This pilot study describe the malnutrition with its double burden ( overweight and under weight ) among Egyptian population and its effect on public health. This poster published in Duphat conference in Dubai

1. INVESTIGATION OF HIDDEN MALNUTRITION AMONG
THE EGYPTIAN POPULATION: A PILOT STUDY
Manar Mohamed Rashada, Mennat Allah Ibrahima, Nourhan Saeeda, Mennat Allah Mohameda, Mina S.Khellab
aSenior Student, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
bB Pharm, M.Sc., Assistant Lecturer, Biochemistry and Molecular Biology Department, Faculty of Pharmacy, Ain Shams University
Introduction
Aim of the work
Subjects and Methods
• Scrutinize important roots of the double forms of malnutrition
in Egyptian population including the habit and non-habit related
causes.
• Discovering the malnutrition related diseases and complications in
the Egyptian population.
Undernutrition is considered a major health hazard in many developing countries
affecting over 815 million people and causing more than one-half of all child deaths1.
However, while those countries make efforts to reduce undernutrition, another pattern of
malnutrition was emerged in the developing world in the form of being overweight or
obese2. So underweight and overweight are both forms of malnutrition, a term that
encompasses either a lack of or excess in energy and/or nutrients. Noteworthy, both
underweight and overweight individuals may lack important dietary nutrients -minerals
and vitamins- that are needed for good health3. This sheds light onto the new concept of
what is called "empty calories" which is defined by the USDA as the calories from solid
fats and added sugars in food which add calories to it but with few or no healthy
nutrients. The malnutrition is considered visible but unfortunately neglected hazard of
the public health4. Both patterns of malnutrition have their own risks and complications
ranging from stunting in case of undernutrition to cancer in case of obesity5,6. Egypt like
other developing countries is battling with this double burden of malnutrition. As a result,
a plenty of causes of malnutrition still need to be discovered in our Arab speaking
countries as well as a lot of protection of public health about its risks and complications
needs to be exerted.
• Moreover, this study aimed to report some important and suitable protective measures
of public health against the causes and complications of malnutrition.
•Cross sectional study of random unrelated 83 subjects (46
underweight & 37 overweight) recruited from the National
Nutrition Institute -Cairo- Egypt, Private clinics of Obesity,
thinness and physiotherapy, and the general Egyptian
population.
•The subjects included are those whom body mass index
puts them at risk for malnutrition and its complications
according to WHO criteria7.
Table (2) Survey Questions to Physicians
• What is the most common age in both under/overweight cases?
• Which gender is more common Males or Females?
• From your point of view, what are the main causes of this malnutrition among
population?
• What are the lab investigations required in diagnosis of malnutrition?
• What are the common bad habits that you notice among your patients suffering from
malnutrition?
• Do all the patients have symptoms related to malnutrition? If yes, what are they?
• What are the complications?
• To what extent the patients are aware of their disease and its complication?
• Are there any ways to provide the patients with the tips they need along with
medication? If any, please explain.
Survey questions
How old are you? What is your Daily diet?
Gender How many meals do you often take?
How tall are you? What is the time for your meals?
How much do you weigh? What is the most type of food you
consume?
Educational level How many cups of water do you drink
daily?
Are you smoker? Do you exert any physical activity
(sport/walking...)?
Did you have any past or current
diseases?
How many times do you eat fast food per
month?
What are the symptoms you suffer
from, for how long?
How many times do you usually drink
soft drinks?
Do you suffer from anemia? How many times do you usually eat fruits
and vegetables?
Do you suffer from overweight? Do you exert a check-up regularly?
Did anyone of your family suffered
from Obesity/diabetes or any other
nutritional disease?
Table (1) Survey Questions to Patients
• 13% of the underweight subjects were due to worms and parasitic infections, while 87% were due to poor food regimen
presented as decrease in number of meals and poor infant feeding practices including unhealthy food, decrease in fruits
and vegetables consumption.
• 50% of obese subjects had family history of obesity. • 70% exert little or no physical activity.
