Machine learning techniques for the identification of risk factors associated with food insecurity among adults in Arab countries during the COVID-19 pandemic.

BACKGROUND: A direct consequence of global warming, and strongly correlated with poor physical and mental health, food insecurity is a rising global concern associated with low dietary intake. The Coronavirus pandemic has further aggravated food insecurity among vulnerable communities, and thus has sparked the global conversation of equal food access, food distribution, and improvement of food support programs. This research was designed to identify the key features associated with food insecurity during the COVID-19 pandemic using Machine learning techniques. Seven machine learning algorithms were used in the model, which used a dataset of 32 features. The model was designed to predict food insecurity across ten Arab countries in the Gulf and Mediterranean regions. A total of 13,443 participants were extracted from the international Corona Cooking Survey conducted by 38 different countries during the COVID -19 pandemic. RESULTS: The findings indicate that Jordanian, Palestinian, Lebanese, and Saudi Arabian respondents reported the highest rates of food insecurity in the region (15.4%, 13.7%, 13.7% and 11.3% respectively). On the other hand, Oman and Bahrain reported the lowest rates (5.4% and 5.5% respectively). Our model obtained accuracy levels of 70%-82% in all algorithms. Gradient Boosting and Random Forest techniques had the highest performance levels in predicting food insecurity (82% and 80% respectively). Place of residence, age, financial instability, difficulties in accessing food, and depression were found to be the most relevant features associated with food insecurity. CONCLUSIONS: The ML algorithms seem to be an effective method in early detection and prediction of food insecurity and can profoundly aid policymaking. The integration of ML approaches in public health strategies could potentially improve the development of targeted and effective interventions to combat food insecurity in these regions and globally.

Perspectives and practices of dietitians with regards to social/mass media use during the transitions from face-to-face to telenutrition in the time of COVID-19: A cross-sectional survey in 10 Arab countries.

During the COVID-19 pandemic, most healthcare professionals switched from face-to-face clinical encounters to telehealth. This study sought to investigate the dietitians' perceptions and practices toward the use of social/mass media platforms amid the transition from face-to-face to telenutrition in the time of COVID-19. This cross-sectional study involving a convenient sample of 2,542 dietitians (mean age = 31.7 ± 9.5; females: 88.2%) was launched in 10 Arab countries between November 2020 and January 2021. Data were collected using an online self-administrated questionnaire. Study findings showed that dietitians' reliance on telenutrition increased by 11% during the pandemic, p = 0.001. Furthermore, 63.0% of them reported adopting telenutrition to cover consultation activities. Instagram was the platform that was most frequently used by 51.7% of dietitians. Dietitians shouldered new difficulties in dispelling nutrition myths during the pandemic (58.2% reported doing so vs. 51.4% pre-pandemic, p < 0.001). Compared to the pre-pandemic period, more dietitians perceived the importance of adopting tele nutrition's clinical and non-clinical services (86.9% vs. 68.0%, p = 0.001), with 76.6% being confident in this practice. In addition, 90.0% of the participants received no support from their work facilities for social media usage. Following the COVID-19 outbreak, the majority of dietitians (80.0%) observed a rise in public interest in nutrition-related topics, particularly those pertaining to healthy eating habits (p = 0.001), healthy recipes (p = 0.001), nutrition and immunity (p = 0.001), and medical nutrition therapies (p = 0.012). Time constraint was the most prevalent barrier to offering telenutrition for nutrition care (32.1%), whereas leveraging a quick and easy information exchange was the most rewarding benefit for 69.3% of the dietitians. In conclusion, to ensure a consistent provision of nutrition care delivery during the COVID-19 pandemic, dietitians working in Arab countries adopted alternative telenutrition approaches through social/mass media.

Status and correlates of food and nutrition literacy among parents-adolescents' dyads: findings from 10 Arab countries.

