164 The North African Journal of Food and Nutrition Research: (2019)03;(05):164-71 https://doi.org/10.5281/zenodo.3344609 Original Article OPEN 9 ACCESS NAI PM? THE NORTH AFRICAN JOURNAL OF FOOD AND NUTRITION RESEARCH Contents lists available at Journal homepage: https://www.najfnr.org elSSN: 2588-1582 Association of Socioeconomic Status, Dietary Behavior, and Obesity among Moroccan Adults of the Region of Rabat: A Case-Control Study Habiba Baiit 1 *, Hasnae Benkirane 2 , Amina Bouziani 1 , Fatima Zahra Mouzouni 3 , Souad Benaich 4 Elarbi Bouati 5 , Hakim Belghiti 6 , Mustapha Mrabet 7 , Amina Barkat 8 , and Hassan Aguenaou 2 1 Joint Research Unit in Nutrition and Food. Ibn Tofai'l University. National Center of Energy Sciences and Nuclear Techniques. Rabat. Kenitra.10110.14000. Morocco. 2 Joint Research Unit in Nutrition and Food. Ibn Tofai'l University. National Center of Energy Sciences and Nuclear Techniques. Regional Designated Center of Nutrition (AFRA.IAEA). Rabat. Kenitra. 14000. Morocco. 3 Epidemiology Direction and Disease Control (DELM). Ministry of Health. 71 Ibn Sina Avenue. Rabat. Morocco. 4 Laboratory of Animal Physiology, Faculty of Sciences, MOHAMMED V UNIVERSITY IN RABAT. 4, Avenue Ibn Battouta BP 1014, Rabat- Morocco 5 Laboratory of Epidemiology and Clinical Research. Faculty of Medicine. Mohammed 5th University. 10100. Rabat. Morocco. 6 Nutrition Unit Hygiene and Collectivity Medicine Ward. Military Hospital of Instruction Mohammed 5th. Rabat. 10110. Morocco. 7 Faculty of Medicine Abulcasis (FMA). Abulcasis International University of Health Sciences (AIUSS). 10100. Rabat. Morocco. 8 Health and Nutrition Research Team of the Mother-Child Couple. Faculty of Medicine. Mohammed 5th University. 10100. Rabat. Morocco. ARTICLE INFO ABSTRACT Article history: Received 03 May 2019 Accepted 16 July 2019 Available online 24 July 2019 * Corresponding author info: Habiba BAJIT Tel: +212675765992 habiba.baiit@gmail.com Article edited by: Pr. Roky R. Dr. Tbahriti H.F. Background: The incidence of worldwide obesity is on the increase. Obesity is defined as an excessive accumulation of fat in the body. 39% of adults, aged 18 years and over, were overweight in 2016 and 13% were obese. Aims: To examine the association of dietary patterns, socioeconomic status, and the body mass index in Moroccan adults. Methods and Material: This is an analytical case-control study, conducted among obese (n=100) and non-obese (n=150) subjects, aged between 18 and 59 years old, when women represented 60% of participants. At recruitment, all anthropometric parameters were measured. The body composition was assessed by the use of impedance meter. Dietary habits were assessed using 24 hours' food recall and food frequency questionnaire. The results were analyzed using the Kolmogorov-Smirnov (K-S) and the chi-squared (x 2 -test) test and the percent distribution. Results: Our results showed that abdominal obesity and overall body fat (BF) percent were much prevalent among the obese group (BF% >30). There was a significant association between the lack of physical activity (p=0.002), educational level (p=0.001) and the risk of development of obesity. Concerning the age (p=0.06) and the gender (p>0.05) of the participants, there was no difference regarding these parameters and the risk of development of obesity (p>0.05). A strong relationship between marriage and the development of obesity was found, when 83.90% of the obese group were married, whereas 73.70% of the non-obese group were single (p<0.001). Concerning dietary assessment, our data revealed that the energy consumption of lipids slightly exceeds the recommended target. The major consumed foodstuffs by the obese group were oils and fats. Conclusions: The adult participants of the region of Rabat have an unbalanced body weight status resulting from an altered dietary behavior and from an altered socioeconomic profile that can lead to various health complications. Further studies are required on a large population aiming to develop effective strategies to fight the rapid increase of obesity. Keywords: Obesity, body mass index, dietary behavior, socioeconomic status. