146x Filetype PDF File size 0.65 MB Source: bpb-eu-w2.wpmucdn.com
NUTRITIONRESEARCH47(2017)1–12 Available online at www.sciencedirect.com ScienceDirect www.nrjournal.com Review Gapsandopportunities for nutrition research in relation to non-communicable diseases in Arab countries: Call for an informed research agenda FarahNajaa,1,HibehShatilaa,LokmanMehob,MohamadAlameddinec,d,1,SallyHabera, a,1 e a, ,1 Lara Nasreddine , Abla Mehio Sibai , Nahla Hwalla ⁎ a Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. BOX 11-0.236 Riad El Solh, 11072020 Beirut, Lebanon b University Libraries, American University of Beirut, P.O. BOX 11-0.236 Riad El Solh, 11072020 Beirut, Lebanon c Mohammed Bin Rashid University, Dubai Healthcare City, Building 14, 505055, Dubai, UAE d Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut. Riad El-Solh, Beirut, 1107 2020, Lebanon e Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, P.O. BOX 11-0.236 Riad El Solh, 11072020 Beirut, Lebanon ARTICLEINFO ABSTRACT Article history: Effective public health nutrition interventions are needed to curb the escalating prevalence of Received 23 January 2017 non-communicable diseases (NCDs) in many Arab countries. In order to generate the scientific Revised 27 July 2017 evidenceneededforthesuccessoftheseinterventions,aninformedresearchagendashouldbe Accepted 31 July 2017 developed. The purpose of this review is to identify gaps and opportunities for research on nutrition and NCDs amongArabcountries,whichisanimportantsteptowardstheformulation Keywords: of this research agenda. Published papers that addressednutritionandNCDsinArabcountries Nutrition betweentheyears2006and2015werereviewed(n = 824).Themaingapsidentifiedwererelated Non-communicablediseases to the predominance of laboratory-based studies with few cohort and intervention studies, and Arab countries the small percentage of articles examining dietary patterns. While food frequency question- Research agenda naires were the main dietary assessment method used, only 35% were validated. Very few Diet studies included children and the majority considered nutrition in isolation, excluding other environmentalfactors.Opportunitiesidentifiedincludedthepromisingmomentuminstudying nutrition and NCDs among Arab countries, evidenced by an increasing number of articles published over the years, that may be guided in future nutrition research to fill the identified gaps. In addition, the higher number of articles in high-income countries coupled with the Abbreviations: NCDs, Noncommunicable diseases; CVD, Cardiovascular diseases; BMI, Body-mass index; DALY, The Disability- adjusted life years; CMD, Cardiometabolic diseases and diabetes mortality; EMBASE, Excerpta Medica database; IF, Impact factor; IDRC, International Development Research Centre; RCT, Randomized controlled trial; JCR, Journal Citation Reports by Thomson Reuters; FFQs, Foodfrequencyquestionnaires;SPSS,StatisticalPackagefortheSocialSciences;HIC,Highincomecountries;UAE,UnitedArabEmirates; KSA, Kingdom of Saudi Arabia; MIC, Middle-income countries; LIC, Low-income countries; R&D, Research and development; GDP, Gross domestic product; QNRF, Qatar National Research Fund. ⁎ Corresponding author. E-mailaddresses:fn14@aub.edu.lb(F.Naja),hs120@aub.edu.lb(H.Shatila),lmeho@aub.edu.lb(L.Meho),shh31@mail.aub.edu(S.Haber), ln10@aub.edu.lb (L. Nasreddine), am00@aub.edu.lb (A.M. Sibai), nahla@aub.edu.lb (N. Hwalla). 1 Naja F, Alameddine M, Nasreddine L, Sibai AM and Hwalla N are members of the Nutrition Obesity and Related Disorders (NORD) program at the Global Health Institute (GHI), American University of Beirut, PO Box 11-0.236 Riad El Solh, 11072020 Beirut, Lebanon. http://dx.doi.org/10.1016/j.nutres.2017.07.011 0271-5317/© 2017 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/). 