Introduction

Non-communicable diseases (NCDs) are now the leading cause of death globally, accounting for approximately 74% of all mortality worldwide, with a disproportionately large share occurring in low- and middle-income countries (LMICs).1 Within sub-Saharan Africa, cardiovascular disease, type 2 diabetes mellitus, and metabolic syndrome are increasing at rates faster than in higher-income regions, often before the burden of communicable disease has been overcome, generating a dual epidemiological burden.2 This acceleration is closely associated with the nutrition transition, defined as the progressive shift from traditional dietary patterns rich in fibre, complex carbohydrates, and micronutrients toward diets dominated by processed and ultra-processed foods high in added sugars, refined fats, and dietary cholesterol.3

Somalia occupies a unique and precarious position within this global narrative. Decades of armed conflict, cyclical droughts, mass displacement, and fragmented governance have critically weakened the national health system and disrupted traditional food systems.4 Simultaneously, the increasing penetration of imported commodities—from sugar-sweetened beverages (SSBs) to hydrogenated vegetable oils—into urban markets such as Mogadishu is reshaping Somali dietary behaviour.5 What is not yet known, and what this commentary makes explicit rather than assumes, is the actual scale of this shift: Somalia has no functioning national dietary or NCD surveillance system, no representative household consumption survey of the kind available in most LMICs, and no facility-based NCD registry comparable to that operating in Somaliland.4,6 The evidence base for Somalia itself is therefore a near-total blank; what exists is indirect, drawn from neighbouring and analogous populations, and this commentary treats that evidence accordingly—as a source of hypotheses rather than of confirmed findings.

A further caution is warranted regarding the assumption, common in nutrition-transition scholarship, that Somalia will simply retrace the epidemiological path already travelled by other LMICs or by relatively more stable proxy regions such as Somaliland. Cyclical droughts, active conflict, and fragmented governance are not incidental background conditions in Somalia; they are active determinants that could alter the shape, speed, and even direction of the transition. Recurrent drought and displacement periodically strip households of assets and push them toward emergency food aid rather than market purchases, which may slow the shift toward commercially marketed processed foods in some seasons and accelerate it in others, depending on the composition of humanitarian rations and the state of local markets. Active conflict restricts the reach of both food-import supply chains and public health surveillance in ways that Somaliland, Djibouti, and eastern Ethiopia—the comparator settings drawn upon in this commentary—have not experienced at comparable intensity or duration. Fragmented governance similarly limits the state’s capacity to implement the fiscal, regulatory, and surveillance measures that have accompanied the nutrition transition elsewhere. These structural features mean that Somalia’s trajectory should be read as plausible rather than predetermined, and any projection drawn from other settings is qualified accordingly throughout this commentary.

This commentary examines the mechanisms through which the dietary transition from traditional Somali foods to processed, high-sugar, high-cholesterol foods may affect public health, situates these mechanisms within the broader African and global literature, and proposes context-sensitive interventions sequenced to the structural, cultural, and institutional realities of Somalia. The goal is to contribute timely, appropriately qualified analysis that can inform policymakers, clinicians, and public health practitioners working in and around Somalia.

A Note on Methodology and Scope

This article is a narrative commentary, not a systematic review or an empirical primary study, and no formal inclusion/exclusion criteria or quality-appraisal process were applied. The literature underpinning it was identified through purposive, non-systematic searches of PubMed, Google Scholar, and the WHO and International Diabetes Federation publication repositories, using combinations of the terms “nutrition transition”, “ultra-processed food”, “Somalia”, “Somaliland”, “Horn of Africa”, “sub-Saharan Africa”, “dyslipidaemia”, “metabolic syndrome”, and “non-communicable disease”, supplemented by hand-searching the reference lists of relevant reviews. This approach is appropriate to the commentary format but carries an acknowledged risk of selection bias; the sources cited should be read as illustrative of the current literature rather than as an exhaustive or systematically weighted synthesis. Throughout the text we distinguish, as far as possible, (i) biological mechanisms established in the global physiological and clinical literature, (ii) epidemiological evidence from Somalia’s regional neighbours and analogous LMIC settings, and (iii) hypotheses or projections specific to Somalia that remain to be tested.

