Timing and types of fluids and foods first introduced in a representative sample of toddlers attending day care programs across Lebanon: Are parents following international recommendations?

BACKGROUND: Current WHO's recommendation for optimal infant feeding advises exclusive breastfeeding for 6 months. After this initial period, infants should receive nutritionally adequate and safe complementary food starting from the age of 6 months with continued breastfeeding up to 2 years of age or beyond. PURPOSE: This study examined the timing and types of fluids and foods first introduced in a representative sample of toddlers (n = 1051) from 79 daycares across Lebanon. Questionnaires were self-administered to parents of toddlers (12-36 months) with a participation rate of 67%. RESULTS: Results showed that more than half of toddlers (55.7%) were introduced to infant formula within their first month of life. Around two-thirds received water as the first type of additional fluid (62.5%) with a mean age of 3.86 ± 2.15 months and fruits or cooked vegetables (69.7%) as the first types of food introduced with a mean age of 5.73 ± 1.56 months. Unfortunately, two-third (67.3%) were not breastfed after solid food introduction. PRACTICE IMPLICATIONS: Our data on current suboptimal feeding practices in Lebanon shows the need to reinforce BF and CF practices recommendations and guidelines at the community, social and health system levels. CONCLUSIONS: In the absence of specific recommendations and with the poor involvement of the various stakeholders, it was noted that more than half of the parents were not following the WHO recommendation concerning unnecessary fluid supplementation of infants and were introducing food before the recommended age of 6 months; moreover, only a minority of mothers continued breastfeeding after introducing food to their infants.

Determinants of Exclusive and Mixed Breastfeeding Durations and Risk of Recurrent Illnesses in Toddlers Attending Day Care Programs Across Lebanon.

PURPOSE: Breastfeeding rates continue to decrease in Lebanon. Studies addressing the relationship between breastfeeding duration and health outcomes in Middle Eastern countries are scarce. This study is the first in Lebanon to have investigated the determinants of both exclusive and mixed breastfeeding durations and the relationship with health in infants and toddlers. DESIGN AND METHODS: Our sample of 1051 toddlers is nationwide and representative of all toddlers enrolled in daycare centers, and aged between 12 and 36 months. RESULTS: Median of exclusive breastfeeding duration was 15 days and mean age of formula introduction was 2.03 (±3.22) months. Exclusive breastfeeding was initiated at a mean age of 10.56 (±27.12) hours and half of the toddlers (51.6%) were exposed to formula milk since day one following birth. Determinants of both exclusive and total breastfeeding durations were related to several parents' socio-demographic and behavioral factors. A longer duration of exclusive breastfeeding was associated with a lower frequency of pediatrician visits, antibiotic prescriptions, absence from daycare, and a lower risk of otitis, colic and UTI occurrence, after adjusting for cofounders. Similarly, a longer duration of total breastfeeding was associated with less antibiotic prescriptions and a lower risk of otitis. CONCLUSIONS: Our study highlights the health benefits of extending exclusive breastfeeding duration. It is urgent to address alarmingly low breastfeeding rates in Lebanon. Policy implementation and enforcement along with raising awareness and creating a supportive environment for breastfeeding mothers should involve the various stakeholders in order to succeed in increasing breastfeeding rates and duration.

Assessment of Dietary Intake Patterns and Their Correlates among University Students in Lebanon.

INTRODUCTION: Unhealthy dietary habits are major risk factors for chronic diseases, particularly if adopted during early years of adulthood. Limited studies have explored the food consumption patterns among young adults in Lebanon. Our study aimed to examine common dietary patterns and their correlates among a large sample of university student population in Lebanon, focusing on correlation with gender and body mass index (BMI). METHODS: A cross-sectional study was carried out on 3384 students, using a proportionate cluster sample of Lebanese students from both public and private universities. A self-administered food frequency questionnaire was used to assess dietary intake of university students. Factor analysis of food items and groups, cluster analysis of dietary patterns, and multivariate regressions were carried out. RESULTS: Three dietary patterns were identified among university youth namely a vegetarian/low calorie dietary pattern (characterized mainly by consumption of plant-based food while avoiding "western" food, composite dishes, and bread); a mixed dietary pattern (characterized by high consumption of plant-based food, followed by composite dishes, bread, and a low consumption of western type food); and finally, a westernized dietary pattern (characterized by high consumption of white bread and western food, and a strong avoidance of plant food and composite dishes). We observed significant differences between males and females in terms of their reported food intake and dietary patterns. Females were particularly more prone to adopt the vegetarian/low calorie diet than males (ORa = 1.69; p < 0.001), while males were more likely to adopt a westernized diet (ORa = 1.51; p < 0.001), seemingly in private universities (p = 0.053). Students with high income and obese students (BMI ≥ 30 kg/m(2)) were more likely to consume vegetarian/low calorie diets (p < 0.05). CONCLUSION: Male university students reported a higher consumption of the westernized dietary pattern as compared to female university students in Lebanon, while the latter reported a higher adoption of a vegetarian diet. Health promotion programs are needed to address the dietary intakes and lifestyle behaviors of young adults in Lebanon to help prevent obesity and other associated comorbidities.

