National Institute of Nutrition Cairo

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National Institute of NutritionCairo

• Capacity Building Initiative
• 14 - 15 July, 2004
• Cairo - Egypt

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Nutrition Country Profile for Kuwait 2004
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  Overview

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• 1- Geography
• The State of Kuwait occupies the north western
  corner of the Arabian Gulf.
• The total area is 17,818 sq km
• - The weather is typical of the Sahara geographic
  region.

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• 2-   Population
• The estimated mid-year population in 2002 stood
  at 2,363,325.
• 37 Kuwaitis and 63 non- Kuwaitis
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• According to 1995 census, among Kuwaiti
  population
• - 55.2 lt 19 yrs
• - 4.1 gt 60 yrs
• - 56.3 of expatriate population are between
  25 to 45 years of age.

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• Health
• Kuwait has a well developed health care system.
• - free to all Kuwaitis
• - Immunization is compulsory and free for all
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• Infant mortality rate decreased from
• 10.9/1000 live births 1998
• 9.6/1000 live births 2002
• Maternal mortality decreased
• No Kuwaiti maternal deaths in 2000 2001.

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• Trends in Energy Requirements and Food Supplies
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• Food Consumption
• The economic transition over the past half
  century
• Increased family income and hence purchasing
  power
• Increased availability of varied and
  commercial foods
• Stimulated food advertisements

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• Traditional diets has been changed to more
  diversified diets
• Canned, frozen, dehydrated foods are imported
  from all over the world
• Sweets, chocolates, pastries, and snacks are
  available in abundance.
• Food franchises covering a wide range of choices
  are widely spread, and eating outside the home
  has become an acquired habit
• - Fast foods such as hamburgers, pizza, fried
  chicken are widely consumed by the younger
  generation.

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• As a result
• Food habits and choices adversely changed
• And in the presence of
• Sedentary lifestyle prevalent in all walks of
  life
• Stress
• Smoking
• the incidence of diet-related non-communicable
  diseases such as diabetes, hypertension,
  cardiovascular disease and cancer had markedly
  increased

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According to Food and Agriculture Organization
Food Balance sheets for Kuwait 1995 versus 1999,
the food availability data showed General
increase in meat and poultry, sweeteners, and
milk and milk products. An increase of
calories by 152 kcal, proteins 4.5 grams and
total fat 2.7 grams per day. Community
based food intake data not available
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Micronutrient Deficiency
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Iron-Deficiency Anemia   - Prevalence increasing
among vulnerable groups - According to Kuwait
nutrition Surveillance, 23 of preschool
children, 22 of adolescent girls, and 24
of child bearing women are anemic
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Based on WHO classification, Kuwait falls in the
medium category group of countries ( anemia
prevalence 15.0 to 39.9 ). Those at risk are
women and children.
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• Iron Fortification of Flour
• Legislation passed in 1999
• Implementation in March 2001
• Quality Control Committee for follow up
• March 2004 Monitoring Group established
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• Iron Supplementation Programs
• Targeted for pregnant ladies at MCHC
• Problem is with compliance!!
• Other high risk groups have to be targeted e.g.
  under 5yrs

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Vitamin D deficiency A study on Vitamin D status
of the Kuwaiti mothers and their neonates in two
hospitals showed that 40 of the mothers and 60
of the neonates are vitamin D deficient on the
day of delivery (Abdul Majid Mulla et al,
2000). More research is needed.
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• Iodine deficiency
• No data available on the status of IDD in the
  population
• It is now mandatory that all salt for human
  consumption to be fortified with Iodine (Kuwaiti
  Standards, 2003).

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• Vitamin A deficiency
• Little data on vitamin A deficiency in Kuwait
• Only one study was conducted on newborns and
  their mothers
• Results showed no evidence of deficiency in
  these groups.
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• Obesity
• Data from previous studies showed
• Obesity in Kuwait steadily increasing (Moussa et
  al., 1999, Surveillance, 2003)
• Probably the highest in Gulf states (Al-Mousa,
  1996)
• Independently, a high risk factor for CHD (
  Al-Mousa 1996) and Type 2 DM in Kuwait (Emara et
  al., 1989 Alwan King, 1992 Abdella et al 1995)

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Prevalence of obesity Data from Nutrition
Surveillance, 1998-2000, showed the prevalence of
obesity (weight-for-height gt2SD) among preschool
children under 5 years to be - 6.5 for males
- 9.2 in females. For the children between
6 to 10 years - 9.3 in males and 9.5 in
females
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Chronic Non-Communicable Diseases

• 1- Cardiovascular disease
• Coronary heart disease is the number one cause of
  mortality in Kuwait
• Incidence is 40.6/100,000

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• 2- Diabetes
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• - Type 2 diabetes mellitus a leading chronic
  non-communicable disease among the adult Kuwaiti
  population.
• Over all, prevalence rate for glucose intolerance
  reached as high as 15.8 among Kuwaiti population
  below 50 years of age. (Abdella et al., 1999)
• The prevalence rises to gt25 if the undiagnosed
  are included

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• A study on incidence of type 1 DM in Kuwait
  showed that Kuwait has the highest incidence in
  the region, (Shaltout et al., 1995)
• - The annual incidence of type 1 DM for children
  aged 0-14 years over the 2 year period was
  15.4/100,000
• Male to female ratio is 1.21.
• Compared with the previous study by Taha et al.
  (1983), there was a nearly 4X increase of type 1
  DM in this age group but mainly in under 5 years

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• Diabetic subjects presented at a relatively young
  age,
• prevalence in the age group
• 20 39 was 5.7
• 40 59 was 18.3 .

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• 3- Cancer
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• Second leading cause of death in Kuwait with an
  incidence of
• 20.2/100,000 males
• 29.2/ 100,000 females
• Lung cancer most common cancer among Kuwaiti
  males
• Breast cancer most common cancer among Kuwaiti
  and non-Kuwaiti females.

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Research in Nutrition

• National Nutrition Survey for Kuwait
• We are in the process of finalizing the
  project, a baseline data on the nutritional
  status of the population identifying at risk
  groups, prevalence of non-communicable diseases
  and micronutrient deficiencies.

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Nutrition Surveillance - room for improvement

• Data is collected on
• Anthropometry
• Infant feeding practices
• Fruit/vegetable consumption
• Smoking
• Physical Activity

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CONSTRAINTS

• Limited number of
• Health educators
• Dietitians
• Clinical nutritionists
• nutrition research
• Still, no B Sc degree
• Totally dependent on Diploma graduates
• Lack of trainers/specialists for in-hospital
  training
• Limited budget for training, research and
  consultation
• Nutrition not a priority

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1- Nutrition Facilities l Infrastructure
Capabilities

• Within the Food and Nutrition Administration
• Central out patient clinic, with lab facilities
• Providing Nutrition Counseling
• Continuous Nutrition Education ( CNE )
• Training department- 9 months concentrated
  training course for all new diploma assistant
  dietitians and B.Ss graduates from other
  specialties.
• Nutrition Education - schools, community and for
  special groups.

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• Research department conducts Nutrition
  Surveillance system to monitor
• Growth in children
• Iron deficiency status among the Kuwaiti
  population
• Prevalence of diabetes and hyperlipidemia among
  Kuwaiti adults.
• Nutrition counseling in some Primary Health
  Centers, and mostly focused in diabetic centers.

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2. Personnel and Expertise, degree of experience
Experience ranges from new graduate to 25 years
for the senior staff.
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