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This study aims at identifying national salt reduction initiatives in countries of the Eastern Mediterranean Region and describing their progress towards the global salt reduction target. A systematic review of published and grey literature was conducted. Key characteristics of strategies were extracted and classified according to a pre-defined framework: salt intake assessments; leadership and strategic approach; implementation strategies; monitoring and evaluation of program impact. Salt intake levels were estimated in 15 out of the 22 countries (68%), while national salt reduction initiatives were identified in 13 (59%). The majority of countries were found to implement multifaceted reduction interventions, characterized by a combination of two or more implementation strategies. The least common implementation strategy was taxation, while the most common was reformulation (100%), followed by consumer education (77%), initiatives in specific settings (54%), and front of pack labelling (46%). Monitoring activities were conducted by few countries (27%), while impact evaluations were lacking. Despite the ongoing salt reduction efforts in several countries of the region, more action is needed to initiate reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluations of ongoing programs. Such efforts are vital for the achievement of the targeted 30% reduction in salt intake.
Ayoub Al-Jawaldeh; Mandy Taktouk; Aya Chatila; Sally Naalbandian; Al-Anoud Mohammed Al-Thani; Majid M. Alkhalaf; Salima Almamary; Rawhieh Barham; Nimah M. Baqadir; Faisal F. Binsunaid; Gihan Fouad; Lara Nasreddine. Salt Reduction Initiatives in the Eastern Mediterranean Region and Evaluation of Progress towards the 2025 Global Target: A Systematic Review. Nutrients 2021, 13, 2676 .
AMA StyleAyoub Al-Jawaldeh, Mandy Taktouk, Aya Chatila, Sally Naalbandian, Al-Anoud Mohammed Al-Thani, Majid M. Alkhalaf, Salima Almamary, Rawhieh Barham, Nimah M. Baqadir, Faisal F. Binsunaid, Gihan Fouad, Lara Nasreddine. Salt Reduction Initiatives in the Eastern Mediterranean Region and Evaluation of Progress towards the 2025 Global Target: A Systematic Review. Nutrients. 2021; 13 (8):2676.
Chicago/Turabian StyleAyoub Al-Jawaldeh; Mandy Taktouk; Aya Chatila; Sally Naalbandian; Al-Anoud Mohammed Al-Thani; Majid M. Alkhalaf; Salima Almamary; Rawhieh Barham; Nimah M. Baqadir; Faisal F. Binsunaid; Gihan Fouad; Lara Nasreddine. 2021. "Salt Reduction Initiatives in the Eastern Mediterranean Region and Evaluation of Progress towards the 2025 Global Target: A Systematic Review." Nutrients 13, no. 8: 2676.
The objective was to assess the prevalence of anemia and nutritional status of mothers and children under five years among Syrian refugees in Lebanon and to identify nutritional deficiencies among pregnant, lactating, and non-pregnant non-lactating (NPNLM) mothers. A cross-sectional study was conducted among Syrian refugee mothers with children under five years in Greater Beirut, Lebanon (n = 433). Data on socio-economic status, maternal health, lifestyle characteristics, dietary intake, anthropometric measurements, and hemoglobin concentrations were collected. The prevalence of anemia was 21.7% among mothers and 30.5% among children. NPNLM with overweight/obesity and an at-risk waist circumference (WC) had 14.7-times and 10.9-times higher odds of anemia than mothers with normal WC and weight. Children of anemic mothers had 2.7-times and 4.4-times higher odds of total and mild anemia than those of non-anemic. Higher odds of mild anemia were found among children of lactating mothers than of NPNLM. A high percent energy intake of total fat and sugar was found among all mothers. Nutritional inadequacy was identified in higher proportions of lactating and pregnant mothers than NPNLM. Our findings highlighted the co-existence of overnutrition and anemia among Syrian refugee mothers and undernutrition among children from the same household. Culture-specific interventions are needed to support maternal nutrition, to ensure the health and wellbeing of their offspring.
Joana Abou-Rizk; Theresa Jeremias; Lara Nasreddine; Lamis Jomaa; Nahla Hwalla; Hani Tamim; Jan Frank; Veronika Scherbaum. Anemia and Nutritional Status of Syrian Refugee Mothers and Their Children under Five Years in Greater Beirut, Lebanon. International Journal of Environmental Research and Public Health 2021, 18, 6894 .
AMA StyleJoana Abou-Rizk, Theresa Jeremias, Lara Nasreddine, Lamis Jomaa, Nahla Hwalla, Hani Tamim, Jan Frank, Veronika Scherbaum. Anemia and Nutritional Status of Syrian Refugee Mothers and Their Children under Five Years in Greater Beirut, Lebanon. International Journal of Environmental Research and Public Health. 2021; 18 (13):6894.
Chicago/Turabian StyleJoana Abou-Rizk; Theresa Jeremias; Lara Nasreddine; Lamis Jomaa; Nahla Hwalla; Hani Tamim; Jan Frank; Veronika Scherbaum. 2021. "Anemia and Nutritional Status of Syrian Refugee Mothers and Their Children under Five Years in Greater Beirut, Lebanon." International Journal of Environmental Research and Public Health 18, no. 13: 6894.
