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Objective:To assess infant and young child feeding (IYCF) practices in Lebanon and investigate their associations with socio-demographic and lifestyle factors.Design:A cross-sectional national survey was conducted in 2012–2013. In addition to a socio-demographic and lifestyle questionnaire, a 24-h dietary recall for the children was collected, with mothers as proxies. IYCF practices were assessed based on the 2021 indicators of the WHO.Setting:Lebanon.Participants:Children aged 0–23 months and their mothers (n 469).Results:While the majority of infants were ever breastfed (87·6 %), the prevalence of exclusive breast-feeding (BF) in those under 6 months of age was 11·0 %. Early initiation of BF was 28 %. A greater child’s birth order, partner’s support for BF, higher parental education, maternal BF knowledge and non-smoking were associated with higher odds of meeting BF recommendations. As for complementary feeding, 92·8 % of children (6–23 months) met the minimum meal frequency indicator, 37·5 % met the minimum dietary diversity (MDD) and 34·4 % met the minimum adequate diet (MAD). The consumption of unhealthy food was observed amongst 48·9 % of children, with nearly 37 % consuming sweet beverages. Older maternal age and maternal overweight/obesity were associated with lower odds of meeting MDD and MAD, while child’s age and partner’s support for BF were associated with higher odds.Conclusions:The results documented suboptimal IYCF practices amongst Lebanese children and identified a number of factors associated with these practices. Findings from this study will help guide the development of culture-specific programmes aimed at improving IYCF practices in Lebanon.

This study aims at investigating the anthropometric status and food consumption patterns of children in the United Arab Emirates (UAE) and assessing their adherence to nutrient and dietary recommendations. It is a population-based cross-sectional survey of 690 children (4–12.9 years), from 3 major Emirates. Socio-demographic and anthropometric characteristics were collected. Dietary intakes were assessed using the 24-hour recall approach. Of the total sample, 4% were stunted, 8% were wasted and 28% were overweight/obese. A third of participating children consumed above the Estimated Energy Requirement, while the majority’s intakes carbohydrate, total fat, and protein were within the recommendations; whereas over 70% and 90% of participants consumed above the WHO daily limits of free sugars and saturated fats, respectively. Inadequate intakes of linoleic acid (36% of children), alpha-linolenic acid (91%) and dietary fiber (100%) were observed. All children failed to meet the recommendation for vitamin D and considerable proportions had inadequate intakes of vitamin A, calcium, zinc, folate, and magnesium. Compared with the American Heart Association/American Academy of Pediatrics recommendations, low dietary adherence was noted for fruits (9%), vegetables (4%), and milk/dairy (14%). These findings may be used in the development of nutritional policies aimed at improving the diets of children in the UAE.

The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July–October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes’ distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.

To determine the intake levels, dietary sources, and determinants of free sugars (FS) consumption amongst Lebanese children and adolescents. This study is based on data collected by two national cross-sectional surveys conducted on representative samples of Lebanese children: survey 1 (under-five years (U5) children) (n = 899) and survey 2 (5–18 years-old children) (n = 1133). Multi-component questionnaires were used for data collection. Dietary intakes were assessed using one 24 h dietary recall. Median daily intakes of FS, and percent contribution of various food groups to FS intake were compared between sex and age groups. Logistic regressions were conducted to explore the determinants of high FS intake (> 10% energy intake/d), as per the WHO recommendations. Median contribution of FS to daily energy intake was 8.5% in U5 children and 11.9% amongst those aged 5–18 years old. The top contributors to FS in both surveys were sugar-sweetened beverages and biscuits and chocolates. The proportion of children and adolescents exceeding WHO upper limits for FS was estimated at 43 and 62% in survey 1 and survey 2, respectively. Regression models showed females, higher household monthly incomes and higher parental educational levels were associated with significantly lower odds of exceeding the WHO upper limit for FS. The study showed that a high proportion of Lebanese children and adolescents exceeded the WHO upper limit for FS intake, while also documenting a socioeconomic gradient in FS intake. Findings call for devising food system-based interventions to help reduce FS intake in this nutritionally vulnerable age group.

At a time when the health benefits of the Mediterranean diet (MD) are pervasively recognised, a paradoxical observation is the decreasing adherence to this dietary pattern in its native countries. This study aims to investigate temporal trends in adherence to the MD among adolescents (10–19 years old) in Lebanon. Data were drawn from three national cross-sectional surveys conducted at three points in time: 1997 (n2004), 2009 (n3656) and 2015 (n1204). Dietary intake was assessed using 24-h dietary recalls, and adherence to the MD was assessed using two country-specific indexes: the composite Mediterranean diet (c-MED) index and Lebanese Mediterranean diet (LMD) index. Significant decreases in c-MED and LMD scores and in the proportion of adolescents adhering to the MD were observed between 1997 and 2015, with more consistent results among females (P< 0·05). Projections for the year 2030 showed further decreases, with less than a quarter of adolescents remaining adherent to the MD. Based on linear regression analyses, belonging to the year 2009 was associated with significantly lower MD scores compared with 1997, even after adjustment for potential covariates (c-MEDβ= –0·16, 95 % CI –0·30, –0·01; LMDβ= –0·42, 95 % CI –0·67, –0·17). Similar results were obtained when comparing survey year 2015 with 1997 (c-MED scoreβ= –0·20, 95 % CI –0·33, –0·06; LMD scoreβ= –0·60, 95 % CI –0·82, –0·37). Findings highlight the erosion of the MD among Lebanese adolescents and underline the need for a comprehensive food system approach that fosters the promotion of the MD as a nutritionally balanced and sustainable dietary pattern.

BackgroundThis is the first study on dietary intakes of infants and young children in the Eastern Mediterranean Region, a region that is currently witnessing the nutrition transition. It aims at characterizing food consumption patterns amongst 0–4 year old children in Lebanon, evaluating their macro- and micronutrient intakes and assessing adherence to dietary recommendations.MethodsBased on a national cross-sectional survey in 2012 (n = 866), the study collected data on sociodemographic and anthropometric characteristics, and one 24-hour dietary recall was administered. Nutrient intakes were compared with reference values: Estimated Average Requirement (EAR), Adequate Intake (AI) and Acceptable Macronutrient Distribution Range (AMDR).ResultsMilk was the highest contributor to energy intake (EI) in infants (95.8 and 56.5% in 0–5.9 months and 6–11.9 months old infants, respectively), while its intake was lower among toddlers and preschoolers (35.4 and 15.1%, respectively). In contrast, intakes of sweets and sweetened beverages were the highest in preschoolers compared to younger children, contributing 18.5% EI in preschoolers. Compared to dietary guidelines, the lowest dietary adherence was found for vegetables (17.8–20.7%) and fruits (14.4–34.3%). Protein intake was within the recommendations for the vast majority of children. Although total fat intake was lower in toddlers and preschoolers compared to infants, more than 40% of toddlers and preschoolers exceeded the AMDR for fat and 87.3% of preschoolers exceeded the upper limit for saturated fat. Only 3.6% of toddlers and 11.5% of preschoolers exceeded the AI level for dietary fiber. Micronutrient intake assessment showed that mean intakes in infants exceeded the AI for all micronutrients, except for vitamin D and magnesium. In toddlers, vitamin D and calcium were below the EAR among 84.7, and 44.6%, respectively. In preschoolers, most of the children (91.9%) had inadequate intakes of vitamin D, and a third had inadequate intakes of folate, calcium and vitamin A.ConclusionsThis study identified priority issues for nutrition intervention in infants and young children in Lebanon. Concerted multi-stakeholder efforts are needed to instill heathier food consumption and nutrient intake patterns early in life.

