Bread type intake is associated with lifestyle and diet quality transition among Bedouin Arab adults

Abstract

The traditionally semi-nomadic Bedouin Arabs in Israel are undergoing urbanisation with concurrent lifestyle changes, including a shift to using unfortified white-flour bread instead of wholewheat bread as the main dietary staple. We explored associations between the transition from wholewheat to white-flour bread and (1) lifestyle factors, (2) overall diet quality, and (3) health status. We conducted a nutrition survey among 451 Bedouin adults, using a modified 24 h recall questionnaire. Bread intake accounted for 32·7 % of the total energy intake. Those consuming predominantly white bread (PWB) (n 327) were more likely to be urban (OR 2·79; 95 % CI 1·70, 4·58), eating store-bought rather than homemade bread (OR 8·18; 95 % CI 4·34, 15·41) and currently dieting (OR 4·67; 95 % CI 1·28, 17·11) than those consuming predominantly wholewheat bread (PWWB) (n 124). PWB consumption was associated with a lower intake of dietary fibre (23·3 (se 0·6) v. 41·8 (se 1·0) g/d; P ≤ 0·001), a higher intake of saturated fats (26·9 v. 24·6 % of total fat; P = 0·013) and lower intakes of Fe (11·0 (se 0·3) v. 16·7 (se 0·4) mg/d), Mg (262·2 (se 5·9) v. 490·3 (se 9·8) mg/d), vitamin E (6·5 (se 0·2) v. 8·6 (se 0·3) mg/d) and most B vitamins than PWWB consumption (P < 0·001 for all), after adjusting for total energy intake. Among those aged ≥ 40 years, PWB consumption was associated with a 9·85-fold risk (95 % CI 2·64, 36·71; P = 0·001) of having one or more chronic conditions, as compared with PWWB consumption, after controlling for other risk factors. White bread intake was associated with a less traditional lifestyle and poorer diet quality, and may constitute a useful marker for at-risk subgroups to target for nutritional interventions.