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The coronavirus (COVID-19) pandemic has had serious repercussions on the global economy, work force, and food systems. In Lebanon, the pandemic overlapped with an economic crisis, which threatened to exacerbate food insecurity (FI). The present study aims to evaluate the trends and projections of FI in Lebanon due to overlapping health and economic crises. Data from Gallup World Poll (GWP) 2015–2017 surveys conducted in Lebanon on nationally representative adults (n = 3000) were used to assess FI trends and explore its sociodemographic correlates. Predictive models were performed to forecast trends in FI (2018–2022), using GWP data along with income reduction scenarios to estimate the impact of the pandemic and economic crises. Pre crises, trend analyses showed that FI could reach 27% considering wave year and income. Post crises, FI was estimated to reach on average 36% to 39%, considering 50–70% income reduction scenarios among Lebanese population. FI projections are expected to be higher among females compared to males and among older adults compared to younger ones (p< 0.05). These alarming findings call for emergency food security policies and evidence-based programs to mitigate the burden of multiple crises on the FI of Lebanese households and promote resilience for future shocks.
Samer Kharroubi; Farah Naja; Marwa Diab-El-Harake; Lamis Jomaa. Food Insecurity Pre- and Post the COVID-19 Pandemic and Economic Crisis in Lebanon: Prevalence and Projections. Nutrients 2021, 13, 2976 .
AMA StyleSamer Kharroubi, Farah Naja, Marwa Diab-El-Harake, Lamis Jomaa. Food Insecurity Pre- and Post the COVID-19 Pandemic and Economic Crisis in Lebanon: Prevalence and Projections. Nutrients. 2021; 13 (9):2976.
Chicago/Turabian StyleSamer Kharroubi; Farah Naja; Marwa Diab-El-Harake; Lamis Jomaa. 2021. "Food Insecurity Pre- and Post the COVID-19 Pandemic and Economic Crisis in Lebanon: Prevalence and Projections." Nutrients 13, no. 9: 2976.
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.
Farah Naja; Jennifer Ayoub; Samar Baydoun; Sahar Nassour; Pamela Zgheib; Lara Nasreddine. Development of national dietary and lifestyle guidelines for pregnant women in Lebanon. Maternal & Child Nutrition 2021, e13199 .
AMA StyleFarah Naja, Jennifer Ayoub, Samar Baydoun, Sahar Nassour, Pamela Zgheib, Lara Nasreddine. Development of national dietary and lifestyle guidelines for pregnant women in Lebanon. Maternal & Child Nutrition. 2021; ():e13199.
Chicago/Turabian StyleFarah Naja; Jennifer Ayoub; Samar Baydoun; Sahar Nassour; Pamela Zgheib; Lara Nasreddine. 2021. "Development of national dietary and lifestyle guidelines for pregnant women in Lebanon." Maternal & Child Nutrition , no. : e13199.
Background: Lockdown measures were implemented in many countries to limit the spread of the COVID-19 pandemic. However, such restrictions could precipitate unintended negative consequences on lifestyle behaviors. The main objective of this study was to investigate the prevalence and determinants of unhealthy behavior changes during the COVID-19 lockdown among residents of the United Arab Emirates (UAE). Methods: A cross-sectional web-based survey of adults residing in the UAE was carried out during lockdown (n = 2060). Using a multi-component questionnaire, the collected data included questions regarding the following lifestyle changes: Increased dietary intake, increased weight, decreased physical activity, decreased sleep, and increased smoking. An unhealthy lifestyle change score was calculated based on the number of unhealthy lifestyle changes each participant reported. In addition, sociodemographic and living conditions information was collected. Descriptive statistics as well as simple and multiple linear regression analyses were used to examine the prevalence and determinants of the unhealthy lifestyle changes considered in this study. Results: Among the unhealthy lifestyle changes examined, increased food intake was the most common (31.8%), followed by decreased physical activity (30%), increased weight (29.4%), decreased sleep (20.8%), and increased smoking (21%). In addition to identifying the correlates of each of the aforementioned lifestyle changes, the results of the multiple regression linear analyses revealed the following correlates for the overall unhealthy lifestyle change score: females (β = 0.32, CI: 0.22;0.42), living in an apartment (β = 0.12, CI: 0.003;0.23) and being overweight/obese (β = 0.24, CI: 0.15;0.32) had higher scores, while older adults (>40 years) had lower scores (β = −0.23, CI: −0.34;−0.12). Conclusions: The COVID-19 lockdown has resulted in a high prevalence of unhealthy lifestyle behaviors and practices among UAE residents. The findings of this study provided the evidence base for officials to design interventions targeting high-risk groups and aiming to improve healthy lifestyle factors among residents during the pandemic.
Hadia Radwan; Mahra Al Kitbi; Hayder Hasan; Marwa Al Hilali; Nada Abbas; Rena Hamadeh; Eman Saif; Farah Naja. Indirect Health Effects of COVID-19: Unhealthy Lifestyle Behaviors during the Lockdown in the United Arab Emirates. International Journal of Environmental Research and Public Health 2021, 18, 1964 .
AMA StyleHadia Radwan, Mahra Al Kitbi, Hayder Hasan, Marwa Al Hilali, Nada Abbas, Rena Hamadeh, Eman Saif, Farah Naja. Indirect Health Effects of COVID-19: Unhealthy Lifestyle Behaviors during the Lockdown in the United Arab Emirates. International Journal of Environmental Research and Public Health. 2021; 18 (4):1964.
