHODS: Thirty-three orphans and vulnerable children from 11 families who were 1-6 y old, were non-anemic, or had mild to moderate anemia were enrolled in an 18-wk trial. Using the probability approach for planning diets in an assisted-living facility, bioavailable iron intake was increased from 0.4 to 0.9mg/d by increasing the amounts of meat and citrus fruits and by adding iron-rich condiments to the diet, for an estimated cost of U.S.$0.59/mo. Hygiene behaviors were modified by implementing hand-washing before meals and by the use of individual plates for meals. Iron status indicators were measured twice and means at enrollment and after intervention were compared. RESULTS: After intervention, hemoglobin concentration increased from 98.7 to 103.8g/L (P=0.006). There was a decrease in total iron binding capacity (107 to 91mumol/L, P=0.05) and a marginal increase in transferrin saturation (13% to 17%, P=0.06). Significant improvement was not observed for serum ferritin concentration or prevalence of depleted iron stores, likely due to the confounding effect of infection. Anemia and iron-deficiency anemia were decreased from 64% to 30% and from 61% to 30%, respectively. CONCLUSION: Dietary modification associated with adequate hygiene behaviors could be a relevant strategy to control iron deficiency and anemia in areas where infection is a major health problem.

Preschool children in developing countries are likely to have multiple, concurrent micronutrient deficiencies. This study was designed to evaluate the effectiveness of different combinations of nutritional fortified diet to improve the blood levels of iron, vitamin A and other essential micronutrients in the preschool population of Banan District of Chongqing, China. From December 2005 to June 2006, a total of 226 2-6 y old preschool children were recruited from three nurseries in the area, and they were randomly assigned to three different fortified diet groups for 6 mo. Group I was fortified with vitamin A; groups II and III were fortified with vitamin A plus iron and vitamin A plus iron, thiamine, riboflavin, folic acid, niacinamide, zinc and calcium, respectively. Subjects' weight and height were measured for assessing the children's growth and development. Blood samples were taken at the beginning and the end of the 6-mo study period for measuring serum levels of micronutrients. Group III with the multiple micronutrient fortified diet was the most effective to improve the serum level of retinol from [media (P25, P75): 1.06 (0.89, 1.32)] mumol/L to 1.29 (1.04, 1.39) mumol/L (p<0.05) and retinol binding protein from 17.0 (12.6, 25.6) mg/L to 31.6 (24.4, 44.0) mg/L (p<0.05) and to mobilize the stored iron in the liver (p<0.05). In addition, the three groups' hemoglobin levels were elevated from 117.0 (109.0, 124.1) g/L, 114.0 (109.2, 119.7) g/L and 115.0 (109.5, 122.7) g/L to 125.7 (119.2, 133.1) g/L, 126.5 (122.2, 135.9) g/L and 125.1 (119.8, 131.6) g/L over the 6 mo of intervention period, but there were no difference among the three groups (p>0.05). Nevertheless, unexpected results were obtained when comparing the effects on growth status among the different supplement groups. Our study has demonstrated that a multiple micronutrient fortified diet for 6 mo is more effective to improve the levels of hemoglobin, serum retinol, and RBP as well as to facilitate the mobilization of iron storage in preschool children.

We investigated the effect of dietary phospholipid (PL) concentrate from bovine milk on the epidermis. Thirteen-week-old hairless male and female mice (Hos:HR-1) were separated into two experimental groups, each fed two experimental diets: the control group and the PL group. The mice were given the experimental diets for 6 weeks. Stratum corneum hydration and transepidermal water loss (TEWL) were measured using Corneometer CM825 and Tewameter TM300 (Courage and Khazaka Electronics, Cologne, Germany) at 3 weeks and 6 weeks. After the feeding period, ceramides in stratum corneum were analyzed. We found that stratum corneum hydration and ceramides in the PL group were significantly higher than those in the control group and that TEWL in the PL group tended to decrease.These results indicate that dietary PL concentrate improves epidermal function by increasing the amount of ceramides, resulting in higher hydration.

