The International Physical Actvity Questionnaire (IPAQ) is a validated tool for physical activity assessment used in many countries however no Arabic version of the long-form of this questionnaire exists to this date. Hence, the aim of this study was to cross-culturally adapt and validate an Arabic version of the long International Physical Activity Questionnaire (AIPAQ) equivalent to the French version (F-IPAQ) in a Lebanese population. The guidelines for cross-cultural adaptation provided by the World Health Organization and the International Physical Activity Questionnaire committee were followed. One hundred fifty-nine students and staff members from Saint Joseph University of Beirut were randomly recruited to participate in the study. Items of the A-IPAQ were compared to those from the F-IPAQ for concurrent validity using Spearman’s correlation coefficient. Content validity of the questionnaire was assessed using factor analysis for the A-IPAQ’s items. The physical activity indicators derived from the A-IPAQ were compared with the body mass index (BMI) of the participants for construct validity. The instrument was also evaluated for internal consistency reliability using Cronbach’s alpha and Intraclass Correlation Coefficient (ICC). Finally, thirty-one participants were asked to complete the A-IPAQ on two occasions three weeks apart to examine its test–retest reliability. Bland-Altman analyses were performed to evaluate the extent of agreement between the two versions of the questionnaire and its repeated administrations. A high correlation was observed between answers of the F-IPAQ and those of the A-IPAQ, with Spearman’s correlation coefficients ranging from 0.91 to 1.00 (p < 0.05). Bland-Altman analysis showed a high level of agreement between the two versions with all values scattered around the mean for total physical activity (mean difference = 5.3 min/week, 95% limits of agreement = −145.2 to 155.8). Negative correlations were observed between MET values and BMI, independent of age, gender or university campus. The A-IPAQ showed a high internal consistency reliability with Cronbach’s alpha ranging from 0.769–1.00 (p < 0.001) and intraclass correlation coefficient (ICC) ranging from 0.625–0.999 (p < 0.001), except for a moderate agreement with the moderate garden/yard activity (alpha = 0.682; ICC = 0.518; p < 0.001). The A-IPAQ had moderate-to-good test-retest reliability for most of its items (ICC ranging from 0.66–0.96; p < 0.001) and the Bland-Altman analysis showed a satisfactory agreement between the two administrations of the A-IPAQ for total physical activity (mean difference = 99.8 min/week, 95% limits of agreement = −1105.3; 1304.9) and total vigorous and moderate physical activity (mean difference = −29.7 min/week, 95% limits of agreement = −777.6; 718.2). The modified Arabic version of the IPAQ showed acceptable validity and reliability for the assessment of physical activity among Lebanese adults. More studies are necessary in the future to assess its validity compared to a gold-standard criterion measure.

The country of Lebanon banned organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) in 1982 and 1997, respectively, and adopted the Stockholm Convention on persistent organic pollutants (POPs) in 2003. Compliance with the Stockholm Convention began immediately, and research related to POPs in Lebanon had already been completed. A National Implementation Plan for POPs was formulated and updated several times, and includes a national inventory of PCBs that were mainly detected in insulating oils and equipment in power stations. High levels of PCBs have also been detected in sediments from the Port of Tripoli, the second major sea port in Lebanon. High levels of OCPs, which are illegally smuggled into Lebanon and improperly handled and used by farmers, have been detected in underground and surface waters for many years. There have also been human biomonitoring studies of PCBs and OCPs; for example, in 1999, measurable amounts of DDE were found in breast milk, and a 2018 study reported measurable amounts of PCBs and OCPs in human serum. While these levels were well below concentrations observed in other countries, they were slightly higher than the levels observed by the National Health and Nutrition Examination Survey (NHANES). This review provides an overview of the available PCB and OCP data from Lebanon between 1999 and 2017. In total, 12 studies of PCBs and OCPs in environmental samples, human serum samples, and human milk samples are included in this review, and the results of these studies are compared in terms of geography and chronology.