Chicago/Turabian StyleHadia Radwan; Mahra Al Kitbi; Hayder Hasan; Marwa Al Hilali; Nada Abbas; Rena Hamadeh; Eman Saif; Farah Naja. 2021. "Indirect Health Effects of COVID-19: Unhealthy Lifestyle Behaviors during the Lockdown in the United Arab Emirates." International Journal of Environmental Research and Public Health 18, no. 4: 1964.
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 (18–65 years), the FFQ was administered at baseline (FFQ-1) and one year thereafter (FFQ-2); 2–3 24-h recalls (24-HRs)/season were collected for a total of 8–12 over four seasons. A subset (n = 67) provided a fasting blood sample in the fall. Spearman-correlation coefficients, Bland–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 α-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 β-carotene. Intra-class correlations for FFQ-1 and FFQ-2 ranged from 0.36 for β-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.
Raeda El Sayed Ahmad; Mariam Baroudi; Hibeh Shatila; Lara Nasreddine; Fatima Chokor; Rana Chehab; Michel Forman; Farah Naja. Validity and Reproducibility of a Culture-Specific Food Frequency Questionnaire in Lebanon. Nutrients 2020, 12, 3316 .
AMA StyleRaeda El Sayed Ahmad, Mariam Baroudi, Hibeh Shatila, Lara Nasreddine, Fatima Chokor, Rana Chehab, Michel Forman, Farah Naja. Validity and Reproducibility of a Culture-Specific Food Frequency Questionnaire in Lebanon. Nutrients. 2020; 12 (11):3316.
Chicago/Turabian StyleRaeda El Sayed Ahmad; Mariam Baroudi; Hibeh Shatila; Lara Nasreddine; Fatima Chokor; Rana Chehab; Michel Forman; Farah Naja. 2020. "Validity and Reproducibility of a Culture-Specific Food Frequency Questionnaire in Lebanon." Nutrients 12, no. 11: 3316.
Excessive Postpartum Weight Retention (PWR) is postulated to increase the risk of adverse health outcomes for mothers and offspring. Using data from the Mother and Infant Nutritional Assessment (MINA) cohort in Lebanon and Qatar, this study aimed to examine PWR and its determinants at 6 months after delivery. Pregnant women (n = 183) were recruited during their first trimester and were followed up through pregnancy and after delivery. During this period, face-to-face interviews as well as extraction from medical charts were conducted to collect data regarding the socioeconomic, anthropometric and dietary intake of participants. The mean PWR (kg) among participants was 3.1 ± 5.6 at delivery, and 3.3 ± 5.3 and 2.7 ± 4.7 at 4 and 6 months after delivery, respectively. Results of the multiple logistic regression analyses showed that a Qatari nationality and excessive GWG were associated with higher odds of a high PWR (above median) while an insufficient GWG had lower odds. After adjustment for energy, participants with a high PWR reported a greater intake of proteins, Trans fat, cholesterol, sodium and lower intakes of mono and polyunsaturated fat as compared to those with a low PWR (below median). These findings suggested priority areas for interventions to prevent excessive PWR amongst women of childbearing age in Lebanon and Qatar.
Lara Nasreddine; Jennifer Ayoub; Nada Abbas; Mariam Abdul Malik; Farah Naja. Postpartum Weight Retention and Its Determinants in Lebanon and Qatar: Results of the Mother and Infant Nutrition Assessment (MINA) Cohort. International Journal of Environmental Research and Public Health 2020, 17, 7851 .
AMA StyleLara Nasreddine, Jennifer Ayoub, Nada Abbas, Mariam Abdul Malik, Farah Naja. Postpartum Weight Retention and Its Determinants in Lebanon and Qatar: Results of the Mother and Infant Nutrition Assessment (MINA) Cohort. International Journal of Environmental Research and Public Health. 2020; 17 (21):7851.
Chicago/Turabian StyleLara Nasreddine; Jennifer Ayoub; Nada Abbas; Mariam Abdul Malik; Farah Naja. 2020. "Postpartum Weight Retention and Its Determinants in Lebanon and Qatar: Results of the Mother and Infant Nutrition Assessment (MINA) Cohort." International Journal of Environmental Research and Public Health 17, no. 21: 7851.
Background: Lockdown measures were implemented in many countries to limit the spread of the COVID-19 pandemic. However, such restrictions could precipitate unintended negative consequences on lifestyle behaviors. The main objective of this study was to investigate the prevalence and determinants of unhealthy behavior changes during the COVID-19 lockdown among residents of the United Arab Emirates (UAE).Methods: A cross-sectional web-based survey of adults residing in the UAE was carried out during lockdown (n=2060). Using a multi-component questionnaire, the collected data included questions regarding the following lifestyle changes: Increased dietary intake, increased weight, decreased physical activity, decreased sleep, and increased smoking. An unhealthy lifestyle change score was calculated based on the number of unhealthy lifestyle changes each participant reported. In addition, sociodemographic and living conditions information was collected. Descriptive statistics as well as simple and multiple linear regression analyses were used to examine the prevalence and determinants of the unhealthy lifestyle changes considered in this study.Results: Among the unhealthy lifestyle changes examined, increased food intake was the most common (31.8%), followed by decreased physical activity (30%), increased weight (29.4%), decreased sleep (20.8%), and increased smoking (21%). In addition to identifying the correlates of each of the aforementioned lifestyle changes, the results of the multiple regression linear analyses revealed the following correlates for the overall unhealthy lifestyle change score: females (β=0.32, CI: 0.22;0.42), living in an apartment (β=0.12, CI: 0.003;0.23) and being overweight/obese (β=0.24, CI: 0.15;0.32) had higher scores, while older adults (>40 years) had lower scores (β=-0.23, CI: -0.34;-0.12).Conclusion: The COVID-19 lockdown has resulted in a high prevalence of unhealthy lifestyle behaviors and practices among UAE residents. The findings of this study provided the evidence base for officials to design interventions targeting high-risk groups and aiming to improve healthy lifestyle factors among residents during the pandemic.
