Abstract Background The increase in the burden of chronic diseases linked to the nutrition transition and associated dietary and lifestyle changes is of growing concern in south and east Mediterranean countries and adolescents are at the forefront of these changes. This study assessed dietary intake and association with socio-economic factors and health outcomes among adolescents in Tunisia. Methods Cross-sectional survey (year 2005); 1019 subjects 15-19 y. from a clustered random sample. Dietary intake was assessed by a validated semi-quantitative frequency questionnaire (134 items) as was physical activity; the Diet Quality Index International measured diet quality; dietary patterns were derived by multiple correspondence analysis from intakes of 43 food groups. Body Mass Index (BMI) ≥85 th and 95 th percentile defined overweight and obesity. Waist Circumference (WC) assessed abdominal fat. High blood pressure was systolic (SBP) or diastolic blood pressure (DBP) ≥90 th of the international reference for 15-17 y., and SBP/DBP ≥120/80 mm Hg for 18-19 y. Results Energy intake levels were quite high, especially for females. The macro-nutrient structure was close to recommendations but only 38% had a satisfactory diet quality. A main traditional to modern dietary gradient, linked to urbanisation and increased economic level, featured an increasing consumption of white bread, dairy products, sugars, added fats and fruits and decreasing consumption of oils, grains, legumes and vegetables; regarding nutrients this modern diet score featured a decreasing relationship with total fat and an increase of calcium intake, but with an increase of energy, sugars and saturated fat, while vitamin C, potassium and fibre decreased. Adjusted for age, energy and physical activity, this modern pattern was associated with increased overweight in males (2 nd vs. 1 st tertile: Prevalence Odds-Ratio (POR) = 4.0[1.7-9.3], 3 rd vs. 1 st : POR = 3.3[1.3-8.7]) and a higher WC. Adjusting also for BMI and WC, among females, it was associated with decreased prevalence of high blood pressure (2 nd vs. 1 st tertile: POR = 0.5[0.3-0.8], 3 rd vs. 1 st tertile: POR = 0.4[0.2-0.8]). Conclusion The dietary intake contrasts among Tunisian adolescents, linked to socio-economic differentials are characteristic of a nutrition transition situation. The observed gradient of modernisation of dietary intake features associations with several nutrients involving a higher risk of chronic diseases but might have not only negative characteristics regarding health outcomes.
Migrant studies in France revealed that Mediterranean migrant men have lower mortality and morbidity than local-born populations for non-communicable diseases (NCDs). We studied overweight and NCDs among Tunisian migrants compared to the population of the host country and to the population of their country of origin. We also studied the potential influence of socio-economic and lifestyle factors on differential health status. A retrospective cohort study was conducted to compare Tunisian migrant men with two non-migrant male groups: local-born French and Tunisians living in Tunisia, using frequency matching. We performed quota sampling (n = 147) based on age and place of residence. We used embedded logistic regression models to test socio-economic and lifestyle factors as potential mediators for the effect of migration on overweight, hypertension and reported morbidity (hypercholesterolemia, type-2 diabetes, cardiovascular diseases (CVD)). Migrants were less overweight than French (OR = 0.53 [0.33–0.84]) and had less diabetes and CVD than Tunisians (0.18 [0.06–0.54] and 0.25 [0.07–0.88]). Prevalence of hypertension (grade-1 and -2) and prevalence of hypercholesterolemia were significantly lower among migrants than among French (respectively 0.06 [0.03–0.14]; 0.04 [0.01–0.15]; 0.11 [0.04–0.34]) and Tunisians (respectively OR = 0.07 [0.03–0.18]; OR = 0.06 [0.02–0.20]; OR = 0.23 [0.08–0.63]). The effect of migration on overweight was mediated by alcohol consumption. Healthcare utilisation, smoking and physical activity were mediators for the effect of migration on diabetes. The effect of migration on CVD was mediated by healthcare utilisation and energy intake. No obvious mediating effect was found for hypertension and hypercholesterolemia. Our study clearly shows that lifestyle (smoking) and cultural background (alcohol) are involved in the observed protective effect of migration.