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.
The Eastern Mediterranean Region (EMR) is experiencing a nutrition transition, characterized by the emergence of overnutrition and micro-nutrient deficiencies. No previous study has comparatively examined nutrient intake in adults across countries in the EMR. This review examined the adequacy of nutrients in adults living in the EMR. Moreover, it analyzed the food balance sheets (FBS) for 1961–2018 to identify the trajectory of energy supply from macro-nutrients in the EMR. A systematic search was conducted from January 2012 to September 2020. Only observational studies were retained with a random sampling design. An assessment of the methodological quality was conducted. Levels of nutrient daily intake and their adequacy compared to the daily reference intake of the Institute of Medicine were reported across the region. No studies were identified for half of the region’s countries. Although nutrient energy intake was satisfactory overall, fat and carbohydrate intake were high. Intake of vitamin D, calcium, potassium, zinc, and magnesium were below that recommended. The analysis of the FBS data allowed for the identification of four linear patterns of trajectories, with countries in the EMR best fitting the ‘high-energy-supply from carbohydrate’ group. This systematic review warrants multi-sectorial commitment to optimize nutrient intake.
Radhouene Doggui; Hanin Al-Jawaldeh; Jalila El Ati; Rawhieh Barham; Lara Nasreddine; Nawal Alqaoud; Hassan Aguenaou; Laila El Ammari; Jana Jabbour; Ayoub Al-Jawaldeh. Meta-Analysis and Systematic Review of Micro- and Macro-Nutrient Intakes and Trajectories of Macro-Nutrient Supply in the Eastern Mediterranean Region. Nutrients 2021, 13, 1515 .
AMA StyleRadhouene Doggui, Hanin Al-Jawaldeh, Jalila El Ati, Rawhieh Barham, Lara Nasreddine, Nawal Alqaoud, Hassan Aguenaou, Laila El Ammari, Jana Jabbour, Ayoub Al-Jawaldeh. Meta-Analysis and Systematic Review of Micro- and Macro-Nutrient Intakes and Trajectories of Macro-Nutrient Supply in the Eastern Mediterranean Region. Nutrients. 2021; 13 (5):1515.
Chicago/Turabian StyleRadhouene Doggui; Hanin Al-Jawaldeh; Jalila El Ati; Rawhieh Barham; Lara Nasreddine; Nawal Alqaoud; Hassan Aguenaou; Laila El Ammari; Jana Jabbour; Ayoub Al-Jawaldeh. 2021. "Meta-Analysis and Systematic Review of Micro- and Macro-Nutrient Intakes and Trajectories of Macro-Nutrient Supply in the Eastern Mediterranean Region." Nutrients 13, no. 5: 1515.
The World Health Organization (WHO) acknowledged that, as health services divert their attention to the COVID-19 pandemic, the delivery of essential nutrition services may be compromised. This impact may be more pronounced in the context of humanitarian crises, such as the one currently unfolding in Yemen. In line with Pillar 9 of the WHO’s COVID-19 Strategic Preparedness and Response Plan, this paper reports on the nutrition program adaptations in Yemen to maintain the delivery of essential nutrition services to under-five children. The process of adaptation focused on the services provided within the nutrition surveillance system (NSS), therapeutic feeding centers (TFC), and isolation units (IU). It was conducted in five steps: (1) situation analysis; (2) development of guidance documents; (3) consultation process; (4) capacity-building programs; and (5) incorporation of programmatic adaptation within nutrition services. As of September 2020, NSS, TFC, and IUs services have shifted their standard operating procedures in line with the context-specific adaptations. The process described in this paper may serve as a case-study for other countries that intend to undertake similar adaptations in their nutrition program to contribute to the implementation of the WHO response plan and maintain the delivery of essential nutrition services to children.
Ferima Coulibaly-Zerbo; Ayoub Al-Jawaldeh; Zita Prinzo; Marina Adrianopoli; Eshrak Al-Falahi; Shafekah Alahnoumy; Nosheen Usman; Fanda Moqbel; Latifah Ali; Mohammed Shroh; Ensegam Al-Sakkaf; AbdulRazzaq Musaed; Maison Al-Sakkaf; Mohammed Dahnan; Fahim Al-Hakimi; Doa Omer; Moatsim Hael; Lara Nasreddine. Maintaining Essential Nutrition Services to Underfive Children in Yemen: A Programmatic Adaptation Amidst the COVID-19 Pandemic. Children 2021, 8, 350 .
AMA StyleFerima Coulibaly-Zerbo, Ayoub Al-Jawaldeh, Zita Prinzo, Marina Adrianopoli, Eshrak Al-Falahi, Shafekah Alahnoumy, Nosheen Usman, Fanda Moqbel, Latifah Ali, Mohammed Shroh, Ensegam Al-Sakkaf, AbdulRazzaq Musaed, Maison Al-Sakkaf, Mohammed Dahnan, Fahim Al-Hakimi, Doa Omer, Moatsim Hael, Lara Nasreddine. Maintaining Essential Nutrition Services to Underfive Children in Yemen: A Programmatic Adaptation Amidst the COVID-19 Pandemic. Children. 2021; 8 (5):350.