Hadia Radwan; Mahra Al Kitbi; Hayder Hasan; Marwa Al Hilali; Nada Abbas; Rena Hamadeh; Eman Rashid Saif; Farah Naja. Diet and Lifestyle Changes During COVID-19 Lockdown in the United Arab Emirates: Results of a Cross-Sectional Study. 2020, 1 .
AMA StyleHadia Radwan, Mahra Al Kitbi, Hayder Hasan, Marwa Al Hilali, Nada Abbas, Rena Hamadeh, Eman Rashid Saif, Farah Naja. Diet and Lifestyle Changes During COVID-19 Lockdown in the United Arab Emirates: Results of a Cross-Sectional Study. . 2020; ():1.
Chicago/Turabian StyleHadia Radwan; Mahra Al Kitbi; Hayder Hasan; Marwa Al Hilali; Nada Abbas; Rena Hamadeh; Eman Rashid Saif; Farah Naja. 2020. "Diet and Lifestyle Changes During COVID-19 Lockdown in the United Arab Emirates: Results of a Cross-Sectional Study." , no. : 1.
Objective: Examine the associations between household food insecurity (HFI) with sociodemographic, anthropometric and dietary intakes of mothers. Design: 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)). Setting: Lebanon. Participants: Mothers, nationally representative sample of Lebanese households with children (n 1204). Results: 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. Conclusions: 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.
Lamis H Jomaa; Farah A Naja; Samer A Kharroubi; Marwa H Diab-El-Harake; Nahla C Hwalla. Food insecurity is associated with compromised dietary intake and quality among Lebanese mothers: findings from a national cross-sectional study. Public Health Nutrition 2020, 23, 1 -13.
AMA StyleLamis H Jomaa, Farah A Naja, Samer A Kharroubi, Marwa H Diab-El-Harake, Nahla C Hwalla. Food insecurity is associated with compromised dietary intake and quality among Lebanese mothers: findings from a national cross-sectional study. Public Health Nutrition. 2020; 23 (15):1-13.
Chicago/Turabian StyleLamis H Jomaa; Farah A Naja; Samer A Kharroubi; Marwa H Diab-El-Harake; Nahla C Hwalla. 2020. "Food insecurity is associated with compromised dietary intake and quality among Lebanese mothers: findings from a national cross-sectional study." Public Health Nutrition 23, no. 15: 1-13.
The use of Complementary and Alternative Medicine (CAM) among Type 2 Diabetes Mellitus (T2DM) patients is increasing to manage the complexities of their condition, enhance their health, and ease complications. The burden of T2DM in the United Arab Emirates (UAE) coupled with the high prevalence of CAM use and its associated risks among patients with T2DM necessitated the investigation of the use of CAM by this patients’ population. The aim of this study is to examine the prevalence, types, and correlates of CAM use among T2DM patients in the UAE. Patients with T2DM attending the outpatient clinics in the two governmental hospitals in Dubai and Sharjah, UAE were invited to participate in a cross-sectional survey. Face-to-face interviews were conducted with participants to complete a multi-component questionnaire. The questionnaire comprised of three main sections: demographic data, diabetes-related information, and CAM use details. Data analysis employed descriptive statistics, univariate and multivariate logistic regression to assess the prevalence and correlates of CAM use. Two hundred forty-four T2DM patients completed the questionnaire (response rate: 80%). A total of 39.3% of participants were CAM users since diagnosis. After adjustment; the logistic regression results showed that CAM use was significantly associated with age, sex, education, employment, and having health insurance. The most commonly used type of CAM by participants were folk foods and herbs followed by spiritual and natural healing and vitamins and minerals supplements. The majority of CAM users were referred or encouraged to use CAM by family (42.7%), friends (25%) or social media (17.7%). Only 13.5% of participants used CAM because it was suggested by health care practitioners. Only 1 in four of CAM users disclosed CAM use to their treating physician. CAM use among T2DM patients in the UAE is considerably high. Health policy and decision-makers are encouraged to dedicate particular attention to facilitating proper regulation and integration of CAM within conventional medicine to protect the health and wellbeing of patients. A concerted effort by medical schools and public health authorities should be committed to educating health care providers and patients on the safe and effective use of CAM therapies.
Hadia Radwan; Hayder Hasan; Rena Hamadeh; Mona Hashim; Zeenat Abdulwahid; Mahboobeh Hassanzadeh Gerashi; Marwa Al Hilali; Farah Naja. Complementary and alternative medicine use among patients with type 2 diabetes living in the United Arab Emirates. BMC Complementary Medicine and Therapies 2020, 20, 1 -12.
AMA StyleHadia Radwan, Hayder Hasan, Rena Hamadeh, Mona Hashim, Zeenat Abdulwahid, Mahboobeh Hassanzadeh Gerashi, Marwa Al Hilali, Farah Naja. Complementary and alternative medicine use among patients with type 2 diabetes living in the United Arab Emirates. BMC Complementary Medicine and Therapies. 2020; 20 (1):1-12.
Chicago/Turabian StyleHadia Radwan; Hayder Hasan; Rena Hamadeh; Mona Hashim; Zeenat Abdulwahid; Mahboobeh Hassanzadeh Gerashi; Marwa Al Hilali; Farah Naja. 2020. "Complementary and alternative medicine use among patients with type 2 diabetes living in the United Arab Emirates." BMC Complementary Medicine and Therapies 20, no. 1: 1-12.
