The etiology of obesity in North Africa is not well understood and few studies shed any light on its development among women. This study compiles what is known about the prevalence of obesity and its determinants in Morocco and Tunisia. Results from the authors' two surveys on nutrition-related disease among reproductive-age women (sample size: 2800) and their children (1200 children under 5 y and 500 adolescents) were combined with data from four national income and expenditure surveys (dating from 1980) to assess obesity trends and development in Morocco and Tunisia. Overall levels of obesity, identified by body mass index (BMI) ≥ 30 kg/m², were 12.2% in Morocco and 14.4% in Tunisia. Obesity is significantly higher among women than among men in both countries (22.7% vs. 6.7% in Tunisia and 18% vs. 5.7% in Morocco) and prevalence among women has tripled over the past 20 y. Half of all women are overweight or obese (BMI > 25) with 50.9% in Tunisia and 51.3% in Morocco. Overweight increases with age and seems to take hold in adolescence, particularly among girls. In Tunisia, 9.1% of adolescent girls are at risk for being overweight (BMI/age ≥ 85th percentile). Prevalence of overweight and obesity are greater for women in urban areas and with lower education levels. Obese women in both countries take in significantly more calories and macronutrients than normal-weight women. The percentage contribution to calories from fat, protein and carbohydrates seems to be within normal limits, whereas fat intake is high (31%) in Tunisia and carbohydrate intake (65–67%) is high in Morocco. These are alarming trends for public health professionals and policy makers in countries still grappling with the public health effects of malnutrition and micronutrient deficiencies. Health institutions in these countries have an enormous challenge to change cultural norms that do not recognize obesity, to prevent significant damage to the public's health from obesity.

Anemia is a multifactorial condition, with a complex etiology that involves nutritional and non-nutritional factors. The misconception that iron deficiency is equivalent to anemia may mask the need to address other potential causative factors. This review paper aims to (1) assess the burden of anemia vs. iron deficiency anemia (IDA) amongst women of reproductive age (WRA), pregnant women (PW), and children under five years old (underfive children, U5C) in the Eastern Mediterranean region (EMR); (2) evaluate trends in anemia prevalence and whether countries are on track towards meeting the World Health Assembly (WHA) target for 2025; and (3) characterize anemia reduction efforts and provide a road map for future programs. A search of pertinent literature and databases was conducted. Anemia prevalence in the EMR ranged between 22.6% and 63% amongst PW, 27% and 69.6% amongst WRA, and 23.8% and 83.5% amongst U5C. Data showed that the EMR is not on course towards meeting the WHA target. The contribution of IDA to anemia was found to be less than half. Other potential contributors to anemia in the region were identified, including micronutrient deficiencies, parasitic infestations, and poor sanitation. A framework of action was proposed as a roadmap to meet the targets set by the WHA.

Background: University life is a crucial period when dietary habits and lifestyle behaviours are formed and may have long-lasting effects on the development of obesity and related chronic diseases. Aim: To investigate the association of overweight/obesity with dietary habits, physical activity, screen time and sleep duration among university students. Methods: A total of 438 students aged 18–26 years were recruited from Mohammed V University in Rabat, Morocco. Anthropometric measurements were assessed using standardized equipment. Data regarding dietary habits, physical and sedentary activities were collected via a self-administered questionnaire. Results: The prevalence of overweight and obesity was 14.8% and 1.6%, respectively. Students who reported frequent consumption (>3 times/week) of fast food, fried potatoes and sugary drinks were more likely to be overweight/obese than peers who did not. Similarly, odds of being overweight/obese were slightly higher among females who reported non-daily intake of fruits and milk or dairy products and among males who ate vegetables less frequently (<7 times/week). Approximately 26% of students were physically inactive, with a higher proportion of females (35.8%) than males (10.7%). Both short and long sleep durations were associated with an increased risk of overweight/obesity in males. In contrast, physical inactivity and increased screen time were associated with a slightly reduced risk of overweight/obesity, particularly in females. Conclusions: Overall, unhealthy dietary habits were associated with an increased risk of overweight/obesity. A similar trend was also observed between abnormal sleep duration and overweight/obesity in males. Interventions to promote healthy dietary and lifestyle habits and prevent overweight/obesity in this population are needed.

