What are the current patterns of food consumption in the KSA?

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:

1. What are the current patterns of food consumption in the KSA?

2. What dietary gaps can be identified by analyzing the current food situation in the KSA?

3. Members of which age group have the healthiest diet, and why?

4. In your opinion, what can be done to encourage better patterns of food consumption among the Saudi population?

The length of the paper assignment should be 500-700 words.

Requirements: 500-700

DietinSaudiArabia:findingsfromanationallyrepresentativesurveyMaziarMoradi-Lakeh1,CharbelElBcheraoui1,AshkanAfshin1,FarahDaoud1,MohammadAAlMazroa2,MohammadAlSaeedi2,MohammedBasulaiman2,ZiadAMemish2,AbdullahAAlRabeeah2andAliHMokdad1,*1InstituteforHealthMetricsandEvaluation,UniversityofWashington,23015thAvenue,Suite600,Seattle,WA98121,USA:2MinistryofHealthoftheKingdomofSaudiArabia,Riyadh,SaudiArabiaSubmitted30March2016:Finalrevisionreceived8September2016:Accepted10October2016:Firstpublishedonline15December2016AbstractObjective:NorecentoriginalstudiesonthepatternofdietareavailableforSaudiArabiaatthenationallevel.ThepresentstudywasperformedtodescribetheconsumptionoffoodsandbeveragesbySaudiadults.Design:TheSaudiHealthInterviewSurvey(SHIS)wasconductedin2013.Datawerecollectedthroughinterviewsandanthropometricmeasurementsweredone.Adiethistoryquestionnairewasusedtodeterminetheamountofconsumptionforeighteenfoodorbeverageitemsinatypicalweek.Setting:ThestudywasahouseholdsurveyinallthirteenadministrativeregionsofSaudiArabia.Subjects:Participantswere10735individualsaged15yearsorolder.Results:Meandailyconsumptionwas70·9(SE1·3)gforfruits,111·1(SE2·0)gforvegetables,11·6(SE0·3)gfordarkfish,13·8(SE0·3)gforotherfish,44·2(SE0·7)gforredmeat,4·8(SE0·2)gforprocessedmeat,10·9(SE0·3)gfornuts,219·4(SE5·1)mlformilkand115·5(SE2·6)mlforsugar-sweetenedbeverages.Dietaryguidelinerecommendationsweremetbyonly5·2%ofindividualsforfruits,7·5%forvegetables,31·4%fornutsand44·7%forfish.Theconsumptionofprocessedfoodsandsugar-sweetenedbeverageswashighinyoungadults.Conclusions:OnlyasmallpercentageoftheSaudipopulationmetthedietaryrecommendations.Programmestoimprovedietarybehavioursareurgentlyneededtoreducethecurrentandfutureburdenofdisease.Thepromotionofhealthydietsshouldtargetboththegeneralpopulationandspecifichigh-riskgroups.Regularassessmentsofdietarystatusareneededtomonitortrendsandinforminterventions.KeywordDietFoodsBeveragesNutritionepidemiologySaudiArabiaDietaryrisksareamongthemostimportantriskfactorsgloballyandintheKingdomofSaudiArabia(KSA)inparticular(1,2).Likemanyotherregionsoftheworld,thenutritiontransitionintheMiddleEasthascontributedtotherisingburdenofnon-communicablediseases(1,3).InKSAin2013,poordietaccountedfor10·4%(95%CI8·9,12·2%)ofdisability-adjustedlifeyearsand22·1%(95%CI18·7,24·5%)ofdeaths(3,4).FAOdatashowanoverallincreaseinfoodsupply(1961–2007)inKSA,withanincreaseinthesupplyofsugar,meat,animalfat,offal(organmeats),eggsandmilk,andalevellingtrendinthevegetableandfruitsupply(5).Asimilartrendwasreportedearlierin2000(6).KhanandAlKanhalreportedarapidlyincreasingsurplusofenergyandproteinavailabilityinKSAafter1975,comparedwiththerecommendeddailyallowances(7).Previousreportshaveshownthedietarypatternsorenergy/nutrientintakesinspecificpopulationsubgroupsorregionsofKSA(8).However,nationallyrepresentativedietdatafromKSAarelimitedtofoodavailability.Foodavailabilitydata(suchasFAOdata)donotrepresentintake,astheydonotaccountforwastageandotheruses.Moreover,theydonotprovideinformationondietbyage,sexandsocio-economicstatus.In2012,theKSAMinistryofHealthpublisheddietaryguidelinesontheamountandcompositionofrecom-mendedfoodstopromoteahealthydietamongthepopulation(9).However,therearenotenoughdataonthesuccessoftheguidelines’implementation,thepopula-tion’scurrentdietarystatusandthepotentialimpactsoftheguidelines.Therefore,theaimsofthepresentstudyPublicHealthNutrition:20(6),1075–1081doi:10.1017/S1368980016003141*Correspondingauthor:[email protected]©TheAuthors2016Downloaded from https://www.cambridge.org/core. 15 Sep 2021 at 21:29:35, subject to the Cambridge Core terms of use.