BackgroundThe present study aimed to determine the association of household food insecurity with dietary intakes and nutrition-related knowledge, attitudes, and practices (KAP) among school-aged children.MethodsThis cross-sectional study was conducted among a representative sample of school-aged children. A total of 380 children and their parents were selected from all Gaza strip governorates, using a random sampling method. The demographic and socioeconomic characteristics; the Radimer/Cornell food security scale; two non-consecutive days of 24-h dietary recall; anthropometric measurements; and the Food and Agriculture Organization KAP-questionnaire (Module 3) were employed. Statistical analysis was performed using SPSS version 25.ResultsAbout 71.6% of school-aged children were household food-insecure, while 28.4% were household food-secure. Significant associations were found between living area, educational level, household monthly income, weight for age and BMI for age z-scores, underweight, malnutrition status, intakes of protein, iron, vitamin D, and zinc among household food-secure, and household food-insecure. After adjustment for confounding variables, having nutrition-related adequate KAP were associated with lower odds of being food-insecure household [OR = 0.519, 95% (CI = 0.320–0.841)], [OR = 0.510, 95% CI = (0.315–0.827)], and [OR = 0.466, 95% CI = (0.285–0.763), P < 0.05 for all], respectively.ConclusionsLow socioeconomic status, low anthropometric indices, poor dietary intakes may be associated with a high level of food-insecurity; while having nutrition-related adequate KAP may be protective against food-insecurity among school-aged children.

Globally, the prevalence of anemia among children during the period of complementary feeding is high. A cross-sectional, mixed-methods study was conducted to examine the main determinants of anemia among Syrian refugee children aged 6 to 23 months (n = 215) and to illuminate the knowledge, attitudes and perceptions of their mothers and Lebanese healthcare staff on its causes and available treatment options. 42% of the children and 20% of their mothers were anemic. Determinants of child anemia were the mother having anemia or not knowing that fish/seafood is a source of iron; the child having been acutely ill the last two weeks or receiving cow’s milk, but not consuming iron-rich infant formula, added fats/oils, or fruits in the previous 24 hours. Several Syrian mothers knew some causes of anemia and named dizziness as a leading symptom but did not mention flesh foods as a key source of heme iron. They reported financial constraints in accessing iron-rich foods and supplements. Lebanese doctors largely gave appropriate dietary advice and prescribed iron supplements as treatment. Multisectoral interventions are needed that combine medical and financial support with nutrition counseling for mothers to reduce the high burden of anemia among young children living in a multiple crises situation.

Syrian refugees in Lebanon are facing vulnerabilities that are affecting their food insecurity (FI) levels. The objectives of this study were to measure dietary diversity, FI and mental health status of Syrian refugee mothers in Lebanon and to explore its associations with their anaemia and nutritional status. A cross-sectional study was conducted among mothers with children under 5 years (n 433) in Greater Beirut, Lebanon. Dietary diversity was measured using the Minimum Dietary Diversity for Women (MDD-W) of reproductive age and FI using the global Food Insecurity Experience Scale at the individual level. Depression and post-traumatic stress disorder (PTSD) were measured to assess the maternal mental health status. Data on socio-economic characteristics, anthropometric measurements and Hb concentrations were collected. Overall, 63·3 % of the mothers had a low dietary diversity (LDD) and 34·4 % were moderately to severely food insecure, with 12·5 % being severely food insecure. The prevalence of PTSD, moderate depression and severe depression was 13·2, 11·1 and 9·9 %, respectively. A significant correlation was found between LDD and FI (P < 0·001). Low income was significantly associated with LDD and FI. Poor mental health was significantly associated with FI. LDD and FI were not associated with anaemia and nutritional status of mothers. Low-income households had significantly higher intakes of grains and refined starchy staples, whereas high-income households consumed more nutritious foods and sweets. Evidence of inadequate diet quality, FI and poor mental health among Syrian refugee mothers in Lebanon is presented. Multifaceted actions are needed to reduce FI and improve dietary diversity.

High intakes of trans fatty acids (TFA), particularly industrially-produced TFA, are implicated in the etiology of cardiovascular diseases, which represent the leading cause of mortality in the Eastern Mediterranean Region (EMR). This systematic review aims to document existing national TFA reduction strategies in the EMR, providing an overview of initiatives that are implemented by countries of the region, and tracking progress toward the elimination of industrially-produced TFA. A systematic review of published and gray literature was conducted using a predefined search strategy. A total of 136 peer-reviewed articles, gray literature documents, websites and references from country contacts were obtained, up until 2 August 2021. Randomized-control trials, case-control studies, and studies targeting unhealthy population groups were excluded. Only articles published after 1995, in English, Arabic or French, were included. Key characteristics of strategies were extracted and classified according to a pre-developed framework, which includes TFA intake assessment; determination of TFA levels in foods; strategic approach; implementation strategies (TFA bans/limits; consumer education, labeling, interventions in public institution settings, taxation), as well as monitoring and evaluation of program impact. Thirteen out of the 22 countries of the EMR (59%) have estimated TFA intake levels, 9 have determined TFA levels in foods (41%), and 14 (63.6%) have national TFA reduction initiatives. These initiatives were mainly led by governments, or by national multi-sectoral committees. The most common TFA reduction initiatives were based on TFA limits or bans (14/14 countries), with a mandatory approach being adopted by 8 countries (Bahrain, Iran, Jordan, KSA, Kuwait, Morocco, Oman and Palestine). Complementary approaches were implemented in several countries, including consumer education (10/14), food labeling (9/14) and interventions in specific settings (7/14). Monitoring activities were conducted by few countries (5/14), and impact evaluations were identified in only Iran and the UAE. The robustness of the studies, in terms of methodology and quality of assessment, as well as the lack of sufficient data in the EMR, remain a limitation that needs to be highlighted. Further action is needed to initiate TFA reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluation of ongoing programs.

This study aims at identifying national salt reduction initiatives in countries of the Eastern Mediterranean Region and describing their progress towards the global salt reduction target. A systematic review of published and grey literature was conducted. Key characteristics of strategies were extracted and classified according to a pre-defined framework: salt intake assessments; leadership and strategic approach; implementation strategies; monitoring and evaluation of program impact. Salt intake levels were estimated in 15 out of the 22 countries (68%), while national salt reduction initiatives were identified in 13 (59%). The majority of countries were found to implement multifaceted reduction interventions, characterized by a combination of two or more implementation strategies. The least common implementation strategy was taxation, while the most common was reformulation (100%), followed by consumer education (77%), initiatives in specific settings (54%), and front of pack labelling (46%). Monitoring activities were conducted by few countries (27%), while impact evaluations were lacking. Despite the ongoing salt reduction efforts in several countries of the region, more action is needed to initiate reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluations of ongoing programs. Such efforts are vital for the achievement of the targeted 30% reduction in salt intake.

Introduction: Lebanon, a middle-income Eastern Mediterranean country, continues to face detrimental economic, health and socio-political challenges that are further exacerbated by the COVID-19 pandemic. In parallel, the country has been experiencing a remarkable nutrition transition that has contributed to the burden of malnutrition and non-communicable diseases, all imposing serious repercussions on people's livelihoods, food security, and health. Such circumstances have prodded public demand for guidance on affordable, healthy, and sustainable dietary choices to alleviate the burden to this emerging unfortunate situation.Objective: The purpose of this study is to provide evidence-based sustainable and healthy dietary recommendations which balance the tradeoffs among the health, environmental footprint and cost dimensions of sustainability, while closely resembling the usual food consumption pattern.Methodology: Data from the latest available national food consumption survey was used as the usual food consumption pattern of Lebanese adults. Optimized dietary patterns were calculated using the optimization model Optimeal which produced patterns most similar to the usual diet and simultaneously satisfying the three main sets of constraints: health, environmental footprints, and cost. The identified healthy and sustainable dietary options were vetted by multiple key stakeholders from the government, academia, international, and national non-governmental organizations.Results: Compared to the usual intake, the optimized diet included higher intakes of whole grain bread, dark green vegetables, dairy products, and legumes, and lower intakes of refined bread, meat, poultry, added sugars, saturated fat, as compared to usual national mean consumption. The optimized dietary model resulted in a decrease in the associated environmental footprints: water use (−6%); and GHG (−22%) with no change in energy use. The cost of the optimized diet was not different from that of the usual intake.Conclusion: An evidence-based sustainable and healthy diet was developed for Lebanon providing the population and policy makers with some answers to a complex situation. Findings highlight the need for the development of sustainable food based dietary guidelines for Lebanon to promote diets that are healthy, sustainable, culturally acceptable, and affordable and that can alleviate food insecurity among the general population.

