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Despite mounting evidence that dietary factors might have a protective role against risk of cancer, few studies have assessed the relationship between diet diversity with colorectal cancer (CRC) and colorectal adenoma (CRA). Thus, we examined the relationship between dietary diversity score (DDS) and the odds of CRC and CRA. Overall, 129 CRC diagnosed patients, 130 CRA diagnosed cases and 240 healthy hospitalised controls were studied. DDS was calculated based on information on the usual diet that was assessed by a valid and reliable food frequency questionnaire (FFQ). Multivariate logistic regression was used to estimate the relationship between DDS and odds of colorectal cancer and adenoma. After adjusting for potential confounders, the diversity of grains is associated with the increased odds of CRC (ORgrains: 2·96 (1·05–8·32); P = 0·032), while the diversity of vegetables and fruits are associated with decreased odds of CRC (ORvegetables: 0·31 (0·16–0·62); P = 0·001, ORfruits: 0·37 (0·23–0·61); P < 0·001). The diversity of vegetables, fruits and dairy are inversely associated with odds of CRA (ORvegetables: 0·41 (0·21–0·78); P = 0·007, ORfruits: 0·58 (0·36–0·93); P = 0·021, ORdairies: 0·56 (0·37–0·83); P = 0·004). Also, higher DDS was related to decreased odds of both CRC (OR: 0·41 (0·23–0·72); P for trend = 0·002) and CRA (OR: 0·36 (0·21–0·65); P for trend = 0·001). Our results indicated that higher dietary diversity and particularly a diet varied in fruits and vegetables may reduce the odds of CRC and CRA. Also, the consumption of dairy products may decrease the odds of CRC, whereas the consumption of grains may increase the odds of CRC.
To assess infant and young child feeding (IYCF) practices in Lebanon and investigate their associations with socio-demographic and lifestyle factors.
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.
Children aged 0–23 months and their mothers (n 469).
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.
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.
During the first 1000 d of life, gestational weight gain (GWG) and postpartum weight retention (PPWR) are considered critical determinants of nutritional status. This study examined the effect of adherence to the Mediterranean diet (MD) during pregnancy on GWG and PPWR at 2 and 6 months among women in the United Arab Emirates (UAE), using data from the Mother-Infant Study Cohort. The latter is a prospective study, for which pregnant women were recruited (n 243) during their third trimester and were followed up for 18 months. Data on socio-demographic characteristics and anthropometric measurements were obtained. An eighty-six-item FFQ was used to examine dietary intake during pregnancy. Adherence to the MD was assessed using the alternate MD (aMED) and the Lebanese MD (LMD). Adherence to the MD, PPWR2 (2 months) and PPWR6 (6 months) were considered high if participants belonged to the third tertile of the respective measures. Results indicated that 57·5 % of participants had excessive GWG while 50·7 % and 45 % retained ≥ 5 kg at 2 and 6 months postpartum, respectively. After adjustment, adherence to both MD scores was associated with lower odds of excessive GWG (aMED, OR:0·41, 95 % CI:0·18, 0·93; LMD, OR:0·40, 95 % CI: 0·16, 0·98). Adherence to MD was also associated with PPWR2 (aMED: OR: 0·23, 95 % CI: 0·06, 0·88) and PPWR6 (aMED OR:0·26; 95 % CI:0·08–0·86; LMD, OR:0·32; 95 % CI: 0·1, 0·98). The findings of this study showed that adherence to the MD may reduce GWG and PPWR and, hence, underscored the importance of promoting the MD for better health of the mother and infant.
Colorectal cancer (CRC) is the third and second most prevalent cancer in men and women, respectively. Various epidemiological studies indicated that dietary factors are implicated in the aetiology of CRC and its precursor, colorectal adenomas (CRA). Recently, much attention has been given to the role of acid–base balance in the development of chronic diseases including cancers. Therefore, the aim of the current study is to examine the association of diet-dependent acid load and the risk of CRC and CRA.
In this case–control study, potential renal acid load (PRAL) was computed based on dietary intake of participants assessed via a validated FFQ. Negative PRAL values indicated a base-forming potential, while positive values of PRAL implied acid-forming potential of diet. Logistic regression was used to derive OR and 95 % CI after adjusting for confounders.
A total of 499 participants aged 30–70 years were included in the study (240 hospital controls, 129 newly diagnosed CRC and 130 newly diagnosed CRA). The current study was conducted between December 2016 and September 2018.
After adjusting for potential confounders, a higher PRAL was associated with increased odds of CRC and CRA. The highest v. the lowest tertile of PRAL for CRC and CRA was OR 4·82 (95 % CI 2·51–9·25) and OR 2·47 (95 % CI 1·38–4·42), respectively.
The findings of the current study suggested that higher diet-dependent acid load is associated with higher risk of CRC and CRA.
Examine the associations between household food insecurity (HFI) with sociodemographic, anthropometric and dietary intakes of mothers.