BACKGROUND: Iron-deficiency anemia is the most prevalent nutritional deficiency worldwide. Iron-deficiency anemia has particular negative consequences on women in their childbearing years, and its prevention is a high priority in most health systems. OBJECTIVE: This interventional study assessed the effect of nutrition education on hematologic indices, iron status, nutritional knowledge, and nutritional practices of high-school girls in Iran. METHODS: Sixty healthy 16- to 18-year-old girls were randomly selected from two high schools in the city of Ahvaz and divided into two equally matched groups, one that received nutrition education, and one that did not. The education group received instruction in face-to-face sessions, group discussions, and pamphlets for 2 months. The control group did not receive any information during the study. Hematologic tests, corpuscular indices, and serum ferritin levels were measured at baseline and after 2 months. Food-frequency questionnaires were administered and histories taken, clinical signs of nutritional deficiencies observed, anthropometric measurements taken, nutritional knowledge tested, practices determined, and lifestyle questionnaires administered to all subjects. RESULTS: There were no statistically significant differences in any baseline characteristics between the two groups. Scores for nutritional knowledge and practices of the education group were significantly higher after two months compared with the baseline (31.4 +/- 6 vs. 24.3 +/- 5.9 points, p <.001, and 31.2 +/- 5 vs. 28.4 +/- 5.7 points, p <.05, respectively). The scores in the control group showed no significant changes from baseline to 2 months. Mean corpuscular volume values were elevated in the education group (p <.001) but not in the control group. However, in the control group, serum ferritin concentrations showed about a 17% drop at the end of the study (p <.004). There were no changes in other hematologic, lifestyle, clinical, or anthropometric data compared with baseline after completion of the study in both groups. CONCLUSION: These findings indicate that nutritional education can improve knowledge of healthy nutrition and lifestyle choices. Focused nutritional education using available resources and correcting current dietary habits in a vulnerable group of young women may result in dietary changes that can ultimately improve iron intake.

Objectives: To compare the effects of wheat flours fortified with NaFeEDTA, FeSO4 and elemental iron (electrolytic iron), in improving iron status in anemic students. Methods: Four hundreds anemic students (11 to 18 years old) were divided into four groups and given wheat flour fortified with different iron fortificants at different concentrations: control group (no added iron); NaFeEDTA group (20 mg Fe/kg); FeSO4 group (30 mg Fe/kg); and elemental iron group (60 mg Fe/kg). The trial lasted for 6 months and the following parameters were examined every 2 months: whole blood hemoglobin, free erythrocyte protoporphyrin, serum ferritin, serum iron, total iron binding capacity and transferrin receptor. Results: The flour consumption in the 4 groups was 300-400 g/person/day, accounted for 70% of total cereal consumption in the diets. There were no significant differences in flour consumption among the 4 groups. Blood hemoglobin level increased in all the 3 intervened groups, but the increment in the NaFeEDTA group was significantly higher and earlier than the other 2 groups; and only 1% of the subjected remained anemic at the end of the trial in the NaFeEDTA group, while 40% and 60% of the subjects in the FeSO4 and electrolytic iron group remained anemic, respectively. The order of improvements in free erythrocyte protoporphyrin, serum ferritin and transferring receptor levels were: NaFeEDTA > FeSO4 > electrolytic iron. No significant changes were found in the control group on all the tested parameters during the trial. Conclusions: The results indicated that even NaFeEDTA was added at a lower level, it has better effects than FeSO4 and elemental iron on controlling iron deficiency anemia and improving iron status in anemic children; while elemental iron was the least effective.

