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By Zahra Sajad-Mohamed, RD, Reviewed by Harriet Smith, RD
The UK is becoming more ethnically diverse1; it is crucial that dietitians provide nutrition support information which reflects this diversity. According to the 2011 census, over 230,500 people in the UK identified themselves as Arabs. However, this figure is likely to underestimate the actual Middle Eastern (ME) population in the UK1. This is because some ME people identify themselves as ‘African’, ‘White Other’ or ‘Other’. The different countries that make up the Middle East include Egypt, Syria, Jordan, Algeria, Bahrain, Kuwait, Lebanon, Libya, Iran, Iraq and the United Arab Emirates2.
There is no data on the prevalence of malnutrition in the UK’s ME population. However, 5.4% are aged 60 years and above3. This figure is likely to be higher as the UK’s ageing population is increasing4. In the literature, it is well documented that the risk of malnutrition increases with age4. Therefore tailoring nutrition support information to meet the cultural needs of this ethnic group is essential. It will help to build rapport, increase patient compliance and in turn, help reduce the prevalence of malnutrition in ethnic minority groups.
Due to dietary acculturation, the traditional ME diet has become more Westernised. This is particularly true amongst the younger generations. However, within the elderly generation, the ME diet has more or less remained the same5.
Generally speaking, a main meal consists of tagines and marags which include red meat (lamb and mutton are favoured meats), fish or poultry along with vegetables and/or legumes. Chickpeas, split peas, fava beans and lentils are common legumes in the ME. This is usually served with a staple and some salad. Rice, bread (i.e. pitta bread) and grains including burgher, freekeh and couscous are everyday staples in the ME diet. Traditional dishes such as falafel (chickpeas fried balls), dolma (stuffed grape leaves) and kibbeh (stuffed patties), kebabs and shawarma are also culturally distinctive dishes in the ME diet.
There is moderate dairy consumption in the form of white cheese (halloumi/akawi) and yoghurt. Labneh, which is strained yoghurt, is commonly consumed for breakfast and supper. Milk is used in hot drinks, haresa (porridge) or desserts such as mahalabia.
Olive oil is one of the most common types of fats used. It is used in salads such as tabbouleh (fresh herbs and bulgur) and fattoush (fried bread green salad), in tahini (sesame seed sauce) and many different dips including hummus and baba ghanoush (aubergine dip). Clarified butter (ghee) is mostly used for frying or pouring over rice dishes for scent and flavour.
With the rise in non-communicable diseases such as type 2 diabetes, hypertension and heart disease in the ME and the UK, people are becoming more health-conscious when making dietary choices5. This may present as a challenge when giving nutrition support information, as it may go against the typical healthy dietary recommendations.
Additionally, in an attempt to cure disease, some people may seek alternative medicine and herbal remedies or others may submit to what is seen as God’s will. These could become potential barriers for people seeking medical and nutritional support. The predominant religion amongst the ME population is Islam. There are religious obligations such as fasting from dawn until dusk every day during the month of Ramadan. Also, Muslims can only eat ‘halal meat’, while pork consumption is prohibited.
The most common language spoken is Arabic. Other languages include Persian or Farsi and Turkish. Patients with limited proficiency in English may not be able to communicate effectively or understand what is being advised by their healthcare professional. This can make the delivery of high-quality healthcare challenging, and a translator may be required6.
The following are commonly eaten with bread:
Where possible, encourage patients and carers to prepare and plan ahead. They may wish to use slow/pressure cookers and cook extra portions of marag and tagines which can be frozen. Traditional and ready-made foods can be shop bought from ME supermarkets, and many big brand supermarkets now stock a wide selection of ME products.