Although a number of international diet and lifestyle guidelines during pregnancy (DLGP) exist in the literature, contextualization to low‐ and middle‐income settings is less common. The aim of this study was to present the Lebanese DLGP and to describe the process followed for their development. A mixed‐method approach was used including a review and synthesis of existing international DLGP and a consensus building nominal group technique (NGT) with a multidisciplinary group of experts (n = 11). During the meeting, participants identified the themes of the guidelines, formulated the wording of each themes' guideline and translated the guidelines to the Arabic language. Consensus was defined as an agreement of 80%. Reviewing the literature, a list of 17 main topics were found to be common themes for the DLGP. For the Lebanese DLGP, participants in the NGT meeting selected seven themes from this list: gestational weight gain, diet diversity, hydration, food safety, harmful foods, physical activity and breastfeeding. In addition, the group formulated three themes based on merging/modifying existing themes: supplementation, alcohol and smoking and religious fasting. Two context‐specific new themes emerged: wellbeing and nutrition resilience. For each of the identified themes, the group agreed upon the wording of its guidelines and description. This study is the first from the Eastern Mediterranean Region to develop through consensus building, context and culture‐specific dietary and lifestyle guidelines for pregnant women. Putting maternal nutrition at the heart of tackling malnutrition and its detrimental health outcomes is a core investment for a better maternal and child health.

The Eastern Mediterranean Region (EMR) has witnessed significant social and economic changes that may have influenced the diet of children and adolescents, and increased the risk for obesity and malnutrition in this age group. This review aims to characterize and assess food consumption patterns and nutrient intakes amongst school-aged children (5–10 years) and adolescents (10–19 years) in countries of the EMR. Electronic databases (MedLine, PubMed, Scopus, and Google Scholar) were searched for relevant articles published between 2005 and 2020; international organizations and governmental websites were also searched. Available studies documented low intakes of fruits, vegetables and fiber, inadequate consumption of water, milk and dairy products, coupled with high intakes of fat, saturated fat, and sugar sweetened beverages, as well as a frequent consumption of energy-dense, nutrient poor foods such as sweet and savory snacks. Micronutrient inadequacies were also observed, particularly for calcium, iron, zinc and vitamins A, D, C, and folate. Acknowledging the impact that nutrition may have on building societies and transforming the lives of children, adolescents and their families, there is a crucial need for a food system approach in developing and implementing national and regional policies and interventions aimed at improving the diet of children and adolescents.

This study aims to assess the validity and reproducibility of a culture-specific semi-quantitative food frequency questionnaire (FFQ) for Lebanese adults. The 94-item FFQ captures intake of traditional Mediterranean dishes and Western food, reflective of current Lebanese nutrition transition. Among 107 participants (18&ndash, 65 years), the FFQ was administered at baseline (FFQ-1) and one year thereafter (FFQ-2), 2&ndash, 3 24-h recalls (24-HRs)/season were collected for a total of 8&ndash, 12 over four seasons. A subset (n = 67) provided a fasting blood sample in the fall. Spearman-correlation coefficients, Bland&ndash, Altman plots, joint-classification and (ICC) were calculated. Mean intakes from FFQ-2 were higher than from the total 24-HRs. Correlations for diet from FFQ-2 and 24-HRs ranged from 0.17 for &alpha, carotene to 0.65 for energy. Joint classification in the same/adjacent quartile ranged from 74.8% to 95%. FFQ-2-plasma carotenoid correlations ranged from 0.18 for lutein/zeaxanthin to 0.59 for &beta, carotene. Intra-class correlations for FFQ-1 and FFQ-2 ranged from 0.36 for &beta, cryptoxanthin to 0.85 for energy. 24-HRs carotenoid intake varied by season, combining season-specific 24-HRs proximal to biospecimen collection to the FFQ-2 improved diet-biochemical correlations. By applying dietary data from two tools with biomarkers taking into consideration seasonal variation, we report a valid, reproducible Lebanese FFQ for use in diet-disease research.

Objective: Exposure to food marketing may influence children’s food preferences and consumption patterns and may increase the risk of childhood obesity. The WHO Office for the Eastern Mediterranean Region (EMR) has recently released a regional nutrient profile model (WHO EMR) for the purpose of regulating the marketing of food and beverages to children. This study aimed at 1) analyzing the frequency and types of food and drink advertisements during children’s viewing time in Lebanon; 2) examining the nutritional content of the advertised food products in reference to the nutrient thresholds specified by the WHO EMR model; and 3) assessing the proportion of food advertisements that included health messages. Design: This study consisted of a cross-sectional content analysis of food advertisements on local TV channels, during children’s viewing time. Setting: Three local Lebanese channels with the highest viewership among 4- to 14-year-olds were selected. Recorded broadcasts (September 2016 through January 2017) were analyzed between 3 pm and 10 pm on weekdays and between 8 am and 10 pm on weekend days. Results: Approximately 31% of advertisements were for foods or drinks. The proportion of food advertisements was the highest during children’s programs (43%) compared to general viewing (32%) and parental guidance (29%) programs. Approximately 8 out of 10 food advertisements were for products that did not meet the standards of the WHO EMR model. Of concern was the heavy advertisement of alcoholic beverages during programs for general audiences. The majority of the advertisements that comprised a health claim were for foods that did not meet the WHO EMR’s nutritional standards (79%). Conclusions: The findings of this study, which is the first to utilize the new WHO EMR profile model, should be viewed as a foundation for the development of food marketing policies aimed at reducing children’s exposure to TV food advertisements in Lebanon, a country that harbors a high burden of childhood obesity.

OBJECTIVES: To determine the intake levels and main sources of total sugars (TS) and free sugars (FS) among Lebanese children and adolescents and to investigate the determinants of high FS consumption. METHODS: In a national cross-sectional survey, data on socio-demographic, anthropometric, and lifestyle characteristics of Lebanese children and adolescents (5–18 years-old) were collected (n = 1133). Dietary intake (24-hr recall) was analyzed using Nutri Pro software to determine average daily energy intake in kilocalories (kcal/d), TS and FS in grams (g/d) and as % of total energy intake (% kcal/d). FS content of foods was defined as 100% of added sugars for non-fruit juice sources and 100% of TS for fruit juice and drinks. Independent t -tests were used to compare mean daily intakes of TS and FS by sex and age groups. Logistic regressions were conducted to explore determinants of high FS intake (>10% kcal/d), as per the World Health Organization recommendations. RESULTS: Children and adolescents consumed, on average, 1899.9 ± 25.2 kcal/d of which 17 ± 0.2% kcal/d from TS and 16 ± 0.2% kcal/d from FS. Percentage of children and adolescents having high FS consumption was 62%. Main contributors to TS and FS were sweetened beverages, biscuits/chocolates, and syrups, jams and honey. Per consumer basis, intakes of FS from all food groups were significantly higher in older boys and girls than younger ones, except for candies, ice cream and fresh fruit juices. Multiple logistic regression showed children with higher paternal educational level and highest household monthly income had significantly lower odds of high FS intake (OR = 0.79, 95% CI: 0.64, 0.96 and OR = 0.70, 95% CI: 0.58, 0.83, respectively). Children meeting physical activity recommendations had higher odds of high FS compared to their counterparts (OR = 1.12, 95% CI: 1.003, 1.23). CONCLUSIONS: High proportion of Lebanese children and adolescents exceeded upper limits for FS intake. Findings highlight the need for developing culture-specific interventions aimed at reducing the intake of TS and FS among adolescents, particularly those from low-income families, to curb rising obesity rates. FUNDING SOURCES: This project was funded by the Lebanese National Council for Scientific Research and the University Research Board at the American University of Beirut.

High dietary glycemic index (GI) and glycemic load (GL) were suggested to increase the risk of metabolic syndrome (MetS). This study aims to estimate dietary GI and GL in a sample of healthy Lebanese adults and examine their association with MetS and its individual abnormalities. The study uses data from a community-based survey of 501 Lebanese urban adults. Dietary intake was assessed using a food frequency questionnaire. Biochemical, anthropometric, and blood pressure measurements were obtained. Subjects with previous diagnosis of chronic disease, metabolic abnormalities, or with incomplete data or implausible energy intakes were excluded, yielding a sample of 283. Participants were grouped into quartiles of GI and GL. Multivariate logistic regression analyses were performed. Average dietary GI and GL were estimated at 59.9 &plusmn, 8 and 209.7 &plusmn, 100.3. Participants belonging to the highest GI quartile were at increased risk of having MetS (odds ratio (OR) = 2.251, 95% CI:1.120&ndash, 4.525) but this association lost significance with further adjustments. Those belonging to the second quartile of GI had significantly lower odds of having hyperglycemia (OR: 0.380, 95% CI:0.174&ndash, 0.833). No associations were detected between GL and MetS. The study contributes to the body of evidence discussing the relationship between GI, GL, and MetS, in a nutrition transition context.