Hepatic hepcidin synthesis is stimulated by inflammation but inhibited during iron deficiency anemia. In humans, the relative strength of these opposing signals on serum hepcidin and the net effect on iron absorption and systemic iron recycling is uncertain. In this prospective, 45-day study, in young women (n=46; age 18-49 y) with or without iron deficiency anemia, we compared iron and inflammation markers, serum hepcidin and erythrocyte iron incorporation from 57Fe-labeled test meals, before and 8, 24 and 36 hours after influenza/DPT vaccination as an acute inflammatory stimulus. Compared to baseline, at 24-36 hours after vaccination: 1) interleukin-6 increased 2-3-fold in both groups (p2-fold in the non-anemic group (p<001), but did not significantly change in the iron-deficiency anemia group; 3) serum iron decreased in the non-anemic group (p<0·05) but did not change in the iron deficiency anemia group; and 4) erythrocyte iron incorporation did not change in either of the two groups, but was ≈2-fold higher in the iron deficiency anemia group both before and after vaccination (p<001). In this study, mild acute inflammation did not increase serum hepcidin in women with iron deficiency anemia, suggesting low iron status and erythropoietic drive offset the inflammatory stimulus on hepcidin expression. In non-anemic women, inflammation increased serum hepcidin and produced mild hypoferremia, but did not reduce dietary iron absorption, suggesting iron-recycling macrophages are more sensitive than the enterocyte to high serum hepcidin during inflammation. The study was registered as a prospective observational trial at www.clinicaltrials.gov as NCT02175888. The study was funded by the International Atomic Energy Agency.

Background: The front of pack nutrition label Nutri-Score, intended to help consumers orient their choices towards foods that are more favorable to health, was developed in France and applied in several European countries. Consideration is underway for its use in Morocco. This study aims to assess Moroccan consumers’ perception and objective understanding of Nutri-Score and 4 other nutritional information labels (Health Star Rating, Health warning, Reference Intakes and Multiple Trafic Light) and their impact on purchase intentions. Methods: 814 participants were asked to choose among 3 food classes (yoghurts, biscuits and cold cuts), which ones they would prefer to buy among three products with different nutritional profiles and then to rank them according to their nutritional quality. Participants first performed these tasks without a visible nutritional label, and then, after being randomized to one of five labels tested, with the nutritional label visible on front of packs. Next, the full set of tested labels was presented to the participants who were asked a series of questions regarding their preferences, the attractiveness of the labels, their perceptions, intention to use and the trustworthiness placed in the labels. Results: Compared to the Reference Intake, the Nutri-Score (OR = 2.48 [1.53–4.05], p < 0.0001), was associated with the highest improvement in the ability to correctly classify foods based on their nutritional quality. The percentage of participants who improved their food choice was higher than those who worsened it for all the labels. For yogurts and cookies, the most significant improvements were observed for the Nutri-Score and the Reference Intakes: Concerning the perception of labels, the Nutri-Score is the label that received the highest number of positive responses, whether concerning the ease of being spotted (82.2%), of being understood (74%), and to provide rapid information (68.8%). The Nutri-Score was ranked as the preferred label by 64.9% of the participants. Conclusion: The Nutri-Score appears to be the most effective nutritional information system to inform consumers about the nutritional quality of foods in Morocco, where it could constitute a useful tool to help consumers in their food choices in situations of purchase.

Objective: The study aimed to detail the lifestyle (physical activity and dietary habits) of Moroccan adolescents.Design: Cross-sectional study undertaken in the framework of the ATLS (Arab Teens Lifestyle Study).Setting: Physical activity and dietary habits were determined using a validated questionnaire in public secondary schools.Subjects: A total of 669 adolescents aged 15·0–19·9 years were randomly recruited from Kenitra, Morocco.Results: Physical activity patterns and intensity differed between genders. As anticipated, male adolescents were more active than female adolescents across a typical week and engaged in more vigorous-intensity physical activity than female adolescents, who spent more time than male adolescents in moderate-intensity physical activity. Of particular concern was that one in five of the adolescents surveyed was inactive, with almost 45 % of the sample reporting television viewing for more than 2 h/d and 38 % engaged in computer use for a similar period. From a dietary perspective, most adolescents reported that they do not take breakfast or consume milk and dairy products, fruits and vegetables on a daily basis. In contrast, most reported consumption of doughnuts, cakes, candy and chocolate more than three times per week and approximately 50 % consumed sugary drinks more than three times per week.Conclusions: Based on a continuation of the self-reported lifestyle behaviours, adolescents in the present study are at risk of developing chronic diseases. Education programmes are urgently needed to assist in the promotion of a healthy lifestyle and reduce the likelihood of overweight and obesity and related health risks among young people.