The World Health Organization’s (WHO) Eastern Mediterranean Region (EMR) is suffering from a double burden of malnutrition in which undernutrition coexists with rising rates of overweight and obesity. Although the countries of the EMR vary greatly in terms of income level, living conditions and health challenges, the nutrition status is often discussed only by using either regional or country-specific estimates. This analytical review studies the nutrition situation of the EMR during the past 20 years by dividing the region into four groups based on their income level—the low-income group (Afghanistan, Somalia, Sudan, Syria, and Yemen), the lower-middle-income group (Djibouti, Egypt, Iran, Morocco, Pakistan, Palestine, and Tunisia), the upper-middle-income group (Iraq, Jordan, Lebanon, and Libya) and the high-income group (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates)—and by comparing and describing the estimates of the most important nutrition indicators, including stunting, wasting, overweight, obesity, anaemia, and early initiation and exclusive breastfeeding. The findings reveal that the trends of stunting and wasting were decreasing in all EMR income groups, while the percentages of overweight and obesity predominantly increased in all age groups across the income groups, with the only exception in the low-income group where a decreasing trend among children under five years existed. The income level was directly associated with the prevalence rates of overweight and obesity among other age groups except children under five, while an inverse association was observed regarding stunting and anaemia. Upper-middle-income country group showed the highest prevalence rate of overweight among children under five. Most countries of the EMR revealed below-desired rates of early initiation and exclusive breastfeeding. Changes in dietary patterns, nutrition transition, global and local crises, and nutrition policies are among the major explanatory factors for the findings. The scarcity of updated data remains a challenge in the region. Countries need support in filling the data gaps and implementing recommended policies and programmes to address the double burden of malnutrition.

Background: Significant attention is being given to the role of sugar-sweetened beverages (SSBs) in the increasing rates of obesity and diet-related noncommunicable diseases in the Eastern Mediterranean Region (EMR). Aim: To document the different approaches being used by EMR countries in implementing the sugar-sweetened beverages taxation. Methods: This study used data on indirect taxes levied on SSBs by the 22 EMR countries and territories collected by WHO between July 2022 and June 2023. For comparison between countries, all applicable taxes were converted to a percentage of the tax-inclusive retail prices and standardized. Results: Eleven EMR countries imposed the national excise tax on carbonated SSBs and 10 imposed excise tax on at least one type of beverage other than carbonated SSBs. Ad valorem excise taxes were the most-used type for carbonated SSBs, with 10 of the 11 countries applying them. Morocco applied volume-based specific excise taxes with different rates depending on the sugar content. Excise tax represented the highest tax proportion (31.7%) in Oman and United Arab Emirates, while total tax represented the highest proportion (42.0%) of the retail price in Saudi Arabia and 36.5% in Oman and United Arab Emirates. Conclusion: Only half of the EMR countries are currently implementing SSBs taxation, and the imposed tax is less than 20% in half of these countries. All EMR countries should start implementing SSBs taxation as part of their national disease control policy frameworks to help reverse the increasing trend of obesity and other diet-related noncommunicable diseases in the region.

Background: The World Health Organization recommends taxes on sugar-sweetened beverages (SSBs) as part of costeffective interventions to prevent diet-related noncommunicable diseases. Aim: To analyse the adoption and implementation of SSBs taxation in Saudi Arabia and United Arab Emirates and its impact on obesity rates. Methods: Using a semi-structured questionnaire, we collected information on progress with implementation of SSBs taxes in Saudi Arabia and United Arab Emirates between January 2015 and December 2023. We searched literature published in Arabic and English on the subject and used the WHO acceleration scenario modelling tool to forecast the potential impact of SSBs on overweight and obesity in the 2 countries over the same period. Results: Both countries implemented SSBs taxation consistently between 2015 and 2023, generating additional revenue and reducing obesity rates. The acceleration scenario estimates showed that SBB taxation could reduce overweight prevalence among children and adolescents (aged 5–19 years) from 38.2% in 2020 to 34.4% in 2030 in Saudi Arabia and from 37.0% to 34.6% in United Arab Emirates, and could reduce obesity rate by approximately 12.7% in Saudi Arabia and 9.5% in United Arab Emirates in the same period. Conclusion: This review provides further evidence that SSBs taxes can be effective in reducing sugar consumption, thereby reducing overweight and obesity rates. However, to effectively combat obesity and overweight among children and adolescents, taxation policies must be implemented alongside other strategies, including public health campaigns to increase awareness about the health risks associated with excessive sugar consumption.

Nutritionally-managed genetic disorders encompass a wide range of conditions in which dietaryinterventions play a critical role in managing or mitigating the effects of genetic abnormalities. Thesedisorders range from inborn errors of metabolism, such as glutaric acidaemia, to inherited metabolicdiseases and congenital disorders of glycosylation. They often involve autosomal genes and are typically inherited, being passed from one generation to the next. The acute symptoms of genetic disorders, such as intoxication, closely resemble those of other conditions like infections, birth traumas, respiratory issues, cardiac disorders, and endocrine problems, often leading to frequent misdiagnosis and severe outcomes, including death. Key organs affected include the liver, brain, heart, muscles and kidneys, which play critical roles in metabolism and energy regulation. Clinical symptoms, which often relate to the type and toxicity of accumulated metabolites or the absence of essential products, include poor feeding reflexes, vomiting, dehydration, abnormal muscle tone, seizures, neurological impairment, coma and even mortality.Proper management of genetic disorders involves adequate newborn screening, nutritional assessment, nutritional diagnosis, nutritional intervention and consequently nutritional monitoring and evaluation. This guide sheds light on the different categories of genetic disorders (urea cycle disorders (UCDs), organic acidaemias, carbohydrate disorders, amino-acid disorders and fatty acid-oxidation disorders), as well as their main characteristics, biochemical features and clinical symptoms, complications and medical nutrition therapy and management guidelines. The medical nutrition therapy of genetic disorders aims to address the deficiency or inactivity of enzymes by (1) limiting the amount of available substrate; (2) providing more of the end product; (3) supplementing additional enzymatic cofactors; (4) promoting the elimination of toxic metabolites; (5) relying on a combination of these approaches; (6) maintaining appropriate blood levels of pertinent indicators; (7) providing adequate energy and nutrients; (8) ensuring proper growth and development; and (9) treating infections and managing seizures if needed.This document is intended to serve as a resource for policy makers, physicians, healthcare practitioners, parents, family members and caregivers. It also emphasizes the need to have a comprehensive referral system and multidisciplinary care teams to better enhance the management of genetic disorders in the Eastern Mediterranean region. This is not a World Health Organization (WHO) guideline but an updated review of various organizations guidelines in various countries as a desk review of the topic. A preliminary advocacy brief was prepared at the WHO Regional Office andcirculated to the various experts from different countries for their feedback and consensus on thecontents.