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2019 The Authors. The North African Journal of Food and Nutrition Research. Nor. Afr. J. Food Nutr. Res. January-June 2019 Volume 03 Issue 05 Bajit ef a/.: Epidemic of obesity in Morocco 165 1. INTRODUCTION Over the last years, the worldwide population has known a new leap concerning its eating habits, frequently assigned as "nutrition transition". This transition is characterized by a higher caloric diet, a less consumption of complex carbohydrates, and a reduced intake of fibers, fruits and vegetables [1]. Several studies (clinical, epidemiological, etc.) have highlighted the role of nutritional factors (integrating food) in the determinism of the main chronic diseases which had a significant human, social and economic cost among a society. Obesity is one of these diseases in which nutritional factors are involved [2]. Furthermore, the lack of physical activity leading to a decrease of energy expenditure, when combined with high caloric intake, can promote the development of obesity and a state of chronic inflammation [3]. The concern of obesity has become a public health issue affecting quality of life. It is well known that obesity is a major risk factor for numerous diseases and a variety of metabolic and medical complications [4,5], such as; cardiovascular disorders, type 2 diabetes, and some cancers, which in turn contribute to the mortality and morbidity [6,7] . According to the World Health Organization (WHO), since 1980, the worldwide prevalence of obesity has more than doubled (more than 70% of the adult population was obese or overweight), with significant increases in every region [8]. 39% of adults aged 18 years and over were overweight in 2016 and 13% were obese [9]. In Morocco, the obesity phenomenon has also propagated; referring to the results of the national survey on anthropometry, carried out by the High Commission for Planning in 2011, the incidence of obesity is affecting 3.6 million Moroccan adults, representing 17.9% of the population (21.2% in urban areas, 12.6% in rural areas). This is the case of 26.8% of women against 8.2% of men [10]. Another recent study (2016) conducted on 10.524 Moroccan adult participants has revealed that 23.2% was the prevalence of obesity in that population [11]. Considering the rapid rise of overweight and obesity among the population, an increasing number of studies have highlighted the role of dietary components in the development of obesity [12]; also excessive consumption of fat is well known to be considered in this etiology [13, 141 . Besides sedentary behavior, socioeconomic factors play a role in the development of obesity too, especially in women which affect their eating behavior and then their body status [15,161 . Giving the background information mentioned above we aim, in the current study, to examine the relationship between dietary patterns, socioeconomic status, and the body mass index (BMI) in Moroccan obese and non-obese adults. To date, the non-such association has been fully investigated. 2. SUBJECTS AND METHODS 2.1. Study Design 2.1.1. Type and period of study This is an analytical case-control study, carried out over a period of one year, between 2015 and 2016. The survey was designed to examine the association of dietary patterns, socioeconomic status and the BMI in Moroccan obese and non-obese adults. 2.1.2. Place of study The study took place at the level of Nutrition Unit, Hygiene and Collectivity Medicine Ward of the Military Hospital of Instruction Mohammed 5 th (M.H.I.M.5, Rabat-Morocco). 