Background: Food literacy is capturing the attention worldwide and gaining traction in the Arab countries. Strengthening food and nutrition literacy among Arab teenagers are important promising empowering tools which can protect them from malnutrition. This study aims to assess the nutrition literacy status of adolescents with the food literacy of their parents in 10 Arab countries. Methods: This cross-sectional study involving a convenient sample of 5,401 adolescent-parent dyads (adolescents: mean age ± SD: 15.9 ± 3.0, females: 46.8%; parents: mean age ± SD: 45.0 ± 9.1, mothers: 67.8%) was launched between 29 April and 6 June 2022 in 10 Arab nations. The Adolescent Nutrition Literacy Scale (ANLS) and the Short Food Literacy Questionnaire (SFLQ) were used to meet the study aims. Results: More than one-quarter (28%) of adolescents had poor nutrition literacy, with 60% of their parents being food illiterate. The top three countries with nutritionally" less literate" adolescents were Qatar (44%), Lebanon (37.4%), and Saudi Arabia (34.9%). Adolescents' age, gender, education level, primary caregivers, employment status, and the inclusion of nutrition education in the schools' curriculum predicted the nutrition literacy levels of Arab adolescents. Besides, parental weight status, health status, parent's food literacy level, and the number of children per household were significant determinants too. Adolescents studying at a university and having parents with adequate food literacy had the highest odds of being nutritionally literate (OR = 4.5, CI = 1.8-11.5, p = 0.001, OR = 1.8, CI = 1.6-2.1, p < 0.001, respectively). Conclusion: Nutrition literacy inadequacy among Arab adolescents is a prioritized challenge to be tackled.

The Impact of the COVID-19 Pandemic on Public Interest in the Energy Labelling on Restaurant Menus.

No study has investigated the effect of the COVID-19 pandemic on the public's interest in using energy labelling on restaurant menus. This study explores the effects of the COVID-19 pandemic on the public interest in using energy labelling on restaurant menus and meal delivery applications and the impact of energy-labelling availability on food choices during the COVID-19 pandemic in Saudi Arabia. An online questionnaire was completed by 1657 participants aged ≥ 18 years. Before the COVID-19 pandemic, 32% of customers visited a restaurant 2-4 times/week. However, during the pandemic, 35% of customers visited a restaurant only once per week. There was no difference in interest in reading energy labelling or using meal delivery applications before and during the pandemic. During the COVID-19 pandemic, about 55% of restaurant customers reported that they had noticed energy labelling, with 42% of them being influenced by the energy-labelling information. Regarding energy information on food delivery applications, 40% of customers noticed energy labelling when using the applications, with 33% of them being affected by the energy labelling. Customer interest in reading about energy on restaurant menus during the pandemic did not change significantly from the level of interest before the pandemic. The interest expressed by the public in using the energy labelling was low both before and during the COVID-19 pandemic.

Household Food Insecurity, Anemia, Malnutrition and Unfavorable Dietary Diversity among Adolescents: Quadruple Whammies in the Era of Escalating Crises in Lebanon.

Adolescence is a transitional period between childhood and adulthood. Nowadays, adolescents in Lebanon are growing during a time of unprecedented health crises and political instability. This study aimed to determine the prevalence and correlates of malnutrition, dietary diversity in adolescents' households, and adolescents' self-reported food insecurity in Lebanon. A national representative sample of 450 parent-adolescent dyads (parents: mean age ± standard deviation (SD) = 46.0 ± 7.0, mothers: 59.0%; adolescents: mean age ± SD = 15.0 ± 3.0, girls: 54.6%) were interviewed. Anthropometric and blood hemoglobin measurements were performed for adolescents. The Food Consumption Score, the Arab Family Food Security Scale and the Adolescent-Level Food-Security Scale were used. The overall prevalence of adolescent stunting, thinness, overweight, obesity and anemia was 6.7%, 4.7%, 19.3%, 12.9% and 16.7%, respectively. Almost 40.4% and 68% of adolescent's households consumed undiversified diets and were food insecure, respectively. Food insecurity (FI) affected 54.0% of adolescents. Adolescents attending schools (vs. university) were eight times more likely to be stunted (p = 0.04). Boys had a 4.3 times higher thinness risk (p = 0.005) compared to girls. Households reporting an income decline since the start of the Lebanese economic crisis were three times more likely to have a thin adolescent (p = 0.01). Parental overweight/obesity (p = 0.002) and lower education level (p = 0.04) nearly doubled the risk of adolescent overweight or obesity. At a time when escalating crises in Lebanon are shifting diets for the youngest generations, the development of adolescent-responsive nutritional policies becomes a must.

A Snapshot of the Experience of Dietitians during the COVID-19 Crisis in Five Arab Countries: Findings from a Regional Cross-Sectional Study.

