Majid Mqbel Alkhalaf

Background/Objectives: Gastrointestinal (GI) manifestations may persist in COVID-19 survivors, potentially worsening pre-existing conditions and increasing the risk of malnutrition. Understanding the long-term association between GI symptoms and nutritional risk is essential. This study aimed to investigate this relationship in COVID-19 survivors, regardless of comorbidities. Methods: A retrospective cohort study with prospective follow-up was conducted among 103 adults (52 males and 51 females) with PCR-confirmed COVID-19 admitted to King Salman Specialist Hospital, Ha’il, Saudi Arabia, between January 2021 and January 2023. Participants were grouped based on the presence of comorbidities, mainly type 2 diabetes mellitus (DM) and hypertension (HTN), and GI symptoms. Demographic characteristics, COVID-19 severity, and clinical data were obtained from medical records and structured interviews. Nutritional risk was assessed using the Malnutrition Screening Tool (MST). Statistical analysis was performed using Chi-Square tests, with p < 0.05 considered significant. Results: Over a mean follow-up of 26.6 months, 40.8% of participants reported at least one persistent GI symptom. Patients with comorbidities were older than those without comorbidities (mean age 58.24 ± 13.23 vs. 48.22 ± 14.83 years), and malnutrition risk was commonly observed in both groups during hospitalization and follow-up. The most frequently reported symptoms were abdominal pain (15.5%), diarrhea (12.6%), appetite loss (9.7%), and vomiting (7.8%), with no significant differences between groups. GI symptoms were significantly associated with reduced food intake, weight loss, and increased malnutrition risk (p < 0.05). Conclusions: Some COVID-19 survivors reported persistent GI symptoms during long-term follow-up, with no significant differences based on comorbidity status. GI symptoms were associated with nutritional risk and lifestyle changes, supporting the need for nutritional screening in post-COVID-19 care.

Background/Objectives: In 2020, the National Nutrition Committee in Saudi Arabia launched a nutrient profile model, aiming to support the classification of foods and beverages in line with successful international approaches. The objective of this study was to compare the existing Saudi Arabian nutrient profile model to other established models to help inform diet-related policies in the country. Methods: Packaged food and beverage data were obtained from Mintel’s Global New Products Database. Products were evaluated under the Saudi Arabian nutrient profile model, Nutri-Score and Chile’s high fat, salt, sugar (HFSS) model. Agreement among the three nutrient profile models was examined using Fleiss’ kappa statistic. Results: There were 6940 products used in analysis. All three models showed a low proportion of eligible/healthy products, with 26% for Chile’s HFSS model, 28% for Nutri-Score and 25% for the Saudi Arabian nutrient profile model. There was substantial agreement (86%; k = 0.74) among all three models examined, with the highest agreement between the Saudi Arabian nutrient profile model and the Nutri-Score model. Conclusions: All three demonstrated a sub-optimal level of overall healthiness in the Saudi Arabian packaged food and beverage supply, with <30% of products under all models considered “healthy”. Given the substantial agreement among all three nutrient profiling approaches examined, it is likely that Saudi Arabia could benefit from the use of a categorical approach to nutrient profiling such as the Nutri-Score model, which allows for a more scaled view on product healthiness compared to a binary approach.

Cancer is one of the leading causes of global morbidity and mortality and one of the most challenging global health conditions, impacting the lives of millions every year. The Eastern Mediterranean Region (EMR) is not on track to achieve the sustainable development goal (SDG) target 3.4 which aims to reduce premature mortality (i.e., before the age of 70 years) for non-communicable diseases (NCDs), including cancer, by a third by year 2030; instead, it is projected that the EMR will experience the least progress towards achieving this target. This review therefore highlights the importance of context-specific cancer management, with a focus on nutritional, lifestyle and supportive care, in the EMR. A comprehensive literature search was conducted using electronic databases, including PubMed, Scopus and Google Scholar, as well as the Academy of Nutrition and Dietetics and key oncology institutes. Nutritional and lifestyle management is a fundamental aspect of cancer care which should be context-specific, achievable and individualized to minimize symptoms and side effects, while maximizing benefits and better addressing the needs of the patients with cancer. A multidisciplinary approach that integrates medical, nutritional, psychological and palliative care is essential to address this growing issue effectively. Cancer care and management requires coordinated efforts from policymakers, healthcare providers and communities to implement evidence-based interventions and promote cancer awareness.