Background Ideally situated within the community, pharmacists can be involved in a broad range of health promotion campaigns including prevention of obesity. Limited evidence is available regarding their involvement in weight management in Lebanon, a country with escalating prevalence rate of obesity. Objective To examine the role of community pharmacists in weight management in Lebanon, specifically studying their beliefs, current practices, services, and knowledge. Methods Using a stratified random sampling approach, a cross sectional national survey of community pharmacists was conducted (n = 341, response rate 89%). At the pharmacy, and through a face-to-face interview, pharmacists completed a multi-component questionnaire that addressed, in addition to socio-demographic and work characteristics, their beliefs, practices, knowledge in relation to weight management. Frequencies and proportions were used to describe the data. Simple and multiple linear regression analyses were used to examine the determinants of knowledge in the study population. Results Over 80% of study participants agreed that they have an important role to play in weight management. However, 50% of pharmacists did not agree that weight loss products are well regulated and 81.1% thought that companies marketing weight loss products are making false promises. The majority of pharmacists always/often sold weight loss products (84.7%) and counseled their patients for diet (86.3%) and physical activity (91.7%). Despite taking weight and height measurements, 50% of pharmacists rarely/never calculated BMI. Among the pharmacists who reported side effects of weight loss products (46.5%), the majority (91.3%) did so to the pharmaceutical company. The knowledge of pharmacists was better for the use of weight loss products as opposed to their side effects and interactions. Significant predictors of knowledge were holding a Masters/ PhD degree in Pharmacy, graduating from a university inside Lebanon, obtaining weight management training within the academic degree, and receiving inquiries about weight management in the pharmacy more than once daily. Conclusions The results of the study provided important insights on the beliefs, practices and knowledge of community pharmacists in weight management in Lebanon. These findings could be used to inform the development of future evidence-based community pharmacists led weight management service provision nationally and internationally.
Mohamad Ali Hijazi; Hibeh Shatila; Abdalla El-Lakany; Hiba Al Rifai; Maha Aboul-Ela; Farah Naja. Role of community pharmacists in weight management: results of a national study in Lebanon. BMC Health Services Research 2020, 20, 386 -12.
AMA StyleMohamad Ali Hijazi, Hibeh Shatila, Abdalla El-Lakany, Hiba Al Rifai, Maha Aboul-Ela, Farah Naja. Role of community pharmacists in weight management: results of a national study in Lebanon. BMC Health Services Research. 2020; 20 (1):386-12.
Chicago/Turabian StyleMohamad Ali Hijazi; Hibeh Shatila; Abdalla El-Lakany; Hiba Al Rifai; Maha Aboul-Ela; Farah Naja. 2020. "Role of community pharmacists in weight management: results of a national study in Lebanon." BMC Health Services Research 20, no. 1: 386-12.
Background Suboptimum weight gain during pregnancy may carry long term health consequences for the infant or mother. Nutritional imbalances are well recognized as a determinant of gestational weight gain. Few studies examined the effect of dietary patterns on gestational weight gain, especially in countries undergoing nutrition transition, such as the United Arab Emirates. Objectives To characterize dietary patterns among pregnant women living in the UAE and examine their associations with gestational weight gain and gestational weight rate. Methodology Data were drawn from the Mother-Infant Study Cohort, a two-year prospective cohort study of pregnant women living in the United Arab Emirates, recruited during their third trimester (n = 242). Weight gain during pregnancy was calculated using data from medical records. The Institute of Medicine’s recommendations were used to categorize gestational weight gain and gestational weight gain rate into insufficient, adequate, and excessive. During face-to-face interviews, dietary intake was assessed using an 89-item culture-specific semi-quantitative food frequency questionnaire that referred to usual intake during pregnancy. Dietary patterns were derived by principal component analysis. Multiple logistic regression analyses were used to evaluate the associations of derived dietary patterns with gestational weight gain/gestational weight gain rate. Results Two dietary patterns were derived, a “Diverse” and a “Western” pattern. The “Diverse” pattern was characterized by higher intake of fruits, vegetables, mixed dishes while the “Western” pattern consisted of sweets and fast food. The “Western” pattern was associated with excessive gestational weight gain (OR:4.04,95% CI:1.07–15.24) and gestational weight gain rate (OR: 4.38, 95% CI:1.28–15.03) while the “Diverse” pattern decreased the risk of inadequate gestational weight gain (OR:0.24, 95% CI:0.06–0.97) and gestational weight gain rate (OR:0.28, 95% CI:0.09–0.90). Conclusion The findings of this study showed that adherence to a “Diverse” pattern reduced the risk of insufficient gestational weight gain/gestational weight gain rate, while higher consumption of the “Western” pattern increased the risk of excessive gestational weight gain/gestational weight gain rate. In view of the established consequences of gestational weight gain on the health of the mother and child, there is a critical need for health policies and interventions to promote a healthy lifestyle eating through a life course approach.
Leila Itani; Hadia Radwan; Mona Hashim; Hayder Hasan; Reyad Shaker Obaid; Hessa Al Ghazal; Marwa Al Hilali; Rana Rayess; Hamid Jan Jan Mohamed; Rena Hamadeh; Hiba Al Rifai; Farah Naja. Dietary patterns and their associations with gestational weight gain in the United Arab Emirates: results from the MISC cohort. Nutrition Journal 2020, 19, 1 -12.
AMA StyleLeila Itani, Hadia Radwan, Mona Hashim, Hayder Hasan, Reyad Shaker Obaid, Hessa Al Ghazal, Marwa Al Hilali, Rana Rayess, Hamid Jan Jan Mohamed, Rena Hamadeh, Hiba Al Rifai, Farah Naja. Dietary patterns and their associations with gestational weight gain in the United Arab Emirates: results from the MISC cohort. Nutrition Journal. 2020; 19 (1):1-12.