Table(3 a): Demographic data of the overweight subjects
Figure (3): Habits related to overweight subjects Figure (4): Fruits and vegetables consumption related to overweight subjects
Figure (1): Metabolic syndrome Criteria associated with obesity (BMI>30) Figure (2): Related diseases among overweight subjects
Figure (6): Diseases found to be related among underweight subjects
Figure (5): Macronutrients consumption among overweight subjects
Results
Recommendations
Acknowledgements
References
• Further studies with larger sample size are required and should be directed for screening lipid profile, liver function tests,
kidney function tests and complete blood picture to find out presence of any complications of obesity, any micronutrient
deficiency or anemia.
• Some modifications in the governmental food program are needed especially for the poor population by adding more
healthy nutrients to ensure achieving both optimal quantity and quality.
• Improve water supply, sanitation and practice hygiene.
• Maternal health education about the healthy diet and breast feeding for their children.
1. Caulfield LE, de Onis M, Blossner M, Black RE. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and
measles. The American journal of clinical nutrition. 2004 Jul;80(1):193-8. PubMed PMID: 15213048. Epub 2004/06/24. eng.
2. Doak CM, Adair LS, Monteiro C, Popkin BM. Overweight and underweight coexist within households in Brazil, China and Russia. The Journal of nutrition.
2000 Dec;130(12):2965-71. PubMed PMID: 11110855. Epub 2000/12/09. eng.
3. Doak CM, Adair LS, Bentley M, Monteiro C, Popkin BM. The dual burden household and the nutrition transition paradox. International journal of obesity (2005).
2005 Jan;29(1):129-36. PubMed PMID: 15505634. Epub 2004/10/27. eng.
4. Haslam DW, James WP. Obesity. Lancet. 2005 Oct 1;366(9492):1197-209. PubMed PMID: 16198769. Epub 2005/10/04. eng.
5. (FAO) FaAO. The Spectrum of Malnutrition Fact Sheet. 2006.
6. WHO. Obesity and Overweight Fact Sheet. 2003.
7. Haslam DW, James WP. Obesity. Lancet. 2005 Oct 1;366(9492):1197-209. PubMed PMID: 16198769. Epub 2005/10/04. eng.
• Dr.Sohier Abd Al Rahman : professor, clinical ,pathology department , faculty of medicine Banha University
• Dr.Ahmed Rezk : specialist of obesity thinness and physiotherapy
• Physicians at the National Nutrition Institute
•The data was collected using a questionnaire survey which was compromised of 2
sections, the first one was directed to the affected subjects and covered some
demographic data and investigated related nutritional habits and several potential risk
factors for malnutrition as seen in Table (1). The second section was directed to the
health care specialists as seen in Table (2).
•Study Approval: The Ethical Committee both of Faculty of Pharmacy, Ain Shams
University, Cairo, Egypt and the National Nutrition Institute approved this study.
Moreover, the study was performed in adherence to the Declaration of Helsinki
Guidelines.
Discussion & Conclusion
•Genetic differences increase one’s susceptibility for obesity in Egyptian population and requires interaction with other
environmental factors.
•Governmental Food program in Egypt is considered a main cause behind malnutrition since macronutrients supplied act
as empty calories which leads to a state of Hidden malnutrition.
•The most affected age among overweight subjects was the females at the age between 20 to 40 years showing that the
physical inactivity is considered one of the neglected risk factors leading to overweight.
•The main undernutrition related health problems are micronutrient deficiency especially calcium and iron causing anemia.
•This study depicted that there are a lot of overweight and obesity related diseases like metabolic syndrome criteria need to
be investigated carefully in all obese subjects as those complications may be silent and undiagnosed
•The study showed that the existence of the double burden of malnutrition among people in Cairo is most probably caused
by inferior level of health education especially maternal education, the sedentary lifestyle and dietary patterns.
•The most affected age among underweight subjects was the females at the age between 1 to 5 years. Undernutrition is not
just a problem of poverty. Children are undernourished in even the richest households. This is not an issue of food access,
but of health education and caring practices.
The results of analyzing the survey are summarized as follows showing causes, related diseases and complications for
both underweight and overweight subjects:
The demographic data of the studied subjects are summarized in Table (3 a & b).
•Exclusion Criteria: malignant disease, current pregnancy, pituitary, adrenal, thyroid,
pancreatic diseases, evidence for any other endocrine disorder and prolonged use of
corticosteroids.
•There was a complete medical evaluation for each case with provided informed consent
prior to inclusion in the study.
Table(3 b): Demographic data of the underweight subjects