Cancer is a complex disease stemming from multiple interactions between genes and the environment, and is regarded as a primary contributor to global mortality. It is a condition in which the irregular and uncontrolled growth and proliferation of certain cells interferes with normal tissue function and has the potential to spread throughout the body. While the most prevalent types of cancer among children are those related to the blood (leukemia - i.e. cancer in the white blood cells (WBC) in the bone marrow), brain and bones, among adults, cancers pertinent to the epithelial tissues are more prevalent. Even though the proposed etiology of cancer is multifactorial, the most commonly known risk factors are genetics (age), physical carcinogens (radiation – ultraviolet and ionizing), chemical carcinogens (unhealthy diet, alcohol consumption, smoking and tobacco use, chemical exposures, plastic containers and storage methods), biological carcinogens (infections, hormones, reduced immunity) and other factors (overweight and obesity, sedentary lifestyle, stress).The 2019 Global Burden of Disease (GBD) study has reported that the total number of cancer deathsglobally attributable to all estimated risk factors was 4.45 million, accounting for 44.4% of all cancerdeaths. According to the International Agency for Research (IARC), by 2022, the estimated numberof new cancer cases was approximately 20 million, with 9.7 million death cases. It is also projectedthat the annual number of new cancer cases will increase to 33.1 million with a corresponding rise incancer-related deaths to 18.2 million by 2050. As for the Eastern Mediterranean Region (EMR), thesituation is similar to the global situation, whereby 781,000 new cases of cancer were reported andcancer accounted for approximately 485,000 deaths in 2022. By 2050, the number of new cases anddeaths is projected to reach 1.77 and 1.21 million, respectively.Successful prevention and management of cancer can benefit from proper identification of the individual’s nutritional status and health condition in order to offer individualized treatment, if needed, and to ensure the provision of their needs. This involves mastering the four steps of the nutrition care process: nutritional assessment, nutritional diagnosis, nutritional intervention and consequently monitoring and evaluation; which are discussed in depth throughout the guide.This guide is intended to serve as a resource for policymakers, healthcare professionals and individuals looking to reduce their risk of cancer or improve treatment outcomes if diagnosed. It also sheds light on the need to develop and incorporate nutritional aspects into national cancer control strategies and plans in countries of the EMR despite the potential challenges being faced in the region.Finally, the guide discusses the most common types of cancer (breast, colorectal, esophageal, gastric,head and neck, hematological, liver, lung, pancreatic and small intestine) by providing a brief overview on their common symptoms and side effects, and adequate dietary intervention.

Early childhood exposure to heavy metals like arsenic (As), cadmium (Cd), and lead (Pb) through baby foods unfolds many concerns about their toxic effects on growth and health. In this study, occurrence and dietary intake of As, Cd, and Pb in stage 1 infant formula (0–6 months), stage 2 infant formula (7–12 months), cereal‐based meals, and biscuits were estimated. First, the levels of As, Cd, and Pb were determined with ICP‐MS, followed by the calculation of estimated daily intake (EDI), target hazard quotient (THQ), and hazard index (HI) for As and Cd, and margin of exposure (MoE) for Pb. Mean levels of As, Cd, and Pb were the highest in cereal‐based meals and biscuits as 15.5–11.1, 5.18–8.76, and 35.2–53.8 μg/kg, respectively. Newborns to 6 months old infants were estimated to be the highest exposed population to Cd and Pb (0.08 and 0.36 μg/kg bw/day), while infants aged 7–12 months old were exposed the highest to As. Based on the THQ, HI, and MoE findings, the current exposure levels from the selected baby foods to As, Cd, and Pb pose low potential chronic risks to both infant age groups. This research provides a roadmap for future investigations in chemical contaminants often detected in baby foods consumed regularly by Saudi infants.

No study has investigated the effect of the COVID-19 pandemic on the public’s interest in using energy labelling on restaurant menus. This study explores the effects of the COVID-19 pandemic on the public interest in using energy labelling on restaurant menus and meal delivery applications and the impact of energy-labelling availability on food choices during the COVID-19 pandemic in Saudi Arabia. An online questionnaire was completed by 1657 participants aged ≥ 18 years. Before the COVID-19 pandemic, 32% of customers visited a restaurant 2–4 times/week. However, during the pandemic, 35% of customers visited a restaurant only once per week. There was no difference in interest in reading energy labelling or using meal delivery applications before and during the pandemic. During the COVID-19 pandemic, about 55% of restaurant customers reported that they had noticed energy labelling, with 42% of them being influenced by the energy-labelling information. Regarding energy information on food delivery applications, 40% of customers noticed energy labelling when using the applications, with 33% of them being affected by the energy labelling. Customer interest in reading about energy on restaurant menus during the pandemic did not change significantly from the level of interest before the pandemic. The interest expressed by the public in using the energy labelling was low both before and during the COVID-19 pandemic.