Chicago/Turabian StyleFerima Coulibaly-Zerbo; Ayoub Al-Jawaldeh; Zita Prinzo; Marina Adrianopoli; Eshrak Al-Falahi; Shafekah Alahnoumy; Nosheen Usman; Fanda Moqbel; Latifah Ali; Mohammed Shroh; Ensegam Al-Sakkaf; AbdulRazzaq Musaed; Maison Al-Sakkaf; Mohammed Dahnan; Fahim Al-Hakimi; Doa Omer; Moatsim Hael; Lara Nasreddine. 2021. "Maintaining Essential Nutrition Services to Underfive Children in Yemen: A Programmatic Adaptation Amidst the COVID-19 Pandemic." Children 8, no. 5: 350.
Anemia is a multifactorial condition, with a complex etiology that involves nutritional and non-nutritional factors. The misconception that iron deficiency is equivalent to anemia may mask the need to address other potential causative factors. This review paper aims to (1) assess the burden of anemia vs. iron deficiency anemia (IDA) amongst women of reproductive age (WRA), pregnant women (PW), and children under five years old (underfive children, U5C) in the Eastern Mediterranean region (EMR); (2) evaluate trends in anemia prevalence and whether countries are on track towards meeting the World Health Assembly (WHA) target for 2025; and (3) characterize anemia reduction efforts and provide a road map for future programs. A search of pertinent literature and databases was conducted. Anemia prevalence in the EMR ranged between 22.6% and 63% amongst PW, 27% and 69.6% amongst WRA, and 23.8% and 83.5% amongst U5C. Data showed that the EMR is not on course towards meeting the WHA target. The contribution of IDA to anemia was found to be less than half. Other potential contributors to anemia in the region were identified, including micronutrient deficiencies, parasitic infestations, and poor sanitation. A framework of action was proposed as a roadmap to meet the targets set by the WHA.
Ayoub Al-Jawaldeh; Mandy Taktouk; Radhouene Doggui; Zahra Abdollahi; Baseer Achakzai; Hassan Aguenaou; Moussa Al-Halaika; Salima Almamary; Rawhieh Barham; Ferima Coulibaly-Zerbo; Laila Ammari; Jalila Elati; Noureen Nishtar; Nasrin Omidvar; Mohammad Shams; Abdul Qureshi; Lara Nasreddine. Are Countries of the Eastern Mediterranean Region on Track towards Meeting the World Health Assembly Target for Anemia? A Review of Evidence. International Journal of Environmental Research and Public Health 2021, 18, 2449 .
AMA StyleAyoub Al-Jawaldeh, Mandy Taktouk, Radhouene Doggui, Zahra Abdollahi, Baseer Achakzai, Hassan Aguenaou, Moussa Al-Halaika, Salima Almamary, Rawhieh Barham, Ferima Coulibaly-Zerbo, Laila Ammari, Jalila Elati, Noureen Nishtar, Nasrin Omidvar, Mohammad Shams, Abdul Qureshi, Lara Nasreddine. Are Countries of the Eastern Mediterranean Region on Track towards Meeting the World Health Assembly Target for Anemia? A Review of Evidence. International Journal of Environmental Research and Public Health. 2021; 18 (5):2449.
Chicago/Turabian StyleAyoub Al-Jawaldeh; Mandy Taktouk; Radhouene Doggui; Zahra Abdollahi; Baseer Achakzai; Hassan Aguenaou; Moussa Al-Halaika; Salima Almamary; Rawhieh Barham; Ferima Coulibaly-Zerbo; Laila Ammari; Jalila Elati; Noureen Nishtar; Nasrin Omidvar; Mohammad Shams; Abdul Qureshi; Lara Nasreddine. 2021. "Are Countries of the Eastern Mediterranean Region on Track towards Meeting the World Health Assembly Target for Anemia? A Review of Evidence." International Journal of Environmental Research and Public Health 18, no. 5: 2449.
To determine the intake levels, dietary sources, and determinants of free sugars (FS) consumption amongst Lebanese children and adolescents. This study is based on data collected by two national cross-sectional surveys conducted on representative samples of Lebanese children: survey 1 (under-five years (U5) children) (n = 899) and survey 2 (5–18 years-old children) (n = 1133). Multi-component questionnaires were used for data collection. Dietary intakes were assessed using one 24 h dietary recall. Median daily intakes of FS, and percent contribution of various food groups to FS intake were compared between sex and age groups. Logistic regressions were conducted to explore the determinants of high FS intake (> 10% energy intake/d), as per the WHO recommendations. Median contribution of FS to daily energy intake was 8.5% in U5 children and 11.9% amongst those aged 5–18 years old. The top contributors to FS in both surveys were sugar-sweetened beverages and biscuits and chocolates. The proportion of children and adolescents exceeding WHO upper limits for FS was estimated at 43 and 62% in survey 1 and survey 2, respectively. Regression models showed females, higher household monthly incomes and higher parental educational levels were associated with significantly lower odds of exceeding the WHO upper limit for FS. The study showed that a high proportion of Lebanese children and adolescents exceeded the WHO upper limit for FS intake, while also documenting a socioeconomic gradient in FS intake. Findings call for devising food system-based interventions to help reduce FS intake in this nutritionally vulnerable age group.
