Arabic

Food &CultureLydia Dysart & Alyssa Fritz

Henry Ford Hospital

Dietetic Interns 2015-2016

The Arab World 21 Arab States identified by UNESCO:

Algeria, Bahrain, Comoros, Djibouti,

Egypt, Iraq, Jordan, Kuwait, Lebanon,

Libya, Malta, Mauritania, Morocco, Oman,

Qatar, Saudi Arabia, Somalia, Sudan,

Syria, Tunisia, United Arab Emirates,

Western Sahara, Yemen,

Facts About the Arab World “Arab” – referring to anyone who speaks Arabic as their first language

Over 300 million worldwide

Muslims, Christians, and Jewish Arabs

“Arab Americans” – Americans of Arab descent Lebanon, Syria, Palestine

Arrived in the late 19th century

Largest community is in the Detroit-Dearborn area:

300,000-350,000 in the Greater-Detroit area

1/3 of the city of Dearborn

Islam

Monotheistic Middle East religion

beginning the 7th century

Five Pillars

Faith, Prayer, Charity, Fasting, Hajj

1.5 Billion followers worldwide

Islamic Holidays

Al-Hijra

Islamic New Year

Ramadan

The month of fasting - fast from sunup to

sundown

Eid-ul-Fitr: Festival of Breaking the Fast

End of Ramadan – celebratory meal

Eid-ul-Adha: Festival of the Sacrifice

Ramadan

Chabbakia-Fried dough, sesame seeds,

honey

Mujadarra- lentils and rice,

yogurt

Konafah- pastry made with phyllo dough and

cheese

Paomo- bread and mutton soup Khyar Bi Laban- cucumber yogurt

saladQatayef- Arabic pancake filled

with sweet cheese and nuts

Eid-ul-Adha: Festival of the Sacrifice

Asian Muslims celebrate with

sheer korma, a sweet dish

made with milk, vermicelli and

biryani.

In Bosnia and Herzegovina

stuffed vegetables called

dolma is served.

Uighur Muslims prepare

traditional Xinjian Noodles

Ramadan – Implications for Diabetes Fasting - one meal at sunrise, one meal at sunset

Quran exempts certain groups from fasting for health reasons

Risks

Hypoglycemia – highest risk in those taking insulin or certain medications

Hyperglycemia – highest risk after overeating at night

Dehydration

Tips

Monitor blood glucose levels throughout the day – end the fast if <70mg/dl

Continue taking medications – dose/times may need to be adjusted by doctor

Dawn meal – whole grains + protein + fat

Dusk meal – limit dates to 1-2 per evening, drink lots of water, be cautious of

overeating

T2DM in Arabic-Speaking Countries Dramatic increase in prevalence past 30

years

Wealth

Urbanization

Decreased physical activity

Changes in nutrition

280,000 diabetes-related deaths per

year

Risk Factors Obesity

78.5% of people with diabetes are overweight

45.7% are obese

Modernization

Urbanization

25.5% have diabetes in urban areas vs. 19.5% in rural areas

Highest rates in wealthiest countries

Education

Marriage

Physical Inactivity

Risk Factors Food Consumption:

Dates, milk, fresh fruits and vegetables,

whole wheat bread, fish high saturated

fat, refined carbohydrates, low dietary

fiber

1990-2007: Average energy

consumption per person is 2780kcal/day

Prevalence Among Arab Americans in Dearborn, Michigan

Sample size: 542 subjects in Dearborn, randomly selected

95% immigrants, in US for 11 years (mean length)

Mean age: 38 years

Glucose tolerance assessed with two hour 75 g oral glucose tolerance test

Higher in men than women

Abnormal Glucose Tolerance:

Affects 41% of the population 20-75 years of age; >70% those >60 years of age

Higher rates than white, African American, Hispanic populations in US

High prevalence of diabetes and impaired glucose intolerance + low detection rates = prevalence expected to increase

Need for increased public awareness and regular surveillance for diabetes, need to develop culturally sensitive community-based interventions aimed at prevention and management

Diabetes in Arabic Population Responsibility

Fatalism- belief that events are controlled/predetermined by fatalism.

Social Acceptance

Status and social acceptance are highly valued in Arabic population-

Illnesses like diabetes could evoke feelings of shame

Single men and women may avoid care

Role of the RD

Motivational interviewing- find culturally appropriate ways to help the patient take their medication, carbohydrate count, or choose different foods

Educate patient– diabetes is unrelated to infertility or impotence.

Diabetes in Arabic Population Desirable Body Type

Overweight is associated with “health”– strength, prosperity, wealth prestige

Westernization changing idealistic body image but mainly in youth, not in adult

population with diabetes

Hospitality and Generosity

Maintain good social status.

Food rituals—host offers unrestricted food (in quantity and variety) and it is

customary to convince guests to eating much more than they are capable of.

The Role of the RD Understanding the cultural context of the disease

Values: conformity, associated with social honor

Patient with diabetes with this background may not be skilled in self management

Patient may perceive RD or CDE to be authority figures

Cause fear of admitting problems or asking questions– feelings that they are unqualified to participate

Providing quality care

Demonstrate a peer-type relationship with patient

Involve the patient in their care– what are their perceived barriers, what are foods that they enjoy eating, what is their plan of action?