Underweight, overweight, and obesity in childhood and adolescence are associated with adverse hea... more Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (...
The prevalence of childhood overweight and obesity among children is on the rise around the world... more The prevalence of childhood overweight and obesity among children is on the rise around the world. Meanwhile, comprehensive multi-sectorial approaches have been found to be e ective in improving nutritional status among children. Ajyal Salima is a public-private partnership (PPP) school-based nutrition and physical activity intervention program implemented in six Arab countries. Its objective is to promote healthy eating and physical activity habits among-year-old students. The stakeholders, involved with the implementation of the program, comprised () local authorities, ministries of Education and Health, and non-governmental organizations (NGOs) as public partners, () The American University of Beirut (AUB) as the academic/regional scientific partner, and () Nestlé as the private partner. The Ajyal Salima program encompasses four coordinated educational components: classroom sessions, family involvement, food service intervention, and training of trainers. The program's educational material has been culturally adapted to each country's needs, as well as pilot tested. This paper describes the strategies used to build the PPP framework of Ajyal Salima, and the role of each stakeholder. The Ajyal Salima program is an example of a promising and sustainable comprehensive PPP program to address childhood obesity, that can be exported to other countries in the region and globally.
The present experiment was designed to study the effect of a high-protein, highcarbohydrate diet ... more The present experiment was designed to study the effect of a high-protein, highcarbohydrate diet versus a high-protein, low-carbohydrate diet on in vivo postprandial glycogen and lipid synthesis of rats treated with prednisolone. Methods: Thirty-two 6-wk-old male Sprague-Dawley rats were randomly assigned to one of four equal groups: high-protein, high-carbohydrate; high-protein, high-carbohydrate with prednisolone; high-protein, low-carbohydrate; and high-protein, low-carbohydrate with prednisolone. Rats were sham operated or subcutaneously implanted with prednisolone pellets while being maintained on their respective diets (39% of energy from protein) for 6 wk. Food intake and body weight were monitored throughout the experiment. At the end of the feeding period, overnight-fasted rats were fed a test meal and injected with 3 H 2 O to measure in vivo rates of glycogen and lipid synthesis. Final plasma glucose, insulin, and triacylglycerol concentrations and hepatic glycogen content were also measured. Results: Results showed that hepatic glycogen content (milligrams per gram of liver) was similar across all four experimental groups. Total hepatic glycogen synthesis and its percentage synthesis via pyruvate (indirect pathway) were higher in rats maintained on the high-protein, high-carbohydrate diet compared with those on the high-protein, low-carbohydrate diet and this was not substantially affected by prednisolone administration. Hepatic and epididymal fat pad lipid syntheses were not altered by diet or prednisolone treatments. Conclusion: Under long-term high-protein conditions, prednisolone administration does not seem to affect hepatic glycogen synthesis, which was increased with the increased carbohydrate content of the diet.
Objectives The study aims to identify lifestyle patterns in a sample of Lebanese adults and exami... more Objectives The study aims to identify lifestyle patterns in a sample of Lebanese adults and examine the association of these patterns with Metabolically Healthy Overweight and Obesity (MHOv/O). Methods This study is based on a cross-sectional survey of Lebanese adults living in Greater Beirut area (n = 305), and which was conducted in 2014. Dietary intake assessment was performed using an 80-item semi-quantitative food frequency questionnaire. The identification of MHOv/O was based on the ATP-III criteria. Principal Component Factor Analysis was implemented to derive lifestyle patterns, including variables related to dietary intake, eating at home, alcohol consumption, drinking water, sleeping difficulties, smoking and physical activity. Results Two lifestyle patterns were identified in the study population: the "Unhealthy" pattern which was characterized by cigarette smoking, fast food, soft drinks and alcohol consumption . Eating at home loaded negatively on this pattern. The "Healthy" lifestyle pattern was characterized by positive loadings of food groups such as milk and dairy products, fruits and vegetables. Sleeping difficulties loaded negatively on this pattern, while physical activity had a positive loading. Multiple logistic regression analyses was performed. The results showed that subjects belonging to the 4th quartile of the "Healthy" pattern scores had higher odds of MHOv/O as compared to those in the 1st quartile (OR: 4.04, CI:1.26-13.01). Conclusions The findings of this study provided evidence on the combined effect of lifestyle factors in relation to cardiometabolic abnormalities that are complex and multifactorial in nature. The results highlighted the importance of focusing on 'holistic' lifestyle patterns modifications in designing and implementing culturally sensitive interventions in overweight and obese subjects. Funding Sources Lebanese National Council for Scientific Research; University Research Board at the American University of Beirut); Medical Practice Plan at the American University of Beirut.