Lamis Jomaa; Samer Hamamji; Samer Kharroubi; Marwa Diab-El-Harakeh; Fatima Al Zahraa Chokor; Lara Nasreddine. Dietary intakes, sources, and determinants of free sugars amongst Lebanese children and adolescents: findings from two national surveys. European Journal of Nutrition 2021, 1 -15.
AMA StyleLamis Jomaa, Samer Hamamji, Samer Kharroubi, Marwa Diab-El-Harakeh, Fatima Al Zahraa Chokor, Lara Nasreddine. Dietary intakes, sources, and determinants of free sugars amongst Lebanese children and adolescents: findings from two national surveys. European Journal of Nutrition. 2021; ():1-15.
Chicago/Turabian StyleLamis Jomaa; Samer Hamamji; Samer Kharroubi; Marwa Diab-El-Harakeh; Fatima Al Zahraa Chokor; Lara Nasreddine. 2021. "Dietary intakes, sources, and determinants of free sugars amongst Lebanese children and adolescents: findings from two national surveys." European Journal of Nutrition , no. : 1-15.
The Eastern Mediterranean Region (EMR) has witnessed significant social and economic changes that may have influenced the diet of children and adolescents, and increased the risk for obesity and malnutrition in this age group. This review aims to characterize and assess food consumption patterns and nutrient intakes amongst school-aged children (5–10 years) and adolescents (10–19 years) in countries of the EMR. Electronic databases (MedLine, PubMed, Scopus, and Google Scholar) were searched for relevant articles published between 2005 and 2020; international organizations and governmental websites were also searched. Available studies documented low intakes of fruits, vegetables and fiber, inadequate consumption of water, milk and dairy products, coupled with high intakes of fat, saturated fat, and sugar sweetened beverages, as well as a frequent consumption of energy-dense, nutrient poor foods such as sweet and savory snacks. Micronutrient inadequacies were also observed, particularly for calcium, iron, zinc and vitamins A, D, C, and folate. Acknowledging the impact that nutrition may have on building societies and transforming the lives of children, adolescents and their families, there is a crucial need for a food system approach in developing and implementing national and regional policies and interventions aimed at improving the diet of children and adolescents.
Ayoub Al-Jawaldeh; Mandy Taktouk; Lara Nasreddine. Food Consumption Patterns and Nutrient Intakes of Children and Adolescents in the Eastern Mediterranean Region: A Call for Policy Action. Nutrients 2020, 12, 3345 .
AMA StyleAyoub Al-Jawaldeh, Mandy Taktouk, Lara Nasreddine. Food Consumption Patterns and Nutrient Intakes of Children and Adolescents in the Eastern Mediterranean Region: A Call for Policy Action. Nutrients. 2020; 12 (11):3345.
Chicago/Turabian StyleAyoub Al-Jawaldeh; Mandy Taktouk; Lara Nasreddine. 2020. "Food Consumption Patterns and Nutrient Intakes of Children and Adolescents in the Eastern Mediterranean Region: A Call for Policy Action." Nutrients 12, no. 11: 3345.
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.
The adoption of a food system approach is vital for the Eastern Mediterranean Region (EMR) in achieving the 2030 Agenda. The objective of this paper is to present a case-study from Oman, where a roadmap of context-specific entry points within the food system was proposed, with the overarching aim of fostering healthier diets in the population. A four-staged process was adopted: (1) selection of potential target food groups; (2) assessment of self-sufficiency and sustainability considerations related to the target foods; (3) characterization of challenges, opportunities and potential interventions related to the target food groups and (4) identification of specific entry points within the three elements of the food system (food supply chain; food environment; and consumer behavior). Data collection was based on a review of pertinent literature as well as a participatory approach involving policy makers and stakeholders. Findings showed that fruit, vegetables, fish and foods that are high in fat, sugar and salt are priority targets for intervention. Specific entry points within the food system were identified and a realistic roadmap of activities was outlined. Findings and recommendations presented in this paper may facilitate policy convergence efforts in Oman and serve as a case-study for other EMR countries.
Ayoub Al-Jawaldeh; Salima Almamary; Lamia Mahmoud; Lara Nasreddine. Leveraging the Food System in the Eastern Mediterranean Region for Better Health and Nutrition: A Case Study from Oman. International Journal of Environmental Research and Public Health 2020, 17, 7250 .
AMA StyleAyoub Al-Jawaldeh, Salima Almamary, Lamia Mahmoud, Lara Nasreddine. Leveraging the Food System in the Eastern Mediterranean Region for Better Health and Nutrition: A Case Study from Oman. International Journal of Environmental Research and Public Health. 2020; 17 (19):7250.