Chicago/Turabian StyleLeila Itani; Hadia Radwan; Mona Hashim; Hayder Hasan; Reyad Shaker Obaid; Hessa Al Ghazal; Marwa Al Hilali; Rana Rayess; Hamid Jan Jan Mohamed; Rena Hamadeh; Hiba Al Rifai; Farah Naja. 2020. "Dietary patterns and their associations with gestational weight gain in the United Arab Emirates: results from the MISC cohort." Nutrition Journal 19, no. 1: 1-12.
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Farah Naja; Rena Hamadeh. Nutrition amid the COVID-19 pandemic: a multi-level framework for action. European Journal of Clinical Nutrition 2020, 74, 1117 -1121.
AMA StyleFarah Naja, Rena Hamadeh. Nutrition amid the COVID-19 pandemic: a multi-level framework for action. European Journal of Clinical Nutrition. 2020; 74 (8):1117-1121.
Chicago/Turabian StyleFarah Naja; Rena Hamadeh. 2020. "Nutrition amid the COVID-19 pandemic: a multi-level framework for action." European Journal of Clinical Nutrition 74, no. 8: 1117-1121.
Background Little 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. Methods Data 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. Results In 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. Conclusions This 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.
Lara Nasreddine; Marie Claire Chamieh; Jennifer Ayoub; Nahla Hwalla; Abla-Mehio Sibai; Farah Naja. Sex disparities in dietary intake across the lifespan: the case of Lebanon. Nutrition Journal 2020, 19, 1 -18.
AMA StyleLara Nasreddine, Marie Claire Chamieh, Jennifer Ayoub, Nahla Hwalla, Abla-Mehio Sibai, Farah Naja. Sex disparities in dietary intake across the lifespan: the case of Lebanon. Nutrition Journal. 2020; 19 (1):1-18.
Chicago/Turabian StyleLara Nasreddine; Marie Claire Chamieh; Jennifer Ayoub; Nahla Hwalla; Abla-Mehio Sibai; Farah Naja. 2020. "Sex disparities in dietary intake across the lifespan: the case of Lebanon." Nutrition Journal 19, no. 1: 1-18.
To derive dietary patterns (DPs) of Lebanese adolescents (10–18 years) and evaluate associations between identified DPs and household food insecurity (HFI). Data on adolescents (n = 693) were drawn from a national survey conducted in 2015 on a representative sample of Lebanese households with children. In addition to a sociodemographic questionnaire, data collection included the validated Arabic-version of the Household Food Insecurity Access Scale, used to evaluate HFI. Dietary intake was assessed using a 187-item validated food frequency questionnaire. Associations between HFI scores and DPs were examined using multiple linear regressions. HFI was observed in 55.2% of the study sample. Two DPs were derived among adolescents: Western and Lebanese-Mediterranean (LM). The Western DP was characterized by higher consumption of sweetened beverages, fast foods, sweets, and refined grains, whereas the LM DP was characterized by higher intakes of fruits, vegetables, dairy products, and whole grains. Scores of the Western DP were negatively associated with fiber, calcium, iron, and vitamins A and D, while the LM DP scores were positively correlated with fiber, proteins, iron, calcium, and vitamins A and D (p < 0.01). LM DP scores were also negatively correlated with total fat, saturated and polyunsaturated fats, p < 0.05. After adjustment for sociodemographics, multiple linear regression showed that higher HFI scores were associated with lower adherence to LM DP among adolescents (β = − 0.026, 95% CI − 0.046, − 0.006). HFI was associated with lower adherence to the Mediterranean pattern among Lebanese adolescents. Preventive strategies are needed to promote better diet quality among food-insecure youth.
Farah Naja; Leila Itani; Samer Kharroubi; Marwa Diab El Harake; Nahla Hwalla; Lamis Jomaa. Food insecurity is associated with lower adherence to the Mediterranean dietary pattern among Lebanese adolescents: a cross-sectional national study. European Journal of Nutrition 2020, 59, 3281 -3292.
AMA StyleFarah Naja, Leila Itani, Samer Kharroubi, Marwa Diab El Harake, Nahla Hwalla, Lamis Jomaa. Food insecurity is associated with lower adherence to the Mediterranean dietary pattern among Lebanese adolescents: a cross-sectional national study. European Journal of Nutrition. 2020; 59 (7):3281-3292.
Chicago/Turabian StyleFarah Naja; Leila Itani; Samer Kharroubi; Marwa Diab El Harake; Nahla Hwalla; Lamis Jomaa. 2020. "Food insecurity is associated with lower adherence to the Mediterranean dietary pattern among Lebanese adolescents: a cross-sectional national study." European Journal of Nutrition 59, no. 7: 3281-3292.
