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Ecohealth approach to the nutrition transition in Lebanon - Dr. Batal - University of Ottawa
 

Ecohealth approach to the nutrition transition in Lebanon - Dr. Batal - University of Ottawa

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    Ecohealth approach to the nutrition transition in Lebanon - Dr. Batal - University of Ottawa Ecohealth approach to the nutrition transition in Lebanon - Dr. Batal - University of Ottawa Presentation Transcript

    • Malek  Batal,  PhD   Nutrition  Program   University  of  Ottawa    
    •   Low  consumption  of  fruits  and   vegetables  (Hwalla,  2004)     High  consumption  of  bread  and   refined  grains  (~350g/d)  (WHO,  1998).       Low  consumption  of  fish  (Hwalla,  2004)       Low  dietary  diversity  in  school   children  (Shaker,  unpublished)       Decreased  consumption  of   traditional  foods  due  to   urbanization  (Mouawad,  2004)     Indicators  of  food  insecurity  (Batal  et   al.,  2007;  IFPRI,  2003)       Obesity  rates  reaching  figures  in   developed  countries  (Batal  et  al.,  2007;  Sibai,   2003)     Hypertension  (23%  in  men  and   women  in  Beirut)  (Tohme,  2005)  
    • Distribution of respondents by BMI categories and gender 0.2% 38.8% 43.9% 13.7% 3.4% 0.0%0.5% 8.5% 2.1% 29.9% 35.7% 23.3% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% <18.5 18.5- 24.9 25.0- 29.9 30.0- 34.9 35.00- 39.9 >=40 BMI(Kg/m2) Male Female
    •   The  Ecohealth  Approach  to  Human  Health  relies  on  the   premise  that  human  health  is:      Closely  linked  to  the  health  of  the  ecosystem       A  holistic  approach  is  needed  to  understand  the  social,  economic  and   environmental  factors  that  influence  human  health,  thus  requiring  a   wide  network  of  disciplines  working  together.       It  is  considered  a  cost-­‐effective  and  creative  approach  to   improving  human  health.       Briceno-Leon, R., & Nugent, R. (2003). PI External Reviews: Summary of Report - Ecosystem Approaches to Human Health (Ecohealth).Venezuela: IDRC. Gopalan, H. (n.d.). Ecohealth:The Ecosystem Approach to HumanWell-Being. Retrieved December 9, 2010, from http://www.unep.org/ourplanet/imgversn/images/Gopalan_ecohealthv3.pdf Briceno-Leon, R., & Nugent, R. (2003). PI External Reviews: Summary of Report - Ecosystem Approaches to Human Health (Ecohealth).Venezuela: IDRC. Gopalan, H. (n.d.). Ecohealth:The Ecosystem Approach to HumanWell-Being. Retrieved December 9, 2010, from http://www.unep.org/ourplanet/imgversn/images/Gopalan_ecohealthv3.pdf Briceno-­‐Leon,  R.,  &  Nugent,  R.  (2003).  PI  External  Reviews:  Summary  of  Report  -­‐  Ecosystem  Approaches  to   Human  Health  (Ecohealth).  Venezuela:  IDRC.      Gopalan,  H.  (n.d.).  Ecohealth:  The  Ecosystem  Approach  to  Human  Well-­‐Being.  Retrieved  December  9,  2010,   from  http://www.unep.org/ourplanet/imgversn/images/Gopalan_ecohealthv3.pdf    
    •    ‘  
    •   Phase  II:  2009-­‐2013     University  of  Ottawa/American  University  of   Beirut     Multi-­‐disciplinary  with  researchers  from:     Nutrition,  Horticulture,  Landscape  Design,   Ethnography,  Physiology,  Economics,  Food   Toxicology,  Epidemiology,  Food  Science     Strong  NGO  and  CBO  linkages     Local  policy  connections  
    •   Goal      To  reduce  the  vulnerability  of  poor  rural   communities  to  human  health  problems  caused   by  ecosystem  and  global  food  market  changes   by  promoting  ecosystem  approaches  to  human   health.         General  Objective      To  develop  practical  interventions  and  provide   policy  options  for  improved  dietary  diversity,   food  security  and  health  in  poor  and  vulnerable   communities  in  Lebanon    
    • Food  Heritage  Preservation   •  There  is  tremendous  pride  associated  with  land  based  food   practices   •  People  identified  cultural,  nutritional/health  and  economic   benefits  associated  with  growing,  preparing  and  consuming   local  foods   •  Despite  this,  there  are  serious  deterrents  to  local  food   production  which  hinder  their  continuance  in  the  future   •  Any  support  must  be  in  line  with  new  economic  realities  of   life  in  the  communities  