COVID-19's intimidating spread has challenged the resilience of the global health systems, causing shifts in the practices of healthcare workers, including dietitians. The current study aimed to assess the change in dietitians' practices and duties in hospitals/clinics after the commencement of COVID-19 pandemic. This cross-sectional study was conducted in five Arab countries between November 2020 and January 2021. A convenient sample of 903 dietitians filled an online self-administered questionnaire to meet the study aims. Nearly 40.0% of the dietitians experienced a change in their workload and caseload during the pandemic. Besides, 18.7% of the dietitians had been assigned additional tasks in their facilities. Nearly half the dietitians (46.9%) had started giving remote nutrition consultations, associated with a 21% drop in the number of dietitians offering in-person consultations (p = 0.001). Approximately 58.9% of the dietitians provided nutrition care to COVID-19 patients, with 48.4% having access to personal protective equipment. Moreover, 17.0% of dietitians supported COVID-19 patients with enteral and parenteral nutrition. In addition, 45.0% of dietitians reported that managing COVID-19 was challenging given that it was a newly discovered condition.

Impact of COVID-19 lockdown on smoking (waterpipe and cigarette) and participants' BMI across various sociodemographic groups in Arab countries in the Mediterranean Region.

INTRODUCTION: Tobacco smokers are at high risk of developing severe COVID-19. Lockdown was a chosen strategy to deal with the spread of infectious diseases; nonetheless, it influenced people's eating and smoking behaviors. The main objective of this study is to determine the impact of the COVID-19 lockdown on smoking (waterpipe and cigarette) behavior and its associations with sociodemographic characteristics and body mass index. METHODS: The data were derived from a large-scale retrospective cross-sectional study using a validated online international survey from 38 countries (n=37207) conducted between 17 April and 25 June 2020. The Eastern Mediterranean Region (WHO-EMR countries) data related to 10 Arabic countries that participated in this survey have been selected for analysis in this study. A total of 12433 participants were included in the analysis of this study, reporting their smoking behavior and their BMI before and during the COVID-19 lockdown. Descriptive and regression analyses were conducted to examine the association between smoking practices and the participant's country of origin, sociodemographic characteristics, and BMI (kg/m2). RESULTS: Overall, the prevalence rate of smoking decreased significantly during the lockdown from 29.8% to 23.5% (p<0.05). The percentage of females who smoke was higher than males among the studied population. The highest smoking prevalence was found in Lebanon (33.2%), and the lowest was in Oman (7.9%). In Egypt, Kuwait, Lebanon, and Saudi Arabia, the data showed a significant difference in the education level of smokers before and during the lockdown (p<0.05). Smokers in Lebanon had lower education levels than those in other countries, where the majority of smokers had a Bachelor's degree. The findings show that the BMI rates in Jordan, Lebanon, Oman, and Saudi Arabia significantly increased during the lockdown (p<0.05). The highest percentages of obesity among smokers before the lockdown were in Oman (33.3%), followed by Bahrain (28.4%) and Qatar (26.4%), whereas, during the lockdown, the percentage of obese smokers was highest in Bahrain (32.1%) followed by Qatar (31.3%) and Oman (25%). According to the logistic regression model, the odds ratio of smoking increased during the pandemic, whereas the odds ratio of TV watching decreased. This finding was statistically significant by age, gender, education level, country of residence, and work status. CONCLUSIONS: Although the overall rates of smoking among the studied countries decreased during the lockdown period, we cannot attribute this change in smoking behavior to the lockdown. Smoking cessation services need to anticipate that unexpected disruptions, such as pandemic lockdowns, may be associated with changes in daily tobacco consumption. Public health authorities should promote the adoption of healthy lifestyles to reduce the long-term negative effects of the lockdown.

Sex disparities in food consumption patterns, dietary diversity and determinants of self-reported body weight changes before and amid the COVID-19 pandemic in 10 Arab countries.

Background: The COVID-19 pandemic along with its confinement period boosted lifestyle modifications and impacted women and men differently which exacerbated existing gender inequalities. The main objective of this paper is to assess the gender-based differentials in food consumption patterns, dietary diversity and the determinants favoring weight change before and amid the COVID-19 pandemic among Arab men and women from 10 Arab countries. Methods: A cross-sectional study was conducted based on a convenience sample of 12,447 households' family members (mean age: 33.2 ± 12.9; 50.1% females) and information from participants aged 18 years and above was collected about periods before and during the pandemic. Results: Findings showed that, during the COVID-19 period, the dietary diversity, declined by 1.9% among females compared to males (0.4%) (p < 0.001) and by 1.5% among overweight participants (p < 0.001) compared to their counterparts. Conclusions: To conclude, gender-sensitive strategies and policies to address weight gain and dietary diversity during emergent shocks and pandemics are urgently needed in the region.

