title: Association between dietary pattern and risk of cardiovascular disease among adults in the Middle East and North Africa region: a systematic review.
abstract: OBJECTIVE
  This paper reviews the evidence related to the association of dietary pattern with coronary heart disease (CHD), strokes, and the associated risk factors among adults in the Middle East and North Africa (MENA) region.
  
  
  METHODS
  A systematic review of published articles between January 1990 and March 2015 was conducted using Pro-Quest Public Health, MEDLINE, and Google Scholar. The term 'dietary pattern' refers to data derived from dietary pattern analyses and individual food component analyses.
  
  
  RESULTS
  The search identified 15 studies. The available data in the MENA region showed that Western dietary pattern has been predominant among adults with fewer adherences to the traditional diet, such as the Mediterranean diet. The Western dietary pattern was found to be associated with an increased risk of dyslipidaemia, diabetes, metabolic syndrome (MetS), body mass index (BMI), and hypertension. The Mediterranean diet, labelled in two studies as 'the traditional Lebanese diet', was negatively associated with BMI, waist circumference (WC), and the risk of diabetes, while one study found no association between the Mediterranean diet and MetS. Two randomised controlled trials conducted in Iran demonstrated the effect of the dietary approach to stop hypertension (DASH) in reducing metabolic risk among patients with diabetes and MetS. Likewise, the consumption of dairy products was associated with decreased blood pressure and WC, while the intake of whole grains was associated with reduced WC. In addition, the high consumption of black tea was found to be associated with decreased serum lipids. The intake of fish, vegetable oils, and tea had a protective effect on CHD, whereas the intake of full-fat yoghurt and hydrogenated fats was associated with an increased risk of CHD.
  
  
  CONCLUSIONS
  There appears to be a significant association of Western dietary pattern with the increased risk of CHD, strokes, and associated risk factors among adults in the MENA region. Conversely, increased adherence to Mediterranean and/or DASH dietary patterns or their individual food components is associated with a decreased risk of CHD and the associated risk factors. Therefore, increasing awareness of the high burden of CHD and the associated risk factors is crucial, as well as the need for nutrition education programs to improve the knowledge among the MENA population regarding healthy diets and diet-related diseases.
authors.affiliation: Public Health, School of Medicine, Griffith University, Southport, Australia.|Menzies Health Institute Queensland, Griffith University, Southport, Australia; najlaa.aljefree@griffithuni.edu.au.
authors.forename: Najlaa
authors.initials: N
authors.lastname: Aljefree
authors.affiliation: Public Health, School of Medicine, Griffith University, Southport, Australia.|Menzies Health Institute Queensland, Griffith University, Southport, Australia.
authors.forename: Faruk
authors.initials: F
authors.lastname: Ahmed
keywords: North Africa; coronary heart disease; diabetes; dietary patterns; food items; hypertension; metabolic syndrome; obesity; stroke; the Middle East