weretodescribetheamountofconsumptionofdifferenttypesoffoodsandbeveragesinKSA;todescribedietaryconsumptionbyage,sex,socio-economicstatusandsub-nationaladministrativeregions;andtoassessthedegreetowhichSaudis’dietsmetthedietaryguidelines.MethodsPerformedbetweenAprilandJune2013,theSaudiHealthInterviewSurvey(SHIS)wasanationalmultistagesurveyofindividualsaged15yearsorolder.Forthissurvey,KSAwasdividedintothirteenregions.Eachregionwasdividedintosub-regionsandblocks.Allregionswereincludedinthesurvey.Aprobability-proportional-to-sizemethodwasusedtorandomlyselectsub-regionsandblocks.House-holdswerethenrandomlyselectedfromeachblock.Arosterofhouseholdmemberswasconductedandanadultaged15yearsorolderwasrandomlyselectedtobesurveyedfromeachselectedhousehold.Iftherandomlyselectedadultwasnotpresent,oursurveyorsmadeanappointmenttoreturn.Atotalofthreevisitswereattemptedbeforethehouseholdwasconsideredasanon-response.Moredetailsaboutthestudyareavailableinpreviouspublications(10–13).TheSaudiMinistryofHealthanditsinstitutionalreviewboard(IRB)approvedthestudyprotocol.TheUniversityofWashingtonIRBdeemedthestudyIRB-exempt,sincetheInstituteforHealthMetricsandEvaluationreceivedde-identifieddataforthepresentanalysis.Allrespondentshadtheopportunitytoconsentandagreetoparticipateinthestudy.Thesurveyincludedforty-twoquestionsondiet(adiethistoryquestionnaire),aswellasquestionsonsocio-economicstatus(educationalandhouseholdmonthlyincomelevels)andotheraspectsofhealth.Respondentswereaskedtoreportthenumberofdaysthattheyconsumedeighteenfoodorbeverageitemsinatypicalweekoverthelastyear.Thefoodandbeverageitemsincludedinthesurveywere:fruits;pure(100%)fruitjuices;vegetables;darkmeatfish;otherfish;shrimp;redmeat;poultrymeat;processedmeat(meatspreservedbysmoking,curingorsalting,orbytheadditionofpreservatives,suchasinthecaseofpastrami,salami,bologna,otherpackagedlunchmeatsordelimeats,sausages,bratwursts,frankfurtersandhotdogs);otherprocessedfoods(suchasfastfoods,cannedfoods,pack-agedentréesorpackagedsoup);eggs;nuts;milk;yoghurt;laban(abeverageofyoghurtmixedwithsalt,whichisalsoknownasayranordoogh);labneh(strainedyoghurt);cheese;andsugar-sweetenedbeverages(SSB).Foreachtypeoffood/beveragethattherespondentsreportedatleastonedayofconsumptionpertypicalweek,therespondentswereasked:‘Howmanyservingsof[thisfood/beverage]doyouusuallyconsume/eat/drinkononeofthosedays?’Theinterviewersusedspecificpicturesthatrepresentedtheservingsizeofeachtypeoffood/bev-erage.Moreover,respondentswereaskedaboutthetypeofoilorfatmostoftenusedformealpreparation,andtheusualtypeofdairyproducts(full-fat,low-fat,non-fat)andbreadinthehousehold.Therewereinsufficientdatatocalculatetotalenergyconsumptiondirectly.SupplementalFile1(seeonlinesupplementarymaterial)showsthemethodforindirectestimationofenergyintakeandtheenergy-adjusteddailyfood/beverageconsumptionestimates.Althoughnotanidealmethodforenergyadjustment,itcanprovidemorecomparabilitywithotherstudiesforinterestedreaders.Anenergyadjustmentisalsonecessarytocomparethestatuswiththedietaryguidelinerecommendations.Averagenumbersofdailyservings–andtheirequiva-lentweight(grams)forfoods,orvolume(millilitres)forbeverages–werecalculated.Incaseswheretheweightofaservingsizehadnotbeenclarifiedinthesurveymanuals(fruits,vegetables,processedmeat,processedfoodsandeggs),wematchedourvisualmanualascloselyaspossibletophrasesintheguidelinesoftheUSDepartmentofAgriculturetoassignanaverageweight(14).Forfruitsandvegetables,weusedtheweightedaverageweightofoneservingofthemostcommontypesoffruitsandvegetablesbasedonthemostrecentfoodsupplydataofFAOinKSA(15).The99thpercentilesofconsumptionwereusedascut-offpointstoidentifyandexcludeimplausiblyhighlevelsofintake.ThestatisticalsoftwarepackageStata13.1forWindowswasusedfortheanalysesandtoaccountforthecomplexsamplingdesign.ResultsAtotalof12000householdswerecontactedand10735participants(5253menand5482women)completedtheSHIS,foraresponserateof89·4%.Table1demonstratestheaveragedailyconsumptionofdifferentfoodandbeverageitems.Table2showsthefoodandbeverageconsumptionofmenandwomen.Non-adjustedconsumptionoffruit,redmeat,otherprocessedfoods,eggsandSSBwasstatisticallyhigherinmenthanwomen,whileyoghurtandcheeseconsumptionwashigherinwomenthanmen.Dailyconsumptionoffruitsandvegetableswasreportedby10·8(SE0·4)%and25·9(SE0·6)%,respectively,and27·0(SE0·7)%reporteddailydrinkingofSSB.Meanconsumptionofprocessedmeat,otherprocessedfoodsandSSBwasclearlyhigherinyoungeragegroups(Table3),whilelabanconsumptionwashigherinolderagegroups.Consumptionoffruit,shrimp,labnehandcheesehadanincreasingpatternwithhighereducation(Table4).AsdemonstratedinTable5,consumptionofsomeofthefooditems(fruit,shrimp,redmeatandlabneh)washigherinindividualswithhigherhousehold1076MMoradi-Lakehetal.Downloaded from https://www.cambridge.org/core. 15 Sep 2021 at 21:29:35, subject to the Cambridge Core terms of use.

