The NNI and FTRI/ARC surveys used different methods for analysing food intake data. In NNI surveys, data were converted into nutrient intakes using the Food Composition Table of Egypt, which is maintained by NNI and dates from 1996. To analyse the adequacy of nutrient intake, the NNI surveys used the RDAs from FAO/WHO/UNU (1985) for protein and energy, WHO (1989) for iron and FAO/WHO (1975) for vitamins A and C, except in the 2004 survey, for which FAO/WHO (2002) recommendations for vitamins and minerals were used.
The food intake data of ARC/FTRI surveys were converted into nutrient intakes using a modification of the USDA standard reference database (the Food Intake and Analysis System, Version 2.3, University of Texas), which was adjusted to remove the influence of enrichment/fortification and to include more than 1 000 Egypt-specific recipes (Khorshed et al., 1998). Nutrient intake adequacy was expressed using current versions of the United States RDAs (published by the National Academy Press from 1989 onwards).
Because of these important methodological differences between the surveys conducted by NNI and FTRI/ARC, each set is presented separately in these annexes. However, both used internally consistent methodology, so trends over time in the data are reliable.
ANNEX 1: FOOD INTAKE AND NUTRITIONAL STATUS
Survey name |
Year |
Sample size |
Age range |
Representation |
Method of analysis |
Institution |
Source |
National Food |
1981 |
6 300 households |
2-6 years |
National |
Dietary1 |
NNI |
Aly et al., 1981 |
Consumption |
|
|
10-19 years |
|
Anthropometry2 |
|
|
Survey |
|
|
Adults = 20 years |
|
|
|
|
Effect of increasing food cost on families behaviour regarding feeding their members |
1989 |
2 022 |
Individuals |
Regional (Cairo |
Dietary1 |
NNI |
Hussein, et al., 1989 |
|
|
363 |
Households |
- Assuit, El-Behera) |
|
|
|
Household food budget survey |
1990/1991 |
1 500 |
Households |
National |
Questionnaire |
CAPMAS |
|
|
|
82 109 |
Individuals |
|
|
|
|
Assessment of IDD status among schoolchildren |
1992 |
9 538 |
6-11 years |
National (22 governorates) |
Total goitre rate |
NNI |
Hussein et al., 1992 |
|
|
11 466 |
12-14 years |
|
Lab3 |
|
|
|
|
9 854 |
15-18 years |
|
- urinary iodine |
|
|
Assessment of vitamin A status in Egypt |
1995 |
1 628 |
0.5-5.99 years |
National (five governorates representing different regions of urban and rural Egypt) |
Dietary1 |
|
|
|
|
855 M |
|
|
Anthropometry2 |
|
|
|
|
775 F |
|
|
Lab3 |
|
|
|
|
1 629 F |
|
|
- haemoglobin |
NNI |
Moussa, El-Nehry and Abdel Galil, 1995 |
|
|
|
|
|
- plasma retinol |
|
|
|
|||||||
Survey name |
Year |
Sample size |
Age range |
Representation |
Method of analysis |
Institution |
Source |
EDHS |
1995 |
9 766 M/F |
0-5 years |
National (26 governorates) |
Anthropometry2 |
National |
EDHS, 1995 |
|
|
265 F |
15-19 years |
|
|
Population |
|
|
|
6 314 F |
15-49 years |
|
|
Council |
|
Development of food consumption monitoring system |
1995 |
3 186 households |
2-6 years Mothers |
National (five governorates representing urban and rural areas: Cairo, Ismalia, Dhakahlia, Aswan, New Valley) |
Anthropometry2 |
Food Technology Research Institute |
Khorshed, Ibrahim and Galal, 1995 |
|
|
|
|
|
Dietary1 |
|
|
Household food budget survey |
1995/1996 |
14 805 |
Households |
National |
Questionnaire |
CAPMAS |
|
|
|
73 939 |
Individuals |
|
|
|
|
Child well-being in Egypt |
1997 |
814 M |
|