The Traditional Somali Diet: A Nutritional Foundation Under Threat

The traditional Somali diet is built upon a pastoral foundation, reflecting millennia of nomadic and agropastoral livelihoods. Camel milk (caano geel) constitutes a nutritional cornerstone, providing high-quality protein, calcium, B-vitamins, and immunologically active components, alongside goat and sheep milk products.7 Grains such as sorghum (masago), millet (daaq), and rice prepared with minimal additives—often consumed as canjeero (fermented flatbread), muufo (sorghum bread), or baasto (pasta cooked with spiced meat sauces)—supply complex carbohydrates and dietary fibre. Legumes, particularly kidney beans and lentils in rural and coastal communities, contribute plant-based protein. Fish consumption is characteristic along the 3333-kilometre Somali coastline, one of the longest in Africa.7

This dietary pattern shares attributes with the broader traditional African diet (TrAfDi), characterised by high plant food intake, moderate dairy, minimal processed sugar, and low dietary cholesterol from saturated animal fats.8 Such diets have been associated with reduced rates of obesity, T2DM, and cardiovascular disease compared with westernised dietary patterns in multiple African populations.9 The TrAfDi’s natural richness in dietary fibre attenuates postprandial glycaemic responses, while its low saturated fat content is protective against elevated LDL cholesterol and atherosclerosis.10

Yet this nutritional heritage is eroding. Rapid urbanisation in Mogadishu and other Somali cities, facilitated partly by internal displacement from conflict and drought, has detached large segments of the population from pastoral food production. Urban households increasingly depend on imported processed goods and market-purchased foods, a pattern documented across sub-Saharan African cities.11 This dependency makes populations financially and physiologically vulnerable to the macronutrient profile of available processed commodities. As discussed below, however, this vulnerability should not be assumed to translate into a westernised nutrition-transition trajectory at the same pace or in the same form observed elsewhere in the region.

Defining Processed and Ultra-Processed Foods

Because this commentary uses the terms “processed” and “ultra-processed” throughout, it is necessary to define them at the outset. We adopt the NOVA classification, which groups foods into four categories according to the nature, extent, and purpose of the processing they undergo: unprocessed or minimally processed foods; processed culinary ingredients (eg, oils, sugar, salt); processed foods, in which group 1 and group 2 items are combined (eg, canned vegetables, cheese, freshly made bread); and ultra-processed foods, industrial formulations manufactured largely or entirely from substances derived from foods and additives, characterised by cosmetic and functional additives and formulated to be convenient, palatable, and profitable.12 Sugar-sweetened beverages, instant noodles, packaged snacks, and reconstituted meat products fall into the ultra-processed category; imported cooking oils, canned goods, and refined flour occupy a more heterogeneous space between the processed and ultra-processed groups. This distinction matters because the health effects attributed to “processed food” consumption in the literature are drawn overwhelmingly from ultra-processed food exposure specifically, and this commentary uses the terms accordingly rather than treating all processed foods as a single, undifferentiated risk category.

Drivers of the Nutrition Transition in Somalia

The nutrition transition in Somalia is driven by a complex interplay of structural, economic, and sociocultural forces. First, conflict and displacement have profoundly disrupted pastoral and subsistence food systems. Internally displaced persons in peri-urban settlements around Mogadishu, Baidoa, and Kismayo are particularly dependent on food aid and market-purchased items, the latter disproportionately composed of imported processed commodities—refined flour, cooking oil, canned goods, and sweetened drinks—owing to cost, shelf-life, and availability.4,5

Second, globalisation and trade liberalisation have facilitated the penetration of multinational food brands into Somali markets. SSBs, instant noodles, biscuits, chips, and margarine—formulated with elevated levels of trans-fatty acids, refined sugars, or dietary cholesterol—are now conspicuous in urban shops and markets.5 Morocco, a North African country undergoing an analogous dietary change, illustrates how this trajectory can unfold: the introduction of industrial products alongside traditional cereals has yielded populations consuming sugar at rates far exceeding WHO recommendations, with direct downstream effects on cardiovascular risk.13 Somalia may be at an earlier stage of a broadly similar transition, although, as discussed above, its distinct conflict and governance context means the comparison should be read as illustrative rather than predictive.

Third, urbanisation concentrates people in settings where time constraints, lack of cooking facilities, and shifting social norms increasingly favour ready-to-eat processed options over traditional home-prepared meals. Studies from analogous contexts across sub-Saharan Africa indicate that urban residence is associated with higher consumption of ultra-processed foods and a corresponding elevation of cardiometabolic risk markers.14 Fourth, the food insecurity that pervades large swathes of Somalia creates a paradoxical vulnerability: populations already deficient in micronutrients may simultaneously over-consume energy-dense, nutrient-poor processed foods—the so-called double burden of malnutrition.