incomes.ConsumptionofSSBwasstatisticallyhigherinindividualswithlowerhouseholdincomes(Table5).Fruit/beverageconsumptionindifferentadministrativeregionscanbefoundinSupplementalFile2(seeonlinesupplementarymaterial).Vegetableoilswerethemostcommontypeofoil/fatusedforpreparationoffood(84·5(SE0·5)%).Oliveoilandbutter/margarinewerereportedby5·3(SE0·3)%and4·8(SE0·3)%,respectively.Mostoftherespondentsreporteduseoffull-fatdairyproducts(77·6(SE0·6)%),followedbylow-fat(15·0(SE0·5)%)andnon-fat(1·3(SE0·1)%);othershadnopreference.Themostcommontypeofbreadwaswhitebread(79·1(SE0·5)%);brownbreadandSaudi-specifictraditionalbreadswerereportedby20·1(SE0·5)%and0·8(SE0·1)%,respectively,astheusualkindofbread.DiscussionThepresentstudyisthefirsttodescribedietarypatternsinanationallyrepresentativesampleofadultsinKSA.ItTable1AveragedailyfoodandbeverageconsumptionofSaudiadults,2013Weight/volumeunitsServingsizeMeettherecommendationsFood/beverageitemServingsizeNMeanSEMeanSE%SEFruits(g)103g*1018770·91·30·6750·0135·2†0·3Vegetables(g)105g*10334111·12·01·0780·0197·5†0·4Pure(100%)fruitjuices(ml)125ml1006631·90·80·2690·007Darkmeatfish(g)75g1009611·60·30·1370·00344·7‡0·7Otherfish(g)75g1008213·80·30·1590·003Shrimp(g)75g98012·40·10·0280·001Redmeat(g)75g1022344·20·70·5210·00985·7§0·5Poultrymeat(g)75g10336103·01·81·3040·022Processedmeat(g)69g*96674·80·20·0700·00380·2§0·6Otherprocessedfoods(g)399g*966497·52·70·2440·007Eggs(g)92g*1021946·00·70·5000·007Nuts(g)40g976810·90·30·2740·00731·4†0·7Yoghurt(g)175g1025775·42·00·4310·01226·2†0·7Milk(ml)250ml10326219·45·10·8850·021Laban(ml)175g10269116·82·80·6670·016Labneh(g)175g986628·90·80·1650·004Cheese(g)50g1011343·70·90·8740·018SSB(ml)125ml9967115·52·60·9240·02178·6‡0·6SSB,sugar-sweetenedbeverages.*EstimatedthroughmatchingofpicturesinthesurveymanualwiththedescriptionsoftheUSDepartmentofAgricultureguideline(14).Referencedietaryguidelines:†DietaryGuidelinesforAmericans(25);‡AmericanHeartAssociation(24);§AmericanInstituteforCancerResearch(23).Table2DailyfoodandbeverageconsumptionofSaudimaleandfemaleadults,2013Male(N5253)Female(N5482)Weight/volumeunitsServingsizeWeight/volumeunitsServingsizeFood/beverageitemMeanSEMeanSEMeanSEMeanSEFruits(g)75·71·90·6200·01665·91·90·5470·017Vegetables(g)105·42·30·9040·020117·03·31·0320·034Pure(100%)fruitjuices(ml)34·01·20·2410·01029·71·10·2140·010Darkmeatfish(g)11·50·40·1230·00511·70·40·1230·004Otherfish(g)14·30·40·1530·00513·30·40·1440·006Shrimp(g)2·50·10·0260·0022·30·10·0230·002Redmeat(g)52·41·20·5900·01435·70·90·4030·012Poultrymeat(g)106·62·41·1950·02799·32·71·1310·033Processedmeat(g)5·00·30·0640·0044·70·30·0680·004Otherprocessedfoods(g)108·44·30·2390·00986·03·20·1940·008Eggs(g)49·81·00·4960·01142·00·90·4140·009Nuts(g)11·20·40·2690·01110·70·40·2430·009Yoghurt(g)67·11·90·3490·01084·23·60·4200·020Milk(ml)217·56·40·7120·019221·48·10·7960·033Laban(ml)122·23·90·5800·017111·23·90·5680·023Labneh(g)27·51·00·1490·00630·41·20·1640·007Cheese(g)40·51·20·6720·01647·01·40·7790·023SSB(ml)131·43·50·9720·02898·83·80·6990·030SSB,sugar-sweetenedbeverages.DietinSaudiArabia1077Downloaded from https://www.cambridge.org/core. 15 Sep 2021 at 21:29:35, subject to the Cambridge Core terms of use.

