Diet and Nutrition: A Knowledge, Attitude and Practice Study of Pregnant Women in Karachi

EDITORIAL COMMENT: We accepted this paper for publication since surely we all believe that diet and nutrition are important in pregnancy; also the facts of (nutritional) life in other lands, especially those containing large percentages of the world's total population, should interest all readers. Public health efforts in Australia, where 1 in every 5 is overseas‐born, should provide for nutrition and health education for new and aged immigrants of non‐European cultural backgrounds (A). This may be particularly relevant when a condition such as gestational diabetes is considered since the prevalence is greatest in women born in Asian and Mediterranean countries (B) and in the Indian subcontinent. How does immigration affect diet and nutrition, and lifestyle in general? With increasing affluence financially do immigrants eat more? Do their body mass indices move upwards as a group? If they eat more, is the traditional food distribution maintained or is there a change in the variety of the diet? The fast food outlets began and invaded the western world after World War 2, and now have a huge impact on dietary customs in most affluent populations. In so far as a tourist can judge, they also have an impact on the inhabitants of large cities in the so‐called undeveloped and developing nations. ‘Fast food’ that satisfies the customer's tastes is generally high in fats and refined carbohydrates —the reverse to that which is recommended for pregnant women. There is an epidemic of diabetes mellitus worldwide, in Australia and all other countries with statistics available, including Africa and India (C, D). In rural India and rural Bangladesh, the prevalence of noninsulin dependent diabetes mellitus is about 4 times lower than in the urban areas (D). This is often assumed to be due to changes in nutrition. However, the diabetes educator who reviewed this manuscript and editorial comment, stressed that the most notable change in immigrants is that as affluence increases exercise/physical activity decreases. The harmful change is in lifestyle, of which nutrition is but one component. The foods that are tasty are often bad for us and ‘takeaway’ items often contain potential harmful preservatives such as salt and sugar. Perhaps we overemphasize the importance of diet and underestimate that of regular physical activity. The increasing tendency towards spectator sport seems to be directly proportional to the intense media coverage that national and international sporting events enjoy, especially in the large towns and cities of both the developed and developing nations. Prentice and Jebb have reviewed the prevalence of clinical obesity in England and concluded that modern inactive lifestyles are at least as important as diet in the aetiology of obesity and possibly represent the dominant factor (E). We need more data about lifestyle changes in immigrants. Hsu‐Hage and colleagues (A) have tackled this problem with vigour and stated ‘Food intake patterns of adult Melbourne Chinese have undergone changes towards Australian eating habits, notably among those who have been in Australia for extended periods, and those who are highly educated or of high socioeconomic status. The aged and less educated, while tending to keep to traditional Chinese eating patterns, consumed a limited variety of foods for their energy source’ (A).