Despite global efforts to promote healthy and sustainable diets, the nutrition transition witness... more Despite global efforts to promote healthy and sustainable diets, the nutrition transition witnessed among adolescents worldwide poses serious threats to health and environmental sustainability. The present study aimed to assess the change in environmental footprints (EFPs) associated with dietary intakes of adolescents in Lebanon between 1997 and 2009. Data of Lebanese adolescents (10-19 years old) were drawn from national food consumption surveys during two time periods (1997, n = 451; 2009, n = 527). Dietary assessments were conducted using 24-h dietary recalls. EFP metrics, including water, energy and greenhouse gas emissions (GHG), were derived using review of existing life-cycle analyses. All EFPs increased significantly between 1997 and 2009; meat and sugar-sweetened beverages were the top contributors to the increase in these EFPs. The changes in EFPs between the two years remained significant even after adjustment for energy and other correlates: water (β = 267.7, CI: 123.5; 411.9); energy (β = 4.3, CI: 2.09; 6.52) and GHG (β = 0.44, CI: 0.11; 0.76). Findings show significant dietary shifts among adolescents that can threaten the environmental sustainability of Lebanese diets. Interventions across the food system are needed to promote adherence to healthy and sustainable diets among adolescents.
This study evaluates total water intake (TWI) from plain water, beverages and foods among Lebanes... more 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.
Diminishing benefits of urban living for children and adolescents' growth and development NCD Ris... more Diminishing benefits of urban living for children and adolescents' growth and development NCD Risk Factor Collaboration (NCD-RisC)* Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being 1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.
The objective is to describe infant feeding practices and the nutritional status of infants under... more The objective is to describe infant feeding practices and the nutritional status of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with children under five years (July-October 2018), mothers with infants under six months were included in the analysis (n=114). Additionally, eleven focus groups 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 (EIBF) was low (31%), and exclusive breastfeeding (EBF) very low (24.6%). About one-fifth of the infants were suffering from anemia (20.5%) and 9.6% were wasted. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and EBF, in addition to receiving support from healthcare professionals and family members. Identified barriers included preterm deli...
High blood cholesterol is typically considered a feature of wealthy western countries1,2. However... more High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, an...
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesit... more From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory ...
At a time when the health benefits of the Mediterranean diet (MD) are pervasively recognised, a p... more 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....
Introduction: Micronutrient deficiencies and malnutrition during the first 1000 days of life can ... more 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. Hemoglo...
Background: Obesity is associated with increased risk for metabolic syndrome (MetS). Anthropometr... more Background: Obesity is associated with increased risk for metabolic syndrome (MetS). Anthropometric cutoffs derived for Caucasians may not be applicable to identify obesity in Middle Eastern populations. This study aims to (1) determine optimal cutoff values of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) for the prediction of MetS among Lebanese adults and (2) to evaluate the ability of the derived cutoffs in predicting MetS, in comparison with published cutoffs. Methods: A cross-sectional study involving adults aged ≥20 years (n = 305) with no history of chronic diseases was conducted. Data collection included sociodemographic characteristics, anthropometric measurements, and fasting blood samples. The International Diabetes Federation criteria were used to identify MetS. Receiver operating characteristic analyses were performed to determine optimal cutoff values. The ability of the derived cutoffs in predicting MetS was examined using multiple logistic regression analyses. Results: The derived cutoff values for men and women were 26.35 and 25.74 kg/m2 for BMI, 94 and 83 cm for WC, and 0.54 and 0.53 for WHtR, respectively. The use of the derived cutoffs improved the prediction of MetS compared to reference published cutoffs. In men, abdominal adiposity indicators performed better than BMI in predicting MetS, while in women, BMI, WC, and WHtR were all strong predictors. Conclusion: The study identified, for three anthropometric indices, the optimal cutoff values that identify MetS among Lebanese adults, hence responding to the need for ethnic-and population-specific cutoffs. Of interest, the study results documented gender differences in the association between anthropometric indices and MetS.