showedpoordietarypracticesintheKingdom.Saudis’dietarybehavioursmetdietaryrecommendationsinonlyasmallpercentageofthepopulation,especiallyforfruitandvegetableconsumption,dairyproducts,nutsandfishmeat.Youngadults(15–24yearsold)hadacon-cerningpatternofhighconsumptionofSSB,processedmeatandotherprocessedfoods,aswellaslowintakeoffruitsandvegetables.Otherstudiesonschoolchildrenshowthattheseunhealthydietarybehavioursstartevensooner(16).ThisevidencecallsforacomprehensiveprogrammetoimprovethedietarysituationofSaudis.Theprogrammeshouldincludeallageranges,consideringthedifferentneedsanddifferentdietarychallengesofeachagegroup.Aclusterofdietaryriskfactorsistheleadingriskfactorfornon-optimalhealth,with11·3millionattributeddeathsand241·4millionattributeddisability-adjustedlifeyearsperannumaroundtheworld(1).TheGlobalBurdenofDiseases,Injuries,andRiskFactors(GBD)studyshowedthatinSaudiArabia,theaveragelevelsofconsumptionoffruits,vegetables,nuts,wholegrains,PUFAandseafoodn-3fattyacidswerefarlessthanoptimum,andtheaveragelevelsofconsumptionofprocessedmeats,redmeats,totalfattyacids,SSBandsodiumwerehigherthanoptimal(3).InthereportoftheWHO2005STEPwisesurvey,therewaslimiteddietaryinformationontheconsumptionoffruits,vegetablesandoils.DuringthetimebetweentheSTEPwisesurveyandourcurrentstudy(2005to2013),thepercentageofindividualsconsumingatleastfivedailyservingsoffruitsorvegetablesincreasedslightly,from5·5to7·3%(11).However,basedonfoodsupplydata,fruitandvegetableavailabilityinKSA(about475g/din2010)(17)ismorethantwicetheaverageconsumptioninourstudy(lessthan200g/d).Thedifferencemightberelatedtousingfruitsaspurejuices(about32ml/d)orsweetenedjuices,aswellasthehigherpotentialofdecayinfruits/vegetablescomparedwithotherfooditems.FurtherdetailsonconsumptionoffruitsandvegetablesbySaudiadultshavebeenreportedelsewhere(11).Consumptionofoliveoilhasincreasedfrom1·7%intheSaudiSTEPwisesurveyto5·3%(18);sincehigherintakeofoliveoilisassociatedwithreducedriskofall-causemortality,cardio-vasculareventsandstroke,thiscanbeconsideredagoodreplacement(19).AlthoughtherewashigherconsumptionofmeatandSSBbymen,andofvegetablesbywomen,non-energy-adjustedconsumptionisnotdirectlycomparablebetweenmenandwomen.Consideringthefactthataverageenergyconsumptionisusuallyhigherinmen,vegetableintakeisexpectedtoremainhigherinwomenafterenergyadjust-ment.Someofthedifferentpatternsoffoodandbeverageconsumptionbetweenmenandwomenmaybeexplainedbytheoriesabouttheassociationofmeatconsumptionwithmasculinityandvegetableconsumptionwithfemi-ninity,butwedonothaveenoughinformationforthatassessment(20–22).Table3DailyfoodandbeverageconsumptionofSaudiadultsbysexandagegroup,201315–24years25–39years40–59years60yearsormoreMale(N1189)Female(N1193)Male(N1857)Female(N2169)Male(N1495)Female(N1575)Male(N712)Female(N545)Food/beverageitemMeanSEMeanSEMeanSEMeanSEMeanSEMeanSEMeanSEMeanSEFruits(g)56·52·946·22·466·02·765·13·677·93·565·53·768·84·460·15·5Vegetables(g)83·03·8104·87·498·23·4104·84·5105·83·5109·25·291·55·0112·513·5Pure(100%)fruitjuices(ml