2 NUTRITIONRESEARCH47(2017)1–12 impact of papers in middle-income countries suggests an opportunity of synergistic collabora- tion among these countries. The identified gaps and opportunities in this review may serve as basis for Arab countries to start developing a research agenda in the area of nutrition and NCDs. ©2017TheAuthors.Published by Elsevier Inc. This is an open access article under the CC BY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/). Article Outline 1. Introduction ...........................................................0 2. Approach.............................................................0 2.1. Identifying the research question ...........................................0 2.2. Search strategy .....................................................0 2.3. Selection of relevant studies ..............................................0 2.4. Data charting ......................................................0 2.5. Collating, summarizing, and reporting the results ..................................0 3. Gapsinnutrition and NCDs research in Arab countries ...................................0 4. Opportunities in nutrition and NCDs research in Arab countries ...................................................0 5. Process for the development of a research agenda ......................................0 6. Future research directions in the area of nutrition and NCDs in Arab countries ......................0 7. Conclusions ...........................................................0 Acknowledgment ..........................................................0 References...............................................................0 1. Introduction vegetables, and complex carbohydrates) and the migration towards a more Westernized type of diet that is lower in During the past decades, many Arab countries have witnessed carbohydrates and higher in animal-based food. This type of economic, social, and lifestyle changes accompanied by a rapid diet is high in sugar and caloric content and contains larger increase in noncommunicable diseases (NCDs) and obesity amounts of processed food (eg, chocolate, soft drinks) [1].A prevalence[1].Thisincreasewasthehighestintheworldbetween comparative risk assessment study examining the impact of the years 2006 and 2015 [2]. In 2008, the death count due to NCDs dietary habits on cardiovascular and diabetes mortality in 22 in Arabcountrieswas1.2million,accountingforalmost60%ofall Arab countries showed that low intake of protective foods, deaths.Inadditiontothesehighrates,theprofilesofNCDsamong namely fruits and whole grains, was the leading dietary risk Arabcountriesaresignificantlydifferentfromothercountriesand factor for cardio-metabolic diseases (CMD) and diabetes even differ between the Arab countries themselves. For instance, mortality, accounting for 12% and 11% of CMD deaths, the epidemiological transition currently experienced by most respectively. Furthermore, among harmful dietary factors, Arabcountries, from a burden of disease dominated by mortality high intake of sodium was responsible for the highest from infectious diseases to mortality from NCDs, is compressed proportion of CMD deaths [8]. into a shorter time frame than that experienced historically by The escalating prevalence of NCDs and their related risk developed countries. Additionally, there is a coexistence of factors has led most Arab countries to hold national, regional, infectious diseases and ill-functioning health systems together andinternationalmeetingsinordertofindsolutionsthatwill withtheescalating burden of NCDs in many Arab countries [3-5]. curb the burden of these diseases [9,10]. A common recom- Furthermore, there is a clear socioeconomic and wealth gradient mendation of these meetings is the need to develop public asaresultofoilproductioninArabcountries.Suchagradientmay health policies and interventions tackling the main modifi- haveadirectinfluenceontheNCDsprofilesofthesecountries[6]. able risk factors of NCDs, including nutrition and dietary Concomitant with the escalating burden of NCDs, Arab habits [9,10]. These policies and interventions ought to be countries have been undergoing nutrition transition and based on the best available scientific evidence for their changes in dietary habits, which were both postulated as feasibility, efficacy, and cost effectiveness [7]. Although major risk factors for most NCDs. In fact, in Arab countries, studies conducted in developed countries contributed signif- available data showthatdietandhighbody-massindex(BMI) icantly to such scientific evidence, their results may have are the risk factors with the highest attributable disability- limitedapplicability to ArabcountriesgiventhedistinctNCDs adjusted life years (DALYs) for NCDs [7]. Since the turn of the profiles in these countries andthespecificities of their dietary century, due to ongoing rapid urbanization and economic habits and practices [11]. Therefore, an elemental step growth, many Arab countries have been witnessing an towards the success of public health nutrition