National (six governorates: Alexandria, Assuit, Aswan, Great Cairo, Quena, Sohag) |
Anthropometry2 |
American University in Cairo, Social Research Center |
El-Tawela, 1997 |
|
|
815 F |
0-5 years |
|
|
|
|
|
|||||||
Survey name |
Year |
Sample size |
Age range |
Representation |
Method of analysis |
Institution |
Source |
EDHS |
1997 |
3 328 |
6-60 months |
National (26 governorates) |
Anthropometry2 |
National Population Council |
EDHS, 1997 |
Assessment of protein energy malnutrition, iron deficiency anaemia and vitamin A deficiency in Menia, Assuit and Sohag governorates |
1997 |
2 700 |
Mothers |
Regional (Menia Sohag, Assuit) |
Anthropometry2 |
High Institute of Public Health Alexandria |
El-Sayed, 2002 |
|
|
2 700 |
Children 6-71 months |
|
Dietary1 |
|
|
|
|
|
|
|
Laboratory3 |
|
|
|
|
|
|
|
- haemoglobin |
|
|
|
|
|
|
|
- plasma retinol |
|
|
|
|
|
|
|
- stool analysis |
|
|
|
|||||||
Survey name |
Year |
Sample size |
Age range |
Representation |
Method of analysis |
Institution |
Source |
Nutritional deficiencies among primary schoolchildren |
1998 |
3 000 |
6-12 years |
Regional (three governorates: Cairo, Quena, Sherkia) |
Anthropometry2 |
NNI |
Hassan et al., 1998 |
o |
|
|
|
|
Dietary1 |
|
|
|
|
|
|
|
Laboratory3 |
|
|
|
|
|
|
|
- haemoglobin |
|
|
|
|
|
|
|
- serum ferritin |
|
|
|
|
|
|
|
- serum zinc |
|
|
|
|
|
|
|
- serum retinol |
|
|
|
|
|
|
|
- serum selenium |
|
|
|
|
|
|
|
- urinary iodine |
|
|
|
|
|
|
|
- stool analysis |
|
|
Transition to adulthood: national survey of Egyptian adolescents |
1999 |
9 128 |
10-19 years |
National (21 governorates) |
Anthropometry2 |
Agriculture Research Centre |
ARC, 2001/2002 |
|
|
13 271 |
Households |
|
Dietary1 |
|
|
|
|
|
|
|
Laboratory3 |
|
|
|
|
|
|
|
- haemoglobin |
|
|
Household food budget survey |
1999/2000 |
47 949 |
Households |
National |
Questionnaire |
CAPMAS |
|
|
|
226 107 |
Individuals |
|
|
|
|
Egyptian adolescent anaemia prevention programme |
1992/2000 |
700 |
Schoolchildren |
Regional (Aswan) |
Questionnaire |
Ministry of Health, health insurance organization |
|
|
|||||||
Survey name |
Year |
Sample size |
Age range |
Representation |
Method of analysis |
Institution |
Source |
Intra-household food distribution among Egyptian families |
2000 |
720 |
2-6 years |
Subnational: Cairo, Kalyobia and Beheira |
Dietary1 |
NNI |
Shaheen and Tawfik, 2000 |
|
|
885 |
6-12 years |
|
Anthropometry2 |
|
|
|
|
532 M |
12-19 years |
|
|
|
|
|
|
554 F |
|
|
|
|
|
|
|
1 270 M |
20-65 years |
|
|
|
|
|
|
1 470 F |
20-48 years |
|
|
|
|
Food consumption pattern and nutrition intake among different population groups |
2000 |
9 134 M/F |
< 24 years |
National (six governorates representing urban and rural areas: Cairo, Alexandria, Sharkia, Beheria, Fayoum, Sohag) |
Anthropometric measurement2 |
NNI |
Hassanyn, 2000 |
|
|
384 M/F |
2-6 years |
|
Dietary assessment1 |
|
|
|
|
1 151 M/F |
6-10 years |
|
|
|
|
|
|
942 M/F |
10-18 years |
|
|
|
|
|
|
3 047 M/F |
³ 18 years |
|
|
|
|
|
|
4 562 M/F |
|
|
|
|
|
EDHS |
2000 |
15 573 M/F |
0-5 years |
National (26 governorates) |
Anthropometry2 |
National Population Council |
EDHS, 2000 |
|
|
|
5-10 years |
|
Laboratory3 |
|
|
|
|
|
10-20 years |
|
- haemoglobin |
|
|
|
|
|
20-65 years |
|
|
|
|
|
|
|
³ 65 years |
|
|
|
|
|
|||||||
Survey name |
Year |
Sample size |
Age range |
Representation |
Method of analysis |
Institution |
Source |
Iron supplement distribution system: A trial for primary schoolchildren |