Cross-sectional survey (2014–2015). In addition to a sociodemographic questionnaire, data collection included the validated Arabic version of the Household Food Insecurity Access Scale, which was used to evaluate HFI. Dietary intake was assessed using 24-h dietary recall of a single habitual day, and maternal BMI was calculated based on weight and height measurements. Associations between HFI and maternal dietary intake (food groups, energy and macronutrients’ intake) were examined. Simple and multiple logistic regression analyses were conducted to explore the associations between HFI status with odds of maternal overweight and measures of diet quality and diversity (Healthy Eating Index (HEI) and Minimum Dietary Diversity for Women of Reproductive Age (MDD-W)).
Mothers, nationally representative sample of Lebanese households with children (n 1204).
HFI was experienced among almost half of the study sample. Correlates of HFI were low educational attainment, unemployment and crowding. Significant inverse associations were observed between HFI and dietary HEI (OR 0·64, 95 % CI 0·46, 0·90, P = 0·011) and MDD-W (OR 0·6, 95 % CI 0·42, 0·85, P = 0·004), even after adjusting for socioeconomic correlates. No significant association was observed between HFI and odds of maternal overweight status.
HFI was associated with compromised maternal dietary quality and diversity. Findings highlight the need for social welfare programmes and public health interventions to alleviate HFI and promote overall health and wellbeing of mothers.
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 (n 2004), 2009 (n 3656) and 2015 (n 1204). 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-MED β = –0·16, 95 % CI –0·30, –0·01; LMD β = –0·42, 95 % CI –0·67, –0·17). Similar results were obtained when comparing survey year 2015 with 1997 (c-MED score β = –0·20, 95 % CI –0·33, –0·06; LMD score β = –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.
Food insecurity (FI) is a major public health problem in Lebanon, a small middle-income country with the highest refugee per capita concentration worldwide and prolonged political and economic challenges. The present study aimed to measure the prevalence and sociodemographic correlates of household FI and to explore the association of household FI with anthropometric measures of children and their mothers.
Cross-sectional survey (2014–2015).
Nationally representative sample of Lebanese households with 4–18-year-old-children and their mothers (n 1204).
FI prevalence (95 % CI), measured using the Arabic-translated, validated Household Food Insecurity Access Scale, was found to be 49·3 (44·0, 54·6) % in the study sample. Mild, moderate and severe FI were found in 7·0 (5·5, 9·2) %, 23·3 (20·1, 26·8) % and 18·9 (14·9, 23·5) % of households, respectively. Multiple regression analysis showed that low maternal and paternal education, unemployment and crowding were significant correlates of household FI (P<0·05). No significant associations were observed between FI and anthropometric measures of children and their mothers, after adjusting for other socio-economic correlates. Food-insecure households reported various mechanisms to cope with food shortage, such as reducing the number of meals/d (49·6 %), borrowing food (54·4 %), spending savings (34·5 %) and withdrawing children from schools (8·0 %).
FI exists among a remarkable proportion of Lebanese households with children. Correlates of household FI should be considered when designing social welfare policies and public health programmes to promote more sustainable, resilient and healthier livelihoods among vulnerable individuals.
To (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.
Cross-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.
Greater Beirut area, Lebanon.
Adults ≥18 years (n 302) with no prior history of chronic diseases.
Of 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).
The study findings may be used for the development of evidence-based interventions aimed at encouraging the consumption of minimally processed foods.
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.
To assess the validity and reliability of the Arabic version of the Household Food Insecurity Access Scale (HFIAS) in rural Lebanon.
A 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.
Mother and child pairs (n 150).
Factor 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).
Our 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.
To identify and characterize dietary patterns in Lebanon and assess their association with sociodemographic factors, BMI and waist circumference (WC).
A cross-sectional population-based survey. In a face-to-face interview, participants completed a brief sociodemographic and semiquantitative FFQ. In addition, anthropometric measurements were obtained following standard techniques. Dietary patterns were identified by factor analysis. Multivariate linear regression was used to assess determinants of the various patterns and their association with BMI and WC.
National Nutrition and Non-Communicable Disease Risk Factor Survey (2009), Lebanon.
A nationally representative sample of 2048 Lebanese adults aged 20–55 years.
Four dietary patterns were identified: ‘Western’, ‘Traditional Lebanese’, ‘Prudent’ and ‘Fish and alcohol’. Factor scores of the identified patterns increased with age, except for the Western pattern in which a negative association was noted. Women had higher scores for the prudent pattern. Adults with higher levels of education had significantly higher scores for the prudent pattern. The frequency of breakfast consumption was significantly associated with scores of both traditional Lebanese and prudent patterns. Multivariate-adjusted analysis revealed a positive association between scores of the Western pattern and the BMI and WC of study participants.
The findings show the presence of four distinct dietary patterns in the Lebanese population, which were associated with age, sex, education and meal pattern. Only the Western pattern was associated with higher BMI.
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