Chicago/Turabian StyleAyoub Al-Jawaldeh; Salima Almamary; Lamia Mahmoud; Lara Nasreddine. 2020. "Leveraging the Food System in the Eastern Mediterranean Region for Better Health and Nutrition: A Case Study from Oman." International Journal of Environmental Research and Public Health 17, no. 19: 7250.
Background Exclusive breastfeeding is recommended for the first 6 months of life with well-established benefits to the mother and child. The traditional practice of the 40-day rest period helps establish and maintain exclusive breastfeeding. This study aims to estimate the prevalence and examine the factors associated with exclusive breastfeeding at 40 days and at 6 months in Lebanon. Methods A cross-sectional survey was conducted in 2011–2012 as part of the “Early Life Nutrition and Health in Lebanon” study. A nationally representative sample of 1005 children aged five years or younger and their mothers was drawn from households using a stratified cluster sampling design. Trained nutritionists interviewed eligible mothers about sociodemographic characteristics of the household and maternal and child characteristics including infant feeding practices. Anthropometric measurements of the mother and child were collected. Multinomial logistic regression analysis was conducted to examine the characteristics associated with exclusive breastfeeding. Results The prevalence of exclusive breastfeeding was 41.5% at 40 days and 12.3% at 6 months. Children in families with three or more children had higher odds of exclusive breastfeeding for 40 days (Adjusted Odds Ratio [AOR] 1.76, 95% Confidence Interval [CI] 1.19, 2.60). Children in families owning two or more cars had lower odds of exclusive breastfeeding for 40 days (AOR 0.45, 95% CI 0.24, 0.83) and at 6 months (AOR 0.32, 95% CI 0.14, 0.77). Similarly, children delivered via Caesarian section had lower odds of exclusive breastfeeding for 40 days (AOR 0.49, 95% CI 0.34, 0.71) and at 6 months (AOR 0.39, 95% CI 0.24, 0.65). The odds of exclusive breastfeeding for 6 months were lower among children of overweight (AOR 0.50, 95% CI 0.26, 0.95) or obese (AOR 0.56, 95% CI 0.32, 0.98) mothers. Conclusions The association between higher socio-economic status, as reflected by car ownership, and C-section delivery with lower odds of exclusive breastfeeding persisted across the first 6 months in Lebanon. Future research should investigate the factors associated with exclusive breastfeeding in prospective cohort studies and help to better understand the cultural practice of the 40-day rest period in relation to breastfeeding.
Rana F. Chehab; Lara Nasreddine; Racha Zgheib; Michele R. Forman. Exclusive breastfeeding during the 40-day rest period and at six months in Lebanon: a cross-sectional study. International Breastfeeding Journal 2020, 15, 1 -10.
AMA StyleRana F. Chehab, Lara Nasreddine, Racha Zgheib, Michele R. Forman. Exclusive breastfeeding during the 40-day rest period and at six months in Lebanon: a cross-sectional study. International Breastfeeding Journal. 2020; 15 (1):1-10.
Chicago/Turabian StyleRana F. Chehab; Lara Nasreddine; Racha Zgheib; Michele R. Forman. 2020. "Exclusive breastfeeding during the 40-day rest period and at six months in Lebanon: a cross-sectional study." International Breastfeeding Journal 15, no. 1: 1-10.
High dietary glycemic index (GI) and glycemic load (GL) were suggested to increase the risk of metabolic syndrome (MetS). This study aims to estimate dietary GI and GL in a sample of healthy Lebanese adults and examine their association with MetS and its individual abnormalities. The study uses data from a community-based survey of 501 Lebanese urban adults. Dietary intake was assessed using a food frequency questionnaire. Biochemical, anthropometric, and blood pressure measurements were obtained. Subjects with previous diagnosis of chronic disease, metabolic abnormalities, or with incomplete data or implausible energy intakes were excluded, yielding a sample of 283. Participants were grouped into quartiles of GI and GL. Multivariate logistic regression analyses were performed. Average dietary GI and GL were estimated at 59.9 ± 8 and 209.7 ± 100.3. Participants belonging to the highest GI quartile were at increased risk of having MetS (odds ratio (OR) = 2.251, 95% CI:1.120–4.525) but this association lost significance with further adjustments. Those belonging to the second quartile of GI had significantly lower odds of having hyperglycemia (OR: 0.380, 95% CI:0.174–0.833). No associations were detected between GL and MetS. The study contributes to the body of evidence discussing the relationship between GI, GL, and MetS, in a nutrition transition context.
Cecile Borgi; Mandy Taktouk; Mona Nasrallah; Hussain Isma’Eel; Hani Tamim; Lara Nasreddine. Dietary Glycemic Index and Glycemic Load Are Not Associated with the Metabolic Syndrome in Lebanese Healthy Adults: A Cross-Sectional Study. Nutrients 2020, 12, 1394 .
AMA StyleCecile Borgi, Mandy Taktouk, Mona Nasrallah, Hussain Isma’Eel, Hani Tamim, Lara Nasreddine. Dietary Glycemic Index and Glycemic Load Are Not Associated with the Metabolic Syndrome in Lebanese Healthy Adults: A Cross-Sectional Study. Nutrients. 2020; 12 (5):1394.