2.1.3. Subjects Inclusion criteria: Participants (male and female, adults: age between 18 and 59 years old) were recruited from the group of patients visiting the Nutrition Unit for a general health check-up, during the consultation days, or women represented 60% of the participants. A total of 250 consenting participants, recruited for the present study, were divided into two groups according to their BMI: obese (BMI>30 kg/m 2 ) and non-obese (18.5 kg/m 2 0.05) as shown in Table 1. The socioeconomic status of the participants is reported in Table 2. A significant relationship between the major variables and the BMI of the participants was found. In fact, a significant correlation was observed between educational level and the BMI among the studied group (p=0.001). Further significant association was found regarding marital status, when 83.90% of the obese group were married, whereas 73.70% of the non-obese group were single (p=0.000). Finally, no difference was noticed concerning household size (p=0.2), coefficient food budget (p=0.232) and the risk of obesity. No difference was observed between genders (Table 2). Table 1: Anthropometric parameters of the obese and the non- obese participants Parameters Obese (n=100) Non-Obese (n=150) P-value Age (years) 38.00 [31.00,43.00] 27.50 [23.00,36.00] 0.06 Weight (kg) 93.65±13.48 62.13±11.42 0.00001 FHeight (cm) 161.00 [157.00,164.00] 169.00 [162.00 ,175.00] 0.12 BMI (kg/m 2 ) 34.67 [31.64,38.39] 22.25 [20.69,24.01] 0.01 WC (cm) 108.89±10.75 84.68±8.45 0.02 HC (cm) 120.52±8.68 100.92±5.90 0.04 WHR (A0.89±0.07; M1.04±0.08) (A0.83±0.03; M0.86±0.08) 0.9 BF% 44.30 [40.50,47.40] 27.50 [21.20,29.70] 0.02 Physical activity (%) 0.002 Very Low 70.40 11.1 Low/Medium 22.20 77.8 Medium 7.40 11.1 *Results are presented as means ± standard deviation for normally distributed variables and on median [percentile 25, percentile 75]; p values are for the comparison between obese and non-obese subjects and were determined by using Chi-square test; Abbreviation: BMI: Body Mass Index, WC: waist circumference, HC: hip circumference, WHR: waist-to-hip ratio, F: female, M: male and BF%: body fat percent. Table 2: Socioeconomic characteristics of the studied participants Parameters Obese (n=100) Non Obese (n=150) P-value Educational level (%) 0.001 Illiterate 19.70 00.00 Primary 17.60 5.00 Secondary 39.20 22.50 University 23.50 72.50 Marital status (%) 0.000 Single 14.30 73.70 Married 83.90 23.70 Widowed 1.80 2.60 Estimated food budget coefficient (%) 0.232 <50% of the monthly budget 38.60 40.00 50%-70% 50.00 60.00 >7i% 11.40 00.00 Family size 4.00 [4.00, 6.00] 4.00 [2.00, 6.00] 0.2 Results are presented as proportion; P values are for the comparison between obese and non-obese subjects and were determined by using the Pearson Chi- square test. Table 3: Nutritionals intakes of both obese and non-obese groups according to the 24h dietary recall Obese (n=100) Non-Obese (n=150) p-value Energy intake (kcal) 1850 1697 0.12 Lipids (g) 67.27 58.80 0.27 Proteins (g) 63.26 68.10 1.00 Carbohydrates (g) 213.47 193.00 0.12 Lipids (% of TEI) 33.80 33.00 0.51 Proteins (% of TEI) 14.88 17.00 0.48 Carbohydrates (% of TEI) 48.98 48.20 0.83 Diverse (%) 2.32 1.70 0.82 TEI: Total energy intake. Intakes based on 3-days dietary recall (food sources only). 3.2. Dietary assessment In Table 3, are presented the results of the 24h dietary recall intake, where carbohydrates and lipids were the main macronutrients consumed. No significant difference between the two groups and in both genders (p>0.05) was found. Figures 1 and 2 show the frequency of consumption of foods (in percentage) that are mostly consumed by the Moroccan population. Analysis of the dietary habits of our participants showed that, oils and fats were the major Nor. Afr. J. Food Nutr. Res. January - June 2019 I Volume 03 I Issue 05 Bajit ef a/.: Epidemic of obesity in Morocco 168 consumed products by the obese group, with 18% of total consumed food, whereas cereals and legumes represented 20% in the non-obese group. Fruits and vegetables