2000 |
1 950 girls |
11-14 years |
Regional (Giza) |
Laboratory3 |
NNI/MOHP |
Shaheen et al., 2000 |
|
|
1 250 boys |
|
|
-haemoglobin |
|
|
|
|
|
|
|
Focus group discussions |
|
|
School-based delivery system for iron supplement programme in Egyptian primary schools |
2000 |
7 256 |
Schoolchildren (11-14 years) |
Regional (Sharkia, Kafr El sheikh) |
Focus group |
NNI/MOHP |
Shaheen et al., 2000 |
|
|
|
|
|
Laboratory3 |
|
|
|
|
|
|
|
- haemoglobin |
|
|
Health and nutritional status of the elderly |
2001 |
4 876 |
³ 65 years |
National (six governorates representing urban and rural areas: Cairo, Alexandria, Port Said, Garbia, Fayoum, Aswan) |
Anthropometry2 |
NNI |
Hassan et al., 2001 |
|
|
|
|
|
Dietary1 |
|
|
|
|
|
|
|
Laboratory3 |
|
|
|
|
|
|
|
- haemoglobin |
|
|
|
|
|
|
|
- fasting blood sugar |
|
|
|
|
|
|
|
- serum retinol |
|
|
|
|
|
|
|
- total cholesterol |
|
|
|
|
|
|
|
- liver enzymes |
|
|
|
|
|
|
|
- renal function |
|
|
|
|
|
|
|
Tests |
|
|
|
|
|
|
|
- plasma oestrogen |
|
|
|
|
|
|
|
- urinary calcium |
|
|
|
|||||||
Survey name |
Year |
Sample size |
Age range |
Representation |
Method of analysis |
Institution |
Source |
Survey to assess current status of anaemia and vitamin A deficiency |
2002 |
3 000 |
F adults |
National (Alexandria, Beheria, Garbia, Assuit) |
Anthropometry2 |
High Institute of Public Health/MOHP/Health Care Department/UNICEF |
El Sayed et al., 2002 |
|
|
3 000 |
2-6 years |
|
Laboratory3 |
|
|
|
|
|
|
|
- haemoglobin |
|
|
|
|
|
|
|
- plasma retinol |
|
|
EDHS |
2003 |
5 761 |
< 5 years |
National (26 governorates) |
Anthropometry2 |
National Population Council |
EDHS, 2003 |
|
|
3 014 M |
15-49 years |
|
Laboratory3 |
|
|
|
|
2 748 F |
|
|
- haemoglobin |
|
|
|
|
8 078 F |
|
|
|
|
|
Social marketing campaign for iodized salt |
2003/2004 |
1 208 |
Market |
Regional (Quena) |
Focus group discussion |
NNI |
Hassan, Abdel Galil and Moussa, 2004 |
|
|
3 114 |
Household |
|
|
|
|
|
|||||||
Survey name |
Year |
Sample size |
Age range |
Representation |
Method of analysis |
Institution |
Source |
Prevalence of obesity in Egypt |
2004 |
31 798 |
Individual |
National (eight governorates representing urban and rural areas: Cairo, Gharbia, Quena, Beniswef, Marsa Matrouh, El wadi El Gadid, Beheria, Swey) |
Anthropometric measurement2 |
NNI |
Shaheen, Hathout and Tawfik, 2004 |
|
|
4 154 |
2-6 years |
|
|
|
|
|
|
2 433 |
6-12 years |
|
|
|
|
|
|
6 190 |
12-19 years |
|
|
|
|
|
|
19 021 |
³ 20 years |
|
|
|
|
Determination of bone mass density among adolescents and adults in Egypt |
2004 |
2 520 |
Households 20-60 years |
National (Cairo, Red Sea, Sohag, Sharkia) |
Dietary1 |
NNI |
Hassan, Abdel Galil and Moussa, 2004 |
|
|
2 446 |
F adults 20-60 years |
|
Anthropometry2 |
|
|
|
|
2 028 |
M adults 20-60 years |
|
- BMD (DXA densitometry) |
|
|
|
|
2 039 |
M adolescents 10-19 years |
|
Laboratory3 |
|
|
|
|
2 021 |
F adolescents 10-19 years |
|
- haemoglobin |
|
|
|
|
|
|
|
- calcium |
|
|
|
|
|
|
|
- phosphorus |
|
|
|
|
|
|
|
- alkaline phosphates |
|
|
|
|
|
|
|
- osteocalcin |
|
|
|
|
|
|
|
- oestrogen |
|
|
|
|
|
|
|
- testosterone |
|
|
|
|
|
|
|
- cholesterol |
|
|
|
|
|
|
|
- retinol |
|
|
|
|
|
|
|
- vitamin D |
|
|
|
|
|
|
|
- zinc/selenium |
|
|
|
|
|
|
|
- TSH |
|
|
1 Method used for dietary analysis was 24-hour recall, comparing the raw composition of the diet in the analysis with the NNI food composition tables.