Breastfeeding Practices, Infant Formula Use, Complementary Feeding and Childhood Malnutrition: An Updated Overview of the Eastern Mediterranean Landscape.

BACKGROUND: With increasing global rates of overweight, obesity and non-communicable diseases (NCDs) along with undernutrition and micronutrient deficiencies, the Eastern Mediterranean Region (EMR) is no exception. This review focuses on specific nutrition parameters among under five years children, namely ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods and malnutrition. METHODOLOGY: PubMed, Google Scholar, United Nations International Children's Emergency Fund (UNICEF) databases, World Health Organization (WHO) databases, the World Bank databases and the Global Nutrition Report databases were explored between 10 January and 6 June 2022, to review the nutrition situation among under five years children in the EMR. RESULTS: The regional average prevalence of ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods was estimated at 84.3%, 30.9%, 42.9%, 41.5%, 32.1% and 69.3%, respectively. Iran, Iraq, Libya and Palestine have seen a decline over time in the prevalence of exclusive breastfeeding. Lebanon, Egypt, Kuwait and Saudi Arabia reported early introduction of infant formula. Moreover, Lebanon, Pakistan, Saudi Arabia and United Arab Emirates were seen to introduce food early to the child, at between 4-6 months of age. The estimated weighted regional averages for stunting, wasting and underweight were 20.3%, 8.9% and 13.1%, respectively. Of concern is the increasing prevalence of stunting in Libya. As for overweight and obesity, the average prevalence was reported to be 8.9% and 3%, respectively. Lebanon, Libya, Kuwait and Palestine showed an increased trend throughout this time. CONCLUSIONS: In this review, the suboptimal infant and young child feeding patterns and the twofold incidence of malnutrition in the EMR are highlighted and we urge the prioritizing of measures to improve children's nutrition.

Prevalence of Essential Nutrient Supplement Use and Assessment of the Knowledge and Attitudes of Lebanese Mothers towards Dietary Supplement Practices in Maternal, Infancy and Preschool Ages: Findings of a National Representative Cross-Sectional Study.

Mothers are understandably concerned about protecting the well-being of their offspring in every way possible, including providing oral dietary supplements (DSs). Up to now, there has been limited data on maternal knowledge and attitudes toward concomitant maternal-child DSs practices in Lebanon. This study evaluated the maternal knowledge and attitudes toward DSs and documented the DS-related practices in mothers and their under-5 children with their correlates. This cross-sectional study involved a representative stratified cluster random sample of 511 mother-child dyads (mothers: mean age ± SD = 30.25 ± 4.98 years; children: mean age ± SD = 18.7 ± 15.5 months, girls: 55.0%). A self-administered questionnaire was used to meet study aims. Most mothers lack awareness and hold unfavorable attitudes regarding DS use. Among all mothers, 47% were DS users, with the majority using vitamin D (82%). Almost 64% of mothers provide DSs for their children, with a predominant use of multivitamin drops (61.0%). "To keep the child healthy" was the reported reason by 60.0% of mothers to provide DSs for their children. Physicians were the primary information source about DSs for most mothers (64.0%). The usage of DSs among mothers was influenced by their pregnancy status, child's age, number of children per household, and their awareness and attitudes towards DSs. DS usage among children was correlated with maternal DS use and their mothers' attitudes towards DSs. DS usage among Lebanese mother-child dyads is common. Mothers should be the focus of education sessions regarding DS use.

The Impact of COVID-19 on Physical (In)Activity Behavior in 10 Arab Countries.

Insufficient physical activity is considered a strong risk factor associated with non-communicable diseases. This study aimed to assess the impact of COVID-19 on physical (in)activity behavior in 10 Arab countries before and during the lockdown. A cross-sectional study using a validated online survey was launched originally in 38 different countries. The Eastern Mediterranean regional data related to the 10 Arabic countries that participated in the survey were selected for analysis in this study. A total of 12,433 participants were included in this analysis. The mean age of the participants was 30.3 (SD, 11.7) years. Descriptive and regression analyses were conducted to examine the associations between physical activity levels and the participants' sociodemographic characteristics, watching TV, screen time, and computer usage. Physical activity levels decreased significantly during the lockdown. Participants' country of origin, gender, and education were associated with physical activity before and during the lockdown (p < 0.050). Older age, watching TV, and using computers had a negative effect on physical activity before and during the lockdown (p < 0.050). Strategies to improve physical activity and minimize sedentary behavior should be implemented, as well as to reduce unhealthy levels of inactive time, especially during times of crisis. Further research on the influence of a lack of physical activity on overall health status, as well as on the COVID-19 disease effect is recommended.