Chicago/Turabian StyleCecile Borgi; Mandy Taktouk; Mona Nasrallah; Hussain Isma’Eel; Hani Tamim; Lara Nasreddine. 2020. "Dietary Glycemic Index and Glycemic Load Are Not Associated with the Metabolic Syndrome in Lebanese Healthy Adults: A Cross-Sectional Study." Nutrients 12, no. 5: 1394.
This study tried at identifying lifestyle patterns in a sample of Lebanese adults and investigating their association with metabolically healthy overweight and obesity (MHOv/O). This study used data from a community-based survey of Lebanese adults living in Greater Beirut (n = 305). Dietary intake was assessed using an 80-item food frequency questionnaire. MHOv/O was defined as having one or none of the following metabolic abnormalities: triglycerides ≥ 150 mg/dL; systolic blood pressure ≥ 130 mmHg; diastolic blood pressure ≥ 85 mmHg; fasting blood glucose ≥ 100 mg/dL; HDL-cholesterol < 40 mg/dL for men and < 50 mg/dL for women. 201 subjects were overweight/obese and 98 had MHOv/O. Factor analysis was implemented to derive lifestyle patterns. Two lifestyle patterns were identified: the unhealthy lifestyle pattern, which included foods such as fast food and soft drinks and was characterized by alcohol consumption and cigarette smoking. 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, vegetables and legumes. Sleep difficulties loaded negatively on this pattern, while vigorous and moderate physical activity loaded positively. Multiple logistic regression analyses showed that subjects belonging to the 3rd tertile of the healthy pattern scores had higher odds of MHOv/O as compared to those in the 1st tertile (OR 2.33, CI 1.04–4.81). Findings of this study provided evidence on the combined effect of lifestyle patterns in relation to cardiometabolic abnormalities and highlighted the importance of focusing on ‘holistic’ lifestyle pattern modifications in designing and implementing prevention interventions in overweight and obese subjects.
Farah Naja; Leila Itani; Mona P. Nasrallah; Hassan Chami; Hani Tamim; Lara Nasreddine. A healthy lifestyle pattern is associated with a metabolically healthy phenotype in overweight and obese adults: a cross-sectional study. European Journal of Nutrition 2019, 59, 2145 -2158.
AMA StyleFarah Naja, Leila Itani, Mona P. Nasrallah, Hassan Chami, Hani Tamim, Lara Nasreddine. A healthy lifestyle pattern is associated with a metabolically healthy phenotype in overweight and obese adults: a cross-sectional study. European Journal of Nutrition. 2019; 59 (5):2145-2158.
Chicago/Turabian StyleFarah Naja; Leila Itani; Mona P. Nasrallah; Hassan Chami; Hani Tamim; Lara Nasreddine. 2019. "A healthy lifestyle pattern is associated with a metabolically healthy phenotype in overweight and obese adults: a cross-sectional study." European Journal of Nutrition 59, no. 5: 2145-2158.
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.
In contrast to the large number of genetic studies on obesity, there has been significantly less nutrigenetics investigation of the interaction between diet and single nucleotide polymorphisms (SNPs) in obesity, especially within Eastern Mediterranean populations. The aim of this study was to evaluate the potential interactions between three candidate SNPs, namely, rs1558902 and rs9939609 in the fat mass and obesity (FTO) gene and the rs7903146 variant of the Transcription factor 7 like 2 (TCF7L2) gene, and macronutrient intake with regard to obesity, body fat, and muscle composition. Three hundred and eight healthy Lebanese adults were included in this study. Data collection included a questionnaire for demographics and lifestyle in addition to a detailed dietary assessment using a culture-specific 80-item semi-quantitative food frequency questionnaire. This was coupled with anthropometric measurements and peripheral blood withdrawal for DNA and genotyping using Taqman allele discrimination assays. The two FTO candidate SNPs were not associated with risk of obesity in this population sample, yet there was a trend, though not a significant one, towards lower muscle mass among carriers of the risk allele of either FTO SNPs. To our knowledge, these results have not been previously reported. As for the TCF7L2 rs7903146 variant, results were congruent with the literature, given that individuals who were homozygous for the risk allele had significantly higher body mass index (BMI) and body fat despite lower intakes of saturated fat. Similar interactions, though not significant, were shown with muscle mass, whereby individuals who were homozygous for the risk allele had lower muscle mass with higher intakes of saturated fat, a result that, to our knowledge, has not been previously reported.
Lara Nasreddine; Reem Akika; Aurelie Mailhac; Hani Tamim; Nathalie Khoueiry Zgheib. The Interaction between Genetic Polymorphisms in FTO and TCF7L2 Genes and Dietary Intake with Regard to Body Mass and Composition: An Exploratory Study. Journal of Personalized Medicine 2019, 9, 11 .