Purpose The high burden of preschool overweight in the Middle East and North Africa highlights the need for rigorous investigations of its determinants. This study aims at identifying dietary patterns amongst preschoolers in Lebanon and assessing their association with overweight and obesity. Methods A national cross-sectional survey was conducted amongst 2–5-year-old children (n = 525). Socio-demographic, dietary, lifestyle and anthropometric variables were collected. Dietary patterns were derived by factor analysis. Overweight/obesity was defined based on the World Health Organization 2006 criteria (BMI-for-age z-score > + 2). Results Two patterns, “Fast Food and Sweets” and “Traditional Lebanese”, were identified. The “Fast Food and Sweets” pattern was characterized by higher consumption of sweetened beverages, fast foods, salty snacks and sweets. The “Traditional Lebanese” was driven by higher intakes of cereals, dairy products, fruits and vegetables. Children belonging to the 3rd tertile of the Traditional pattern scores had significantly lower odds of overweight/obesity compared to the 1st tertile (OR 0.33; 95% CI 0.11, 0.97). Higher maternal education and higher frequency of eating with family predicted adherence to the traditional pattern, while the presence of a household helper was a negative determinant. Adherence to the Fast Food and Sweets pattern was positively associated with the child’s age, and negatively associated with female gender and maternal education. Conclusions The “Traditional Lebanese” pattern was associated with decreased risk of preschool overweight. Policies aiming at re-anchoring this traditional dietary pattern in contemporary lifestyles may be developed as potential preventive strategies against overweight in this age group.

BackgroundLittle is known about sex-based dietary differences in middle-income countries, particularly those undergoing the nutrition transition. This study aims at examining sex disparities in energy and macronutrients’ intakes, food consumption patterns, and micronutrients’ adequacy in Lebanon, while adopting a life course approach.MethodsData were derived from a national cross-sectional survey conducted in Lebanon in 2008/2009. The study sample consisted of 3636 subjects: 956 children and adolescents aged 6–19.9 years; 2239 adults aged 20–59.9 years and 441 older adults aged above 60 years. At the households, trained nutritionists conducted face-to-face interviews with participants to complete a sociodemographic questionnaire and one 24-h diet recall. Food items were categorized into 25 food groups. The Nutritionist Pro software was used for the analysis of dietary intake data and the estimation of energy, macronutrients’, and micronutrients’ intakes.ResultsIn all age groups, males had significantly higher energy intakes, while females had significantly higher fiber intakes. In addition, in adolescents aged 12–19.9 years, females had higher fat intakes as compared to males (37.02 ± 0.6% vs 35.03 ± 0.61%), and in adults aged 20–59.9 years, females had significantly higher total fat (37.73 ± 0.33% vs 36.45 ± 0.38%) and saturated fat intakes (11.24 ± 0.15% vs 10.45 ± 0.18%). These differences in macronutrient intakes were not observed in younger children nor in older adults. Sex-based differences in food groups’ intakes were also observed: men and boys had significantly higher intakes of red and processed meat, bread, fast food, soft drinks, and alcohol, while girls and women had higher intakes of fruits, vegetables, milk, and sweets. In all age groups, females had lower micronutrient intakes compared to males, including calcium, iron, and zinc.ConclusionsThis study identified sex-specific priorities that ought to be tackled by context-specific interventions to promote healthier diets in Lebanon. The fact that sex-based differences in nutrient intakes and food consumption patterns were the most noticeable in the adolescent and adult years, hence women’s reproductive years call for concerted efforts to improve nutrition for women and girls as this would lay the foundation not only for their future education, productivity, and economic empowerment, but also for the health of future generations.

Introduction: Micronutrient deficiencies and malnutrition during the first 1000 days of life can have lifelong effects on the physical and cognitive development of the child. Lebanon, host of the world's highest per capita number of refugees, is becoming increasingly vulnerable to micronutrient deficiencies and facing a protracted crisis. Up-to-date, there is a lack of studies assessing hidden hunger, such as anemia and its determinants, particularly in a fragile setting.Material and methods: A cross-sectional survey was applied to 539 mother-child pairs of Syrian refugees and Lebanese host communities attending primary health care centers in 6 vulnerable areas of Greater Beirut, Lebanon between July and September 2018. The interview was completed by 476 pairs consisting of women of reproductive age (15–49 years) and children (0–59 months). The questionnaire gathered data on socio-economic characteristics, infant and young child feeding practices, and nutritional status. Hemoglobin concentrations were measured using the HemoCue Hb301 + analyzer. Data analysis used descriptive statistics, t-test, and chi-square test.Results: Overall, 45.4% of the women were lactating (LW), 16.6% pregnant (PW), and 38.0% non-pregnant non-lactating (NP/NL). The vast majority of the infants were ever breastfed (96.6%) and received colostrum (90.5%); however, more than half of the infants were offered pre-lacteal feedings (55.0%) and only one third were breastfed within the first hour after birth (35.2%). The rate of exclusive breastfeeding under six months was 22.2%. About half of the children were predominantly breastfed under six months (50.4%). Long-term breastfeeding up to the age of 1 year (47.2%), or even 2 years (19.2%), was practiced in line with the WHO recommendations. Anemia rates among mothers were significantly higher among NP/NL compared to PW and LW (26.1%, 17.7%, 18.8%, respectively, p < 0.05). Whereas, anemia rates among children were significantly higher in LW compared to NP/NL and PW (43.0%, 30.0%, 21,5%, respectively, p < 0.01). Among breastfed children, maternal anemia was significantly higher among anemic children (25.8%) compared to non-anemic children (14.0%, p < 0.05). Mild anemia of children under six months was significantly higher among overweight and obese mothers compared to mothers with a healthy BMI (67.7% vs 32.3%, p < 0.05).Conclusions: Despite an almost universal initiation of breastfeeding, early onset and exclusive breastfeeding under six months were low. Higher anemia rates were found among breastfed children and this was significantly associated to the maternal nutritional- and anemia status. Further analysis is required to examine the determinants of anemia and breastfeeding in this setting.

Amidst the ongoing societal and economic shifts in the Eastern Mediterranean region (EMR), this study aims at investigating temporal trends in food consumption and nutrient intakes among Lebanese adults, by age and sex. Data were derived from two national cross-sectional surveys conducted in Lebanon during two time periods (1997, 2008/2009). In both surveys, dietary assessment was based on 24-h recalls. The results, expressed as % energy intake (%EI), revealed a significant decrease (p &lt, 0.001) in the consumption of bread, fruits, fresh fruit juices, milk and eggs, whereas the consumption of added fats and oils, poultry, cereals and cereal-based products, chips and salty crackers, sweetened milk and hot beverages increased over time (p &lt, 0.001). A significant increase in dietary energy (kcal/day) and fat intake (%EI) was observed, coupled with decreases in carbohydrate intake (%EI) and dietary density of vitamin A and vitamin C (per 1000 kcal) (p &lt, 0.001). These changes were noted in both genders and across age groups, albeit there were some disparities between groups. In conclusion, based on national nutrition surveys, this study is the first to characterize the nutrition transition in a middle-income country of the EMR, shedding light on priority areas for nutrition policies and interventions.

