Estimated 24-Hour urinary sodium and potassium excretion in adults in the Northwest Region of Morocco, 2017.

BACKGROUND: Excessive sodium (Na) and insufficient potassium (K) intake contribute to a high risk of cardiovascular events. Morocco lacks data on actual Na and K intake in adults. We estimated mean Na and K intake in a Moroccan population of adults residing in the Northwest region using 24-h urinary excretion and examined their association with blood pressure (BP). METHODS: A total of 371 adults from this region, who were recruited for the STEPs Survey Morocco 2017, completed demographic, anthropometric as well as BP data and provided a valid 24-h urine collection according to the standard World Health Organization (WHO) protocol. Multiple Linear Regression analysis was used to examine the association between 24-h urinary sodium (24-hUNa) and 24-h potassium excretion (24-hUK) with BP. RESULTS: Mean Na excretion was 2794 mg/day and mean K excretion was 1898 mg/day. Overall, only 114 (30.7%) adults met the WHO recommendation for Na intake (< 2000 mg/d) and 31 (8.4%) met the adequate level for K intake (⩾3510 mg/d). There was no association between 24-hUNa and 24-hUK with BP (P > 0.05 for all). CONCLUSION: Na intake was higher and K intake was lower than WHO recommendations in the study population. There was no association between estimated Na and K intake levels with BP in this population.

Determination of salt content in traditional and industrial Moroccan white bread by inductively coupled plasma mass spectrometry.

Introduction: evaluating the sodium content of staple foods is essential for implementing a salt reduction strategy. In Morocco, bread is a major contributor to sodium intake. However, currently few studies have been carried out to assess the salt content in bread. Our study aimed to estimate the sodium and salt content of white bread available in artisanal and industrial bakeries in the twelve regions of Morocco. Methods: it is a cross-sectional study of the sodium content of white bread available for sale in artisanal and industrial bakeries in Morocco (N=120). Inductively coupled plasma mass spectrometry (ICP-MS) was used to quantify the sodium content of the bread. The percentage of samples meeting the recommendations and bread contribution to the daily salt intake was calculated. Results: the results of our study show that the mean levels of sodium and salt added to bread samples were 5.7 ± 1.5 g/Kg and 14.5 ± 3.7 g/Kg, respectively. With an average of 4.4 ± 0.5 g/Kg and 11.2 ± 1.2 g/Kg for artisanal bread and an average of 7.0 ± 0.8 g/Kg and 17.8 ± 2.1 g/Kg for industrial bread, respectively. Daily salt intake from bread consumption (500 g/d/person) is estimated at 5.6 g/d (52.8% of total salt intake) for artisanal bread and 8.9 g/d (84% of total salt intake) for industrial bread. Conclusion: bread salt content in Morocco exceeds the recommended threshold of the national federation of bakery and pastry and health authorities. Further efforts are necessary to increase knowledge and awareness of bakers and to teach them how to reduce salt content without affecting the flavor and the quality of their products.

Association between overweight and anemia in Moroccan adolescents: a cross-sectional study.

Introduction: obesity and anemia remain global public health problems, having major negative effects on human health. We aimed to estimate the prevalence of anemia and investigate its association with overweight/obesity and excess body fat among Moroccan adolescents. Methods: a total of 292 adolescents aged 11-17 years were recruited. Body mass index (BMI) and waist circumference (WC) were determined using standardized equipment. Body fat mass was measured by bioelectrical impedance analysis. Hemoglobin concentration was measured by the HemoCue method. Results: the overall prevalence of anemia was 13.7%. Anemia was more common among overweight/obese participants (15.2%) compared to non-overweight participants (12.8%). Overweight/obese boys were more likely to experience anemia than their non-overweight peers (odds ratio (OR): 1.49; 95% confidence interval (95%CI): 0.51-4.41). Similarly, anemia likelihood was higher among individuals having excess body fat than those who do not have excess body fat, particularly among girls (OR: 1.64; 95%CI: 0.69-3.87). Excess body fat was also significantly associated with lower hemoglobin concentration in both the total sample and girls (P=0.014, and P=0.041, respectively). Overall, increased BMI, WC, fat mass, and percent body fat were associated with reduced hemoglobin concentrations. There was a significant negative correlation between hemoglobin concentration and BMI among anemic girls (P=0.023). Conclusion: elevated BMI and body fat level were associated with lower hemoglobin concentrations and anemia. Further studies are needed to delineate the basis of such associations, and if these findings are confirmed, the guidelines for screening for anemia may need to be modified to include overweight/obesity as a risk factor.

A Household-Based Survey of Iodine Nutrition in Moroccan Children Shows Iodine Sufficiency at the National Level But Risk of Deficient Intakes in Mountainous Areas.