Elemental iron powders are widely used to fortify flour and other cereal products. Our objective was to test the hypothesis that baking enhances the bioavailability of elemental iron powders by oxidizing Fe(0) to Fe(2+) or Fe(3+). An in vitro digestion/Caco-2 cell culture model and a piglet model were used to measure bioavailability. Bread flour, either unfortified or fortified with hydrogen-reduced (HR) iron powder or FeSO(4)(300 mg Fe/kg flour), was baked into bread. For the in vitro studies, bread samples were treated with pepsin at pH 2, 3, 4, 5, 6, or 7 and subsequently incubated with pancreatic enzymes at pH 7 in a chamber positioned above monolayers of cultured Caco-2 cells. Ferritin formation in the cells was used as an index of iron bioavailability. Ferritin formation in cells fed HR Fe bread was similar to cells fed FeSO(4) bread when the peptic digestion was conducted at a pH 2 but lower when the peptic phase was conducted at pH 3, 4, 5, 6, or 7 (P < 0.05). Pig diets containing 35% dried bread were prepared and fed to cross-bred (Hampshire x Landrace x Yorkshire) anemic pigs in two studies. The rate of increase in hemoglobin Fe over the feeding period was used to calculate relative biological value (RBV), an index of iron bioavailability. In the first pig study, RBV of HR Fe added to flour prior to baking was 47.9% when compared to FeSO(4) fortified flour (P < 0.05). In the second pig study, a third treatment consisting of unfortified bread with HR iron added during diet mixing (after bread baking) was included. RBVs of the HR Fe diet (Fe added after baking) and HR Fe diet (Fe added before baking) were 40.1% and 53.5%, respectively, compared to the FeSO(4) diet. Differences in RBV between the HR Fe (before and after baking) and FeSO(4)(before baking) treatment groups were significant, but the difference between the before and after HR treatment groups was not significant. We conclude that bread baking does not enhance the bioavailability of elemental iron powders.

Objective:To determine the effect of iron supplementation on iron status and endurance capacity.Design:Randomized, double-blind iron supplementation.Setting:University of Missouri-Columbia and surrounding community.Subjects:Twenty iron-deficient (serum ferritin, sFer<16 mug/l; serum transferrin receptor, sTfR>8.0 mg/l; or sTfR/log sFer index >4.5), nonanemic (hemoglobin, Hb>120 g/l, women;>130 g/l, men) men and women (18-41 years) were recruited via fliers and newspaper advertisements; 20 of 31 eligible subjects participated.Interventions:A 30 mg measure of elemental iron as ferrous sulfate or placebo daily for 6 weeks.Results:Dietary iron intake and physical activity did not differ between groups before or after supplementation. Iron supplementation significantly increased sFer compared to placebo (P=0.01), but did not affect Hb or hematocrit. Iron supplementation prevented the decline in ventilatory threshold (VT) observed in the placebo group from pre- to post-supplementation (P=0.01); this effect was greater in individuals with lower sFer before intervention (P<0.05). Changes in sFer from pre- to post-treatment were positively correlated with changes in VT (P=0.03), independent of supplementation. The iron group significantly increased gross energetic efficiency during the submaximal test (P=0.04). Changes in sFer were negatively correlated with changes in average respiratory exchange ratio during the submaximal test (P<0.05).Conclusions:Iron supplementation significantly improves iron status and endurance capacity in iron-deficient, nonanemic trained male and female subjects.Sponsorship:Missouri University Alumni Association, by the Elizabeth Hegarty Foundation and by the Department of Nutritional Sciences.European Journal of Clinical Nutrition advance online publication, 12 July 2006; doi:10.1038/sj.ejcn.1602479.

Iron deficiency is endemic in much of the world, and food system-based approaches to eradication may be viable with new plant breeding approaches to increase the micronutrient content in staple crops. It is thought that conventional plant breeding approaches provide varieties of rice that have 400-500% higher iron contents than varieties commonly consumed in much of Asia. The efficacy of consuming high-iron rice was tested during a 9-mo feeding trial with a double-blind dietary intervention in 192 religious sisters living in 10 convents around metro Manila, the Philippines. Subjects were randomly assigned to consume either high-iron rice (3.21 mg/kg Fe) or a local variety of control rice (0.57 mg/kg Fe), and daily food consumption was monitored. The high-iron rice contributed 1.79 mg Fe/d to the diet in contrast to 0.37 mg Fe/d from the control rice. The 17% difference in total dietary iron consumption compared with controls (10.16 +/- 1.06 vs. 8.44 +/- 1.82 mg/d) resulted in a modest increase in serum ferritin (P = 0.10) and total body iron (P = 0.06) and no increase in hemoglobin (P = 0.59). However, the response was greater in nonanemic subjects for ferritin (P = 0.02) and body iron (P = 0.05), representing a 20% increase after controlling for baseline values and daily rice consumption. The greatest improvements in iron status were seen in those nonanemic women who had the lowest baseline iron status and in those who consumed the most iron from rice. Consumption of biofortified rice, without any other changes in diet, is efficacious in improving iron stores of women with iron-poor diets in the developing world.