OBJECTIVES: The study aims to: estimate the prevalence of exclusive breastfeeding in Lebanon; and examine socio-demographic, maternal, and child-related determinants associated with exclusive breastfeeding for 40 days and 6 months. METHODS: In a cross-sectional study of a nationally representative sample of 1005 Lebanese mother-child dyads, mothers of children

Objectives To explore the perspectives and experiences of children and their mothers towards healthy eating habits and regular physical activity in Lebanon and to identify potential strategies that can be recommended for future interventions to promote healthy lifestyles among children. Methods Qualitative research methodology and the social cognitive theory were used. Focus group discussions and in-depth interviews were conducted with children (aged 10–11 years) and their mothers, respectively, from two private and one public schools in Beirut, Lebanon. Thematic inductive analytical approach was adopted. Results A total of six FGDs and 11 in-depth interviews with mothers were conducted from February till November 2020. Four main overarching themes emerged. Theme 1 pertained to the different views of children and mothers regarding the meaning of healthy eating and physical activity and their perceived impact on children's wellbeing. Theme 2 revealed a set of intrapersonal, social, and environmental determinants, which were reported differently between children and their mothers. Participants in our study who were interviewed after the COVID-19 pandemic talked about how their eating habits were adversely affected as a result of the sudden changes in daily schedules, boredom and anxiety. Theme 3 reflected the role of schools and sports facilities in setting a good example for children's healthy eating and active behaviors. Theme 4 revolved around participants’ suggestions to receive support for healthy eating and lifestyle habits at multiple levels, including intrapersonal, family/social, community, and policy-level strategies. Our findings highlight the importance of using theory-driven interventions, such as the social cognitive theory, to improve long-term health behaviors. Conclusions Findings highlight the multiple influences that pertain to children's eating and activity habits and shed light on the need to use child- and parental-driven strategies in the planning and development of programs to promote children's health and wellbeing. Funding Sources This study was partially funded by the Department of Nutrition and Food Sciences at the American University of Beirut.

The Eastern Mediterranean Region (EMR) is experiencing a nutrition transition, characterized by the emergence of overnutrition and micro-nutrient deficiencies. No previous study has comparatively examined nutrient intake in adults across countries in the EMR. This review examined the adequacy of nutrients in adults living in the EMR. Moreover, it analyzed the food balance sheets (FBS) for 1961–2018 to identify the trajectory of energy supply from macro-nutrients in the EMR. A systematic search was conducted from January 2012 to September 2020. Only observational studies were retained with a random sampling design. An assessment of the methodological quality was conducted. Levels of nutrient daily intake and their adequacy compared to the daily reference intake of the Institute of Medicine were reported across the region. No studies were identified for half of the region’s countries. Although nutrient energy intake was satisfactory overall, fat and carbohydrate intake were high. Intake of vitamin D, calcium, potassium, zinc, and magnesium were below that recommended. The analysis of the FBS data allowed for the identification of four linear patterns of trajectories, with countries in the EMR best fitting the ‘high-energy-supply from carbohydrate’ group. This systematic review warrants multi-sectorial commitment to optimize nutrient intake.

There have been increases in the incidence of obesity in Lebanon over the past few decades. Fatty acid intake and metabolism have been postulated to influence obesity, but few epidemiological studies have been conducted. The aim of this study was to investigate the correlation between serum fatty acid levels and indicators of obesity in a cross-sectional study nested within a cohort of 501 Lebanese adults residing in Greater Beirut. A total of 395 available serum samples (129 men, 266 women) were profiled for phospholipid fatty acid composition. Spearman correlation coefficients adjusted for relevant confounders and corrected for multiple testing were calculated between serum fatty acids, desaturation indices, and indicators of adiposity (body mass index (BMI) and waist). BMI was significantly positively correlated with saturated fatty acids in men (r = 0.40, p &lt, 0.0001, q &lt, 0.0001) and women (r = 0.33, p &lt, 0.0001). BMI was significantly positively correlated with monounsaturated fatty acid palmitoleic acid in women (r = 0.15, p = 0.01, q = 0.03). This study suggests that high blood levels of some saturated fatty acids and the monounsaturated fatty acid palmitoleic acid, likely derived from both dietary intakes of saturated fatty acids and endogenous lipogenesis, may have been associated with adiposity in the Lebanese population. The causality of these associations needs to be explored in experimental settings.

This study tried at identifying lifestyle patterns in a sample of Lebanese adults and investigating their association with metabolically healthy overweight and obesity (MHOv/O). This study used data from a community-based survey of Lebanese adults living in Greater Beirut (n = 305). Dietary intake was assessed using an 80-item food frequency questionnaire. MHOv/O was defined as having one or none of the following metabolic abnormalities: triglycerides ≥ 150 mg/dL; systolic blood pressure ≥ 130 mmHg; diastolic blood pressure ≥ 85 mmHg; fasting blood glucose ≥ 100 mg/dL; HDL-cholesterol

Adolescent obesity is associated with both immediate and longer-term health implications. This study aims to identify dietary patterns among a nationally representative sample of Lebanese adolescents aged between 13 and 19 years (n 446) and to assess the association of these patterns with overweight and obesity. Through face-to-face interviews, socio-demographic, lifestyle and anthropometric variables were collected. Dietary intake was assessed using a sixty-one-item FFQ. Dietary patterns were derived by factor analysis. The following two dietary patterns were identified: Western and traditional Lebanese. The Western pattern was characterised by high consumption of red meat, eggs and fast-food sandwiches. The traditional Lebanese pattern reflected high intakes of fruits and vegetables, legumes and fish. Female sex and a higher maternal education level were associated with a greater adherence to the traditional Lebanese pattern. As for the Western pattern, the scores were negatively associated with crowding index, physical activity and frequency of breakfast consumption. After adjustment, subjects belonging to the 3rd tertile of the Western pattern scores had significantly higher odds of overweight compared with those belonging to the 1st tertile (OR 2·3; 95 % CI 1·12, 4·73). In conclusion, two distinct dietary patterns were identified among adolescents in Lebanon: the traditional Lebanese and the Western, with the latter pattern being associated with an increased risk of overweight. The findings of this study may be used to guide the development of evidence-based preventive nutrition interventions to curb the obesity epidemic in this age group.

Women of childbearing age are particularly vulnerable to the adverse effects of elevated blood pressure (BP), with dietary and lifestyle habits being increasingly recognized as important modifiable environmental risk factors for this condition. Using data from the National STEPwise survey conducted in Qatar in year 2012, we aimed to examine lifestyle patterns and their association with elevated BP among Qatari women of childbearing age (18–45 years). Socio-demographic, lifestyle, dietary, anthropometric and BP data were used (n = 747). Principal component factor analysis was applied to identify the patterns using the frequency of consumption of 13 foods/food groups, physical activity level, and smoking status. Multivariate logistic regression analyses were used to evaluate the association of the identified lifestyle patterns with elevated BP and to examine the socio-demographic correlates of these patterns. Three lifestyle patterns were identified: a “healthy” pattern characterized by intake of fruits, natural juices, and vegetables, a “fast food &amp, smoking” pattern characterized by fast foods, sweetened beverages, and sweets, in addition to smoking, and a “traditional sedentary” pattern which consisted of refined grains, dairy products, and meat in addition to low physical activity. The fast food &amp, smoking and the traditional &amp, sedentary patterns were associated with an approximately 2-fold increase in the risk of elevated BP in the study population. The findings of this study highlight the synergistic effect that diet, smoking and physical inactivity may have on the risk of elevated BP among Qatari women.

The Eastern Mediterranean Region (EMR) is undergoing social and economic changes that may impact the nutritional status of children living in its countries. The objective of this review is to evaluate the nutritional status and dietary intakes of children (0-12 years) in selected EMR countries, namely, Jordan, Lebanon, Kingdom of Saudi Arabia (KSA), and the United Arab Emirates. MedLine, PubMed, Scopus, and Google Scholar were searched for relevant articles published between 1990 and 2016; international organizations and governmental websites were also searched. Stunting in the region was estimated at 7.3% to 9.3%, wasting at 1.1% to 11.8%, and underweight at 1.6% to 5.3%. In contrast, overweight and obesity affected 19% to 21% of school-aged children from Lebanon and KSA. Available biochemical data showed that pediatric anemia, vitamin A, and vitamin D deficiencies remain a challenge in the region. Dietary intake studies have identified inadequate intakes of iron, calcium, zinc, folic acid, vitamin A, and vitamin D, concurrently with high intakes of fat, saturated fat, and sugar. This review provides valuable insight into the nutrition situation of children in 2 major areas of the EMR, the Levant and the Gulf, and identified several gaps and challenges in existing nutritional assessment studies. Key issues include the triple burden of malnutrition in this age group (underweight, nutrient inadequacies, and overweight/obesity), while calling for integrated action to improve the nutritional status of children in countries of the region. Opportunities for future research include nationwide nutritional and dietary surveys in countries where the largest data gaps remain such as the United Arab Emirates and KSA.