Biochemical and Pathophysiological Mechanisms

The mechanisms described in this section are drawn from the global physiological and clinical literature and are well established within it. None has yet been directly demonstrated in a Somali population specifically, and their application to Somalia here should be read as an extension of established biology to a context in which local confirmatory data do not yet exist.

Added Sugar and Metabolic Dysregulation

Excessive consumption of added sugar, particularly fructose and sucrose delivered through SSBs and processed snack foods, initiates a cascade of metabolic disturbances.15 Dietary fructose is metabolised almost exclusively in the liver, where it bypasses the regulatory step controlled by phosphofructokinase and is rapidly converted to fatty acids via de novo lipogenesis, elevating plasma triglycerides and very-low-density lipoprotein production.16 Chronic high-sugar intake also induces peripheral insulin resistance—a precursor to T2DM—by impairing insulin receptor signalling in skeletal muscle and adipose tissue.16 In a systematic review encompassing 23,500 participants from six continents, higher ultra-processed food consumption—whose primary macronutrient contributors include added sugars and refined carbohydrates—was significantly associated with metabolic syndrome risk (pooled RR 1.25, 95% CI 1.09–1.42).14 Elevated fasting glucose, central obesity, hypertriglyceridaemia, and low HDL-cholesterol—the cardinal components of metabolic syndrome—substantially increase the probability of cardiovascular events and T2DM in affected populations, as established in the global literature; whether this risk elevation is of similar magnitude in Somali populations specifically has not been tested.

Dietary Cholesterol, Saturated Fats, and Dyslipidaemia

The shift toward diets rich in saturated animal fats, hydrogenated vegetable oils containing trans-fatty acids, and high-cholesterol processed meats alters lipid homeostasis through well-established hepatic mechanisms. Increased dietary cholesterol suppresses LDL-receptor expression, impairing hepatic clearance of circulating LDL particles, while dietary trans-fatty acids simultaneously elevate LDL-cholesterol and reduce HDL-cholesterol—a uniquely atherogenic lipoprotein profile.17 Dyslipidaemia, characterised by elevated total cholesterol, high LDL-cholesterol, elevated triglycerides, and reduced HDL-cholesterol, is a central modifiable risk factor for atherosclerotic cardiovascular disease.17 Dietary modifications that limit saturated fat, processed refined grains, and sugar-sweetened beverages consistently lower LDL-cholesterol and reduce cardiovascular risk in the populations studied to date.17

In sub-Saharan African populations, the relationship between urbanisation and adverse cholesterol profiles has been empirically documented. A study conducted in Benin found a positive rural-to-urban gradient in cholesterol abnormalities, with urban residents exhibiting more adverse lipid profiles independent of other confounders.5 Nutrition-related NCDs, including elevated cholesterol and hypertriglyceridaemia, have been documented across the Eastern Mediterranean Region at rates ranging from 19% to 45% for metabolic syndrome, and significantly higher in urban, higher-income populations that have advanced further along the nutrition transition than Somalia has yet reached—a comparison offered here as context rather than as a direct estimate for Somalia.18

Inflammation and Systemic Effects

Beyond lipid dysregulation, ultra-processed foods can induce a proinflammatory state through several pathways, including gut microbiome disruption from low dietary fibre, elevated circulating advanced glycation end-products from high-temperature food processing, and the pro-oxidative effects of excess fructose metabolism.16 Chronic low-grade inflammation is an independent cardiovascular risk factor and can accelerate the progression of insulin resistance to overt T2DM.15 The transition away from fibre-rich traditional foods—which modulate gut microbiota composition and attenuate cholesterol absorption—removes a biological buffer against metabolic disease that has not yet been quantified in the Somali setting.

NCD Burden in Somalia and the Horn of Africa: What is Known, Inferred, and Projected

Direct, population-representative data on NCD prevalence in Somalia remain unavailable owing to the collapse of national health information systems.4 The evidence assembled below is therefore organised into three tiers of increasing inferential distance from Somalia itself: regional comparator evidence, cross-regional and global comparator evidence, and projections that should be read as hypotheses rather than findings.