Objectives To derive dietary patterns (DPs) of Lebanese adolescents (10–18 years) and evaluate as... more Objectives To derive dietary patterns (DPs) of Lebanese adolescents (10–18 years) and evaluate associations between identified DPs and household food insecurity (HFI). Methods Data was drawn from a national survey on a representative sample of Lebanese households (n = 1204, 2015). HFI was assessed using a locally-validated, Arabic-translated version of the Household Food Insecurity Access Scale. Dietary intake was assessed using a 187-item locally-validated food frequency questionnaire. Principal component factor analysis was used to derive the DPs. Partial correlations were conducted to investigate the associations between DPs and macro- and micron-nutrient intakes (energy-adjusted). Multiple linear regression models were applied to examine the association between HFI scores and derived DPs. Results Two DPs were derived from the study population: Western and Lebanese-Mediterranean (LM). The Western DP was characterized by higher consumption of sweetened beverages, fast foods, sweet...
Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/anm_issues No. 2
Background: The decision to lose weight among adolescents is complex and is guided by a number of... more Background: The decision to lose weight among adolescents is complex and is guided by a number of body-related factors. This study examined the extent of agreement between actual weight, measured as body mass index, and self-perceived weight and assessed their relative importance in weight loss behaviour among Lebanese adolescents. Methods: Data on 278 adolescents aged 13-17 years were drawn from the nationwide Nutrition and Non-Communicable Disease Risk Factor Survey (Lebanon, 2009). Binary multivariable logistic regressions were conducted to test associations with "effort to lose weight" as the outcome variable, controlling for a number of potential confounders. Results: Close to 36% reported trying to lose weight. Around 21% and 13% were overweight and obese, respectively, and 40% and 10% perceived their weight as slightly high and very high, respectively. Inaccurate perceivers, those underestimating or overestimating their weight, constituted 39%, with overall percent agreement between actual and self-perceived weight being 60.8% (kappa statistic = 0.319, 95% CI [0.242, 0.396]). About a third of the overweight adolescents (30.5%) and more than half of the obese (56.8%) underestimated their weight. In the multivariable analysis, self-perceived weight was statistically significant and a stronger predictor of weight loss effort than body mass index (adjusted odds ratios = 14.42 and 6.42 for slightly high and very high perceived weight, respectively, compared to odds ratios = 1.47 and 2.31 for overweight and obese adolescents, respectively). Conclusion: Health professionals need to consider self-perceived weight in conjunction with actual weight in their pursuit of weight management goals and in planning prevention programmes that guide weight loss behaviours for adolescents.
This study investigated the effect of lifestyle patterns, as a combination of diet, physical acti... more This study investigated the effect of lifestyle patterns, as a combination of diet, physical activity and smoking, on Metabolic Syndrome (MetS) among Qatari women of childbearing age (n = 418), a population group particularly vulnerable to the health sequela of this syndrome. Using data from the National WHO STEPwise survey conducted in Qatar in 2012, Principal Component Factor Analysis was performed to derive lifestyle patterns with survey variables related to the frequency of consumption of 13 foods/food groups, physical activity levels, and smoking status. MetS was diagnosed using ATPIII criteria. Three lifestyle patterns were identified: 'High Risk' pattern, characterized by intakes of fast foods, sweets and sugar sweetened beverages, in addition to lower levels of physical activity and higher smoking prevalence; 'Prudent' pattern, driven mainly by higher intakes of fruits, vegetables, fish, and whole grains; and 'Traditional' pattern which included beans, meat, dairy products, and a low prevalence of smoking. Among these three lifestyle patterns, only the 'High Risk' was associated with MetS, whereby subjects belonging to the third tertile of this pattern's score had 2.5 times the odds of MetS compared to those belonging to the first tertile. The findings of this study demonstrated the synergy among high risk behaviors among Qatari women in increasing the odds of MetS; the latter being a major risk factor for cardiovascular diseases.
