Quality of Life, Nutritional and Health status, and Omega-3 Fatty Acid Levels among Vulnerable Populations from Levant

Background: In recent years, a large number of people from other cultures, especially from the Middle East, have come to Germany. Recent immigrants in particular face many new challenges that also affect their diet, health and quality of life. Due to the changed food supply, immigrants have to adapt their diet and eating habits to a certain extent to their new environment. In addition, micronutrient deficiency is one of the main public health problems in the Middle East and affects the economic, political and social development of countries. The question therefore arises as to how to assess the nutritional and health status and quality of life of recently arrived adults from the Middle East. Therefore, the aim of this thesis is to examine quality of life and to find out whether general socioeconomic factors are predictors of quality of life (QOL). In addition, dietary intake as well as nutritional and health status in comparison with reference values among of Syrian refugees who have lived in Germany for at least 6 months to 4 years since 2015 and to evaluate omega-3 status and associated factors in healthy young Palestinians. Methods: Three separate human studies were conducted, the first two of which were conducted on a total of 114 Syrian refugees aged 18 to 45 years who had been granted one of the following statuses: asylum, refugee protection, or subsidiary protection. The quality of life of Syrian refugees was assessed using the WHOQOL-BREF tool, Participants completed questionnaires on sociodemographic variables, exercise behavior, and diet (3-day food diary). After fasting blood sampling, the anthropometric parameters of the participants (height, weight, body mass index, waist circumference, waist-to-hip ratio, and body composition) were examined using a bioelectrical impedance analyzer. Multiple hematological markers such as iron status, hematological parameters, vitamin D status, lipid metabolism, glucose metabolism, and total homocysteine (tHcy) were measured. Omega-3 status was assessed using the Omega-3 index - defined as the sum of EPA + DHA relative to the total fatty acid content in red blood cells. Results: The lowest quality of life scores was in the social relations domain (60.5%), while the lowest psychological scores were in participants aged 40-45 years (P = 0.011). Age was significantly negatively correlated with physical health (P = 0.010), psychological health (P < 0.001). In addition, more than 60% of men and 30% of women were overweight or obese while 79% of men and 74% of women had increased body fat. Vitamin D blood values revealed a high prevalence of vitamin D insufficiency (25-49.9 nmol/l: 38% of men and 21% of women) and vitamin D deficiency (<25 nmol/l: 44% of men and 70% of women). 83% of men and 67% of women had plasma tHcy levels >10 nmol/L. Furthermore, the mean (standard deviation) of the omega-3 index was 2.56 (0.57) %, with 97.9% of Palestinian participants having an index below 4%. Most participants (91.8%) consumed less than two servings of fish per week, and only 4% reported taking omega-3 supplements, mostly irregularly. Conclusions: The Syrian refugees who participated in the study had a lower quality of life score in all domains compared to the general population. Additionally, the nutritional and health status of the Syrian refugees in Germany is considered unsatisfactory, and many of the refugees have a risk of cardiovascular disease and obesity. The results indicate that Palestinian young students have a troublingly low omega-3 composition. Future planned investigations should explore the possibility of having low omega-3 levels in the general Palestinian population.