The most proximate evidence comes from Somaliland, Djibouti, and eastern Ethiopia—populations sharing genetic, cultural, and dietary characteristics with mainland Somalia, though not necessarily its recent conflict history or degree of institutional fragmentation. In Somaliland, NCDs account for over 40% of mortality, with cardiovascular disease the leading cause, yet none of the hospitals surveyed as recently as 2022 met WHO Package of Essential NCD Interventions (PEN) standards for human resources, equipment, or medicines.6 This is regional, not Somalia-specific, evidence; Somaliland’s comparatively more consolidated governance and functioning primary care system mean its NCD burden may understate or overstate—in either direction—the burden likely present in Mogadishu and other mainland urban centres.

A second, more distant tier of evidence comes from cross-regional and global comparators. In Morocco, a study of 981 adults found that 26.5% had hypercholesterolaemia, 17.6% had hypertension, and 15% had hyperglycaemia, associated with a transition from a traditional cereal-and-legume diet toward a western-influenced, processed-food-dominated pattern.13 The Malawi experience illustrates how urbanisation in a low-income African country can generate a co-occurring rise in NCDs before the communicable disease burden is resolved.2 The International Diabetes Federation projects that the greatest relative increase in diabetes prevalence between 2021 and 2045 will occur in low- and middle-income African countries, with increases of up to 134% projected for sub-Saharan Africa.19 These are inferential comparisons, not direct evidence from Somalia: Morocco’s more centralised state, stronger healthcare infrastructure, and different food-import profile mean that extrapolating its findings to Mogadishu specifically is a substantial inferential leap that should not be mistaken for confirmed local data.

Given this evidentiary structure, it is more accurate to describe Somalia’s likely NCD trajectory as a plausible hypothesis grounded in established biological mechanisms and regional comparator data, rather than as an established or precisely quantifiable projection. Variables specific to Somalia—the extent of institutional stability, the reach of healthcare access, the pace of urbanisation, and the country’s continued exposure to acute malnutrition and communicable disease—could accelerate, slow, or qualitatively alter this trajectory relative to the comparator settings discussed above. The recommendations that follow are framed with this uncertainty in mind.

The enabling and inhibiting factors for healthy dietary behaviour identified in comparable settings are also relevant to Somalia. A qualitative systematic review grounded in a socio-ecological model identified economic constraints, limited nutrition literacy, unhealthy social and cultural norms, and poor food-environment diversity as principal barriers to healthy eating across intrapersonal, interpersonal, organisational, community, and policy levels, while knowledge, self-efficacy, and social support were identified as facilitators.20 These findings underscore that purely knowledge-based interventions are unlikely to succeed without concurrent changes to the food environment and, in Somalia’s case, to the humanitarian and market systems that shape food access.

Competing Priorities and the Dual Burden of Disease

Any discussion of NCD prevention in Somalia must be situated within the country’s continuing dual burden of disease. Somalia faces a severe ongoing burden of communicable disease, acute and chronic undernutrition, population displacement, and a weakened health infrastructure that remains focused, appropriately, on acute and emergency needs.4 NCD prevention should not be positioned as a competing priority to this acute burden; it should instead be integrated into the humanitarian and primary care platforms that already exist. Practical entry points include incorporating basic blood pressure and glucose screening into existing nutrition and maternal-and-child-health contacts, embedding NCD risk messaging within ongoing community health worker programmes rather than creating parallel structures, and using humanitarian food-assistance planning as an opportunity—rather than a threat—to influence the nutritional composition of rations and market-linked vouchers. Somalia’s fragile governance and resource constraints argue not for deferring NCD prevention, but for embedding it within systems that are already functioning, rather than building new, stand-alone regulatory or clinical infrastructure that the state may not yet be able to sustain.

Public Health Implications and Recommendations

The recommendations below are deliberately sequenced by feasibility rather than presented as a uniform policy package. Somalia’s fragile and fragmented governance means that measures requiring substantial state enforcement capacity—such as fiscal regulation of food products—are unlikely to be implementable in the near term across most of the country, even though such measures have demonstrated effectiveness elsewhere.21 Presenting such measures without qualification would be inconsistent with the structural constraints described throughout this commentary. Accordingly, they are framed below as long-term, governance-contingent aspirations, while short- and medium-term recommendations are limited to actions that do not depend on centralised enforcement capacity.