Background: The food frequency questionnaire (FFQ) is the most frequently used method to assess dietary intake in epidemiological studies evaluating diet-disease association. The objective of this study was to validate a FFQ for use among Lebanese adults by evaluating various facets of validity and reproducibility. Methods: The quantitative 164-items FFQ was validated against the average of six 24-h dietary recalls (DRs) in a sample of 238 Lebanese adults. Reproducibility of the FFQ was assessed by administering it twice within 1 month’ time interval. Results: Positive statistically significant Pearson correlations were observed in most macro and micronutrients between the FFQ and the six 24-h DRs, ranging from 0.16 to 0.65, with two thirds of the correlation coefficients exceeding 0.3. Energy, gender, and age-adjusted statistically significant Pearson correlation coefficients ranged from 0.14 to 0.64, with two thirds of the coefficients exceeding 0.2. Intakes from the FFQ were mostly higher than those of the 24-h DRs. Mean percent difference between nutrient intakes from both dietary methods decreased remarkably after using energy-adjusted mean intakes. Values were acceptable to good for all macronutrients and several micronutrients. Cross-classification analysis revealed that around 64.3 to 83.9% of participants were classified into the same and adjacent quartile whereas grossly misclassified proportions ranged from 3.7 to 12.2%. Weighted kappa values ranged from 0.02 to 0.36 with most of them exceeding 0.2. In indirect validity analysis, key nutrient mean intakes estimated from the six 24-h DRs were significantly positively associated with tertiles of food groups derived from the FFQ. Bland Altman plots showed that the majority of data points fell within the limits of agreement (LOA) for all nutrients. As for reproducibility analysis, ICC values were all statistically significant ranging from 0.645 to 0.959 and Bland Altman plots confirmed these results. Conclusions: Based on various aspects of validity and reproducibility, and an extensive range of statistical tests, the present FFQ developed for a Lebanese community is an acceptable tool for dietary assessment and is useful for evaluating diet-disease associations in future studies.

Background: The understanding of per- and polyfluoroalkyl substances (PFAS) health effects is rapidly advancing among critical populations. Therefore, the objective of this study was to assess PFAS serum levels among Lebanese pregnant women, cord serum and human milk levels, their determinants, and effects on newborn anthropometry. Methods: We measured concentrations of six PFAS (PFHpA, PFOA, PFHxS, PFOS, PFNA and PFDA) using liquid chromatography MS/MS for 419 participants, of which 269 had sociodemographic, anthropometric, environmental and dietary information. Results: The percentage of detection for PFHpA, PFOA, PFHxS and PFOS was 36.3–37.7%. PFOA and PFOS levels (95th percentile) were higher than HBM-I and HBM-II values. While PFAS were not detected in cord serum, five compounds were detected in human milk. Multivariate regression showed that fish/shellfish consumption, vicinity to illegal incineration and higher educational level were associated with an almost twice higher risk of elevated PFHpA, PFOA, PFHxS and PFOS serum levels. Higher PFAS levels in human milk were observed with higher eggs and dairy products consumption, in addition to tap water (preliminary findings). Higher PFHpA was significantly associated with lower newborn weight-for-length Z-score at birth. Conclusions: Findings establish the need for further studies, and urgent action to reduce exposure among subgroups with higher PFAS levels.

Exposure to persistent organic pollutants (POPs) in the general population is 90% from food intake. Dietary patterns provide a global estimation of exposure to POPs, taking into account multiple food sources of environmental contaminants. To evaluate the association of dietary, socio-demographic, anthropometric, and lifestyle-related variables with clusters of polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs), in a sample of students and employees of Saint Joseph University of Beirut. A total of 302 participants were randomly recruited. Questionnaires covering dietary, socio-demographic, and lifestyle-related characteristics were administered. Anthropometric measurements were obtained. Serum concentrations of six indicator PCBs (PCB 28, 52, 101, 138, 153 and 180) and four OCPs, hexachlorobenzene (HCB), β-hexachlorocyclohexanes (β-HCH), p,p'-dichlorodiphenyltrichloroethane (DDT) and its metabolite p,p'-dichlorodiphenyldichloroethylene (DDE) were measured, and cluster analysis was applied. We evaluated the association of dietary intake with PCBs/OCPs exposure using two different approaches: food consumption categories and dietary patterns retrieved from principal component analysis (PCA). Three clusters of PCBs/OCPs were obtained: middle-level, high-level, and low-level. Practicing physical activity was associated with a three times higher risk of having high-level PCBs/OCPs, after adjustment for confounding variables (ORa = 2.97; CI = 1.23-7.19; p < 0.05). The highest tertile of fish and shellfish consumption increased by three-folds the odds of having high-level PCBs/OCPs (ORa = 3.41; CI = 1.07-10.84; p < 0.05). PCA revealed six dietary patterns. A "cereals, fats and oils, and eggs" dietary pattern was associated with 50% increase in the risk of having high-level PCBs/OCPs (ORa = 1.48; CI = 1.03-2.13; p < 0.05). The present results offer a valuable contribution to the understanding of the factors increasing exposure to POPs, namely fish consumption and the "cereals, fats and oils, and eggs" dietary pattern. We also demonstrated that physical activity was positively associated with a higher risk of exposure to PCBs and OCPs, knowing that data on this matter are scarce.