The Effect of the COVID-19 Pandemic on Saudi Adults' Behavior Regarding Food Literacy and Food Consumption.

Background The coronavirus pandemic has forced worldwide closures, especially of restaurants closed, which partly contributed to people all over the world changing the way they choose and prepare foods. Objective The objective of this study was to compare changes in behavioral food literacy (planning, selecting, and preparing food) and food consumption before and during the COVID-19 crisis in the Kingdom of Saudi Arabia (KSA). Design This was a cross-sectional study, with data from an online survey made in UAntwerpen Qualtrics Accounts and collected from April-June 2020. The study was part of the International Corona Cooking Survey. Results There were 2788 respondents (83%, n = 2323 females) who reported that the COVID-19 home lockdown had positively affected all their behavioral food literacy components (all p<0.05) except feeling confident about cooking a variety of healthy meals in which the difference was not significant (p>0.05); however, its impact on their food consumption was varied. There was a noticeable positive increase in fruit intake (Z= -3.330, p=0.001) and a noticeable positive decrease in processed meat (Z= -11.375, p<0.001) and sweetened drinks consumption (Z= -2.403, p<0.05). There were simultaneously noticeable adverse effects represented in the reduction in the consumption of the vegetable group (Z= -3.447, p=0.001) and an increase in sweets consumption (Z= -2.268, p<0.05). However, the overall impacts of these changes as measured by the Hedges' g measure indicated a small effect (Hedges' g = 0.04, 95% CI (-0.07, -0.16)). Discussion and conclusions Even though the pandemic may have created a sense of responsibility for one's health and increased people's nutritional awareness, the Saudi population may be still a long way from having healthy eating habits. Public health campaigns need to increase the population's level of nutritional awareness, educate them about the meaning of healthy eating, and how they can achieve that by advocating the national dietary guidelines and providing reliable and accurate information by authorized official bodies.

Machine learning techniques for predicting depression and anxiety in pregnant and postpartum women during the COVID-19 pandemic: a cross-sectional regional study.

Background: Maternal depression and anxiety are significant public health concerns that play an important role in the health and well-being of mothers and children. The COVID-19 pandemic, the consequential lockdowns and related safety restrictions worldwide negatively affected the mental health of pregnant and postpartum women. Methods: This regional study aimed to develop a machine learning (ML) model for the prediction of maternal depression and anxiety. The study used a dataset collected from five Arab countries during the COVID-19 pandemic between July to December 2020. The population sample included 3569 women (1939 pregnant and 1630 postpartum) from five countries (Jordan, Palestine, Lebanon, Saudi Arabia, and Bahrain). The performance of seven machine learning algorithms was assessed for the prediction of depression and anxiety symptoms. Results: The Gradient Boosting (GB) and Random Forest (RF) models outperformed other studied ML algorithms with accuracy values of 83.3% and 83.2% for depression, respectively, and values of 82.9% and 81.3% for anxiety, respectively. The Mathew's Correlation Coefficient was evaluated for the ML models; the Naïve Bayes (NB) and GB models presented the highest performance measures (0.63 and 0.59) for depression and (0.74 and 0.73) for anxiety, respectively. The features' importance ranking was evaluated, the results showed that stress during pregnancy, family support, financial issues, income, and social support were the most significant values in predicting anxiety and depression. Conclusion: Overall, the study evidenced the power of ML models in predicting maternal depression and anxiety and proved to be an efficient tool for identifying and predicting the associated risk factors that influence maternal mental health. The deployment of machine learning models for screening and early detection of depression and anxiety among pregnant and postpartum women might facilitate the development of health prevention and intervention programs that will enhance maternal and child health in low- and middle-income countries.

Prevalence, correlates, and gender disparities related to eating disordered behaviors among health science students and healthcare practitioners in Lebanon: Findings of a national cross sectional study.