AMA StyleLara Nasreddine, Reem Akika, Aurelie Mailhac, Hani Tamim, Nathalie Khoueiry Zgheib. The Interaction between Genetic Polymorphisms in FTO and TCF7L2 Genes and Dietary Intake with Regard to Body Mass and Composition: An Exploratory Study. Journal of Personalized Medicine. 2019; 9 (1):11.
Chicago/Turabian StyleLara Nasreddine; Reem Akika; Aurelie Mailhac; Hani Tamim; Nathalie Khoueiry Zgheib. 2019. "The Interaction between Genetic Polymorphisms in FTO and TCF7L2 Genes and Dietary Intake with Regard to Body Mass and Composition: An Exploratory Study." Journal of Personalized Medicine 9, no. 1: 11.
Background. Hypertension (HTN) has been identified as the leading risk factor for mortality and the third cause of disability worldwide. Lebanon has witnessed a threefold increase in the prevalence of HTN in the past decade. The timely exploration and detection of the factors contributing to a higher prevalence of the disease among the Lebanese population is fundamental. The objectives of this study were to assess the prevalence, awareness, and control rates of HTN in Greater Beirut Area in Lebanon and to identify their respective predictors. Methods. A representative sample of 501 participants aged 18-79 years residing in Greater Beirut Area was examined. Data collection form was filled up, through interviews, physical exams, and lab tests. The analysis was done for three defined outcomes: blood pressure status (normotensive, prehypertension, and hypertension), unaware HTN, and uncontrolled HTN. These were compared for the various associated predictors. Results. The sample consisted of 64.3% women and mean age 45.4 ± 15 years and the subjects were predominantly from low educational income levels. The results showed that 36.4% of the study participants were hypertensive, 25.3% were prehypertensive, and 38.2% had optimal blood pressure, while the awareness rate was 65.4% and control rate was 61%. The independent predictors of HTN were age, gender, marital status, T2D, body fat, triglyceride (positive correlates), and income level (negative correlate). Moreover, unawareness of HTN was common among older age, men, single participants, and the obese. We could not identify any factor related to uncontrolled HTN. Conclusion. The trend in the prevalence of HTN in Greater Beirut Area is found to be consistent and relatively high, yet there was an observed improvement in the awareness and control of the disease. Public health measures on a national level are urgently needed to curb the increasing prevalence of HTN, achieve primary prevention, and better control the disease.
Aya Noubani; Lara Nasreddine; Abla Mehio Sibai; Hani Tamim; Hussain Isma’Eel. Prevalence, Awareness, and Control of Hypertension in Greater Beirut Area, Lebanon. International Journal of Hypertension 2018, 2018, 1 -15.
AMA StyleAya Noubani, Lara Nasreddine, Abla Mehio Sibai, Hani Tamim, Hussain Isma’Eel. Prevalence, Awareness, and Control of Hypertension in Greater Beirut Area, Lebanon. International Journal of Hypertension. 2018; 2018 ():1-15.
Chicago/Turabian StyleAya Noubani; Lara Nasreddine; Abla Mehio Sibai; Hani Tamim; Hussain Isma’Eel. 2018. "Prevalence, Awareness, and Control of Hypertension in Greater Beirut Area, Lebanon." International Journal of Hypertension 2018, no. : 1-15.
There have been increases in the incidence of obesity in Lebanon over the past few decades. Fatty acid intake and metabolism have been postulated to influence obesity, but few epidemiological studies have been conducted. The aim of this study was to investigate the correlation between serum fatty acid levels and indicators of obesity in a cross-sectional study nested within a cohort of 501 Lebanese adults residing in Greater Beirut. A total of 395 available serum samples (129 men, 266 women) were profiled for phospholipid fatty acid composition. Spearman correlation coefficients adjusted for relevant confounders and corrected for multiple testing were calculated between serum fatty acids, desaturation indices, and indicators of adiposity (body mass index (BMI) and waist). BMI was significantly positively correlated with saturated fatty acids in men (r = 0.40, p < 0.0001, q < 0.0001) and women (r = 0.33, p < 0.0001, q < 0.0001). BMI was significantly positively correlated with monounsaturated fatty acid palmitoleic acid in women (r = 0.15, p = 0.01, q = 0.03). This study suggests that high blood levels of some saturated fatty acids and the monounsaturated fatty acid palmitoleic acid, likely derived from both dietary intakes of saturated fatty acids and endogenous lipogenesis, may have been associated with adiposity in the Lebanese population. The causality of these associations needs to be explored in experimental settings.
Sahar G. Yammine; Farah Naja; Hani Tamim; Mona Nasrallah; Carine Biessy; Elom K. Aglago; Michèle Matta; Isabelle Romieu; Marc J. Gunter; Lara Nasreddine; Véronique Chajès. Association between Serum Phospholipid Fatty Acid Levels and Adiposity among Lebanese Adults: A Cross-Sectional Study. Nutrients 2018, 10, 1371 .