2 Anthropometry analysis was according to age: for two to 12 years - weight, height z-score (weight-for-age, weight-for-height, height-for-age); for 12 to 19 years - BMI for age, height for age; = 20 years - BMI.
3 The laboratory method used was selected according to the objectives of the study.
ANNEX 2: DIETARY ASSESSMENT
The methods used to measure the food consumption of the families surveyed can be classified into two major categories: dietary pattern methods, for example, those that use food frequency questionnaires; and quantitative daily consumption methods, which are based on recall or records of the quantities of foods and beverages consumed over a one-day period - the 24-hour recall method.
Dietary pattern: food frequency questionnaire
This method obtained qualitative descriptive information about the usual frequency of food and beverage consumption for the whole family per day or per week; food items were categorized according to whether they were consumed - for example - fewer than three times a week, or at least three times a week.
The food groups included in this questionnaire were:
sugar.
24-hour recall method
In this method, every surveyed person was asked to recall his or her exact food and beverage intake for the previous 24-hour period. Quantities of foods and beverages consumed were estimated in household measures and grams.
The information obtained covered all eating events, in sequence, beginning with the first of the day; each event was classified as major or minor and all the food items consumed were recorded.
Each food and beverage consumed was described in detail, including cooking methods and the amounts of each ingredient used. Household measures were converted into grams by referring to a list of weights of commonly used household measures in Egypt, which was developed by NNI. NNIs food composition tables were used to determine the energy and nutrient intakes of each individual.
Adequacy of the diet consumed was assessed by comparing the energy and nutrient intakes of each person with his or her RDAs (FAO/WHO/UNU, 1985; WHO, 1989).
A food coding system was used, in which the first two digits denoted the food group, the second two digits denoted the food item, and the third two digits denoted the preparation method.
Weights of foods and beverages were converted into energy and nutrient intakes by a computer program developed from an energy and nutrient database.
Analysis was based on:
energy and nutrients as percentages of RDAs (< 50 percent, 50 to 75 percent, 75 to 100 percent, and ³ 100 percent);
iron bioavailability was assessed according to the daily quantity of haem iron sources consumed - meat, poultry and fish - in grams, or of ascorbic acid in milligrams:
- low bioavailability: < 30 g of haem iron sources, or < 25 mg of ascorbic acid;
- intermediate bioavailability: 30 to 90 g of haem iron sources, or 25 to 75 mg of ascorbic acid;
- high bioavailability: ³ 90 g of haem iron sources, or > 75 mg of ascorbic acid;
the vitamin A content of the diet was based on the retinol activity equivalent, which is equivalent to 1 µg of all trans retinol, to 6 µg of all trans betacarotene, and to 12 µg of other provitamin A carotenes.