ObjectiveTo (i) estimate the consumption of minimally processed, processed and ultra-processed foods in a sample of Lebanese adults; (ii) explore patterns of intakes of these food groups; and (iii) investigate the association of the derived patterns with cardiometabolic risk.DesignCross-sectional survey. Data collection included dietary assessment using an FFQ and biochemical, anthropometric and blood pressure measurements. Food items were categorized into twenty-five groups based on the NOVA food classification. The contribution of each food group to total energy intake (TEI) was estimated. Patterns of intakes of these food groups were examined using exploratory factor analysis. Multivariate logistic regression analysis was used to evaluate the associations of derived patterns with cardiometabolic risk factors.SettingGreater Beirut area, Lebanon.SubjectsAdults ≥18 years (n302) with no prior history of chronic diseases.ResultsOf TEI, 36·53 and 27·10 % were contributed by ultra-processed and minimally processed foods, respectively. Two dietary patterns were identified: the ‘ultra-processed’ and the ‘minimally processed/processed’. The ‘ultra-processed’ consisted mainly of fast foods, snacks, meat, nuts, sweets and liquor, while the ‘minimally processed/processed’ consisted mostly of fruits, vegetables, legumes, breads, cheeses, sugar and fats. Participants in the highest quartile of the ‘minimally processed/processed’ pattern had significantly lower odds for metabolic syndrome (OR=0·18, 95 % CI 0·04, 0·77), hyperglycaemia (OR=0·25, 95 % CI 0·07, 0·98) and low HDL cholesterol (OR=0·17, 95 % CI 0·05, 0·60).ConclusionsThe study findings may be used for the development of evidence-based interventions aimed at encouraging the consumption of minimally processed foods.

Sodium intake is high in Lebanon, a country of the Middle East region where rates of cardiovascular diseases are amongst the highest in the world. This study examines salt-related knowledge, attitude and self-reported behaviors amongst adult Lebanese consumers and investigates the association of socio-demographic factors, knowledge and attitudes with salt-related behaviors. Using a multicomponent questionnaire, a cross-sectional study was conducted in nine supermarkets in Beirut, based on systematic random sampling (n = 442). Factors associated with salt-related behaviors were examined by multivariate regression analysis. Specific knowledge and attitude gaps were documented with only 22.6% of participants identifying processed foods as the main source of salt, 55.6% discerning the relationship between salt and sodium, 32.4% recognizing the daily limit of salt intake and 44.7% reporting being concerned about the amount of salt in their diet. The majority of participants reported behavioral practices that increase salt intake with only 38.3% checking for salt label content, 43.7% reporting that their food purchases are influenced by salt content and 38.6% trying to buy low-salt foods. Knowledge, attitudes and older age were found to significantly predict salt-related behaviors. Findings offer valuable insight on salt-related knowledge, attitude and behaviors in a sample of Lebanese consumers and provide key information that could spur the development of evidence-based salt-reduction interventions specific to the Middle East.

ObjectiveTo assess the validity and reliability of the Arabic version of the Household Food Insecurity Access Scale (HFIAS) in rural Lebanon.DesignA cross-sectional study on a sample of households with at least one child aged 0–2 years. In a one-to-one interview, participants completed an adapted Arabic version of the HFIAS. In order to evaluate the validity of the HFIAS, basic sociodemographic information, anthropometric measurements of the mother and child, and dietary intake data of the child were obtained. In order to examine reproducibility, the HFIAS was re-administered after 3 months.SettingRural Lebanon.SubjectsMother and child pairs (n 150).ResultsFactor analysis of HFIAS items revealed two factors: ‘insufficient food quality’ and ‘insufficient food quantity’. Using Pearson's correlation, food insecurity was inversely associated with mother's and father's education levels, number of cars and electrical appliances in the household, income, weight-for-age and length-for-age of the child and the child's dietary adequacy. In contrast, mother's BMI and crowding index were positively associated with food insecurity scores (P < 0·05 for all correlations). Cronbach's α of the scale was 0·91. A moderate correlation was observed between the two administrations of the questionnaire (intra-class correlation = 0·58; P < 0·05).ConclusionsOur findings indicated that the adapted Arabic version of the HFIAS is a valid and reliable tool to assess food insecurity in rural Lebanon, lending further evidence to the utility of the HFIAS in assessing food insecurity in culturally diverse populations.

The Eastern Mediterranean region is characterized by one of the highest burdens of paediatric obesity worldwide. This study aims at examining dietary, lifestyle, and socio-economic correlates of overweight, obesity, and abdominal adiposity amongst children and adolescents in Lebanon, a country of the Eastern Mediterranean basin. A nationally representative cross-sectional survey was conducted on 6–19-year-old subjects (n = 868). Socio-demographic, lifestyle, dietary, and anthropometric data (weight, height, waist circumference) were collected. Overweight and obesity were defined based on BMI z-scores. Elevated waist circumference (WC) and elevated waist to height ratio (WHtR) were used as indices of abdominal obesity. Of the study sample, 34.8% were overweight, 13.2% were obese, 14.0% had elevated WC, and 21.3% had elevated WHtR. Multivariate logistic regression analyses showed that male gender, maternal employment, residence in the capital Beirut, sedentarity, and higher consumption of fast food and sugar sweetened beverages were associated with increased risk of obesity, overweight, and abdominal adiposity, while regular breakfast consumption, higher intakes of milk/dairies and added fats/oils were amongst the factors associated with decreased risk. The study’s findings call for culture-specific intervention strategies for the promotion of physical activity, healthy lifestyle, and dietary practices amongst Lebanese children and adolescents.

This study aimed to examine the proportion and socio-demographic correlates of Metabolically Healthy Overweight and Obesity (MHOv/O) among Lebanese adults and to investigate the independent effect of previously identified dietary patterns on odds of MHOv/O. Data were drawn from the National Nutrition and Non-Communicable Disease Risk Factor Survey (Lebanon 2008–2009). Out of the 337 adult participants who had complete socio-demographic, lifestyle, dietary as well as anthropometric and biochemical data, 196 had a BMI ≥ 25 kg/m2 and their data were included in this study. MHOv/O was identified using the Adult Treatment Panel criteria. Dietary patterns previously derived in this study population were: Fast Food/Dessert, Traditional-Lebanese and High-Protein. The proportion of MHOv/O in the study sample was 37.2%. Females, higher education and high level of physical activity were positively associated with odds of MHOv/O. Subjects with higher adherence to the Traditional-Lebanese pattern had higher odds of MHOv/O (OR: 1.83, 95% CI: 1.09–3.91). No significant associations were observed between the Fast Food/Dessert and the high-protein patterns with MHOv/O. Follow-up studies are needed to confirm those findings and understand the mechanisms by which the Traditional-Lebanese pattern may exert a protective effect in this subgroup of overweight and obese adults.

To develop and cross-validate bioelectrical impedance analysis (BIA) prediction equations of total body water (TBW) and fat-free mass (FFM) for Asian pre-pubertal children from China, Lebanon, Malaysia, Philippines and Thailand.Height, weight, age, gender, resistance and reactance measured by BIA were collected from 948 Asian children (492 boys and 456 girls) aged 8-10 years from the five countries. The deuterium dilution technique was used as the criterion method for the estimation of TBW and FFM. The BIA equations were developed using stepwise multiple regression analysis and cross-validated using the Bland-Altman approach.The BIA prediction equation for the estimation of TBW was as follows: TBW=0.231 × height(2)/resistance+0.066 × height+0.188 × weight+0.128 × age+0.500 × sex-0.316 × Thais-4.574 (R (2)=88.0%, root mean square error (RMSE)=1.3 kg), and for the estimation of FFM was as follows: FFM=0.299 × height(2)/resistance+0.086 × height+0.245 × weight+0.260 × age+0.901 × sex-0.415 × ethnicity (Thai ethnicity =1, others = 0)-6.952 (R (2)=88.3%, RMSE=1.7 kg). No significant difference between measured and predicted values for the whole cross-validation sample was found. However, the prediction equation for estimation of TBW/FFM tended to overestimate TBW/FFM at lower levels whereas underestimate at higher levels of TBW/FFM. Accuracy of the general equation for TBW and FFM was also valid at each body mass index category.Ethnicity influences the relationship between BIA and body composition in Asian pre-pubertal children. The newly developed BIA prediction equations are valid for use in Asian pre-pubertal children.