Background Nutritional status of women during pregnancy has been considered an important prognostic indicator of pregnancy outcomes. Objectives To investigate the pattern of gestational weight gain (GWG) and gestational diabetes mellitus (GDM) and their risk factors among a cohort of Emirati and Arab women residing in the United Arab Emirates (UAE). A secondary objective was to investigate pre-pregnancy body mass index (BMI) and its socio-demographic correlates among study participants. Methods Data of 256 pregnant women participating in the cohort study, the Mother-Infant Study Cohort (MISC) were used in this study. Healthy pregnant mothers with no history of chronic diseases were interviewed during their third trimester in different hospitals in UAE. Data were collected using interviewer-administered multi-component questionnaires addressing maternal sociodemographic and lifestyle characteristics. Maternal weight, weight gain, and GDM were recorded from the hospital medical records. Results Among the study participants, 71.1% had inadequate GWG: 31.6% insufficient and 39.5% excessive GWG. 19.1% reported having GDM and more than half of the participants (59.4%) had a pre-pregnancy BMI ≥ 25 kg/m2. The findings of the multiple multinomial logistic regression showed that multiparous women had decreased odds of excessive gain as compared to primiparous [odds ratio (OR): 0.17; 95% CI: 0.05–0.54]. Furthermore, women with a pre-pregnancy BMI ≥ 25 kg/m2 had increased odds of excessive gain (OR: 2.23; 95%CI: 1.00–5.10) as compared to those with pre-pregnancy BMI < 25 kg/m2. Similarly, women who had a pre-pregnancy BMI ≥ 25 kg/m2 were at higher risk of having GDM (OR: 2.37; 95%CI: 1.10–5.12). As for the associations of women’s characteristics with pre-pregnancy BMI, age and regular breakfast consumption level were significant predictors of higher pre-pregnancy BMI. Conclusions This study revealed alarming prevalence rates of inadequate, mainly excessive, GWG and GDM among the MISC participants. Pre-pregnancy BMI was found a risk factor for both of these conditions (GWG and GDM). In addition, age and regular breakfast consumption were significant determinants of pre-pregnancy BMI. Healthcare providers are encouraged to counsel pregnant women to maintain normal body weight before and throughout pregnancy by advocating healthy eating and increased physical activity in order to reduce the risk of excessive weight gain and its associated complications.
Mona Hashim; Hadia Radwan; Hayder Hasan; Reyad Shaker Obaid; Hessa Al Ghazal; Marwa Al Hilali; Rana Rayess; Noor Chehayber; Hamid Jan Jan Mohamed; Farah Naja. Gestational weight gain and gestational diabetes among Emirati and Arab women in the United Arab Emirates: results from the MISC cohort. BMC Pregnancy and Childbirth 2019, 19, 1 -11.
AMA StyleMona Hashim, Hadia Radwan, Hayder Hasan, Reyad Shaker Obaid, Hessa Al Ghazal, Marwa Al Hilali, Rana Rayess, Noor Chehayber, Hamid Jan Jan Mohamed, Farah Naja. Gestational weight gain and gestational diabetes among Emirati and Arab women in the United Arab Emirates: results from the MISC cohort. BMC Pregnancy and Childbirth. 2019; 19 (1):1-11.
Chicago/Turabian StyleMona Hashim; Hadia Radwan; Hayder Hasan; Reyad Shaker Obaid; Hessa Al Ghazal; Marwa Al Hilali; Rana Rayess; Noor Chehayber; Hamid Jan Jan Mohamed; Farah Naja. 2019. "Gestational weight gain and gestational diabetes among Emirati and Arab women in the United Arab Emirates: results from the MISC cohort." BMC Pregnancy and Childbirth 19, no. 1: 1-11.
Many Mediterranean countries, including Lebanon, are experiencing a shift in food consumption away from the traditional Mediterranean diet (MD), concomitant with the escalating burden of non-communicable diseases and dwindling environmental resources. Objective: to examine the adherence to the MD and its association with environmental footprints (EFPs), including water use, energy use, and greenhouse gas (GHG) emissions, among Lebanese adults. Data of Lebanese adults were drawn from the national food consumption survey (n = 2610). Assessment of dietary intake was conducted using a food-frequency questionnaire. Adherence to the MD was examined using four published MD scores. Metrics for the EFPs were calculated using a review of existing life cycle assessments (LCAs). For all MD scores, less than 13% of participants were in the highest tertile. After adjustments for covariates, two of the MD scores were associated with lower water use. For GHG, significant inverse associations were observed with all MD scores. Energy use was not associated with MD scores. Overall, low adherence to the MD among Lebanese adults was observed, together with an inverse association between adherence to the MD and water use and GHG emissions. These findings support and enforce ongoing efforts that aim to increase adherence to the MD in order to address health issues, as well as tackle environmental sustainability.
Farah Naja; Leila Itani; Rena Hamade; Marie Claire Chamieh; Nahla Hwalla. Mediterranean Diet and its Environmental Footprints amid Nutrition Transition: The Case of Lebanon. Sustainability 2019, 11, 6690 .
AMA StyleFarah Naja, Leila Itani, Rena Hamade, Marie Claire Chamieh, Nahla Hwalla. Mediterranean Diet and its Environmental Footprints amid Nutrition Transition: The Case of Lebanon. Sustainability. 2019; 11 (23):6690.
Chicago/Turabian StyleFarah Naja; Leila Itani; Rena Hamade; Marie Claire Chamieh; Nahla Hwalla. 2019. "Mediterranean Diet and its Environmental Footprints amid Nutrition Transition: The Case of Lebanon." Sustainability 11, no. 23: 6690.
Human milk oligosaccharides (HMOs), phospholipids (PLs), and gangliosides (GAs) are components of human breast milk that play important roles in the development of the rapidly growing infant. The differences in these components in human milk from the United Arab Emirates (UAE) were studied in a cross-sectional trial. High-performance liquid chromatography‒mass spectrometry was used to determine HMO, PL, and GA concentrations in transitional (5-15 days) and mature (at 6 months post-partum) breast milk of mothers of the United Arab Emirates (UAE). The results showed that the average HMO (12 species), PL (7 species), and GA (2 species) concentrations quantified in the UAE mothers' transitional milk samples were (in mg/L) 8204 ± 2389, 269 ± 89, and 21.18 ± 11.46, respectively, while in mature milk, the respective concentrations were (in mg/L) 3905 ± 1466, 220 ± 85, and 20.18 ± 9.75. The individual HMO concentrations measured in this study were all significantly higher in transitional milk than in mature milk, except for 3 fucosyllactose, which was higher in mature milk. In this study, secretor and non-secretor phenotype mothers showed no significant difference in the total HMO concentration. For the PL and GA components, changes in the individual PL and GA species distribution was observed between transitional milk and mature milk. However, the changes were within the ranges found in human milk from other regions.