Background: The raised prevalence of eating disorders (ED) amongst health science students and health professionals is of mounting concern. This study aims to determine the prevalence and correlates of eating disorders risk amongst a sample of Lebanese health science students and healthcare practitioners of both genders. Methods: This cross-sectional study enrolled a convenient sample of 1,000 participants (mean age: 23 ± 5.4; females: 74.9%) from faculties of health sciences, clinics, pharmacies, and hospitals. The validated Eating Attitudes Test (EAT-26) was used to screen for eating disorders. Anthropometric data were self-reported by respondents to assess their nutritional status. Results: The risk of eating disorders was prevalent in 22.5% of participants. Females were at higher risk of ED compared to males p = 0.03. Eating disorders risk did not differ between students and practitioners (p = 0.3). The highest proportion of high-risk participants were students studying nutrition and practitioners (40.9%), outracing their counterparts in nursing (18.7%), medicine (17.8%), pharmacy (17.7%), and midwifery (4.9%) sciences (p = 0.02). Most high-risk participants had normal body weight (60.4%), and 28.9% were overweight (p = 0.001). Female gender, nutrition profession, and dieting were associated with increasing the odd of ED. Particularly, dieting increased the risk around five times. Further, each 3 participants over 10 were facing binge eating behavior. Conclusion: This study uncovers an undervalued profession-related-health-disorder in Lebanese health science students and healthcare practitioners. Specific attention should be given to EDs in professional educational programmes across healthcare disciplines.

Is Undernutrition Associated With Deterioration of Outcomes in the Pediatric Intensive Care Unit (PICU): Systematic and Meta-Analysis Review.

Background and aim: Undernutrition (UN) may negatively impact clinical outcomes for hospitalized patients. The relationship between UN status at pediatric intensive care unit (PICU) admission and clinical outcomes is still not well-reported. This systematic meta-analysis review evaluated the impact of UN at admission to PICU on clinical outcomes, including mortality incidence, length of stay (LOS), and the need for and length of time on mechanical ventilation (MV). Methods: A search was conducted using relevant and multi-medical databases from inception until January 2022. We considered studies that examined the link between UN at PICU admission and clinical outcomes in patients aged 18 years or younger. Pooled risk difference estimates for the PICU outcomes were calculated using a random-effects model. Result: There were a total of 10,638 patients included in 17 observational studies; 8,044 (75.61%) and 2,594 (24.38%) patients, respectively, were normal-nourished (NN) and undernourished (UN). In comparison to NN patients, UN patients had a slightly higher risk of mortality (RD = 0.02, P = 0.05), MV usage (RD = 0.05, P = 0.02), and PICU LOS (RD = 0.07, P = 0.007). While the duration of MV was significantly longer in UN than in NN (RD = 0.13, P < 0.0001). Sensitivity analysis of UN classification cohorts with a z-score < -2 or in the 5%, patetints age up to 18 years, and mixed diagnose for PICU admission demonstrated a 6-fold increase in the probability of PICU LOS in UN patients compared to NN patients (RD = 0.06, 95% CI = 0.01, 0.12). UN patients have a higher risk of MV usage RD = 0.07, 95% CI = 0.00, 0.14) in studies involving cohorts with a mixed primary diagnosis for PICU admission. Conclusion: In PICU, UN is linked to mortality incidence, longer PICU stay, MV usage, and duration on MV. The primary diagnosis for PICU admission may also influence clinical outcomes. Determining the prevalence of UN in hospitalized patients, as well as the subgroups of patients diagnosed at the time of admission, requires more research. This may help explain the relationship between nutritional status and clinical outcomes in PICU patients.

Aflatoxin B1 Occurrence in Children under the Age of Five's Food Products and Aflatoxin M1 Exposure Assessment and Risk Characterization of Arab Infants through Consumption of Infant Powdered Formula: A Lebanese Experience.