    •   Linear  programming  to  establish  food  based  dietary   guidelines  based  on  24-­‐hour  recall  data  from  phase  1     Nutrient  analysis  of  local  mixed  dishes  (500  composite   dishes  and  production  of  Food  Composition  Tables)     School  feeding  program  using  locally  produced  traditional   food     Metabolic  study  comparing  between  rural  and  urban  diets   and  impact  on  glucose  tolerance  and  insulin  sensitivity    
    •   A  mathematical  technique  used  to  develop   inexpensive  and  nutritious  diets.     MS  Excel  2010  using  data  from  24-­‐hour   recalls.     Including:  food  prices  nutritional  composition       Goal:  Achieve  a  diet  that  follows  dietary   recommendations  while  minimizing  cost  and   energy  intake  
    • Nutritional constraints used for Lebanese women and men, 19-50 years old (Derived from Institute of Medicine, 2005; Institute of Medicine, 2011; U.S. Department of Agriculture, 2010) Females Males Minimum Maximum Minimum Maximum Energy (Kcal)* 2000 2000 2600 2600 Macronutrients Carbohydrate (% of E) 45% 65% 45% 65% Protein (% of E) 10% 35% 10% 35% Fat (% of E) 20% 35% 20% 35% Saturated fat (g) - 20 - 20 Fiber (g) 25 38 Sugar (g) - 50 - 65 Vitamins Vitamin D (ug) 15 100 15 100 Minerals Sodium (mg) 1500 2300 1500 2300 Potassium (mg) 4.7 - 4.7 - Calcium (mg) 1000 2500 1000 2500 Iron (mg) 18 45 8 45 *For 19-30 years of age, Energy needs are of 2000-2200 Kcal and 2600-2800 Kcal for females and
    • Food list and total diet cost for females, minimizing energy intake, and including nutritional constraints Food item Quantity (grams) Bread, French 80 Milk, cow's, fluid, whole 187 Pear, Prickly (Cactus Figs) 84 Cucumber 1711 Onions, Scallion or Spring Green 315 Shorbit kishk b' toum (Kishk soup with garlic) 356 Rice with vermicelli 229 Samkeh harra (Broiled fish with spicy sauce) 197 Energy intake (Kcal) 1553 Total diet cost (LBP) 7701
    • One week food basket for females,with all constraints Food item Quantity (grams) Bread, Pita, White 1272 Yoghurt from goat's milk, low fat, plain 379 Milk, cow's, fluid, whole 500 Cheese, Gruyere 200 Watermelon 200 Cantaloupe 1780 Apple 200 Banana 200 Pear, Prickly (Cactus Figs) 200 Cucumber 3853 Oil, Olive 86 Chips, Potato, Salted 65 Fattoush (Crisp bread salad) 70 Tabbouli (Parsley, mint, and bulgur salad) 300 Cucumber and tomato salad 100 Warak areesh b' zayt (Vine leaves stuffed-meatless) 58 Fassoulia bayda b' zayt (White beans-meatless) 561 Dajaj bil saniyeh (Roasted chicken with potato) 1383 Silik b' lahm (Swiss chard leaves stuffed with rice and meat) 500 Rice with vermicelli 500 Hrisse (Wheat and meat porridge) 500 Samkeh harra (Broiled fish with spicy sauce) 300 Energy intake (Kcal) 14000 Total diet cost (LBP) 36344
    •     Semi-­‐arid   rural   community   experiencing   a   nutrition   transition,   environmental   degradation   and   abandonment   of  agriculture.  
    •    ‘Food  and  health  in  rural  Lebanon:  Options  to  
    • Important  in  lower  income   countries  for  most   vulnerable  households,  of   low  socio-­‐economic  status   with  food  insecurity.     Improvements  in:     School  attendance     School  performance     Nutritional  status   (particularly  height)     Improvement  in  mental,   physical  and  psychosocial   health.     Kristjansson  et  al.(2007)  School  feeding  for  improving  the  physical  and  psychosocial  health  of  disadvantaged  students  (Review).   Cochrane  Database  Syst  Rev.  
    •      To  investigate  the  feasibility  and  impact  of  a  community  based   school   feeding   and   a   nutrition   education   program   on   nutritional  status,  breakfast  consumption  and  attitude  towards   traditional  diets.    
    •   At  baseline  and  endpoint:  breakfast  recall,  socio-­‐demographic  data,   weight,  height,  and  hemoglobin(Hemocue)     Meal  provision  at  the  Intervention  school:     Optimized  traditional  recipes     Prepared  safely  by  local  women  involved  with  the  healthy  kitchen     A  snack  to  meet  25%  of  daily  energy,  protein  and  micronutrient  needs     Interactive  education  sessions  for  students,  parents  and  teachers  at   two  schools.  
