Adult-onset diabetes among Arabs and Jews in Israel: a population-based study.

AIMS: To study the age at presentation and factors associated with adult-onset diabetes (≥ 20 years) among Arabs and Jews in Israel. METHODS: Participants (n = 1100) were randomly selected from the urban population of the Hadera District in Israel. The study sample was stratified into equal groups according to sex, ethnicity (Arabs and Jews) and age. Information on age at diabetes presentation, family history of diabetes, history of gestational diabetes, socio-demographic and lifestyle characteristics was obtained through personal interviews. Self reports of diabetes were compared with medical records and were found reliable (κ = 0.87). The risk for diabetes was calculated using Kaplan-Meier survival analysis. Factors associated with diabetes in both ethnic groups were studied using Cox proportional hazard model. RESULTS: The prevalence of adult-onset diabetes was 21% among Arabs and 12% among Jews. Arab participants were younger than Jews at diabetes presentation. By the age of 57 years, 25% of Arabs had diagnosed diabetes; the corresponding age among Jews was 68 years, a difference of 11 years (P < 0.001). The greater risk for diabetes among Arabs was independent of lifestyle factors, family history of diabetes and, among women, history of gestational diabetes; adjusted hazard ratio 1.70; 95% confidence interval 1.19-2.43. CONCLUSIONS: Arabs in Israel are at greater risk for adult-onset diabetes than Jews and are younger at diabetes presentation. Culturally sensitive interventions aimed at maintaining normal body weight and active lifestyle should be targeted at this population. Possible genetic factors and gene-environmental interactions underlying the high risk for diabetes among Arabs should be investigated.

Undernutrition among Bedouin Arab children: a follow-up of the Bedouin Infant Feeding Study.

After 10 y of urban settlement, 680 Bedouin Arab children, who had had anthropometric assessment from birth (1981-1982) through early childhood, were reassessed in 1991-1992 to compare the rates of stunting in early and later childhood as well as to describe the factors influencing current height-for-age. Stunting had dropped from 32.7% at 18 mo to 7.2% at 10 y in the 1981 birth cohort and dropped from 17.5% at 9 mo to 8.2% at 9 y in the 1982 birth cohort. Based on a multiple-linear-regression analysis, height in early childhood and maternal height were statistically significantly and positively associated with current mean height-for-age in both cohorts. In the 1982 cohort socioeconomic status in early childhood was positively and current family size was negatively and significantly associated with current mean height-for-age. Thus, conditions that were present in early childhood had the largest influence on current height. In 1992, 10% and 6% of the infant siblings of the 1981 and 1982 cohorts, respectively, were stunted compared with 17% and 1% of the siblings aged 1-2 y of the respective cohorts. Therefore, the high rates of early childhood stunting in 1981-1982 appeared to be a birth cohort-specific phenomenon.

PIP: During 1991-1992 in Israel, researchers re-examined the anthropometric assessment of Bedouin children 9-10 years old, living in the Negev, whose anthropometric assessment was initially examined when they were 6-18 months old, to compare the rates of stunting in early and later childhood and to determine the factors affecting current height-for-age. For the 1981 birth cohort, stunting fell from 32.7% at 18 months to 7.2% at 10 years. The corresponding figures for the 1982 birth cohort were 17.5% at 9 months and 8.2% at 9 years. Thus, despite the social change and urban settlement the children experienced in the 10 year span, they still had some catch-up growth. Stunting among the siblings less than 2 years old of the 1991-1992 cohorts was much less common than stunting of the index children in early childhood in 1981 (17% vs. 44%), but not so in 1982 (14% vs. 11%). In 1992, the prevalence of stunting stood at 10% and 6% of siblings less than one year old of the 1981 and 1982 cohorts, respectively, while it was 17% and 1% for siblings 1-2 years old of the 1981 and 1982 cohorts, respectively. Maternal height and index child's height-for-age in early childhood were positively associated with current height-for-age in the 1981 cohort (p = 0.0001). They explained 33% of the variation in height-for-age. In the 1981 cohort, neither socioeconomic status (SES) in early childhood nor family size were associated with current height-for-age. Yet, in the 1982 cohort, both SES in early childhood and family size were associated with current height-for-age, SES positively (p = 0.04) and family size negatively (p = 0.03). Maternal height and height-for-age in early childhood were positively associated with current height-for-age (p = 0.002 and 0.0001, respectively). These 4 variables accounted for 34% of the variation in height-for-age in the 1982 cohort. These findings indicate that factors or conditions present in early childhood had the greatest impact on current height-for-age.

Maternal weight misperceptions and smoking are associated with overweight and obesity in low SES preschoolers.

OBJECTIVES: To identify modifiable risk factors for obesity among low socioeconomic status (LSES) children. METHODS: Cross-sectional data were obtained from 238 4-7-year-old children and 224 mothers from LSES preschools. Anthropometric measurements were obtained; mothers were interviewed about sociodemographic characteristics, health behaviors, perceptions and beliefs. RESULTS: The combined prevalence of overweight and obesity (OWOB) among children was 29.8% based on the new World Health Organization (WHO) growth standard. Prevalence of OWOB (body mass index ≥25) among mothers was 51.8%. Mean age, sleeping hours, gender distribution and poverty level were similar between normal and OWOB children. Over 82% of mothers underestimated their child's weight status. Of the 62 OWOB children, 74.2% were perceived by their mothers as having 'normal weight' (NW) and 8% were perceived as 'thin'. Mothers perceived 67 out of 158 NW children (42.4%) as 'thin' (P<0.001). Mediation analysis indicated that 10% of the effect of maternal underestimation on child's OWOB may be mediated through child's daily sedentary hours (P=0.06). In a multivariable logistic-regression analysis controlling for maternal obesity, knowledge regarding breakfast's importance and child's daily sedentary hours, maternal underestimation of the child's weight status (odds ratio=7.33; 95% confidence interval (CI):2.41-22.37; P<0.0001) and parental smoking (odds ratio=3.25; 95% CI: 1.26-8.40; P=0.015) were the only significant factors associated with OWOB in LSES children. CONCLUSIONS: Maternal perception of child's weight status and parental smoking are associated with childhood OWOB among LSES children. These parameters can help identify children at risk for obesity. Maternal perception may be amenable to intervention.