Short-Term Actions (Feasible Without Centralised Enforcement Capacity) Community-based nutrition education delivered through trusted channels—Islamic scholars, mothers’ groups, community health workers, and social media platforms widely used by Somali youth—emphasising the protective value of traditional foods and the specific risks of high sugar and saturated fat intake within realistic household budgets.Integration of basic NCD risk messaging and opportunistic blood pressure/glucose screening into existing maternal, child health, and nutrition programmes, rather than creation of new parallel services.Voluntary, NGO- or donor-facilitated front-of-pack labelling pilots negotiated directly with the small number of formal importers supplying urban markets—an approach that does not require state enforcement machinery to begin.Medium-Term Actions (Feasible with Modest Capacity Building) Task-shifting of NCD screening and basic counselling to community health workers, building on the demonstrated success of Somaliland’s PEN-Plus pilot programme in improving hypertension control in a resource-constrained environment.6Investment in point-of-care laboratory capacity for lipid profiling and HbA1c measurement, prioritised at referral hospitals in Mogadishu and other major urban centres.Establishment of population-based dietary and NCD risk-factor surveys, beginning with feasible facility- or district-level pilots rather than a national survey, to build the evidence base described in the Research Agenda below.Long-Term, Governance-Contingent Actions Fiscal and regulatory measures—including taxation of sugar-sweetened beverages, mandatory front-of-pack labelling, and marketing restrictions on ultra-processed foods—that have demonstrated effectiveness in reducing processed food consumption elsewhere,21 but whose implementation in Somalia is contingent on the development of centralised revenue and regulatory enforcement capacity currently found only in more institutionally consolidated areas of the country (eg, Somaliland, Puntland). Pilots in such areas, if successful, could provide a template for phased national adoption as governance capacity expands.Investment in traditional food systems—pastoral livelihoods, camel and goat milk value chains, sorghum and millet production, artisanal fishing—as both an economic development and a public health intervention, reducing structural exposure to imported processed alternatives.7,8Adoption of the WHO Global Action Plan for the Prevention and Control of NCDs 2013–2030 as a long-term national framework, sequenced to Somalia’s institutional development rather than assumed to be immediately implementable.1Research Agenda

The near-total absence of nationally representative dietary and NCD prevalence data from Somalia, described throughout this commentary, is the critical evidence gap that must be addressed before Somalia’s NCD trajectory can be confirmed rather than hypothesised. Investment in population-based surveys measuring dietary intake, cholesterol levels, blood pressure, and glycaemic status—beginning with feasible district-level pilots—would provide the epidemiological baseline required to design, monitor, and evaluate the interventions proposed above. Academic institutions such as Al Hayat Medical University are well positioned to lead community-level nutritional research in partnership with international collaborators.

Conclusion

The dietary transition from traditional camel milk and whole-grain-centred Somali foods toward imported processed foods high in added sugars and dietary cholesterol represents an emerging public health concern. The biochemical pathways linking excess sugar consumption to insulin resistance and dyslipidaemia, and linking dietary saturated and trans fat to atherosclerotic risk, are well characterised in the global literature, making an eventual rise in Somalia’s NCD burden a biologically plausible trajectory. Whether, and how quickly, this trajectory materialises in Somalia specifically cannot yet be confirmed: the near-total absence of nationally representative baseline data means the current phase of any epidemic curve, and the precise window remaining for preventive action, cannot be determined with confidence from existing evidence. This uncertainty is itself a reason for urgency in building the surveillance and research capacity described above, rather than a reason for inaction.

The path forward requires a convergence of nutrition policy, food-system investment, community education, healthcare capacity building, and contextual research, sequenced to Somalia’s institutional realities rather than assumed to be immediately implementable in full. Traditional Somali dietary culture—camel and goat milk, sorghum and millet, legumes, and fish—offers a culturally resonant foundation for this response, though it should not be idealised as uniformly protective: traditional dietary patterns in Somalia vary by region, income, and degree of urbanisation, and some already include substantial intakes of animal fat, salt, or refined grain. A balanced public health strategy will build on the genuinely protective elements of Somali food culture while recognising this internal diversity.

A politically fragmented and resource-constrained setting need not be passive in the face of the nutrition transition. Sequencing interventions to what is feasible now, while building the governance and evidence capacity for what is not yet feasible, offers a realistic and culturally grounded path toward reducing Somalia’s future NCD burden.

Data Sharing Statement

Data sharing is not applicable to this article as no data were created or analysed in this study. This commentary is based exclusively on previously published literature and publicly available sources.

Acknowledgments

The author thanks colleagues at Al Hayat Medical University for stimulating discussions on public health challenges in Somalia.

Author Contributions

Ibrahim Abubakar Abdi – Conceptualisation; Investigation; Literature Review; Writing – Original Draft; Writing – Review & Editing; Visualisation; Supervision.