    •   S i g n i fi c a n t   c h a n g e s   i n   b r e a k f a s t   consumption:   -­‐  Increase  in  breakfast  consumption   -­‐  Increase   in   breakfast   containing   at   least   2   food  groups   -­‐  Increase   in   breakfast   containing   at   least   1   fruit  and/or  vegetable  
    • Outcome School  1  (Edu)   n=156 School  2  (SFP)   n=143 Total     n=299 Change  from  baselinea   Mean  height-­‐for-­‐age  Z  scoreb  ±   SEM -­‐0.11  ±0.07 -­‐0.28  ±0.08 -­‐0.19  ±0.05 Mean  BMI-­‐for-­‐age  Z  score  ±  SEM -­‐0.01  ±0.07 0.21  ±0.07 0.99  ±0.05 Mean  hemoglobin  (mg/dl)  ±  SEM -­‐0.70  ±0.13        0.07  ±0.11e -­‐0.32  ±0.09a When comparing across schools, age and gender were corrected for. b Comparison of height-for-age corrected for father’s education. C P<0.05, d P<0.01, e P<0.001 Changes from baseline nutritional status indicators during the 5-mo intervention in schoolchildren receiving a school meal plus education or education alone.
    • “The  Aarsal  Healthy  kitchen  practiced  safer  methods  that  we   saw  throughout  all  our  rotations”  -­‐  Nutrition  intern  student    
    •   Successful  preparation  &  delivery  of  the  school  meal  (mid-­‐morning  snack)  4  days   a  week.       High  acceptability  of  school  meal,  plate  waste  decreased  from  beginning  to  end   of  program  (not  shown).     An  improvement  in  breakfast  consumption  and  food  choices.     Marginal  improvements  in  Hb  status     Cost:  0.40USD  per  student  per  day    
    •   The  set  up  of  4  pilot  plants  under  the  “Healthy   Kitchen”  network     Healthy  Kitchen  is  a  catering  unit  providing  local  food  choices  using   nutritious  organic  whole  ingredients  
    •   All  kitchens  make  enough  financial  profit  to  cover  their   expenses  and  employees’  salaries  (around  20  women  per   kitchen).  Occasionally,  additional  financial  profit  is   generated  to  make  small  purchases  of  necessary  kitchen   supplies.    
    • Implement  an  enhanced  food  safety   program  that  is  critical  to  assure  the   safety  of  locally  produced,  ecosystem   based  foodstuffs  for  self-­‐consumption   and  build  consumer  confidence,     increasing  marketability  of  the   traditionally  produced  food  items   A  modified  HACCP  program  has   been  developed  and  applied  in   the  communities.  The  model   was  tested  nationally  by  the   Lebanese  Association  for  Food   Safety  which  now  provides   certification  to  restaurants  
    • “The  important  goal  of  empowering  women  has  been  fulfilled  to  some   extent  through  establishing  the  kitchens.”  Halimeh  Hojeiry     “  Women,  who  have  been  confined  to  their  own  homes  within  the  borders  of   their  villages,  are  now  traveling  throughout  Lebanon,  meeting  new   people  from  different  backgrounds,  entering  new  markets  and  taking   responsibilities  for  major  business  transactions  within  the  sales  context.”   Iqbal  Bousaleh     “The  kitchens  have  also  allowed  local  suppliers  from  the  agriculture  and   animal  farming  sectors  to  sell  their  own  products  and  increase  their   profits.”  Khadijeh  Chahine    
    •    Edible  Wall  Boxes      Containing:  cherry  tomatoes,  beans,  basil,  rosemary,   sweet  pepper,  marjoram
    • AARSAL,  North  East  Lebanon   Landscape  Design  and  Eco-­‐System  Management   FINAL  YEAR  PROJECT  –  2011   Karel  Matar  
    • Setting  up    of  nurseries  for  native  species  
    •   malek   batal,   salma   talhouk,   omar   obeid,   zeina   kassaify,   jad  chaaban,  ammar  olabi,  jala  makhzoumi,  hala  ghattas,   najat   saliba,   michael   robidoux,   mounir   mabsout,   salah   sadek,  rabih  shibli,  elke  berger,  roland  riachi,  carla  haibi,   mélanie   mattar,   bassam   hamzeh,   reem   hamzeh,   rheam   abou   ezze   ,   lina   abou   farraj,   qassem   al   assad,   olga   safa   majzoub,   rawad   massoud,   carol   itani,   francine   francis,   hayat   hatab   hala   khudari   ,   karel   matar,   nassim   basma,   mahmoud   el   jazzar,   dana   hamra   fatima   jebara   ,   ziad   kachmar,   hussein   mheidli,   chaza   houjeiri,   racha   zarzour,   rodolphe  ghossoub,  dima  ousta.  
    • Aarsal  Festival  –  Closing  Ceremony