Underweight, overweight, and obesity in childhood and adolescence are associated with adverse hea... more Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (...
The prevalence of childhood overweight and obesity among children is on the rise around the world... more The prevalence of childhood overweight and obesity among children is on the rise around the world. Meanwhile, comprehensive multi-sectorial approaches have been found to be e ective in improving nutritional status among children. Ajyal Salima is a public-private partnership (PPP) school-based nutrition and physical activity intervention program implemented in six Arab countries. Its objective is to promote healthy eating and physical activity habits among-year-old students. The stakeholders, involved with the implementation of the program, comprised () local authorities, ministries of Education and Health, and non-governmental organizations (NGOs) as public partners, () The American University of Beirut (AUB) as the academic/regional scientific partner, and () Nestlé as the private partner. The Ajyal Salima program encompasses four coordinated educational components: classroom sessions, family involvement, food service intervention, and training of trainers. The program's educational material has been culturally adapted to each country's needs, as well as pilot tested. This paper describes the strategies used to build the PPP framework of Ajyal Salima, and the role of each stakeholder. The Ajyal Salima program is an example of a promising and sustainable comprehensive PPP program to address childhood obesity, that can be exported to other countries in the region and globally.
The present experiment was designed to study the effect of a high-protein, highcarbohydrate diet ... more The present experiment was designed to study the effect of a high-protein, highcarbohydrate diet versus a high-protein, low-carbohydrate diet on in vivo postprandial glycogen and lipid synthesis of rats treated with prednisolone. Methods: Thirty-two 6-wk-old male Sprague-Dawley rats were randomly assigned to one of four equal groups: high-protein, high-carbohydrate; high-protein, high-carbohydrate with prednisolone; high-protein, low-carbohydrate; and high-protein, low-carbohydrate with prednisolone. Rats were sham operated or subcutaneously implanted with prednisolone pellets while being maintained on their respective diets (39% of energy from protein) for 6 wk. Food intake and body weight were monitored throughout the experiment. At the end of the feeding period, overnight-fasted rats were fed a test meal and injected with 3 H 2 O to measure in vivo rates of glycogen and lipid synthesis. Final plasma glucose, insulin, and triacylglycerol concentrations and hepatic glycogen content were also measured. Results: Results showed that hepatic glycogen content (milligrams per gram of liver) was similar across all four experimental groups. Total hepatic glycogen synthesis and its percentage synthesis via pyruvate (indirect pathway) were higher in rats maintained on the high-protein, high-carbohydrate diet compared with those on the high-protein, low-carbohydrate diet and this was not substantially affected by prednisolone administration. Hepatic and epididymal fat pad lipid syntheses were not altered by diet or prednisolone treatments. Conclusion: Under long-term high-protein conditions, prednisolone administration does not seem to affect hepatic glycogen synthesis, which was increased with the increased carbohydrate content of the diet.
Objectives The study aims to identify lifestyle patterns in a sample of Lebanese adults and exami... more Objectives The study aims to identify lifestyle patterns in a sample of Lebanese adults and examine the association of these patterns with Metabolically Healthy Overweight and Obesity (MHOv/O). Methods This study is based on a cross-sectional survey of Lebanese adults living in Greater Beirut area (n = 305), and which was conducted in 2014. Dietary intake assessment was performed using an 80-item semi-quantitative food frequency questionnaire. The identification of MHOv/O was based on the ATP-III criteria. Principal Component Factor Analysis was implemented to derive lifestyle patterns, including variables related to dietary intake, eating at home, alcohol consumption, drinking water, sleeping difficulties, smoking and physical activity. Results Two lifestyle patterns were identified in the study population: the "Unhealthy" pattern which was characterized by cigarette smoking, fast food, soft drinks and alcohol consumption . Eating at home loaded negatively on this pattern. The "Healthy" lifestyle pattern was characterized by positive loadings of food groups such as milk and dairy products, fruits and vegetables. Sleeping difficulties loaded negatively on this pattern, while physical activity had a positive loading. Multiple logistic regression analyses was performed. The results showed that subjects belonging to the 4th quartile of the "Healthy" pattern scores had higher odds of MHOv/O as compared to those in the 1st quartile (OR: 4.04, CI:1.26-13.01). Conclusions The findings of this study provided evidence on the combined effect of lifestyle factors in relation to cardiometabolic abnormalities that are complex and multifactorial in nature. The results highlighted the importance of focusing on 'holistic' lifestyle patterns modifications in designing and implementing culturally sensitive interventions in overweight and obese subjects. Funding Sources Lebanese National Council for Scientific Research; University Research Board at the American University of Beirut); Medical Practice Plan at the American University of Beirut.