)26·22·324·82·432·51·826·51·430·92·125·32·020·82·224·32·9Darkmeatfish(g)11·00·810·40·712·10·712·80·78·80·68·70·67·21·05·90·9Otherfish(g)12·80·811·70·913·90·714·60·813·90·712·50·912·41·37·71·1Shrimp(g)1·70·21·90·33·40·32·70·32·20·21·50·21·30·31·00·5Redmeat(g)51·42·431·21·847·91·834·81·449·21·837·91·954·23·136·85·3Poultrymeat(g)101·13·996·45·598·14·087·24·183·22·983·13·979·84·578·06·1Processedmeat(g)6·30·75·80·64·20·45·70·52·40·32·70·41·40·70·90·3Otherprocessedfoods(g)121·67·893·56·596·25·384·44·869·65·154·14·132·14·729·84·0Eggs(g)48·41·835·81·446·61·644·11·544·21·737·01·432·62·126·82·4Nuts(g)12·90·810·40·610·40·710·30·79·20·68·80·75·30·85·41·1Yoghurt(g)57·83·464·96·461·83·172·75·964·23·280·56·067·05·0108·019·6Milk(ml)183·09·1201·318·0163·66·9191·39·5170·17·4187·49·4205·011·2247·127·7Laban(ml)97·25·887·07·2104·34·799·47·0102·04·2112·66·5113·57·7129·014·5Labneh(g)23·12·030·22·628·41·727·61·531·02·129·42·219·82·521·33·1Cheese(g)36·91·742·92·533·71·140·51·531·11·333·11·423·01·528·73·0SSB(ml)172·26·6127·38·0119·26·084·34·964·94·342·53·130·43·521·63·6SSB,sugar-sweetenedbeverages.1078MMoradi-Lakehetal.Downloaded from https://www.cambridge.org/core. 15 Sep 2021 at 21:29:35, subject to the Cambridge Core terms of use.

Comparedwiththerecommendationsofdietaryguidelines(9,23–25),consumptionoffruits,vegetables,dairyproductsandnutsisverylow,andlessthan45%oftheKSApopulationconsumesfishasrecommended.Ontheotherhand,thereisconsiderableunnecessaryconsump-tionofprocessedmeatandSSBcomparedwiththerecommendations(23,24).A2006studyinLebanonshowedthatLebaneseadultsconsumethesameamountoffishandredmeatasSaudisinourstudy,butlesspoultrymeat(36v.103g/d)andeggs(12v.46g/d),andmorefruitsandvegetables(367v.182g/d)(26).ThepreviouslypublishedGBDestimatesfordietaryriskfactorsinKSAwereclosetoourestimatesforredmeat,processedmeatandSSB.OurestimatefornutswashigherthanpreviousGBDestimates(about11v.4g/d)(3).Midhatetal.reportedtheconsumptionofdifferentfooditemsaspartoftheroutinemealsintheQassimregionofKSA.However,theydidnotreporttheamount(orservingsizes)ofconsumption.Thatstudyshowedanincreasingprobabilityofroutineintakeoffish,vegetables,freshfruitsandbarbecuedmeats(calleda‘healthydiet’)withincreasingage(27).OurfindingsshowedthatSaudisofolderagesconsumemorefruitandvegetables,andfewerprocessedfoods.Thehealthierdietseenamongolderindividualsmightberelatedtodifferentfactors,suchasabirthcohorteffect(duetothenutritiontransitionintheTable4DailyfoodandbeverageconsumptionofSaudiadultsbyeducationallevel,2013Primaryorless(N3286)Elementary/highschool(N4780)Collegeorhigher(N2649)Food/beverageitemMeanSEMeanSEMeanSEFruits(g)64·22·355·61·774·83·0Vegetables(g)99·64·396·93·0108·03·9Pure(100%)fruitjuices(ml)22·01·425·61·235·81·6Darkmeatfish(g)10·30·59·90·411·90·6Otherfish(g)12·90·712·30·513·30·6Shrimp(g)0·90·12·10·13·60·3Redmeat(g)43·91·642·11·241·51·4Poultrymeat(g)99·23·593·82·582·53·5Processedmeat(g)4·80·54·20·35·10·4Otherprocessedfoods(g)66·34·295·34·092·84·7Eggs(g)36·41·243·81·044·81·3Nuts(g)11·70·89