Historically, mountainous areas of Morocco have been affected by endemic goiter and severe iodine deficiency. In 1995, Morocco legislated salt iodization to reduce iodine deficiency. There has been no national survey of iodine nutrition in school-age children for nearly 3 decades. Our aim was to assess iodine nutrition in a national sample of 6-12-year-old children in Morocco to inform the national salt iodization strategy. In this cross-sectional household-based survey, we randomly recruited healthy 6-12-year-old children from 180 clusters in four geographic zones (north and east, central, north and south) covering the 12 regions of Morocco. A questionnaire was completed, including socio-economic status and parental level of education. In addition, anthropometric measurements were taken to assess nutrition status, and a spot urine sample was collected to measure urinary iodine concentration (UIC). A total of 3118 households were surveyed, and 1043 eligible children were recruited, 56% from urban areas and 44% from rural areas. At the national level, the percentage of surveyed samples with UIC < 50 µg/L was 21.6% (19.2%; 24.2%), which exceeds the WHO suggestion of no more than 20% of samples below 50 µg/L, despite an adequate level of median urinary iodine concentration (mUIC) at 117.4 µg/L (110.2; 123.3). There were no statistically significant differences in mUIC comparing urban vs. rural areas and socio-economic status. However, the mUIC was significantly lower in the central (high-altitude non-coastal) zone (p < 0.004), where the mUIC (95% CI) was deficient at 89.2 µg/L (80.8; 102.9). There was also a significant difference in the mUIC by head of household education level (p = 0.008). The mUIC in Moroccan children >100 µg/L indicates iodine sufficiency at the national level. However, the percentage of surveyed samples with UIC < 50 µg/L above suggests that a significant proportion of children remain at risk for iodine deficiency, and it appears those at greatest risk are residing in the central (high altitude non-coastal) zone. A national level mUIC value may conceal discrepancies in iodine intake among different sub-groups, including those defined by geographic region.

Implementing the national strategy of salt reduction in Morocco: the baker´s perspective.

INTRODUCTION: Morocco launched a national salt reduction strategy in 2019. The commitment of bakeries is key in the success of this strategy. However, the evaluation of such a commitment is not yet done. This study aims to examine knowledge of bakers about the national strategy of salt reduction and evaluate their commitment in implementing the specific recommendation related to salt reduction in bread. METHODS: a quantitative exploratory study targeted bakeries (N=432) from all the administrative regions of Morocco. Data was collected using a questionnaire composed of three sections: knowledge of bakers related to national strategy of salt, current contribution of bakers in implementing the national strategy and future commitment towards implementing the national strategy. RESULTS: about 73% (n=317) bakers lack of knowledge about the recommendations on the progressive reduction of the salt content in bread. Radio and TV were the most used sources to obtain information by bakers (45.2% (n=52) and 35.6% (n=41) respectively). None of the bakers was informed about the process of gradual reduction of salt content in bread, and none of them was committed to it. A total of 60.32% (n=252) of bakeries do not respect the national recommendations of 10g of salt/Kg of flour while 89.6% (n=387) of bakers express their interest in getting committed to the process in the next 2 years. CONCLUSION: increasing the knowledge of bakers is highly recommended to guarantee their commitment toward contributing to the strategy of reducing salt in bread. Dissemination of messages via TV and radio could be appropriate.

Acceptance of sugar reduction in yoghurt among Moroccan population.

INTRODUCTION: Morocco has recently developed a plan of reducing sugar consumption to reinforce prevention of non-communicable diseases and to contribute to the achievement of global voluntary targets for non-communicable diseases set by ICN2 by 2025. The objective of the present study was to assess acceptance of yogurts with different percentage reduction of sugar by the Moroccan population. METHODS: A total of 201 participants (age > 15 y.) were recruited to determine the level of sugar reduction in yogurt. Sucrose was added to a plain yoghurt in the following different concentrations 166.5; 149.8; 133.2; 116.5; 99; 83.2 mM/l, corresponding to the reduction of sugar of 0%, -10%, -20%, -30%, -40% and -50%, respectively, compared available yogurt in local market. Overall, the acceptability scores of the different yoghurts were based on liking, "Just About Right" (JAR) and purchase intent scales was used to score the different yoghurts. RESULTS: Yogurts containing -20% and -30% added sugar were highly accepted by 81% and 74% of respondents. Based on JAR score, yoghurt with 20% (133.2mM/l) and 30% (116.5 mM/l) reduction were considered as "Just about right" by 42.7% and 44.3% respectively. Best average score of purchase intent was obtained for sucrose concentration of 149.8 mM/l. 35.8% and 40.3% for yoghurt with sucrose concentration of 133.2 mM/l and 116.5 mM/l respectively. CONCLUSION: The finding from this study indicated that yogurts containing -20% and -30% added sugar were most accepted by respondents. Advocacy before dairy industry to have them commit towards sugar reduction in yogurt is needed, in order to help achieving the national sugar reduction strategy in Morocco.