All authors gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

No funding was received for the preparation of this commentary.

Disclosure

The author declares no competing interests.

References

1. World Health Organization. Noncommunicable diseases. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases. Accessed May, 2025.

2. Gowshall M, Taylor-Robinson SD. The increasing prevalence of non-communicable diseases in low-middle income countries: the view from Malawi. Int J Gen Med. 2018;11:255–8. doi:10.2147/IJGM.S157987

3. Popkin BM. Urbanization, lifestyle changes and the nutrition transition. World Dev. 1999;27(11):1905–1916. doi:10.1016/S0305-750X(99)00094-7

4. Hirschler B, Macpherson F. Antimicrobial resistance in Somalia: a silent public health crisis demanding urgent action. Infect Drug Resist. 2026. doi:10.2147/IDR

5. Delisle H, Ntandou-Bouzitou G, Agueh V, Sodjinou R, Fayomi B. Urbanisation, nutrition transition and cardiometabolic risk: the Benin study. Br J Nutr. 2012;107(10):1534–1544. doi:10.1017/S0007114511004661

6. Somaliland NCD Clinic Study Group. Implementing noncommunicable disease clinics to improve control of hypertension in Somaliland: an observational study. medRxiv. 2025. doi:10.1101/2025.10.26.25338788

7. FAO/IGAD. Camel Milk in Somalia and the Horn of Africa: Production, Nutrition, and Markets. Rome: Food and Agriculture Organization; 2019.

8. Dahl WJ, Auger J, Alyousif Z, Miller JL, Ahmed N. Definition of the traditional African diet: a scoping review. Nutrients. 2025;17(12):1952. doi:10.3390/nu17121952

9. Holdsworth M, Pradeilles R, Tandoh A, et al. Evaluating the African food supply against nutrient intake goals for preventing diet-related non-communicable diseases: 1990 to 2017 trend analysis. BMJ Open. 2021;11(1):e040050. doi:10.1136/bmjopen-2020-040050

10. Steyn NP, Mchiza ZJ. Obesity and the nutrition transition in sub-Saharan Africa. Ann N Y Acad Sci. 2014;1311:88–101. doi:10.1111/nyas.12358

11. Nkengasong J, Tessema SK. Africa needs a new public health order to tackle infectious disease threats. Cell. 2020;183(2):296–300. doi:10.1016/j.cell.2020.09.041

12. Monteiro CA, Cannon G, Levy RB, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936–941. doi:10.1017/S1368980018003762

13. Talha I, Elkhoudri N, Hilali A. Lifestyle change, nutrition transition and cardiovascular risk in Settat Region, Morocco. Nutr Diet Suppl. 2024;16:1–13. doi:10.2147/NDS.S443981

14. Shu L, Zhang X, Zhou J, Zhu Q, Si C. Ultra-processed food consumption and increased risk of metabolic syndrome: a systematic review and meta-analysis of observational studies. Front Nutr. 2023;10:1211797. doi:10.3389/fnut.2023.1211797

15. Noubiap JJ, Nansseu JR, Lontchi-Yimagou E, et al. Exploring the prevalence and components of metabolic syndrome in sub-Saharan African type 2 diabetes mellitus patients: a systematic review. medRxiv. 2024;2024. doi:10.1101/2024.02.15.24302899

16. Rv F Jr, Walther TC. Lipid droplets finally get a little R-E-S-P-E-C-T. Cell. 2009;139(5):855–860. doi:10.1016/j.cell.2009.11.005

17. Nwagwu CD, Egbuche O, Harrington D, et al. A heart-healthy diet for cardiovascular disease prevention: where are we now? Vasc Health Risk Manag. 2023;19:237–253. doi:10.2147/VHRM.S379874

18. Musaiger AO, Hassan AS, Obeid O. The paradox of nutrition-related diseases in the Arab countries: the need for action. Int J Environ Res Public Health. 2011;8(9):3637–3671. doi:10.3390/ijerph8093637

19. International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels: IDF; 2021.

20. Fenta ET, Tiruneh MG, Anagaw TF. Exploring enablers and barriers of healthy dietary behavior based on the socio-ecological model, a qualitative systematic review. Nutr Diet Suppl. 2023;15:13–23. doi:10.2147/NDS.S395444

21. GBD Diet Collaborators. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2019;393(10184):1958–1972. doi:10.1016/S0140-6736(19)30041-8