Despite global efforts to promote healthy and sustainable diets, the nutrition transition witness... more Despite global efforts to promote healthy and sustainable diets, the nutrition transition witnessed among adolescents worldwide poses serious threats to health and environmental sustainability. The present study aimed to assess the change in environmental footprints (EFPs) associated with dietary intakes of adolescents in Lebanon between 1997 and 2009. Data of Lebanese adolescents (10-19 years old) were drawn from national food consumption surveys during two time periods (1997, n = 451; 2009, n = 527). Dietary assessments were conducted using 24-h dietary recalls. EFP metrics, including water, energy and greenhouse gas emissions (GHG), were derived using review of existing life-cycle analyses. All EFPs increased significantly between 1997 and 2009; meat and sugar-sweetened beverages were the top contributors to the increase in these EFPs. The changes in EFPs between the two years remained significant even after adjustment for energy and other correlates: water (β = 267.7, CI: 123.5; 411.9); energy (β = 4.3, CI: 2.09; 6.52) and GHG (β = 0.44, CI: 0.11; 0.76). Findings show significant dietary shifts among adolescents that can threaten the environmental sustainability of Lebanese diets. Interventions across the food system are needed to promote adherence to healthy and sustainable diets among adolescents.
This study evaluates total water intake (TWI) from plain water, beverages and foods among Lebanes... more 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.
Diminishing benefits of urban living for children and adolescents' growth and development NCD Ris... more Diminishing benefits of urban living for children and adolescents' growth and development NCD Risk Factor Collaboration (NCD-RisC)* Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being 1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.
The objective is to describe infant feeding practices and the nutritional status of infants under... more The objective is to describe infant feeding practices and the nutritional status of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with children under five years (July-October 2018), mothers with infants under six months were included in the analysis (n=114). Additionally, eleven focus groups 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 (EIBF) was low (31%), and exclusive breastfeeding (EBF) very low (24.6%). About one-fifth of the infants were suffering from anemia (20.5%) and 9.6% were wasted. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and EBF, in addition to receiving support from healthcare professionals and family members. Identified barriers included preterm deli...
High blood cholesterol is typically considered a feature of wealthy western countries1,2. However... more High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, an...
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesit... more From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory ...
At a time when the health benefits of the Mediterranean diet (MD) are pervasively recognised, a p... more 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....
Introduction: Micronutrient deficiencies and malnutrition during the first 1000 days of life can ... more 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. Hemoglo...
Background: Obesity is associated with increased risk for metabolic syndrome (MetS). Anthropometr... more Background: Obesity is associated with increased risk for metabolic syndrome (MetS). Anthropometric cutoffs derived for Caucasians may not be applicable to identify obesity in Middle Eastern populations. This study aims to (1) determine optimal cutoff values of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) for the prediction of MetS among Lebanese adults and (2) to evaluate the ability of the derived cutoffs in predicting MetS, in comparison with published cutoffs. Methods: A cross-sectional study involving adults aged ≥20 years (n = 305) with no history of chronic diseases was conducted. Data collection included sociodemographic characteristics, anthropometric measurements, and fasting blood samples. The International Diabetes Federation criteria were used to identify MetS. Receiver operating characteristic analyses were performed to determine optimal cutoff values. The ability of the derived cutoffs in predicting MetS was examined using multiple logistic regression analyses. Results: The derived cutoff values for men and women were 26.35 and 25.74 kg/m2 for BMI, 94 and 83 cm for WC, and 0.54 and 0.53 for WHtR, respectively. The use of the derived cutoffs improved the prediction of MetS compared to reference published cutoffs. In men, abdominal adiposity indicators performed better than BMI in predicting MetS, while in women, BMI, WC, and WHtR were all strong predictors. Conclusion: The study identified, for three anthropometric indices, the optimal cutoff values that identify MetS among Lebanese adults, hence responding to the need for ethnic-and population-specific cutoffs. Of interest, the study results documented gender differences in the association between anthropometric indices and MetS.