policies and erosion of traditional dietary patterns (ie, rich in fruits, interventions to curb the NCDs epidemic in Arab countries is NUTRITIONRESEARCH47(2017)1–12 3 the formulation of a comprehensive and informed research Bahrain OR Bahrein OR Comores OR Comoros OR Djibouti agenda that will ultimately allow for generating the needed OREgypt OR Egypte OR Emirats OR Emirates OR Irak OR Iraq robust context and culture specific evidence base. Such an ORJordanORJordanieORKuwaitORKoweitORLebaneseOR informed research agenda will support Arab countries in Lebanon OR Liban OR Libanaise OR Libya OR Libye OR reducing research waste and will assist research funders in Mauritania OR Mauritanie OR Morocco OR Maroc OR Oman setting granting priorities in the area of nutrition and NCDs [12]. OR Palestine OR Palestinian OR Palestinienne OR Qatar OR Over the past 2 decades, scoping reviews have become an SaudiORSaouditeORSomaliaORSomalieORSudanORSyria increasingly popular form of knowledge synthesis of health- ORSyrie OR Tunisia OR Tunisie OR Yemen OR Gaza OR West related research, especially in areas with complex multifac- Bank. In PubMed, while keywords and the majority of titles torial concepts, disciplines with emerging evidence, and and abstracts are in English language, the affiliation of the where various study designs are employed [13]. Among authors could be listed in a language different than English. reasons cited for conducting a scoping review, the most Given that in several countries of the Arab world French is relevant in the context of this study are: examining the considered an official language in addition to Arabic (such as extent,range,andnatureofresearchactivity;identifyinggaps LebanonandAlgeria),theuseoftheFrenchinadditiontothe and opportunities in the existing literature; informing prac- English versions of country names was deemed important. tice, programs, and policy; and providing direction for future The terms used for nutrition were Eating OR Nutrient* OR research priorities [14,15]. Nutritio* OR Diet* OR Food OR Hunger* OR Malnutritio* OR The objective of this scoping review is to identify gaps and Malnourish* OR Undernutri* OR Undernourish*. As for NCDs, opportunitiesinnutritionresearchinrelationtoNCDsinorderto the following terms were used: Angina Pectoris OR Artery formulate an informed research agenda leading to evidence- Disease* OR Arterial Disease* OR Atherosclerosis OR Cancer* based national policies and interventions to curb the escalating ORCardiovascular Disease* OR Cerebrovascular Accident* OR burden of NCDs in Arab countries. Using PubMed, a literature Degenerative Disease* OR Diabet* OR Diabetes Mellitus OR search was conducted to retrieve articles that addressed nutri- Dyslipidemia OR Dyspnea OR Familial Hypercholesterolemia OR tioninrelationtoNCDsinArabcountriesbetweentheyears2006 Fibrosis ORGlucoseImpairmentORHeartDisease*ORHeartFailure* and 2015. According to Ulrich's International Periodicals Directory, OR Heart Infarction* OR High Blood Glucose OR Raised Blood approximately 57% of indexed Arabic medical journals are not Pressure OR Hypercholesterolemia OR Hyperchylomicronemia OR covered by PubMed [16]. To ensure sufficient coverage of Arabic Hyperglycemia OR Hyperinsulinemia OR Hyperlipidemia OR journals the search was also carried out in Embase, Scopus, HyperlipoproteinemiaORImpairedGlucoseToleranceORMetabolic EBSCO, and ProQuest. With the addition of these databases, the Syndrome* OR Nerve Degeneration OR Pulmonary Disease* OR coverage of indexed Arabic medical journals in this review Pulmonary Function* OR Stroke* OR Thrombosis OR Transient increased to 82%. Ischemic Attack OR Tumor* OR Vascular Dementia OR Vascular Disease* OR Overweight OR Obesity OR BMI. 2. Approach 2.3. Selection of relevant studies Ascoping review method was implemented to examine and A total of 2851 articles were identified using the search studytherelevantliterature.Forthepurposeofthisstudy,the strategy. Several meetings of the research team were held at methodological framework first proposed by Arksey et al and the beginning, midpoint, and at the end of the review to revised later by Levac et al was used [13,14]. This framework discuss issues related to selection of relevant studies. The consists of 5 iterative steps: (1) identifying the research process of choosing the criteria for selecting relevant studies question; (2) search strategy; (3) selection of relevant