come in the second place and represented the same percentage (17%) in both groups. Sugars represent 12% in the first group and 10% in the second one. Dry fruits Aromatic herbs Meat, fish, eggs Milk and dairy products Sugars Diverse: tea, coffee Cereals and legumes Fruits and Vegetables Oils and fats Figure 1: Food frequency consumption in the obese group Aromatic herbs Dry fruits Meat, fish, eggs Sugars Milk and dairy products Diverse: tea, coffee Oils and fats Fruits and Vegetables Cereals and legumes Figure 2: Food frequency consumption in the non-obese group 4. DISCUSSION The study was designed to investigate the relationship between socioeconomic status, eating behavior, and the development of obesity in obese (case) and non-obese (control) Moroccan subjects. Our results showed that there was a highly significant difference between the two groups, regarding their anthropometric measurements (p<0.01). In the current study, the prevalence of abdominal obesity was considerable as the prevalence of overall obesity for the obese group who exhibited class II of obesity (BMI>35 kg/m 2 , BF %> 30) [17,251 . The WF1R defined an abdominal obesity (> 0.90 cm for men and > 0.85 cm for women; WHO guidelines), in which the risk of metabolic complications, as well as serious health issues, is substantially increased, because of the fat distribution [ 261 . This last indicator has also been shown to be a greater predictor of cardiovascular diseases [ 271 . A highly significant association was found between the lack of physical activity and the risk of developing obesity. Where 70.40% of obese subjects had a very low level, whereas 7.40 % had a medium level. This, it is compatible with the finding of a previous survey indicating that only 0.8% of Moroccans are practicing sport [28]. Results from another study showed a linear association of physical activity and other health status like obesity, cardiovascular disease, diabetes [29]. Indeed, several studies reported that, the lack of physical activity does not only lead to overall/abdominal obesity, but also is associated with increased indicators of systemic inflammation [30 ,311 . Socioeconomic status is considered to be associated with overweight and obesity risk, that is generally measured by the educational level, income, marital status, etc. Results from the 1996 Health Survey for England revealed the association of a higher risk of obesity and the lower educational/economic level and a lower occupational status [32]. In our study, the educational level plays a significant role in the development of obesity (p=0.001) among Moroccan subjects, when 19.60% of the obese group were illiterate, whereas 72.50% of the non-obese group had a university degree. These results agree with those from a national survey that revealed the predominance of obesity among adults with low levels of education [28] and disagree with a Polish study conducted in southwestern region, in which the educational level did not have a significant role [33]. Another significant association was found concerning marital status, when 83.90% of the obese group were married, whereas 73.70% of the non-obese group were single (p=0.000). Finding from other studies have highlighted the strong association of marriage and the development of obesity [34,351 . Indeed, there was no difference regarding household size, coefficient food budget and the development of obesity (p>0.05). Also, no difference was observed between genders. In the present study, we assessed the eating habits of our participants, through the 24h dietary recall and a food frequency questionnaire. We calculated the frequency of consumption of all food patterns generally consumed by Moroccan population. Our results showed that the carbohydrates and lipids were the main macronutrients consumed and represent respectively, 48.98% and 33.80% of total energy intake in the obese group and 48.20% and 33.00 % of TEI in