·60·39·70·4Yoghurt(g)74·95·062·12·469·74·0Milk(ml)219·69·5177·26·9168·68·5Laban(ml)104·54·397·63·899·85·1Labneh(g)20·31·427·91·335·51·7Cheese(g)33·01·337·31·138·91·4SSB(ml)86·55·1120·93·988·54·3SSB,sugar-sweetenedbeverages.Table5FoodandbeverageconsumptionofSaudiadultsbyhouseholdmonthlyincomelevel,2013Lessthan5000Riyals(N3161)5000–14999Riyals(N4549)15000Riyalsormore(N1131)Food/beverageitemMeanSEMeanSEMeanSEFruits(g)51·52·065·21·779·34·7Vegetables(g)94·13·796·22·2118·36·6Pure(100%)fruitjuices(ml)20·91·528·31·440·52·4Darkmeatfish(g)9·80·510·80·510·60·8Otherfish(g)13·30·713·80·514·00·9Shrimp(g)1·70·22·30·23·90·4Redmeat(g)37·21·542·41·250·32·4Poultrymeat(g)89·33·388·62·193·34·3Processedmeat(g)3·40·44·40·35·20·7Otherprocessedfoods(g)91·05·386·83·782·76·6Eggs(g)38·91·245·21·042·21·8Nuts(g)8·10·510·10·411·20·8Yoghurt(g)66·43·464·62·361·94·0Milk(ml)188·58·7166·54·9189·411·1Laban(ml)104·74·999·53·298·75·8Labneh(g)22·71·531·91·436·42·7Cheese(g)37·51·836·20·935·91·8SSB(ml)113·65·495·93·291·05·6SSB,sugar-sweetenedbeverages.DietinSaudiArabia1079Downloaded from https://www.cambridge.org/core. 15 Sep 2021 at 21:29:35, subject to the Cambridge Core terms of use.

youngerbirthcohorts),thelongerlifeofindividualswithhealthydiets,morefrequentcontactsbetweenhealthcare-providersandolderindividuals(comparedwithyoungerpeople),andbetteradherenceamongolderindividualstodietaryguidelinesbecauseoftheirperceivedriskofdiseaseanddeath.Theaverageconsumptionoffruit,vegetablesandshrimpinindividualswithacollegeorhighereducationwasmorethaninothereducationalgroups.Thehighestintakeofmilkwasreportedbyindividualswithprimaryorlesseducation.IndividualswiththelowesthouseholdincomehadthehighestconsumptionofSSB,whilecon-sumptionoffruits,vegetablesandpurejuiceswaslowerthaninindividualswithhigherincome.Inourstudy,thehighestintakeoffishwasintheJizan,Aasir,AlBahahandMakkahregions(alllocatedinthesouth-westernpartofthecountryandclosetotheRedSea),aswellasinRiyadh(capital);thelowestconsump-tionoffishwasreportedbyresidentsofHa’il,AlJawfandAlHududashShamaliyah(alllocatedinthenorth-westernpartofthecountry).AlthoughtheprevalenceofobesityhasdecreasedinrecentyearsinKSA,thecurrentcombinationofhighoverweight/obesityprevalence(28),sedentarylifestyle(10)andinappropriatedietthreatensthecurrentandfuturehealthofthepopulation.Ourstudyhassomelimitations.First,weusedadiethistoryquestionnairethatdidnotcontaindetailsforalltypesoffoodsandbeverages.Second,ourfoodandbeverageconsumptiondataareself-reportedandsubjecttorecallandsocialdesirabilitybiases.Third,ourstudydidnotincludetheamountofallfoodsandbeverages(forinstance,complexcarbohydrates),andwewerenotabletodirectlycalculatetotalenergyexpenditure.Ontheotherhand,ourstudyisbasedonalargesamplesizeandusedastandardizedmethodologyforallitsmeasures.Itisnationallyrepresentativeandhasthemeritofprovidingaccuratedataduetoournear-real-timedataqualitymonitoringthroughthewholesurveyperiod.TheSaudiMinistryofHealthhasinitiatedprogrammesandprojects,suchastheCrownHealthProject(29,30