ANNEX 3: DIET-RELATED CHRONIC DISEASES, DATA SETS
Survey name and source |
Year |
Sample size |
Age range |
Representation |
Method of analysis used |
Health Profile of Egypt-Health Examination Survey (HPE-HES) Said, 1987 |
1987 |
14 151 |
> 6 years |
National |
Measurement of blood pressure |
|
|
48.0% F |
|
33.7% urban areas |
Questionnaire, self-reported treatment with antihypertensive medication |
|
|
52.0% M |
|
66.3% rural areas |
|
National Hypertension Project (NHP) Ibrahim et al., 1995 |
1991 |
6 733 |
25-95 years |
National (six governorates: Cairo, Bani Sweif, Aswan, Sharkia, Port Said, El Wadi El Gedid) |
Measurements of blood pressure (average of four) |
|
|
|
|
|
Hypertension defined as average systolic blood pressure ³ 140 mmHg, and/or diastolic ³ 90 mmHg, and/or self-reported treatment with antihypertensive medication |
Prevalence of Hypertension in Adolescents Abdel Fattah, Abd-Alla and Al-Saeid, 2000 |
2000 |
5 133 |
14-20 years |
Regional (Qalyubia governorate) |
Measurements of blood pressure (average of three) |
|
|
2 660 M |
|
|
Blood pressure classified according to Fifth Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNCV) (1993) for the young age group, as a percentile correlated with height |
|
|
2 473 F |
|
|
|
|
|
Most primary and secondary schools |
|
|
|
Diet, Nutrition and Prevention of Chronic Non-Communicable Diseases Ismail, 2005 |
2003/2004 |
6 000 |
12-18 years |
National, urban and rural areas (seven governorates: Giza, Kalyubia, Kafr al Shekh, Al Sharkia, Aswan, Suhag, Al Menia) |
Full medical history |
|
|
|
|
|
Dietary history |
|
|
|
|
|
Anthropometric measurement (weight and height) for BMI |
|
|
|
|
|
Blood pressure measurement |
|
|
|
|
|
Blood pressure classified according to Fifth Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNCV) (1993) for the young age group, as a percentile correlated with height |
|
|
|
|
|
Blood sugar: fasting and post-prandial |
|
|
|
|
|
Serum lipids: cholesterol, LDL-ch, HDL-ch and triglycerides |
|
|||||
Survey name and source |
Year |
Sample size |
Age range |
Representation |
Method of analysis used |
Diabetes Mellitus in Egypt |
1991-1994 |
4 620 |
³ 20 years |
Regional (Cairo, Giza, Kaliubia) |
Height, weight, WHR |
Hermann et al., 1995 |
|
|
|
|
Random capillary glucose |
|
|
|
|
|
For individuals at risk: |
|
|
|
|
|
- fasting blood glucose |
|
|
|
|
|
- glucose 2 hours after 75 g glucose load |
|
|
|
|
|
- diabetes and impaired glucose tolerance (IGT) classified according to WHO (1993) criteria |
Focusing on the Health Requirements and Style of Living to Improve the Health of Elderly People in Different Cultural Sectors in Egypt |
2001 |
4 876 |
³ 65 yrs |
National, rural and urban areas (six governorates: Cairo, Alexandria, Port- Said, El Garbia, El Fayoum, Aswan) |
Full medical history |
Hassan et al., 2001 |
|
|
|
|
BMD measured by DXA densitometer acting peripherally on calcaneous site |
|
|
|
|
|
Assessment of BMD status based on WHO (1994) diagnostic categories |
|
|
|
|
|
Anthropometric measurements (weight and height) for BMI |
|
|
|
|
|
Dietary history (24-hour recall) |
|
|
|
|
|
Laboratory measurement: liver function, kidney function and heartbeat |
National Survey for the Determination of Bone Mass Density (BMD) among Adolescents and Adults in Egypt. |
2004 |
2 520 families |
10-19 years |
National, rural and urban (six governorates: Cairo, Sohag, Red Sea, Sharkia, Dhakahlia, Beheira) |
Full medical history |
Hassan, Abdel Galil and Moussa, 2004 |
|
|
20-60 years |
|
BMD measured by DXA densitometer acting peripherally on calcaneous site |
|
|
|
|
|
Anthropometric measurements (weight and height) for BMI |
|
|
|
|
|
Dietary history (24-hour recall) |
|
|
|
|
|
Laboratory measurement of haemoglobin, calcium, phosphorus, alkaline phosphates, osteocalcin, oestrogen, testosterone, cholesterol, retinol, vitamin D, zinc, TSH, and selenium |
|
|
|
|
|
Assessment of BMD status based on WHO (1994) diagnostic categories |