Aflatoxin M1 (AFM1) is a salient metabolite that can be used to assess Aflatoxin B1 (AFB1) exposure in humans and animals. The carcinogenic potency of AFB1 and AFM1 was severely reported. The aims of this study were (1) to survey the contamination level of AFM1 in the most traded infant powdered formula brands (IPF) (n = 42) along with the AFB1 level in under 5's children food brands (biscuits, cornflakes, and cereals) (n = 42) and (2) to assess the estimated daily intake (EDI), the hazard quotient (HQ) and the margin of exposure (MOE) of AFM1 among infants (0-12 months) in Lebanon. All of the samples were analyzed using ELISA technique. AFB1 was below detection limit in all of the children's food brands samples. Out of 42 IPF samples 9.5% were AFM1-positive in the range of 29.54-140.16 ng/L and exceeded the maximum tolerable limit (MTL) set by the European commission (25 ng/kg). The overall average contamination level was 5.72 ± 0.014 ng/L. The EDI of AMF1 for male was in the range of 0.37-0.78 ng/kg/b.w./day and 0.40-0.87 ng/kg/b.w./day for females. Similarly, the HQ calculation resulted in an average of 3.05 for males and 3.28 for females. MOE calculations were far lower from 10,000 in both genders which indicates a high risk of genotoxicity and carcinogenicity. Our findings show that AFM1's EDI, HQ and MOE scored high among Lebanese infants. As infants consume more IPF relative to their body weight, the persistence of IPF with high AFM1 levels threatens their health. Thus, infant's exposure risk to AFM1 in IPF should be a continuous focus of attention.

Adherence to the United States Department of Agriculture Dietary Recommendations Pre- and During the Coronavirus Disease-19 Pandemic Among Pregnant Women in Arab Countries.

During pregnancy, woman's diet is one of the most preeminent factors affecting mother and child's health. Prior to the coronavirus disease-19 (COVID-19) pandemic, inadequate maternal diet and low adherence to dietary guidelines was reported among pregnant women in the Arab countries. Nowadays, COVID-19 infection during pregnancy is widely discussed among literature. However, there is limited data on the health impacts of the COVID-19 pandemic on non-infected pregnant women. This substantially larger group also suffered significant lifestyle changes during the lockdown period. The aim of the study is to characterize dietary patterns, intake and adherence to the United States Department of Agriculture (USDA) pregnancy guidelines before and during the COVID-19 pandemic in Arab pregnant women. Using a specially designed questionnaire and using the snowball sampling method, the survey was carried out among a convenient sample of 1,939 pregnant women from five Arab countries. Our study found an increment in the consumption of cereals, fruits, vegetables, dairy products, meats, and nuts that occurred during the pandemic compared to the preceding period. Despite this noticeable increase during the pandemic, the Arab pregnant women in this study had significantly lower adherence to the USDA pregnancy guidelines. The daily consumption of almost all food groups was lower than the USDA's daily recommendations, except for fruits intake, which was higher than the daily standard. Demonstrated poor adherence to prenatal USDA dietary guidelines by Arab pregnant women can lead to numerous deficiencies and health risks among their offspring. In conclusion, our study showed that before and during the COVID-19 pandemic, poor adherence to dietary recommendations occurred in a considerable number of Arab pregnant women. The findings emphasize the need for nutritional education and intervention during prenatal visits.

Dietary Diversity in the Eastern Mediterranean Region Before and During the COVID-19 Pandemic: Disparities, Challenges, and Mitigation Measures.

The COVID-19 pandemic has revealed the Eastern Mediterranean Region's food system's fragility posing severe challenges to maintaining healthy sustainable lifestyle. The aim of this cross-sectional study (N = 13,527 household's family members, mean age: 30.3 ±11.6, 80% women) is to examine the impact of the COVID-19 pandemic on food consumption patterns and household's dietary diversity in 10 Eastern Mediterranean countries. A food frequency questionnaire was used to investigate the consumption patterns along with the calculation of the Food Consumption Score (FCS), a proxy indicator of dietary diversity. Data collected on cooking attitudes, shopping and food stock explore the community mitigation measures. In the overall population, before and during the pandemic, most food groups were consumed less or equal to 4 times per week. As evident from our findings and considering that the pandemic may be better, but it's not over, small to moderate changes in food consumption patterns in relatively short time periods can become permanent and lead to substantial poor dietary diversity over time. While it is a priority to mitigate the immediate impact, one area of great concern is the long-term effects of this pandemic on dietary patterns and dietary diversity in Eastern Mediterranean households. To conclude, the COVID-19 crisis revealed the region's unpreparedness to deal with a pandemic. While the aggressive containment strategy was essential for most countries to help prevent the spread, it came at a high nutritional cost, driving poor dietary diversity.

A cross-sectional exploratory study of food literacy among Saudi parents of adolescent children aged 10 to 19 years.