the non-obese group. Compared to the nutritional guidelines (FAO/WHO), it seems clear that the energy needs of carbohydrates for both groups are not sufficiently covered, while their energy needs of lipids slightly exceed the recommended target [36]. Results from Nor. Afr. J. Food Nutr. Res. January - June 2019 I Volume 03 I Issue 05 Bajit ef a/.: Epidemic of obesity in Morocco 169 two other studies indicate that the fat intakes of a population exceed by 10% the recommendations, and most of individuals do not consume sufficient vegetables/fruits or fibers [37,381 . Moreover, the finding from the frequency questionnaire showed that the major consumed foodstuffs, by the obese group, were oils and fats, contrary to the non- obese group, where the cereals and legumes were the main consumed. These results show the difference observed in the quality of food usually ingested. In general, when comparing the nutritional intake of both groups, we did not observe any significant difference, even between genders (p>0.05). Our survey provides baseline data on the dietary intake of the target population. It seems prudent to increase the implementation of effective strategies to combat obesity, taking into consideration the requirements of a better understanding of the associated risk factors through the study of physiological and genetic mechanisms in a large population. 5. CONCLUSION To the best of our knowledge, the current study constitutes the first case-control study identifying the relationship between socioeconomic status, dietary behaviors and the high levels of BMI among a group of Moroccan adults that showed an unbalanced weight status resulting from an altered dietary behavior and an altered socioeconomic profile. We do believe that our results will lead to a better understanding of the implication of some factors in the development of obesity in Moroccan population. Further research is required on the effect of obesity on health taking into consideration the socioeconomic impact. List of abbreviations WHO: world health organization, BMI: body mass index, WC: waist circumference, HC: hip circumference, WHR: waist to hip ratio, TEI: total energy intake, FFQ: food frequency questionnaire, SPSS: Statistical Package for the, Social Sciences, SD: standard deviation, BF%: body fat percent, F: female, M: male, FAO: Food and Agriculture Organization, CEBR: Committee of Ethics and Biomedical Research. Ethics approval The present study was approved by the Committee of Ethics and Biomedical Research (CEBR, folder number: 38/15) of the Faculty of Medicine and Pharmacy of Rabat, in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Before undertaking the protocol, all objectives and modalities were clarified to the participants by attending physician. Written and oral consents were therefore willingly obtained. Informed consent Informed consent was obtained from all individual participants included in the study. Acknowledgement The authors wish to thank kindly all the participants in this study for their consent, time and energy. They also thank the staff of the Nutrition Unit, Hygiene and Collectivity Medicine Ward at the Military Hospital of Instruction Mohammed 5th (M.H.I.M.5, Rabat-Morocco) for their assistance and support. 6. REFERENCES 1. Drewnowski A, Popkin BM. The nutrition transition; new trends in the global diet. Nutrition Reviews. 1997; 55(2):31-43. DQL/10.1111/i.1753-4887.1997.tb01593.x 2. Bounaud V, Moreau F, Garnaud AT. ORS - Observatoire Regional de la Sante Poitou-Charentes. Nutrition, maladies chroniques, obesite, activite physique. 2014. Available at URL: http://www.ors- poitou-charentes.org/pdf/bAUDpQSynthNutrition- 2014.pdf 3. Kelly BM, Xenophontos S, King JA and Nimmo MA: An evaluation of low volume high-intensity intermittent training (HIIT) for health risk reduction in overweight and obese men. BMC Obes. 2017;4:17. DOI:/10.1186/s40608-017-0151-7 4. Lafortuna CL, Adorni F, Agosti F, De Col A, Zennaro R, Caranti D, Sartorio A. Factor analysis of metabolic syndrome components in severely obese girls and boys. J. Endocrinol invest. 