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Aim: To examine the burden of cardiovascular disease (CVD) risk factors in Middle East and North Africa countries and their associations with dietary behaviors as nutrition transition is unfolding in the region. Data: Data on CVD risk factors were collected from scholarly papers and a systematic review of published articles was performed. Dietary patterns were derived from the WHO Food and Agriculture Organization Statistical Databases. Results: Wide variations exist across countries in the prevalence of CVD risk factors, namely obesity, diabetes, hypertension, hyperlipidemia, smoking and physical inactivity, with some countries showing high values of certain factors which approach those observed in the developed world. In particular, obesity prevalence rates have reached alarming levels, particularly among women in the oil-rich countries (over 40%), making it the most pressing health concern in the region. Trends in the dietary pattern illustrated a consistent rise in total energy supply by approximately 730 kcal per capita per day between 1970 and 2005. Dietary patterns showed an increased consumption of fat and animal protein and a decreased intake of carbohydrates, particularly whole grain cereals, and fresh fruits and vegetables. Conclusion: Regional differences were attributed to differences in lifestyle, occupation and a shift from traditional food habits. Our understanding of the CVD disparities across various geographic regions is key to our effort in planning relevant intervention programs. Public health efforts should focus on obesity, physical inactivity and unhealthy dietary practices. The success of these interventions depends on governmental commitment, multisectoral partnership and a consideration of the sociocultural norms of the target population.

Background/Aims: Ethnic-based associations between obesity and the metabolic syndrome (MS) have been suggested. The prevalence of MS in obese children was found to range between 13.9 and 48.8%, depending on the country of origin. This study was conducted to investigate the relationship between obesity and various components of MS in prepubertal children in Lebanon. Methods: Eighty-seven obese children (Tanner stage 1), 25 overweight and 28 normal-weight controls were recruited from private and public schools. Anthropometric, biochemical and blood pressure measurements were performed. Results: According to the modified Adult Treatment Panel III definition, the MS was identified in 26.4 and 4% of obese and overweight children, respectively, with a higher prevalence among girls than boys. The most common abnormalities among subjects with MS were elevated waist circumference (WC) (100.0%), high triglyceride (91.7%) and low high-density lipoprotein cholesterol (66.7%) levels. Insulin resistance was identified in 70% of obese children and 75% of those having the MS. Body mass index, WC and homeostasis model assessment of insulin resistance were significant determinants of the MS in this age group. Conclusion: MS was found in 26.4% of obese Lebanese children, thus underscoring the importance of early screening of obesity and its associated metabolic abnormalities and of developing successful multicomponent interventions addressing pediatric obesity and MS.

ObjectivesTo investigate, measure and assess the food consumption pattern of the adult population living in Beirut, Lebanon, and to identify inadequate or excessive intake of food groups particularly linked to non-communicable diseases.DesignA cross-sectional food consumption survey was conducted in 2001. Dietary habits were assessed by means of a quantitative food-frequency questionnaire.SettingDietary survey of the urban population (Beirut).SubjectsRandom sample of 444 adult subjects (aged 25–54 years) in Beirut.ResultsThe mean consumption of food by the study population was estimated to be 3030 g day−1, providing an energy intake of 2523.57 kcal day−1. Fat contributed 38.9% to the average daily energy intake, protein 13.4% and carbohydrates 47.2%. Mean consumption of fruits and vegetables was approximately 367 g day−1and 45.3% of subjects consumed less than the recommended 400 g daily. Cereals contributed 324.5 g day−1, providing 35.0% of daily energy intake, with bread being the most highly consumed (146.2 g day−1) in this food group. The mean intake of meat and poultry products was 91.7 g day−1and provided 8.8% of daily energy intake, with consumption of butchery products especially beef being the highest (47.6 g day−1) followed by poultry (36.1 g day−1). A low consumption of fish was noted (19.7 g day−1), with 73.6% of subjects consuming less than the recommended 2 servings of fish per week. Dairy products contributed 243.1 g day−1or 10.9% of daily energy intake, and milk was the least consumed dairy product (56.8% of consumers). The intake of added fats and oils, excluding those in cooked recipes, was 20.4 g day−1; olive oil was not used in cooking but was added solely at the table and its mean intake was 5 g day−1. The consumption of butter was low (0.86 g day−1) and vegetable oil was the type of fat mostly used in cooking. The average intake of alcoholic beverages was low (33.6 g day−1), accounting for 0.7% of total energy intake. Women had significantly higher intakes of milk, dairy products, vegetables and coffee than men (P< 0.05). The percentage of women who reported the use of low-fat items was significantly higher than that of men. Younger people (25–34 years) ate significantly more meat, sugar, alcoholic beverages and soft drinks, and consumed significantly less cooked vegetables and legumes, than older ones (P< 0.05).ConclusionsThe rather high contribution of fat to daily energy intake, the low intake of fish and the relatively high percentage of people consuming less than the recommended amount of fruits and vegetables observed in this study suggest that the adult Lebanese population is at increased risk of cardiovascular diseases, obesity and other non-communicable diseases, which provides the basis for recommending increased intakes of fish, particularly fatty fish, and fruits and vegetables.

Background The Middle East has one of the lowest rates of exclusive breastfeeding in the world, highlighting the need to promote breastfeeding in this region. Young adults represent a key population of interest, since decisions about infant-feeding appear to be made before children are even conceived. Objective To examine breastfeeding knowledge, attitude, and perceived behavior among female undergraduate students in Lebanon and Syria and determine factors associated with intention to breastfeed in this population. Methods This cross-sectional study was conducted in 2010/11 in Damascus and Beirut. Four universities were selected in each city. A multicomponent questionnaire was administered to a convenience sample of participants ( n = 194 from Beirut and n = 199 from Damascus). The questionnaire included breastfeeding knowledge (measured by the Infant Feeding Knowledge Test Form), attitude (Iowa Infant Feeding Attitude Scale), perceived behavior (Breastfeeding Behavior Questionnaire), and intention (Infant Feeding Intention Scale). Factors associated with intention to breastfeed were examined by multivariate linear regression analysis. Results The participants had an average breastfeeding knowledge level (mean score, 10.39 ± 2.09) and neutral perceived behavior (mean score, 22.00 ± 3.68), while having relatively positive attitudes (mean score, 58.12 ± 6.49). Knowledge gaps and negative perceptions were identified, particularly linked to breastfeeding in public and among working mothers. Breastfeeding intention was found to be significantly associated with knowledge and attitude in Lebanon (β = 0.103 and β = 0.230, respectively), and with perceived behavior in Syria (β = −0.135). Conclusions By revealing specific knowledge gaps and misconceptions and identifying country-specific disparities in the predictors of the intention to breastfeed, the findings of this study may provide a basis for devising culture-specific interventions aimed at promoting breastfeeding.

There is increasing evidence linking early life adiposity to disease risk later in life. This study aims at determining the prevalence and correlates of overweight and obesity among preschoolers in Lebanon. A national cross-sectional survey was conducted amongst 2–5 years old children (n = 525). Socio-demographic, lifestyle, dietary, and anthropometric data were obtained. The prevalence of overweight and obesity was estimated at 6.5% and 2.7%, respectively. Based on stepwise logistic regression for the prediction of overweight and obesity (combined), the variance accounted for by the first block (socioeconomic, parental characteristics) was 11.9%, with higher father’s education (OR = 5.31, 95% CI: 1.04–27.26) and the presence of household helper (OR = 2.19, 95% CI: 1.05–4.56) being significant predictors. The second block of variables (eating habits) significantly improved the prediction of overweight/obesity to reach 21%, with eating in front of the television (OR = 1.07, 95% CI: 1.02–1.13) and satiety responsiveness (OR = 0.83, 95% CI: 0.70–0.99) being significantly associated with overweight/obesity. In the third block, fat intake remained a significant predictor of overweight/obesity (OR = 2.31, 95% CI: 1.13–4.75). This study identified specific risk factors for preschool overweight/obesity in Lebanon and characterized children from high socioeconomic backgrounds as important target groups for preventive interventions. These findings may be of significance to other middle-income countries in similar stages of nutrition transition.