)andtheSaudidietaryguidelines(9),toalleviatetheburdenofriskfactorsofnon-communicablediseases.Theoutcomesoftheseprogrammesneedtobeevaluated,sothatthelessonslearnedfromthemcanbeusedintheadjustmentofcurrentprogrammesandtheplanningandinstallationofnewcomprehensiveprogrammes.ConclusionOurstudyshowedthatSaudis’dietsdonotfollowtheguidelinesforhealthydiets.IncreasedeffortstoimproveeatinghabitsinKSAareneeded.Theseeffortsshouldpro-moteabalanceddietaccordingtoenergyintakeandcom-positionofdiet.Specifically,increasingtheconsumptionoffruits,vegetables,dairyproducts,nutsandfishshouldbetargeted.StrategiesarerequiredtolimittheconsumptionofprocessedfoodsandSSB,especiallyinyoungadults.Theseeffortsshouldinvolveallstakeholders,includingeducationrepresentatives,agriculturepartners,foodcompaniesandfoodimporters.Inaddition,regularassessmentsofSaudis’dietarystatusareneededtomonitortrendsandinforminterventions.Finally,politicalwillisneededtoenforcefoodlabellingandmanufacturingregulations.AcknowledgementsAcknowledgements:TheauthorswouldliketothankKevinO’RourkeattheInstituteforHealthMetricsandEvaluationforeditingthemanuscript.Financialsupport:ThisstudywassupportedbyagrantfromtheMinistryofHealthoftheKSA.TheMinistryofHealthhadnoroleinthedesign,analysisorwritingofthisarticle.Conflictofinterest:Thestudyandtheauthorshavenotreceivedanyfinancialsupportfromthefoodindustries.Authorship:A.H.M.conceivedanddesignedthestudy.M.B.,Z.A.M.,M.A.S.andM.A.A.performedthesurvey.C.E.B.andF.D.participatedinquestionnairedesignandinterviewers’training.M.M.-L.,A.A.andA.H.M.analysedthedata.M.M.-L.,A.H.M.,C.E.B.,A.A.,F.D.,M.B.,Z.A.M.,M.A.S.,M.A.A.andA.A.A.R.draftedorcommentedonthemanu-script.A.A.A.R.supervisedthestudy.Allco-authorsareresponsibleforthecontentofthisarticleandhavereadandapprovedthefinalmanuscript.Ethicsofhumansubjectparticipation:TheSaudiMinistryofHealthanditsIRBapprovedthestudyprotocol.TheUniversityofWashingtonIRBdeemedthestudyIRB-exempt,sincetheInstituteforHealthMetricsandEvaluationreceivedde-identifieddatafortheanalysis.Allrespondentshadtheopportunitytoconsentandagreetoparticipateinthestudy.SupplementarymaterialToviewsupplementarymaterialforthisarticle,pleasevisithttps://doi.org/10.1017/S1368980016003141References1.GBD2013RiskFactorsCollaborators,ForouzanfarMH,AlexanderLetal.(2015)Global,regional,andnationalcomparativeriskassessmentof79behavioural,environ-mentalandoccupational,andmetabolicrisksorclustersofrisksin188countries,1990–2013:asystematicanalysisfortheGlobalBurdenofDiseaseStudy2013.Lancet386,2287–2323.2.MemishZA,JaberS,MokdadAHetal.(2014)Burdenofdisease,injuries,andriskfactorsintheKingdomofSaudiArabia,1990–2010.PrevChronicDis11,E169.3.AfshinA,MichaR,KhatibzadehSetal.(2015)TheimpactofdietaryhabitsandmetabolicriskfactorsoncardiovascularanddiabetesmortalityincountriesoftheMiddleEastand1080MMoradi-Lakehetal.Downloaded from https://www.cambridge.org/core. 15 Sep 2021 at 21:29:35, subject to the Cambridge Core terms of use.

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