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.
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...
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.
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...
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