This study evaluates total water intake (TWI) from plain water, beverages and foods among Lebanese children and compares TWI to dietary reference intakes (DRIs). In a national cross-sectional survey, data on demographic, socioeconomic, anthropometric, and physical activity characteristics were obtained from 4 to 13-year-old children (n = 752). Food and beverage consumption patterns were assessed using a validated food-frequency questionnaire. TWI was estimated at 1651 mL/day, with beverages contributing 72% of the TWI compared to 28% from foods. Beverages with the highest contribution to TWI included plain water, fruit juice and soda. A significantly higher proportion of 9–13-year-old children failed to meet the DRIs compared to 4–8 years old (92%–98% vs. 74%). Gender differentials were observed with a significantly higher proportion of boys meeting the DRIs compared to girls. The water to energy ratio ranged between 0.84 and 0.87, which fell short of meeting the desirable recommendations. In addition, children from higher socioeconomic status had higher intakes of water from milk and bottled water, coupled with lower water intakes from sodas. The study findings show an alarming high proportion of Lebanese children failing to meet TWI recommendations, and call for culture-specific interventions to instill healthy fluid consumption patterns early in life.

Background In Lebanon, Type 2 diabetes (T2D) has a major public health impact through high disease prevalence, significant downstream pathophysiologic effects, and enormous financial liabilities. Diet is an important environmental factor in the development and prevention of T2D. Dietary patterns may exert greater effects on health than individual foods, nutrients, or food groups. The objective of this study is to examine the association between dietary patterns and the odds of T2D among Lebanese adults. Methods Fifty-eight recently diagnosed cases of T2D and 116 population-based age, sex, and place of residence matched control participants were interviewed. Data collection included a standard socio-demographic and lifestyle questionnaire. Dietary intake was evaluated by a semi-quantitative 97-item food frequency questionnaire. Anthropometric measurements including weight, height, waist circumference, and percent body fat were also obtained. Dietary patterns were identified by factor analysis. Multivariate logistic regression analysis was used to evaluate the associations of extracted patterns with T2D. Pearson correlations between these patterns and obesity markers, energy, and nutrient intakes were also examined. Results Four dietary patterns were identified: Refined Grains & Desserts, Traditional Lebanese, Fast Food and Meat & Alcohol. While scores of the “Refined Grains & Desserts” had the highest correlations with energy (r = 0.74) and carbohydrates (r = 0.22), those of the “Fast Food” had the highest correlation with fat intake (r = 0.34). After adjustment for socio-demographic and lifestyle characteristics, scores of the Refined Grains & Desserts and Fast Food patterns were associated with higher odds of T2D (OR: 3.85, CI: 1.13-11.23 and OR: 2.80, CI: 1.14-5.59; respectively) and scores of the Traditional Lebanese pattern were inversely associated with the odds of T2D (OR: 0.46, CI: 0.22-0.97). Conclusions The findings of this study demonstrate direct associations of the Refined Grains & Desserts and Fast Food patterns with T2D and an inverse association between the Traditional Lebanese pattern and the disease among Lebanese adults. These results may guide the development of nutrition interventions for the prevention and management of T2D among Lebanese adults.

BackgroundSocioeconomic status (SES) is postulated to be a major predictor of dietary intake and nutrition-related knowledge in adults. To date, very few studies have addressed this effect among adolescents.ObjectiveTo explore differences in nutrient intake and nutrition-related knowledge among adolescents of contrasting SES in Lebanon.MethodsIn a cross-sectional survey, 209 males and females, aged 17 to 19 years, were recruited from a private university with high tuition and a free public university in Beirut. The participants completed a multicomponent, self-administered questionnaire that inquired about demographic characteristics and nutrition-related knowledge. Three nonconsecutive 24-hour dietary recalls were obtained through interviews. Energy-adjusted means of dietary intake and age-adjusted nutrition-related knowledge were compared between groups using a general linear model.ResultsAdolescents in the high-SES group consumed more vegetables, meats, and fats and oils ( p < .05). Energy and nutrient intake analysis showed that adolescents in the high-SES group consumed significantly higher amounts of calories, protein, fat, vitamin A, vitamin C, and iron ( p ConclusionsAlthough both groups showed good nutrition-related knowledge, SES significantly affected dietary intake in a sample of Lebanese adolescents. This warrants consideration of other factors, such as cost and environment, that may modulate eating behavior among adolescents from different socioeconomic strata.

Suboptimal feeding patterns during the first two years of life are key determinants of malnutrition in children and constitute an important predictor of health in later years. Early-childhood nutritional factors, stunting, and obesity have been highlighted as prominent core underlying factors of Non-Communicable Disease (NCD) development whereas the improvement of complementary feeding practices has been cited as one of the most effective preventive strategies for reducing malnutrition and adult NCDs. In the MENA region NCD prevalence shows very high rates and the limited available studies show that current practices fall behind global recommendations. Common to all countries of this region are practices of mixed breast and bottle-feeding as early as the first month, as well as the premature introduction of complementary foods. Early introduction of non-milk fluids, such as sweetened water and herbal teas, has been described as a common practice in the region and the premature introduction of complementary foods has been reported in as high as 80% of infants in several of the countries. Thus, enhancing infant/young child health can significantly reduce morbidities and mortalities, as well as adult-onset diseases, ultimately decreasing the region's overall burden of disease.

Overweight and obesity in Asian children are increasing at an alarming rate; therefore a better understanding of the relationship between BMI and percentage body fat (%BF) in this population is important. A total of 1039 children aged 8–10 years, encompassing a wide BMI range, were recruited from China, Lebanon, Malaysia, The Philippines and Thailand. Body composition was determined using the 2H dilution technique to quantify total body water and subsequently fat mass, fat-free mass and %BF. Ethnic differences in the BMI–%BF relationship were found; for example, %BF in Filipino boys was approximately 2 % lower than in their Thai and Malay counterparts. In contrast, Thai girls had approximately 2·0 % higher %BF values than in their Chinese, Lebanese, Filipino and Malay counterparts at a given BMI. However, the ethnic difference in the BMI–%BF relationship varied by BMI. Compared with Caucasian children of the same age, Asian children had 3–6 units lower BMI at a given %BF. Approximately one-third of the obese Asian children (%BF above 25 % for boys and above 30 % for girls) in the study were not identified using the WHO classification and more than half using the International Obesity Task Force classification. Use of the Chinese classification increased the sensitivity. Results confirmed the necessity to consider ethnic differences in body composition when developing BMI cut-points and other obesity criteria in Asian children.

Purpose The main objective of this study was to evaluate the association between dietary patterns and the metabolic syndrome (MetS) and its metabolic abnormalities among Lebanese adults, using data from a national nutrition survey. Methods A cross-sectional analysis involving adults aged ≥18 years (n = 323) with no prior history of chronic diseases was conducted. Participants completed a brief sociodemographic and 61-item food frequency questionnaire. Anthropometric measurements and fasting blood samples were also obtained. The International Diabetes Federation criteria were used to classify study participants with the metabolic syndrome. Dietary patterns were identified by factor analysis. Multivariate logistic regression analysis was used to evaluate the associations of extracted patterns with MetS and its metabolic abnormalities. Results Out of 323 participants, 112 (34.6%) were classified as having MetS. Three dietary patterns were identified: “Fast Food/Dessert,” “Traditional Lebanese,” and “High Protein.” Compared with participants in the lowest quintile of the Fast Food/Dessert pattern, those in the highest quintile had significantly higher odds for MetS (OR, 3.13; 95% CI: 1.36–7.22) and hyperglycemia (OR, 3.81; 95% CI: 159–9.14). Subjects with the highest intake of the High Protein pattern had an increased risk for hypertension (OR, 2.98; 95% CI: 1.26–7.02). The Traditional Lebanese pattern showed no association with MetS or its components. Conclusions The findings of this study demonstrate a positive association of the Fast Food/Dessert pattern with MetS and hyperglycemia among Lebanese adults. These results may guide the development of improved preventive nutrition interventions in this adult population.