Abstract
The Eastern Mediterranean Region (EMR) is experiencing a nutrition transition, characterized by the emergence of overnutrition and micro-nutrient deficiencies. No previous study has comparatively examined nutrient intake in adults across countries in the EMR. This review examined the adequacy of nutrients in adults living in the EMR. Moreover, it analyzed the food balance sheets (FBS) for 1961–2018 to identify the trajectory of energy supply from macro-nutrients in the EMR. A systematic search was conducted from January 2012 to September 2020. Only observational studies were retained with a random sampling design. An assessment of the methodological quality was conducted. Levels of nutrient daily intake and their adequacy compared to the daily reference intake of the Institute of Medicine were reported across the region. No studies were identified for half of the region’s countries. Although nutrient energy intake was satisfactory overall, fat and carbohydrate intake were high. Intake of vitamin D, calcium, potassium, zinc, and magnesium were below that recommended. The analysis of the FBS data allowed for the identification of four linear patterns of trajectories, with countries in the EMR best fitting the ‘high-energy-supply from carbohydrate’ group. This systematic review warrants multi-sectorial commitment to optimize nutrient intake.
Highlights
We expect the interpretation of nutrient intake adequacy to be biased by the missing data in the food composition tables in the region. This first meta-analysis assessing nutrients adequacy in the Eastern Mediterranean Region (EMR) revealed that countries from the EMR did not meet recommended daily intakes (RDIs) for most nutrients
Lack of national representative data was clearly reflected among adults and missing data could be more pronounced among other specific groups such as pregnant women
The meta-analysis results reflect the nutrition transition occurring in the region, especially with the excess intake of fat, carbohydrate and sodium, along with the deficient intake of certain trace elements and vitamins
Summary
The burden of non-communicable diseases (NCDs) has increased significantly in lowand middle-income countries in the last decades, with unhealthy diet being a major risk factor [1,2]. With the emergence of chronic NCDs, several countries from the Eastern Mediterranean Region (EMR) have undergone a nutrition transition in the last decades [5]. This nutrition transition was characterized by dramatic changes in nutrient intakes, an increase in energy, salt, sugar and fat intakes (total fat, saturated fatty acids (SFA) and trans-fatty acids (TFA)) [4]. Proxy measures of the nutrition transition have been assessed and revealed the co-occurrence of micro-nutrient deficiencies and the alarming increases in the rates of overweight and obesity among all age groups [7]. There is an urgent need to thoroughly assess nutrient intake in the EMR to inform policy and decision makers, given the lack of updated information
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