COVID-19’s intimidating spread has challenged the resilience of the global health systems, causing shifts in the practices of healthcare workers, including dietitians. The current study aimed to assess the change in dietitians’ practices and duties in hospitals/clinics after the commencement of COVID-19 pandemic. This cross-sectional study was conducted in five Arab countries between November 2020 and January 2021. A convenient sample of 903 dietitians filled an online self-administered questionnaire to meet the study aims. Nearly 40.0% of the dietitians experienced a change in their workload and caseload during the pandemic. Besides, 18.7% of the dietitians had been assigned additional tasks in their facilities. Nearly half the dietitians (46.9%) had started giving remote nutrition consultations, associated with a 21% drop in the number of dietitians offering in-person consultations (p = 0.001). Approximately 58.9% of the dietitians provided nutrition care to COVID-19 patients, with 48.4% having access to personal protective equipment. Moreover, 17.0% of dietitians supported COVID-19 patients with enteral and parenteral nutrition. In addition, 45.0% of dietitians reported that managing COVID-19 was challenging given that it was a newly discovered condition.

Introduction: Tobacco smokers are at high risk of developing severe COVID-19. Lockdown was a chosen strategy to deal with the spread of infectious diseases; nonetheless, it influenced people’s eating and smoking behaviors. The main objective of this study is to determine the impact of the...

Insufficient physical activity is considered a strong risk factor associated with non-communicable diseases. This study aimed to assess the impact of COVID-19 on physical (in)activity behavior in 10 Arab countries before and during the lockdown. A cross-sectional study using a validated online survey was launched originally in 38 different countries. The Eastern Mediterranean regional data related to the 10 Arabic countries that participated in the survey were selected for analysis in this study. A total of 12,433 participants were included in this analysis. The mean age of the participants was 30.3 (SD, 11.7) years. Descriptive and regression analyses were conducted to examine the associations between physical activity levels and the participants’ sociodemographic characteristics, watching TV, screen time, and computer usage. Physical activity levels decreased significantly during the lockdown. Participants’ country of origin, gender, and education were associated with physical activity before and during the lockdown (p < 0.050). Older age, watching TV, and using computers had a negative effect on physical activity before and during the lockdown (p < 0.050). Strategies to improve physical activity and minimize sedentary behavior should be implemented, as well as to reduce unhealthy levels of inactive time, especially during times of crisis. Further research on the influence of a lack of physical activity on overall health status, as well as on the COVID-19 disease effect is recommended.

Aflatoxin M1 (AFM1) is a salient metabolite that can be used to assess Aflatoxin B₁ (AFB1) exposure in humans and animals. The carcinogenic potency of AFB1 and AFM1 was severely reported. The aims of this study were (1) to survey the contamination level of AFM1 in the most traded infant powdered formula brands (IPF) (n = 42) along with the AFB1 level in under 5’s children food brands (biscuits, cornflakes, and cereals) (n = 42) and (2) to assess the estimated daily intake (EDI), the hazard quotient (HQ) and the margin of exposure (MOE) of AFM1 among infants (0–12 months) in Lebanon. All of the samples were analyzed using ELISA technique. AFB1 was below detection limit in all of the children’s food brands samples. Out of 42 IPF samples 9.5% were AFM1-positive in the range of 29.54–140.16 ng/L and exceeded the maximum tolerable limit (MTL) set by the European commission (25 ng/kg). The overall average contamination level was 5.72 ± 0.014 ng/L. The EDI of AMF1 for male was in the range of 0.37–0.78 ng/kg/b.w./day and 0.40–0.87 ng/kg/b.w./day for females. Similarly, the HQ calculation resulted in an average of 3.05 for males and 3.28 for females. MOE calculations were far lower from 10,000 in both genders which indicates a high risk of genotoxicity and carcinogenicity. Our findings show that AFM1’s EDI, HQ and MOE scored high among Lebanese infants. As infants consume more IPF relative to their body weight, the persistence of IPF with high AFM1 levels threatens their health. Thus, infant’s exposure risk to AFM1 in IPF should be a continuous focus of attention.