The Young Adults' Cigarette Dependence (YACD) score: an improved tool for cigarette dependence assessment in university students.

BACKGROUND: Cigarette smoking induces dependence in young smokers. PURPOSE: The primary objective of this work was to validate the use of the Fagerström Test for Nicotine Dependence (FTND) in young Lebanese university students, and to improve it eventually by adding new items covering DSM-IV and ICD-10 dependence components. METHODS: We used data from a cross-sectional study on university students. A standardized questionnaire was administered, with items related to cigarette dependence: the FTND and the new Young Adults' Cigarette Dependence (YACD) scale. For both tools, factor and reliability analyses were performed. RESULTS: Although the FTND test showed satisfactory psychometric properties, the YACD showed better construct validity and reliability, covered dependence concept better and discriminated better between those who wanted to stop smoking and those who did not. CONCLUSIONS: FTND could be used in university students' population; however, the YACD scale could be more useful.

The shortest way to reach nutritional goals is to adopt Mediterranean food choices: evidence from computer-generated personalized diets.

BACKGROUND: Dietary guidelines can be derived from dietary patterns known to be healthy such as the traditional Mediterranean diet. They can also be deduced by translating a set of nutrient recommendations into food combinations. However, the latter may vary depending on the decisions made by different expert committees. OBJECTIVE: The objective was to compare the effect of removing or adding selected nutrient recommendations on the dietary changes needed to fulfill a whole set of nutrient recommendations. DESIGN: For each adult participating in the French INCA dietary survey (Enquête Individuelle et Nationale sur les Consommations Alimentaires) (n = 1171), a nutritionally adequate diet was modeled that simultaneously met a whole set of nutrient goals (proteins, fiber, essential fatty acids, 10 vitamins, 9 minerals, sodium, saturated fatty acids, free sugars) while deviating the least from the observed diet in terms of food content. Eight sets of models were developed according to the inclusion or not of constraints on total fats, total carbohydrates, total MUFAs, and cholesterol. RESULTS: Compared with the observed intakes, fulfilling the whole set of nutrient constraints systematically decreased total fats and increased total carbohydrates, even in the absence of specific constraints on those macronutrients. For whichever model used, a strong consistency was observed in the dietary changes needed to fulfill the constraints, and the greatest increases were seen for unsalted nuts, unrefined grains, legumes, fruit, fish and shellfish, and vegetables. CONCLUSION: Whether recommendations on total fats, MUFAs, or total carbohydrates are included or not in the definition of overall nutrient adequacy, foods typical of the Mediterranean diet are needed to reach overall nutrient adequacy.

Obesity associated behavior in adolescents of private schools in Lebanon.

OBJECTIVE: Since adolescence obesity is becoming an international concern, our objective was to evaluate obesity-related behavior in Lebanese adolescents. METHODS: We performed a cross-sectional study in 19 Lebanese private schools, using a random multistage cluster sampling process. Dietary and physical activity behaviors were assessed in 1933 adolescents aged 12 to 18 years, stressing on differences between boys and girls and obesity categories. RESULTS: We found that boys were more obese than girls (72% versus 3.7% ; p < 0.001); they were less likely to adopt dietary behaviors that maintain or increase weight, such as eating lighter food (13.1% versus 20.9% ; p < 0.001). However, girls were less likely to perform physical activity (81% versus 71%; p < 0.001). Our results are similar to those of other researchers. CONCLUSION: In this sample of Lebanese adolescents, dietary and physical activity behaviors differed between boys and girls ; these differences could explain their obesity rates. Educational and participative scholar interventions are necessary to induce changes in adolescents' behavior, stressing on physical activity for girls and healthier eating for boys.

The nutrient profile of traditional Lebanese composite dishes: comparison with composite dishes consumed in France.

PRIMARY OBJECTIVE: To estimate the overall nutritional quality of traditional Lebanese dishes by calculating their nutrient profile. METHODS: Fifty traditional Lebanese composite dishes (LD) were compared with 50 composite dishes consumed in France (FD), based on the SAIN (score of nutritional adequacy of individual foods) and LIM (score of nutrients to be limited) nutrient profiling system. Each dish was attributed to one of four nutrient profiling classes based on their SAIN and LIM values. The dishes' distributions within the four classes and their content in selected nutrients and ingredient groups were compared. RESULTS: LD had a better nutrient profile than FD (P <0.001). LD were richer in vitamin C and contained less proteins, saturated fatty acids, and sodium. They contained more vegetables and unrefined starches and less cheese and refined starches than FD. CONCLUSIONS: Nutrient profiles may help identify those composite dishes whose consumption should be encouraged to promote healthy eating in Lebanon.