Introduction: Parental food literacy is fundamental in laying a solid foundation for healthy eating among their children. This study aimed to (1) evaluate the current state of food literacy among Saudi parents of 10-19 years old adolescent children, and (2) determine the correlates associated with parental food literacy. Methods: This cross-sectional study was conducted between April and June 2022, with a convenience sample of 1845 Saudi parents (mean age = 45.1 ± 11; mothers: 56%). A Short Food Literacy Questionnaire (SFLQ) was used to meet the study aims. Results: Findings showed that around 46% of parents had poor food literacy. Fathers were 2.4 times more likely than mothers to be food illiterate (OR = 2.4, CI = 1.9-3.0, p < 0.001). Parents residing in Riyadh, Northern borders, Jawf, or Ha'il had a three times higher risk of being food illiterate than those residing in other provinces (OR = 3.2, CI = 2.6-3.9, p < 0.001). Parental overweight or obesity increased their risk of being food illiterate by 60% (OR = 1.6, CI = 1.3-2.1, p < 0.001). Healthy parents, in contrast to those having a chronic disease (s), had a 60% higher probability of food illiteracy (OR = 0.4, CI = 0.3-0.6, p < 0.001). Educated parents had a three times higher risk of being food illiterate (vs. uneducated parents, OR = 3.0, CI = 1.6-5.8, p = 0.001). Parents making less than 3000 Saudi Riyal (SR) per month (<798 USD/779 EUR) were 40% more likely to be food illiterate than those who reported 3000-25000 SR (798-6652 USD/779-6499 EUR) (OR = 0.6, CI = 0.4-0.9, p = 0.02), and 70% more likely to be food illiterate than those making more than 25000 SR (>6652 USD/6497 EUR) (OR = 0.3, CI = 0.2-0.6, p < 0.001). Parents who lived in crowded households were twice as likely to be food illiterate as those who did not (OR = 1.9, CI = 1.5-2.4, p < 0.001). Conclusion: The current study findings should be employed in future programming and policy-making approaches to reach Saudi parents for necessary food literacy interventions. These interventions could include bolstering their confidence while cooking, buying groceries, reading nutrition labels, and integrating them into nutrition education lessons with their children in school settings.

Public health risk associated with the co-occurrence of aflatoxin B1 and ochratoxin A in spices, herbs, and nuts in Lebanon.

Background: Aflatoxin B1 and ochratoxin A are mycotoxins produced by filamentous fungi that attack crops on field and storage. Both mycotoxins present a risk on public health since aflatoxin B1 is a hepatotoxic and hepatocarcinogenic agent while ochratoxin A can be nephrotoxic. Those mycotoxins can be found in several food items including spices, herbs, and nuts. Objectives: In Lebanon, few studies address aflatoxin B1 and ochratoxin A contamination in spices, herbs, and nuts. So, the aim of this study is to investigate the concentrations of those two mycotoxins particularly in spices and herbs and the concentration of aflatoxin B1 in nuts, and to determine the dietary exposure of the Lebanese population and their possible attribution to liver cancer and renal damage. Methods: In this work, a total of 198 samples of spices, herbs, and nuts were collected from different sites. Aflatoxin B1 and ochratoxin A were quantified using immune-affinity columns. A food frequency questionnaire was used to quantify the consumption of spices, herbs, and nuts in Lebanon. Exposure to aflatoxin B1 and ochratoxin A was calculated accordingly and liver and kidney cancer risks were evaluated. Results: Aflatoxin B1 was respectively found in 100, 20.4, and 98.6% of the spices, herbs, and nuts samples, while ochratoxin A was found in 100 and 44.4% of spices and herbs, respectively. Aflatoxin B1 was found at mean concentration of 0.97, 0.27, and 0.40 µg/kg in spices, herbs, and nuts, respectively while ochratoxin A was found at mean concentrations of 38.8 and 1.81 µg/kg in spices and herbs, respectively. Aflatoxin B1 occurrence was shown to be associated in this study with 0.017 additional cancer cases per 100,000 persons per year, and ochratoxin A weekly exposure was shown to be 5.04 ng/kg bw less than the Provisional Tolerable Weekly Intake of 100 ng/kg bw which indicates low risk of renal damage from spices and herbs consumption. Conclusion: The consumption of spices, herbs, and nuts in Lebanon could lead to an increase in health risks associated with aflatoxin B1 and ochratoxin A, specifically spices. The reported occurrence may be directly related to poor storage conditions.