AMA StyleSahar G. Yammine, Farah Naja, Hani Tamim, Mona Nasrallah, Carine Biessy, Elom K. Aglago, Michèle Matta, Isabelle Romieu, Marc J. Gunter, Lara Nasreddine, Véronique Chajès. Association between Serum Phospholipid Fatty Acid Levels and Adiposity among Lebanese Adults: A Cross-Sectional Study. Nutrients. 2018; 10 (10):1371.
Chicago/Turabian StyleSahar G. Yammine; Farah Naja; Hani Tamim; Mona Nasrallah; Carine Biessy; Elom K. Aglago; Michèle Matta; Isabelle Romieu; Marc J. Gunter; Lara Nasreddine; Véronique Chajès. 2018. "Association between Serum Phospholipid Fatty Acid Levels and Adiposity among Lebanese Adults: A Cross-Sectional Study." Nutrients 10, no. 10: 1371.
The Qatar Dietary Guidelines (QDGs) were developed as part of the national strategy to prevent chronic diseases. This study aims at characterizing gaps between the QDGs and usual dietary and lifestyle patterns in Qatar, identifying demographic and socioeconomic determinants of adherence to the QDGs and investigating the association between adherence and cardiometabolic risk. This study is based on the Qatar National STEPwise cross-sectional survey which was conducted on a nationally representative sample of Qatari adults, aged 18 to 64 years (n = 1109). Data collection included socio-demographic characteristics, lifestyle factors, anthropometric (weight, height and waist circumference (WC)), and blood pressure measurements. The dietary intake of participants was evaluated using a non-quantitative food frequency questionnaire (FFQ). Biochemical assessment was performed to measure the fasting levels of blood sugar, triglycerides (TG) and HDL cholesterol. The metabolic syndrome (MetS) was defined as the presence of three or more cardiometabolic risk factors. To examine adherence to the guidelines, each specifc recommendation was matched to corresponding data drawn from the survey. To investigate the association of sociodemographic, lifestyle and cardiometabolic characteristics with adherence to the QDGs, an adherence score was calculated. More than 83% of adults did not meet the recommendations for vegetables, fruits, whole grains, legumes and high fibre intakes, 70% were overweight or obese, 50–72% reported frequent consumption of sweetened beverages and sweets, and 47% reported frequent consumption of fast foods. Younger adults, the unemployed, the least educated and those not married had lower adherence to the QDGs. Adherence was inversely associated with elevated WC (OR: 0.88, 95% CI:0.82–0.95) and the MetS (OR:0.84,95% CI:0.74–0.96). Building on the identified gaps and vulnerable population groups, the study findings should provide a road map for the prioritization of interventions and the development of culture- specific programs aiming at promoting adherence to dietary guidelines in Qatar, while serving as a model to other countries in the region.
Mohammed Al Thani; Al Anoud Al Thani; Walaa Al-Chetachi; Badria Al Malki; Shamseldin A. H. Khalifa; Ahmad Haj Bakri; Nahla Hwalla; Farah Naja; Lara Nasreddine. Adherence to the Qatar dietary guidelines: a cross-sectional study of the gaps, determinants and association with cardiometabolic risk amongst adults. BMC Public Health 2018, 18, 1 -12.
AMA StyleMohammed Al Thani, Al Anoud Al Thani, Walaa Al-Chetachi, Badria Al Malki, Shamseldin A. H. Khalifa, Ahmad Haj Bakri, Nahla Hwalla, Farah Naja, Lara Nasreddine. Adherence to the Qatar dietary guidelines: a cross-sectional study of the gaps, determinants and association with cardiometabolic risk amongst adults. BMC Public Health. 2018; 18 (1):1-12.
Chicago/Turabian StyleMohammed Al Thani; Al Anoud Al Thani; Walaa Al-Chetachi; Badria Al Malki; Shamseldin A. H. Khalifa; Ahmad Haj Bakri; Nahla Hwalla; Farah Naja; Lara Nasreddine. 2018. "Adherence to the Qatar dietary guidelines: a cross-sectional study of the gaps, determinants and association with cardiometabolic risk amongst adults." BMC Public Health 18, no. 1: 1-12.
Farah Naja; Hibeh Shatila; Lokman Meho; Mohamad Alameddine; Sally Haber; Lara Nasreddine; Abla Mehio Sibai; Nahla Hwalla. Gaps and opportunities for nutrition research in relation to non-communicable diseases in Arab countries: Call for an informed research agenda. Nutrition Research 2017, 47, 1 -12.
AMA StyleFarah Naja, Hibeh Shatila, Lokman Meho, Mohamad Alameddine, Sally Haber, Lara Nasreddine, Abla Mehio Sibai, Nahla Hwalla. Gaps and opportunities for nutrition research in relation to non-communicable diseases in Arab countries: Call for an informed research agenda. Nutrition Research. 2017; 47 ():1-12.
Chicago/Turabian StyleFarah Naja; Hibeh Shatila; Lokman Meho; Mohamad Alameddine; Sally Haber; Lara Nasreddine; Abla Mehio Sibai; Nahla Hwalla. 2017. "Gaps and opportunities for nutrition research in relation to non-communicable diseases in Arab countries: Call for an informed research agenda." Nutrition Research 47, no. : 1-12.