Paul McJarrow; Hadia Radwan; Lin Ma; Alastair K.H. MacGibbon; Mona Hashim; Hayder Hasan; Reyad Shaker Obaid; Farah Naja; Hamid Jan Jan Mohamed; Hessa Al Ghazal; Bertram Y. Fong. Human Milk Oligosaccharide, Phospholipid, and Ganglioside Concentrations in Breast Milk from United Arab Emirates Mothers: Results from the MISC Cohort. Nutrients 2019, 11, 2400 .
AMA StylePaul McJarrow, Hadia Radwan, Lin Ma, Alastair K.H. MacGibbon, Mona Hashim, Hayder Hasan, Reyad Shaker Obaid, Farah Naja, Hamid Jan Jan Mohamed, Hessa Al Ghazal, Bertram Y. Fong. Human Milk Oligosaccharide, Phospholipid, and Ganglioside Concentrations in Breast Milk from United Arab Emirates Mothers: Results from the MISC Cohort. Nutrients. 2019; 11 (10):2400.
Chicago/Turabian StylePaul McJarrow; Hadia Radwan; Lin Ma; Alastair K.H. MacGibbon; Mona Hashim; Hayder Hasan; Reyad Shaker Obaid; Farah Naja; Hamid Jan Jan Mohamed; Hessa Al Ghazal; Bertram Y. Fong. 2019. "Human Milk Oligosaccharide, Phospholipid, and Ganglioside Concentrations in Breast Milk from United Arab Emirates Mothers: Results from the MISC Cohort." Nutrients 11, no. 10: 2400.
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 < 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 < 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 < 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.
Lara Nasreddine; Jennifer J. Ayoub; Fatima Hachem; Jiana Tabbara; Abla M. Sibai; Nahla Hwalla; Farah Naja. Differences in Dietary Intakes among Lebanese Adults over a Decade: Results from Two National Surveys 1997–2008/2009. Nutrients 2019, 11, 1738 .
AMA StyleLara Nasreddine, Jennifer J. Ayoub, Fatima Hachem, Jiana Tabbara, Abla M. Sibai, Nahla Hwalla, Farah Naja. Differences in Dietary Intakes among Lebanese Adults over a Decade: Results from Two National Surveys 1997–2008/2009. Nutrients. 2019; 11 (8):1738.
Chicago/Turabian StyleLara Nasreddine; Jennifer J. Ayoub; Fatima Hachem; Jiana Tabbara; Abla M. Sibai; Nahla Hwalla; Farah Naja. 2019. "Differences in Dietary Intakes among Lebanese Adults over a Decade: Results from Two National Surveys 1997–2008/2009." Nutrients 11, no. 8: 1738.
Accumulating evidence has highlighted the role of maternal nutritional status on fetal development, birth outcomes and child health. The Mother and Infant Nutritional Assessment (MINA) cohort is a 3-year follow-up study of pregnant women and their children in Qatar and Lebanon. This study reports on the characteristics and determinants of pre-pregnancy BMI and Gestational Weight Gain (GWG) of MINA particiants, as well as birth outcomes. A total of 272 pregnant women were recruited during their first trimester from primary healthcare centers as well as private clinics in Beirut (n = 194) and Doha (n = 147). During the first visit, data collection included pre-pregnancy weight, sociodemographic and lifestyle characteristics. The weight before delivery and neonatal outcomes were extracted from the medical records. GWG was calculated as the difference between weight before delivery and pre-pregnancy weight and was classified into insufficient, adequate, and excessive, as per the IOM criteria. Overall, 42.1% of women had a pre-pregnancy BMI≥25 Kg/m2 (58% in Qatar vs 30.8% in Lebanon, p<0.001). Only 30.2% of women had adequate GWG, while 25.7% and 44.1% of women had insufficient and excessive GWG, respectively. In the cohort 68.7% of infants had a weight adequate-for-gestational age (AGA), 6.7% were SGA and 24.6% were LGA. The proportions of LGA were higher with greater GWG (p<0.05). After adjustment, Qatari women were 3 times more likely to be overweight or obese before pregnancy while a higher education level was associated with significantly lower odds of pre-pregnancy BMI≥25 Kg/m2. Pre-pregnancy BMI≥25 Kg/m2 and regular breakfast consumption were predictors of excessive GWG (OR: 3.20, CI: 1.48–6.91; OR: 2.84, CI: 1.15–7.02, respectively). The high prevalence of pre-pregnancy overweight and excessive GWG among MINA participants underscores the need for culture-specific intervention programs to promote healthy body weight in women of childbearing age, and prevent excessive weight gain during pregnancy.
Mariam Ali Abdulmalik; Jennifer J. Ayoub; Amira Mahmoud; Lara Nasreddine; Farah Naja; Mina Collaborators. Pre-pregnancy BMI, gestational weight gain and birth outcomes in Lebanon and Qatar: Results of the MINA cohort. PLOS ONE 2019, 14, e0219248 .
AMA StyleMariam Ali Abdulmalik, Jennifer J. Ayoub, Amira Mahmoud, Lara Nasreddine, Farah Naja, Mina Collaborators. Pre-pregnancy BMI, gestational weight gain and birth outcomes in Lebanon and Qatar: Results of the MINA cohort. PLOS ONE. 2019; 14 (7):e0219248.
