Reflections of the Holy Quran and the Mediterranean diet: A culturally congruent approach to obesity?

1Introduction

According to the World Health Organization (WHO), the obesity crisis has reached epidemic proportions with more than one billion adults classified as obese (Body Mass Index [BMI] between 30–39.9) and nearly 300 million as clinically obese (BMI ≥40) [1]. Factors contributing to this epidemic has been characterized by an increased consumption of energy-dense, nutrient-poor foods that are high in saturated fats and refined sugars complemented by a reduction in physical activity [1]. In the predominately-Muslim Arab countries of North Africa and the Middle East, the prevalence of obesity has drastically increased over the last 30 years [2–4]. The Middle East region has the second highest mean BMI after North America and the second highest mean waist-to-hip ratio after South America [2]. Consequently, the burden of obesity-associated co-morbidities i.e. cardiovascular diseases (CVD), cancers, and type 2 diabetes in these Muslim Arab countries have increased [5].

Studies [6–11] have shown a significant dietary shift, particularly among Arab adolescents and young adults, towards unhealthy calorie-dense dietary patterns characterized by frequent eating out, ready-to-eat convenience foods, and overeating replacing wholesome, nutritious diets rich in fruits, vegetables, legumes, and whole grains. A cross-sectional survey [12] in the North African country of Morocco found a reduction in adherence to the Mediterranean-style diet (MD) and that dietary patterns have transitioned towards a western style dietary pattern. In Lebanon, there has been a transition from the typical MD towards convenient food patterns [13]. Other studies [9, 14–16] reported similar dietary deviation away from the MD in North Africa and the Eastern Mediterranean region. Regarded as one of the healthiest diets, the MD is the dietary pattern traditionally consumed among the populations bordering the Mediterranean Basin. The dietary foundation of the MD includes a significant focus on fruits, vegetables, unrefined whole grains, legumes, dried nuts, poultry, eggs, fish, low-fat dairy products, a low consumption of red meat, physical activity, and a liberal use of olive oil [17]. Several studies [18–21] have firmly established the MD as an ideal evidence-based dietary model and weight management guideline for healthy eating with a significant reduction in the risk of many chronic diseases associated with obesity and cardiovascular health. The American Heart Association, supported by the Lyon Diet Heart Study, issued an evidence-based advisory advocating that a MD pattern possesses positive and protective effects against CVD [22].

With obesity becoming a growing public health concern particularly among Arab populations, culturally competent dietary and health-promoting strategies and interventions are warranted. Musaiger [23] offers a unique culturally relevant dietary guideline, the Arab Food Dome, designed for Arab countries with food groups common to the MD and specific to the Middle East and North African region. Such culturally competent health promoting campaigns and dietary guidelines continue to be necessary to help reduce the growing obesity problem facing Muslim Arab countries.

This study offers the traditional MD patterns with special reference given to passages from the Holy Quran to help address the growing obesity epidemic in Arab countries bordering the Mediterranean basin. Regarded as the word of God and divided into 114 Surah (Chapters) and ayah (passages), the Holy Quran is regarded as the divinely inspired authoritative text for practicing Muslims worldwide. For this reason, the aim of this narrative study is to examine passages from the Holy Quran and narratively compare these passages with the characteristic dietary theme of the MD.

2Methods

A narrative review of the Holy Quran was carried out using both electronic and hard copy formats [24, 25] in order to compare the accuracy and translation of each relevant Quranic passage. Both formats were reviewed and evaluated qualitatively for foods, features, and thematic content that are characteristic of the MD. All passages were translated to the English language and tabulated by topic, Quranic citation, and passage (Table 1).

3Results

A total of 24 relevant passages out of 6236 total passages were identified in this narrative review (See Table 1). Surat An-Nahl (The Honey Bees) had four passages. Surat Al-Baqara (The Cow), Al-An’am (The Livestock), and Al-Mu’minun (The Believers) had two in each chapter. Surat Ar-Ra’d (The Thunder), Maryam (Mary), Ya-Sin (Y.S.), As-Saffat (Those Ranged in Ranks), Ar-Rahman (The Most Gracious), Al-Waqi’ah (The Inevitable Event), Al-Naba (The Announcement), Abasa (He Frowned), At-Tin (The Fig), Al-Ma’idah (The Table), Al-Kahf (The Cave), Muhammed or Al-Qital (The Fighting), An-Nur (The Light), and Sad (The letter S.) had one passage in each chapter. Sixteen passages focused on fruits, vegetables, and whole grain, three passages on fish and seafood, two passages on milk and dairy products, two passages on olive oil, and one passage on physical activity. Specific foods mentioned in the Holy Quran included figs, grapes, pomegranates, dates, pumpkins, cucumbers, garlic, lentils, onions, olives, fish, whole grains, and olive oil. These foods are commonly found in Arab countries, particularly those bordering the Mediterranean basin, and concurrently serve as the dietary foundation that characterizes the traditional MD.

4Discussion

Although different regions in the Mediterranean basin have their unique diets, the traditional dietary pattern that exists within North African and Middle East countries, share a common dietary theme [17]. This universal theme has traditionally been characterized by a foundation based on fruits, vegetables, legumes, and whole grain followed by a liberal use of olive oil. In addition, Arab countries bordering the Mediterranean basin share a common access to fish and seafood.

The Middle Eastern origin of the MD dates as far back as ancient times [26, 27]. Comparable to passages from the Holy Quran, the Bible also mentions food components such as wheat, barley, grapes, figs, pomegranates, olives, and dates [26]. These foods are indigenous to the Middle East and North Africa and have been scientifically recognized for its nutritional benefits [28–34]. A reflection between the Holy Quran and the MD indicate a comparative foundation characterized by a significant focus on fruits, vegetables, and whole grain, followed closely by olive oil, fish and seafood, milk and dairy, and physical activity. In addition, previous studies have supported the use of the Holy Quran as a culturally relevant health-promoting resource and guide intended for target populations [35–38].

5Conclusion

Given the worldwide obesity crisis, particularly facing Muslim Arab countries, culturally relevant-based nutrition education programs and interventions targeting Arab Muslim populations continue to be warranted. With a significant focus on fruits, vegetables, and whole grains, the Holy Quran could serve as a significant faith-based resource for culturally competent dietitians, public health educators, and health professionals serving in Arab countries to assist target populations in making healthful food choices and developing nutritionally wholesome dietary habits. Employing passages from the Holy Quran as an authoritative source for health interventions would help individuals embrace a healthy diet reflective of the MD and promote a healthier lifestyle. Because Arab countries vary in their socio-economic and political situations, the Holy Quran serves as an authoritative resource for health promotion that could provide a universally accepted approach for international diet and health strategies to combat obesity in both the Muslim-dominated region of North Africa and the Middle East as well as Arab Muslim communities outside the Arab world. The Holy Quran serves not only as a culturally enriching example with deep religious connotations but also as a highly respected and revered model for health promotion and education in predominately-Muslim countries. As a result, health educators, dietitians, and other health care professionals operating and serving in Muslim-dominant Arab countries, as well as Arab Muslim communities in other countries, should thoroughly familiarize themselves with passages of the Holy Quran associated with diet, health promotion, and its applications toward a healthy lifestyle.

Limitations

Some limitations to this narrative review should be noted. Although two formats of the Holy Quran was reviewed, some relevant verses may have been missed. In addition, since the English language was the primary language of translation, relevant citations may have been misinterpreted through semantics and syntax. It is important to note that narrative reviews are one the lowest levels of evidence-based research and, therefore, should be considered with some level of caution regarding their conclusions.

Funding source

None.