2009;32(6):552-8. D0l:/10.1007/bf03346506 5. Pergola G De, Silvestris F. Obesity as a major risk factor for cancer. J. Obes. 2013;2013:291546. DOL/10.1155/2013/291546 6. Giskes K, Van Lenthe F, Avendano-Pabon M, Brug J. A systematic review of environmental factors and obesogenic dietary intakes among adults: are we getting closer to understanding obesogenic environments? Obes. Rev. 2011 May;12(5):e95-e106. DOI:/10.1111/i.1467-789X.2010.00769.x 7. Belarmino G, Torrinhas RS, Sala P, Horie LM, Damiani L, Lopes NC, Heymsfield SB, and Waitzberg DL. A new anthropometric index for body fat estimation in patients with severe obesity. BMC Obes. 2018;5:25. DOI:/10.1186/s40608-018-0202-8 8. Chan M. Obesity and diabetes: the slow-motion disaster Keynote address at the 47th meeting of the National Academy of Medicine (WHO). The Miibank Nor. Afr. J. Food Nutr. Res. January - June 2019 I Volume 03 I Issue 05 Bajit ef a/.: Epidemic of obesity in Morocco 170 Quarterly. 2017;95(1):11-4 DOI:/1Q.1111/1468- 0009.12238 9. WHO: Obesity and overweight. February 2018; available at URL: https://www.who.int/news- room/fact-sheets/detail/obesitv-and-overweight 10. HCP. Haut-Commissariat au Plan. Les Cahiers du Plan/ Site institutionnel du Haut-Commissariat au Plan du Royaume du Maroc. Hcp.ma. https://www.hcp.ma/Les-Cahiers-du-Plan r225.html 11. Benghanem Gharbi M, Elseviers M, Zamd M, Belghiti Alaoui A, Benahadi N, Trabelssi El H, Bayahia R, Ramdani B, De Broe ME. Chronic kidney disease, hypertension, diabetes, and obesity in the adult population of Morocco: how to avoid "over"- and "under"-diagnosis of CKD. Kidney International. 2016; 89(6):1363-71. D0l:/10.1016/i.kint.2016.02.019 12. Paradis AM, Godin G, Perusse L and Vohl MC. Associations between dietary patterns and obesity phenotypes. Int. J. Obes. 2009;33(12):1419-26. DPI :/10.1038/iio.2009.179 13. Mella DJ and Scchetti DA. Sensory preferences for fats: relationships with diet and body composition. Am. J. CUn. Nutr. 1991;53(4):908-15. D0l:/10.1093/aicn/53.4.908 14. Stewart JE, Bisset CF, Golding M, Delahunty C, Clifton PM, Keast RS. Oral sensitivity to fatty acids, food consumption and BMI in human subjects. Br. J. Nutr. 2010;104(1):145-52. D0l:/10.1017/s0007114510000267 15. Sundquist J and Johansson SE. The influence of socioeconomic status, ethnicity and lifestyle on body mass index in a longitudinal study. Int. J. Epidemiol. 1998;27(1):57-63. DOI:/10.1093/iie/27.1.57 16. Barich F, Zahrou FZ, Laamiri FZ, El Mir N, Rjimati M, Barkat A, Rjimati El and Aguenaou H. Association of Obesity and Socioeconomic Status among Women of Childbearing Age Living in Urban Area of Morocco. Journal of Nutrition and Metabolism. 2018; Vo I 2018, Article ID 6043042, 6 pages. DPI 710.1155/2018/6043042 17. WHO: Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization Technical Report Series (1995), 854:1-452. Available at URL: https://apps.who.int/iris/bitstream/handle/10665/370 03/WHQ TRS 854.pdf 18. Dare S, Mackay DF, Pell JP. Relationship between Smoking and Obesity: A Cross-Sectional Study of 499,504 Middle-Aged Adults in the UK General Population. PLoS One. 2015;10(4):e0123579. DOI:/10.1371/iournal.pone.Q123579 19. Kozakowski J, Gietka-Czernel M, Leszczynska D, Majos A. Obesity in menopause - our negligence or an unfortunate inevitability? Prz Menopauzainy. 2017;16(2):61-5. DQI:/10.5114/pm.2017.68594 20. Thompson F, Byers T. Dietary assessment resource manual. J. Nutr. 1994,124(11 Suppl): 2245S-2317S. DQI:/10.1093/in/124.suppl 11.2245s 21. Tran KM, Johnson RK, Soultanakis RP, Matthews DE. In-person vs telephone-administered multiple-pass 24-hour recalls in women: validation with doubly labeled water. J. Am. Diet. Assoc. 