Chicago/Turabian StyleMariam Ali Abdulmalik; Jennifer J. Ayoub; Amira Mahmoud; Lara Nasreddine; Farah Naja; Mina Collaborators. 2019. "Pre-pregnancy BMI, gestational weight gain and birth outcomes in Lebanon and Qatar: Results of the MINA cohort." PLOS ONE 14, no. 7: e0219248.
The scarcity of evidence-based research on non-communicable diseases (NCDs) among Syrian refugees has hampered efforts to address the high burden of these diseases in host countries. The objective of this study is to examine published research on NCDs among Syrian refugees in order to inform future research, practice, programs, and policy. . Using the scoping review framework proposed by Arksey et al., 17 different databases were searched to identify studies reporting on NCDs among Syrian refugees. The number of relevant documents found was 34, with the earliest going back to 2013-2 years after the beginning of the Syrian conflict. The majority of these documents were descriptive in nature and only two studies addressed the effectiveness of interventions in the management of NCDs. No studies investigated the prevention of these diseases. Furthermore, only 7 studies addressed the host community and only one research article, conducted in Lebanon, included subjects from the host community. The increasing number of documents over the past 5 years illustrates a growing interest in studying NCDs among Syrian refugees. Examination of the papers showed high prevalence of NCDs among Syrian refugees as well as unmet healthcare needs. The findings of this review highlighted the dire need for further research on the burden of NCDs among Syrian refugees. Future studies should diversify research design to include interventions, address the host community in addition to the refugees, tackle prevention as well as treatment of NCDs, and explore strategies to enhance the resilience of the host country's health system while ensuring quality of care for NCDs. The increasing momentum for research found in this review presents an opportunity to fill current knowledge gaps, which could result in preventing, controlling and ultimately reducing the burden of NCDs among Syrian refugees and their host communities.
Farah Naja; Hibeh Shatila; Maria El Koussa; Lokman Meho; Lilian Ghandour; Shadi Saleh. Burden of non-communicable diseases among Syrian refugees: a scoping review. BMC Public Health 2019, 19, 637 .
AMA StyleFarah Naja, Hibeh Shatila, Maria El Koussa, Lokman Meho, Lilian Ghandour, Shadi Saleh. Burden of non-communicable diseases among Syrian refugees: a scoping review. BMC Public Health. 2019; 19 (1):637.
Chicago/Turabian StyleFarah Naja; Hibeh Shatila; Maria El Koussa; Lokman Meho; Lilian Ghandour; Shadi Saleh. 2019. "Burden of non-communicable diseases among Syrian refugees: a scoping review." BMC Public Health 19, no. 1: 637.
Declining participation rates are impeding health research. Little is known about factors influencing the decision to participate in low- and middle-income countries (LMIC). Therefore, this paper reports on the various individual factors and their with contextual factors in influencing participation in research among pregnant women and the recommendations to enhance their recruitment in Lebanon. This study used a qualitative research design drawing on focus groups and in-depth interviews. The Theoretical Domain Framework guided data collection and analysis. The three participant groups included: Group 1-Pregnant women (n = 25) attending public pre-natal events and antenatal clinics in Beirut; Group 2-Pregnant women (n = 6) already enrolled in the ongoing Mother and Infant Nutritional Assessment birth cohort study; Group 3-Key informants (n = 13) including health care workers involved in recruiting pregnant women. Conversations were audio recorded, transcribed, translated into English, and thematically analyzed. Three main factors influencing participation were revealed, with each factor encompassing several sub-themes: (1) personal factors (altruism, self-confidence, personal interest in the topic, previous understanding of the nature and purpose of research, education level, and previous research experience), (2) contextual factors (societal factors, family and friends), and (3) study characteristics (burden of the study, ethical considerations, incentives, and research interpersonal skills and physician endorsement to participate). The results suggested a dynamic interaction among the identified factors, forming two intersecting axes, with a four-quadrant configuration. The y- and x-axes represented personal factors and contextual factors, respectively. Individuals positioned on the lower-left quadrant were the least likely to participate; those on the upper-right quadrant were the most likely to participate; while those on the upper-left and lower-right quadrants were indecisive. Study characteristics seemed to affect the decision of pregnant women to participate situated in any of the four quadrants. Specific recommendations to improve participation were also identified. Our findings suggested an interaction of personal factors, contextual factors, and study characteristics affecting subjects’ participation. This interaction integrates factors into a novel dynamic framework that could be used in future studies. The recommendations identified may help improve participation of pregnant women in health research hence enhancing the quality and generalizability of research findings in LMIC.
Jennifer J. Ayoub; Mina Collaborators; May Abiad; Michele R. Forman; Gladys Honein-AbouHaidar; Farah Naja. The interaction of personal, contextual, and study characteristics and their effect on recruitment and participation of pregnant women in research: a qualitative study in Lebanon. BMC Medical Research Methodology 2018, 18, 1 -13.
AMA StyleJennifer J. Ayoub, Mina Collaborators, May Abiad, Michele R. Forman, Gladys Honein-AbouHaidar, Farah Naja. The interaction of personal, contextual, and study characteristics and their effect on recruitment and participation of pregnant women in research: a qualitative study in Lebanon. BMC Medical Research Methodology. 2018; 18 (1):1-13.
Chicago/Turabian StyleJennifer J. Ayoub; Mina Collaborators; May Abiad; Michele R. Forman; Gladys Honein-AbouHaidar; Farah Naja. 2018. "The interaction of personal, contextual, and study characteristics and their effect on recruitment and participation of pregnant women in research: a qualitative study in Lebanon." BMC Medical Research Methodology 18, no. 1: 1-13.