| Summary: | Background:
The traditional Omani diet of dates, milk, rice, brown bread, fish and vegetables has undergone considerable change, now resembling a Western diet that is high in calories, high glycaemic index carbohydrates, total fat and saturated, trans and omega 6 fatty acids, and low in omega-3 fatty acids and essential micronutrients. The available data on daily food intake and its impact on micro- and macro-nutrients are scanty in the Arab world. Obtaining these data is especially important in light of the growing prevalence of non-communicable diseases (NCDs) - cardiovascular diseases, diabetes, cancer and respiratory diseases - which now account for more than 60% of the global disease burden and mortality, and contribute to more than 50% of annual deaths in Arabian countries, including Oman. Moreover, obesity, an antecedent of NCDs, has reached epidemic proportions in the region. Since NCDs develop gradually during the course of the lifespan, various national and international committees on NCDs have recommended that children and young adults be the primary focus of any action plan that aims to prevent and control non-communicable diseases.
Specific aims:
The aims of the study are:
a) To assess the nutrient intake, body composition, blood lipids, blood pressure, blood glucose and cognitive behaviour of Omani school children;
b) To assess the level of Vitamin A, D, E, and Beta Carotene among the Omani school children
c) To assess the level of red blood cell fatty acids of Omani school children
d) To investigate the effect of fish consumption on red blood cell omega-3 fatty acids and plasma fat-soluble vitamins;
e) To investigate the impact of omega-3 fatty acids obtained from fish oil capsule on the red blood cell omega-3 fatty acids and plasma fat-soluble vitamins.
Methods:
Children ages 9 and 10 years (n = 314) were recruited from three randomly selected schools in the Muscat Governorate. The schools were assigned to a fish, fish oil, or control group and the children were accordingly provided a lightly grilled oily fish, a re-esterified triacylglycerol fish oil capsule, or no fish for 12 weeks. Baseline body weight, height and body mass index were assessed and a non-fasting blood sample collected at baseline and after 12 weeks of intervention. Data on food intake were gathered using a 24-hour recall questionnaire; also collected were data on weight, height, blood pressure, triglycerides and fasting glucose. In addition, teachers completed the National Initiative for Children’s Health Quality Vanderbilt Assessment Scales-Teacher Assessment Scale to assess the prevalence and sub-types of ADHD.
Results:
At baseline, a significant number of the children had low levels of vitamin D, and omega-3 fatty acids. The low levels of vitamin D and omega-3 fatty acids were ameliorated significantly by fish consumption and fish oil supplementation. In terms of weight, the prevalence of overweight or obesity for the total sample was 28.2% (10%, 46%) and 22.6% (8%, 38%). That is, about one fourth of the study subjects were overweight or obese. With regards to ADHD, the prevalence rate of PIS, PHIS and ADHDCIH among Omani school children was 7.3%, 3% and 8.8%, respectively.
After 12 weeks intervention, the children who received fish oil (54.1±17.5 nmol/L; p<0.001) and fish (49.2±17.4 nmol/L; p<0.05) had elevated levels of vitamin D than those who did not (42.3±17.5 nmol/L). The fish oil (1.2±0.70 μmol/L) and fish (1.20±0.7 μmol/L) groups also had higher concentrations of beta carotene than the placebo group (0.85±0.43 μmol/L; p<0.0001). Systolic and diastolic blood pressure (p=0.0001) and plasma triglycerides (p<0.05) but not HDL, LDL and total cholesterol (p>0.05) were lower in the fish oil group compared with those who were fed oily fish.
Conclusions:
This study provides important and underreported data on nutrient intake levels by school children in Arab world. For the first time, these data will be available as a benchmark for future research and health programs in the region. A large number of boys and girls had diets that failed to provide the recommended levels of daily nutrients. This study also indicates that ADHD is relatively common among Omani school children; additional studies are needed to assess the generalisability of these findings.
Vitamin D deficiency is prevalent in Omani school children, but can be mitigated with omega-3 fatty acid supplementation. This study also provides evidence that Omani pre-adolescents have a low level n-3 fatty acid index that can be ameliorated by fish oil supplementation or consumption of oily fish. Hence, there is a need for a child-focused program of food fortification, school feeding programmes, targeted intervention with n-3 fatty acid enriched food products, family nutrition education and outdoor activities to alleviate the problem.
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