studies; wasiterative and relied on examining the title, abstract, and, (4) data charting; and finally (5) collating, summarizing, and whennecessary,thefulltextofthearticles.Twoindependent reporting the results [14]. reviewers(HSandSH)examinedthetitlesandabstractsofthe 2851 identified articles. When disagreement occurred regard- 2.1. Identifying the research question ing the inclusion/exclusion of an article, the input of a third reviewer from the research team was sought. For every batch The primary research question that guided this study: What of 500 articles reviewed, the agreement between the 2 aretheexistinggapsandopportunitiesofcurrentresearchled reviewers was assessed. Only in one instance was the by scientists affiliated with institutions in the Arab world in agreement found to be below 85%, and a meeting was held the area of nutrition in relation to NCDs? between members of the research team to clarify the selection process and address concerns. 2.2. Search strategy Foranarticletobeselectedandincludedinthisreviewthe following conditions should have been met: The search strategy was developed by a multidisciplinary team consisting of a nutrition epidemiologist, an NCDs 1- The affiliation of the first or the corresponding author epidemiologist, 2 clinical nutritionists, and a librarian. Three was with an institution in Arab country. Articles in main topics related to the key concepts of the research which the first and/or the corresponding author were questions were identified, namely Arab countries, nutrition, affiliated with an institution in any Arab country were andNCDs.Withinthesearchstrategy,thetermsusedforArab included. The affiliations of the first authors were countries were Alger OR Algeria OR Algerie OR Algiers OR extracted from PubMed. As for the affiliations of the 4 NUTRITIONRESEARCH47(2017)1–12 corresponding authors, they were imported from reading the full text of the articles, 233 additional articles EMBASE for the years 2005 until 2014, when these were excluded. Out of the remaining 847 articles, 23 were affiliations became available through PubMed. The duplicates and were also removed. The final count of articles affiliations of both the first and the corresponding included in this review was 824 (Fig. 1). authors were considered relevant because in health, nutrition, and medical sciences, both are generally 2.4. Data charting considered the main authors of multi-authored article. 2- The article addressed one of the 4 main NCDs as listed In line with the scope of the research question of this study, by the WHO (cardiovascular diseases, cancers, chronic the research team developed the data charting form in order respiratory diseases, and diabetes) or one of the main to determine which variables to extract. The development metabolic or physiological risk factors for these NCDs process of this form was iterative in that, after the initial (elevated blood pressure, high blood glucose, over- versionwasdeveloped,the2researcherswholaterconducted weight or obesity, and hyperlipidemia) [17]. data extraction independently pilot tested the form by 3- The article addressed nutrition or nutrition-related reviewing and extracting data from 15 articles. The research topics, such as energy, macro- or micronutrients, team then met to review the pilot test of this form and used foods, diets, and dietary habits. the results to refine it in order to ascertain that the approach that they had used appropriately addressed the research Of the 2851 articles identified through the search strategy, question of the study. The data charting form captured 1771 were excluded at the title and abstract review level for information related to the affiliation of the corresponding irrelevanceand/orfornotmeetingtheinclusioncriteria.Upon author, year of publication, impact factor (IF) of the journal, Identification Articles identified through the search strategy (n = 2,851) Articles excluded upon reading the abstract, for not meeting the inclusion criteria (n = 1,771) Screening Articles screened for inclusion (n = 1080) Articles excluded upon reading the full text (n = 233) Eligibility Articles eligible for inclusion (n = 847) Duplicate articles excluded (n = 23) Articles addressing nutrition Inclusion in NCD research (n = 824) Fig. 1 – Selection of articles in the review of nutrition in NCDs research among Arab countries from 2006 to 2015.
no reviews yet
Please Login to review.