Objectives To derive dietary patterns (DPs) of Lebanese adolescents (10–18 years) and evaluate as... more Objectives To derive dietary patterns (DPs) of Lebanese adolescents (10–18 years) and evaluate associations between identified DPs and household food insecurity (HFI). Methods Data was drawn from a national survey on a representative sample of Lebanese households (n = 1204, 2015). HFI was assessed using a locally-validated, Arabic-translated version of the Household Food Insecurity Access Scale. Dietary intake was assessed using a 187-item locally-validated food frequency questionnaire. Principal component factor analysis was used to derive the DPs. Partial correlations were conducted to investigate the associations between DPs and macro- and micron-nutrient intakes (energy-adjusted). Multiple linear regression models were applied to examine the association between HFI scores and derived DPs. Results Two DPs were derived from the study population: Western and Lebanese-Mediterranean (LM). The Western DP was characterized by higher consumption of sweetened beverages, fast foods, sweet...
Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/anm_issues No. 2
Background: The decision to lose weight among adolescents is complex and is guided by a number of... more Background: The decision to lose weight among adolescents is complex and is guided by a number of body-related factors. This study examined the extent of agreement between actual weight, measured as body mass index, and self-perceived weight and assessed their relative importance in weight loss behaviour among Lebanese adolescents. Methods: Data on 278 adolescents aged 13-17 years were drawn from the nationwide Nutrition and Non-Communicable Disease Risk Factor Survey (Lebanon, 2009). Binary multivariable logistic regressions were conducted to test associations with "effort to lose weight" as the outcome variable, controlling for a number of potential confounders. Results: Close to 36% reported trying to lose weight. Around 21% and 13% were overweight and obese, respectively, and 40% and 10% perceived their weight as slightly high and very high, respectively. Inaccurate perceivers, those underestimating or overestimating their weight, constituted 39%, with overall percent agreement between actual and self-perceived weight being 60.8% (kappa statistic = 0.319, 95% CI [0.242, 0.396]). About a third of the overweight adolescents (30.5%) and more than half of the obese (56.8%) underestimated their weight. In the multivariable analysis, self-perceived weight was statistically significant and a stronger predictor of weight loss effort than body mass index (adjusted odds ratios = 14.42 and 6.42 for slightly high and very high perceived weight, respectively, compared to odds ratios = 1.47 and 2.31 for overweight and obese adolescents, respectively). Conclusion: Health professionals need to consider self-perceived weight in conjunction with actual weight in their pursuit of weight management goals and in planning prevention programmes that guide weight loss behaviours for adolescents.
This study investigated the effect of lifestyle patterns, as a combination of diet, physical acti... more This study investigated the effect of lifestyle patterns, as a combination of diet, physical activity and smoking, on Metabolic Syndrome (MetS) among Qatari women of childbearing age (n = 418), a population group particularly vulnerable to the health sequela of this syndrome. Using data from the National WHO STEPwise survey conducted in Qatar in 2012, Principal Component Factor Analysis was performed to derive lifestyle patterns with survey variables related to the frequency of consumption of 13 foods/food groups, physical activity levels, and smoking status. MetS was diagnosed using ATPIII criteria. Three lifestyle patterns were identified: 'High Risk' pattern, characterized by intakes of fast foods, sweets and sugar sweetened beverages, in addition to lower levels of physical activity and higher smoking prevalence; 'Prudent' pattern, driven mainly by higher intakes of fruits, vegetables, fish, and whole grains; and 'Traditional' pattern which included beans, meat, dairy products, and a low prevalence of smoking. Among these three lifestyle patterns, only the 'High Risk' was associated with MetS, whereby subjects belonging to the third tertile of this pattern's score had 2.5 times the odds of MetS compared to those belonging to the first tertile. The findings of this study demonstrated the synergy among high risk behaviors among Qatari women in increasing the odds of MetS; the latter being a major risk factor for cardiovascular diseases.
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