Le modèle conceptuel le plus récent de l'obésité en Tunisie remonte à 2002, soulignant l'urgence de mettre à jour les facteurs de risque impliqués, compte tenu de la transition épidémiologique et nutritionnelle. Cette étude visait à mettre à jour le modèle conceptuel de l'obésité et à renforcer la prise en compte des facteurs de risque de l'obésité dans les investigations étiologiques. Nous avons organisé un atelier collaboratif à Tunis, rassemblant des experts multisectoriels et multidisciplinaires des niveaux national et international pour générer un modèle hypothétique de l'obésité. En se basant sur une approche participative, l'atelier a généré une liste de facteurs de risque. Parallèlement, nous avons effectué une revue exhaustive de la littérature basée sur des études nationales et régionales. Nous avons étudié l'association entre divers facteurs inclus dans le modèle conceptuel ainsi que les facteurs associés identifiés par régression logistique en analysant les études étiologiques. Le modèle conceptuel affiné a fait l'objet d'une mise à jour approfondie, mettant en lumière divers facteurs de risque. L'étude a révélé des facteurs allant au-delà des facteurs sociodémographiques et économiques conventionnels, tels que le sexe, l'âge, le niveau d'éducation, l'état matrimonial et le niveau de vie. Le modèle englobait des éléments environnementaux, le changement climatique, l'insécurité, l'instabilité politique et les caractéristiques du système de santé. Les études étiologiques publiées sur l'obésité ont omis des facteurs spécifiques, et le modèle conceptuel a été essentiel pour reconnaître et mettre à jour ces facteurs de risque. Le modèle conceptuel mis à jour de l'obésité offre une compréhension complète des facteurs de risque, mais la validation par le biais d'études étiologiques holistiques est impérative. Dans ce contexte, l'établissement du projet JEAI-TANIT illustre une approche visant à concrétiser des perspectives holistiques dans les études étiologiques de l'obésité et d'autres maladies chroniques.
Summary Adult Tunisian women aged 20–59 (national random sample, n = 1849), were assessed with respect to environmental and socioeconomic factors associated with obesity (body mass index ≥30 kg m −2 ) and abdominal obesity (waist circumference ≥88 cm). At the national level, prevalence of obesity and abdominal obesity were, respectively, 22.6% and 29.2%, but varied markedly (both P < 0.0001) among living environments classified as big cities (30.2% and 36.6%), other cities (25.9% and 32.4%), rural clustered (19.4% and 24.8%) and rural dispersed (9.5% and 16.5%). Adjusted prevalences of both types of obesity increased with age, parity and economic level of the household, while educationally, the risk was greatest in women with intermediate schooling. Differences between the four environments were accounted for by socioeconomic factors, mostly household wealth, except for most rural environment; socio‐cultural factors were possibly influential. Observed differences between rural areas confirmed that finer measures of urbanization are necessary for the drivers of obesity prevalence at the national level. Obesity was still more prevalent in wealthy than in poor women, but given the high prevalence in all the environments, actions are needed at the national level before highly prevalent obesity extends into those of lower socioeconomic status and thereby increases health inequities.
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Introduction: The role of dietary composition in relation to the development of childhood obesity remains inconclusive.The macronutrient composition of the diet may play a contributing role.This study investigated the difference in macronutrient composition of the diet between controls and obese children.Methods: Data of height and weight measurements, along with a 5-day dietary record were collected from Belgian boys and girls aged 6-16 years.Food records were analyzed by a skilled dietician using Becel Institute Nutrition Software (version 3.0.0.4).Results: 47 children were recruited with a mean age of 11.1 +/-2.8.Based on IOTF criteria 22 had overweight or obesity and 25 were part of a normal weight control group.No significant differences between cases and controls were observed for percentage carbohydrates (P=0.2),fat percentage (P=0.5)or total energy intake expressed in kcals (P=0.3).There was no difference in protein intake expressed in percent in the obese children compared to the controls (P=0.1).However, protein intake (in g/kg bodyweight) was significantly lower in our cases (P=<0.001) with a median of 1.39 (0.58-2.86) vs. 2.01 (0.82-4.37) in the controls.Conclusions: As a recently published Australian report (Elliot, Nutrition Journal 2011) on 24h dietary recall records described, the percentage of carbohydrate, protein and fat intake did not differ significantly between cases and controls.However in our cohort, protein intake per kg bodyweight was significantly lower in obese children, which may have an impact on guidelines for protein intake in children as they are based on total bodyweight.
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