Importance of ethnic foods as predictors of and contributors to nutrient intake levels in a minority population.

OBJECTIVES: To evaluate the role of ethnic foods as predictors of intake levels of selected nutrients that are important during pregnancy among the Bedouin Arab minority population in southern Israel, and to compare the main food predictors for Bedouin intakes of the selected nutrients with those for the region's Jewish majority population. SUBJECTS/METHODS: Ethnic foods/recipes (n=122) reported in the Bedouin Nutrition Study (BNS) were added to a preexisting, validated Israeli food composition table using European Food Information Resource standard criteria. Food items reported by the 519 BNS participants were combined into 146 food groups that distinguished between existing foods and new ethnic recipes and were entered into a stepwise multiple regression model to identify the main predictors of intake levels of the selected nutrients. The results were compared with those of an identical analysis for the selected nutrients using 24 h recall data from the majority Jewish population. RESULTS: Over 80% of the BNS between-person variability in the intake of all selected nutrients was explained by 34 food groups, of which 13 (38.2%) were ethnic foods. Homemade whole wheat bread was a main predictor of intake levels for five of the eight selected nutrients, and other ethnic foods/recipes (for example, za'atar, leafy dark green vegetables and camel milk) emerged as predictors of iron, folate, calcium and ω-3 fatty acid intakes. Breads explained 60 and 44% of the between-person variation, and 38 and 36% of the total intakes of iron and zinc intakes in the BNS sample, respectively, whereas for the Jewish population, animal sources and fortified foods predominated as main predictors and contributors of these nutrients. CONCLUSIONS: The addition of ethnic foods to food composition databases is important, as some of these foods are main predictors of nutrient intake levels in ethnic minority populations. In turn, this should facilitate the development of more sensitive dietary assessment tools and more effective diet-based health interventions for ethnic minorities.

The relative importance of traditional and "modern" foods for Israeli Negev Bedouins. A population in transition.

The impact of urbanization on the health and nutritional status of developing populations is an issue of concern worldwide. The Bedouin Arabs in Southern Israel are a traditionally semi-nomadic/nomadic population undergoing a rapid process of urbanization which is accompanied by rising chronic disease rates. We examined the diet of urban and rural (more traditional) Bedouins to determine the relative importance of modern foods and drinks in their daily diet. We found that for main meals both populations rely heavily on traditional foods (available before 1948) but for snacks and drinks many manufactured products are used. These products rich in calories may contribute to the changing disease patterns. Rural areas rely more on traditional milk products which are made non-perishable, while urban populations use more meat products and pre-prepared meals because of the availability of electricity and refrigeration. Traditional foods and drink and the traditional way of eating (eating from a common plate) is still a very important part of the Bedouin way of life. This pattern of eating requires the development of culture-specific dietary assessment methodology to allow quantitative assessment of both traditional and more modern foods consumption and handle the eating practices of the Bedouin society today.

Evaluating the process of tailoring the global HIV/AIDS practice guidelines for use in developing countries.

OBJECTIVE: To describe a systematic procedure for adapting, or 'tailoring' the World Health Organisation's 'global guidelines for the management of HIV/AIDS in adults and children' for use in two developing countries: Malawi and Barbados. DESIGN: In order for these guidelines to achieve reproducibility, clinical flexibility, and clinical applicability, a systematic procedure is needed to tailor the guidelines to the local practice conditions of specific settings. METHODS: A group of local experts in each country used a nominal group process to modify the global program on AIDS (GPA) guidelines for local use. Semantic analysis techniques, known as clinical algorithm nosology (CAN), were used to compare the two modified guidelines with the global ones to determine the extent and type of differences between sets of guidelines. RESULTS: Standard, locally-tailored algorithm map guidelines (AMG) were developed within 4 months. CAN semantic analysis showed that guideline structure was maintained; 572/858 (66.6%) decision nodes were found to be the same in the GPA/Malawi, GPA/Barbados and Malawi/Barbados comparisons. However, different guideline versions managed patients quite differently, as evidenced by clinical algorithm patient abstraction (CAPA) scores of between 0 and 8.46 (0 = different; 8 = similar; 10 = identical). Analysis of the 197 specific differences found in these abstractions showed that 83% were in approaches to diagnosis and therapy, while the remaining 17% related to disease prevalence. CONCLUSIONS: Standard techniques involving consensus used to develop clinical guidelines can also be employed to tailor these guidelines to local settings. Semantic analysis shows that the tailoring preserves structure but may involve significant modification to the processes of clinical care that could in turn affect care outcomes.

Women's health custom made: building on the 40 days postpartum for Arab women.

The 40-day postpartum period is characterised in the Middle East and elsewhere by an observance of seclusion, congratulatory visiting, the reciprocal exchange of gifts and money, and a special diet. Based on primary data from in-depth interviews among the Negev Bedouin in Israel, health enhancing practices are reviewed. The data are a subset from a larger study carried out in this setting. Often postnatal checkups, family planning counselling, and immunization services may not be routinely available or used. It is argued that these health services could be provided at the end of the 40-day period for mother and child, as in a pilot study in Tunisia some years ago. Health service provision would thus build on the health enhancing practices of the 40-day period.