2000;100(7):777-83. DOI:/10.1016/S0002-8223(00)00227-3 22. Guenther PM, Demaio TJ, Ingwersen LA, Berlin M. The multiple pass approach for the 24-hour recall in the Continuing Survey of Food Intakes by Individuals. Handbook of Assessment Methods for Eating Behaviors and Weight-Related (1994-1996). Presented at the 2 nd International Conference of Dietary Assessment Methods, Boston, MA. 1996. 23. Hercberg S, Deheeger M, Preziosi P. Portions alimentaires: Manuel photos pour I'estimation des quantites. Ed. Economica Anthropos (2002). pp 132. ISBN-10: 2717845623 24. Perez Rodrigo C, Aranceta J, Salvador G, Varela- Moreiras G. Food Frequency Questionnaires. Nutr. Hosp. 2015;31(Suppl 3):49-56. DQI:/10.3305/nh.2015.31.sup3.8751 25. Okorodudu DO, Jumean MF, Montori VM, Romero- Corral A, Somers VK, Erwin PJ, Lopez-Jimenez F. Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis, int. J. Obes. (Lond). 2010;34(5):791-9. D0l:/10.1038/iio.2010.5 26. WHO: Waist circumference and waist-hip ratio. Report of a WHO Expert Consultation (Geneva, 8-11 December 2008). Available at URL: http://whqlibdoc.who.int/publications/2011/97892415 01491 enq.pdf 27. Morkedal B, Romundstad PR, Vatten LJ. Informativeness of indices of blood pressure, obesity and serum lipids in relation to ischemic heart disease mortality: the HU NT-11 study. Eur. J. Epidemiol. 2011;26(6): 457-61. DOI:/10.1007/s10654-011-9572-7 28. Haut-Commissariat au Plan, Les Indicateurs Sociaux 2012-2013, Haut-Commissariat au Plan, Casablanca, Morocco, 2016. pp 292. https://www.hcp.ma/region- drda/attachment/834622/ 29. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity. The evidence. CMAJ. 2006,174(6): 801-9. DOI:/10.1503/cmai.Q51351 30. Thomas NE, Williams DR. Inflammatory factors, physical activity, and physical fitness in young people. Scand. J. Med. Sci Sports. 2008;18(5):543-56. D0l:/10.1111/i.1600-0838.2008.00824.x 31. Plaisance EP, Grandjean PW. Physical activity and high-sensitivity C-reactive protein. Sports Med. 2006; 36(5):443-58. D0l:/10.2165/00007256-200636050- 00006 Nor. Afr. J. Food Nutr. Res. January - June 2019 I Volume 03 I Issue 05 Bajit ef a/.: Epidemic of obesity in Morocco 171 32. Wardle J, Waller J, Jarvis MJ. Sex differences in the association of socioeconomic status with obesity. Am J. Public Health . 2002;92(2):1299-304. DPI :/10.2105/AJ PH.92.8.1299 33. Jafri A, Jabari M, Dahhak M, Saile R, Derouiche A. Obesity and its related factors among women from popular neighborhoods in Casablanca, Morocco. Ethn. Dis. 2013;23(3):369-73. 34. Okoh M. Socio-demographic correlates of overweight and obesity among women of reproductive age in Nigeria. Afr. J. Reprod. Health. 2013;17(4):66-76. 35. Lipowicz A, Gronkiewicz S, Malina RM. Body mass index, overweight and obesity in married and never married men and women in Poland. Am. J. Hum. Biol. 2002;14(4):468-75. D0l:/10.1002/aihb.10062 36. OMS: Obesite "Prevention et prise en charge de I'epidemie mondiale. Rapport d'une Consultation de TOMS. OMS, Serie de Rapports techniques", N° 894, 2003 (xii + 284 pages). Available at URL: https://apps.who.int/iris/bitstream/handle/10665/427 34/WHO TRS 894 fre.pdf 37. Giskes K, Lenthe Fv Fv, Brug HJ, Mackenbach J. Dietary intakes of adults in the Netherlands by childhood and adulthood socioeconomic position. Eur. J. Clin. Nutr. 2004;58(6):871-80. D0l:/10.1038/si.eicn.1601889 38. Song WO, Chun OK, Obayashi S, Cho S, Chung CE. Is consumption of breakfast associated with body mass index in US adults? J. Am. Diet. Assoc. 2005,105(9): 1373-82. DOI:/10.1Q16/i.iada.2005.06.002 Cite this article as: Bajit H, Benkirane H, Bouziani A, Mouzouni F.Z, Bouaiti E, Belghiti H, Mrabet M, Barkat A, Aguenaou H. Association of socioeconomic status, dietary behavior, and obesity among Moroccan adults of the region of Rabat: a case-control study. Nor Afr. J. Food Nutr. Res. January - June (2019);03 (05):164-71. https://doi.org/10.5281/zenodo.3344609 Nor. Afr. J. Food Nutr. Res. 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