Assessing the nutritional content and adequacy of food parcels among vulnerable Lebanese during a double crisis: COVID-19 pandemic and an economic meltdown.

OBJECTIVES: This study aimed to explore the nutritional content and quality of food parcels distributed in Lebanon and assess their adherence to dietary guidelines during the COVID-19 pandemic and an unprecedented economic crisis. DESIGN: Cross-sectional study (June-July 2020); phone survey (thirty items). SETTING: Lebanon. PARTICIPANTS: Food parcel providers (FPP; n 72) involved in food parcel distribution (FPD), mainly to Lebanese households. RESULTS: FPP included international non-governmental organizations (INGO) (n 3), local non-governmental organizations (n 45) and personal initiatives (n 24). Overall, low adherence to the World Food Programme (WFP) food parcel guidelines were observed among FPP for specific food items, including vegetables, fish, legumes and cereals, whereas salt content significantly surpassed the guidelines (all P-values <0·001). On average, a food parcel provided 608·4 ± 55 kcal/d/person. The greatest contributors to total energy intake (TE) in the food parcel were carbohydrates (46·4 %) and fats (46·8 %), while protein contributed to 7 %TE. In addition, %TE from fats and sugars significantly surpassed the dietary reference intakes (DRI) for a single person per d (134-234 % and 185 % of DRI, respectively, P-values <0·001). Only 10-15 % of daily needs for key micronutrients, including Fe, Zn, thiamin, riboflavin and dietary folate, were met through the food parcels. Adequate food safety and hygiene practices were reported among FPP, yet dramatic changes in food costs due to overlapping crises affected the quality and quantity of food in parcels. CONCLUSIONS: Findings highlight the need to improve the nutritional content of food parcels and adherence to dietary guidelines to alleviate food and nutrition insecurity while preventing diet-related diseases among vulnerable beneficiaries in Lebanon.

Anemia among Syrian Refugee Children Aged 6 to 23 Months Living in Greater Beirut, Lebanon, including the Voices of Mothers' and Local Healthcare Staff: A Mixed-Methods Study.

Globally, the prevalence of anemia among children during the period of complementary feeding is high. A cross-sectional, mixed-methods study was conducted to examine the main determinants of anemia among Syrian refugee children aged 6 to 23 months (n = 215) and to illuminate the knowledge, attitudes and perceptions of their mothers and Lebanese healthcare staff on its causes and available treatment options. 42% of the children and 20% of their mothers were anemic. Determinants of child anemia were the mother having anemia or not knowing that fish/seafood is a source of iron; the child having been acutely ill the last two weeks or receiving cow's milk, but not consuming iron-rich infant formula, added fats/oils, or fruits in the previous 24 hours. Several Syrian mothers knew some causes of anemia and named dizziness as a leading symptom but did not mention flesh foods as a key source of heme iron. They reported financial constraints in accessing iron-rich foods and supplements. Lebanese doctors largely gave appropriate dietary advice and prescribed iron supplements as treatment. Multisectoral interventions are needed that combine medical and financial support with nutrition counseling for mothers to reduce the high burden of anemia among young children living in a multiple crises situation.

Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study.

The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.

Food insecurity and mental health of college students in Lebanon: a cross-sectional study.

The present study aimed to assess the prevalence of food insecurity (FI) among college students and explore its association with indicators of mental and psychosocial health. Data were collected using a cross-sectional online survey from college students in different universities in Lebanon during the Spring 2021 semester. FI was assessed using the validated eight-item food insecurity experience scale. The mental health of college students was assessed using validated screening tools for depression, anxiety and well-being, namely the Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder-7 (GAD-7) and the World Health Organization (WHO-5) index, respectively. Multiple linear regression models were conducted to assess the relationship of FI with PHQ-9, GAD-7 and WHO-5 scores. A total of 745 students completed the online survey. Approximately 39 % of students in the sample were experiencing FI of which 27·4, 8·1, and 3·5 % were experiencing mild, moderate and severe FI , respectively. Low maternal education, low household monthly income and high levels of stress were significant correlates of FI among college students (P-trend < 0·001). In addition, 22·6 and 34·4 % of students showed severe symptoms of depression and anxiety, respectively. Regression models showed that FI was associated with higher scores on PHQ-9 and GAD-7 (ß = 2·45; 95 % CI [1·41, 3·49]) and (ß = 1·4; 95 % CI [1·1, 2·2], respectively) and lower scores on WHO-5 (ß = -4·84; 95 % CI [-8·2, -1·5]). In conclusion, a remarkable proportion of college students reported experiencing different forms of FI, which was associated with poorer mental health and well-being outcomes. Public health programmes and interventions are needed to mitigate FI and improve student health-related outcomes.

Financial Wellbeing and Quality of Life Among a Sample of the Lebanese Population: The Mediating Effect of Food Insecurity.

Background: Lebanon is undergoing multiple overlapping crises, affecting the food security, financial well-being, and quality of life (QOL) of its residents. Objective: The primary objective was to assess the food insecurity (FI) status of a sample of the Lebanese population. The second objective was to explore factors related to QOL parameters and evaluate the mediating effect of food security between financial well-being and QOL. Methods: The study was cross-sectional and enrolled 412 participants recruited online using the snowball sampling technique. The survey included questions related to sociodemographic and economic characteristics of Lebanese households and validated scales to assess FI, QOL measures, financial well-being, and fear of COVID-19. Results: Almost 43% of the study participants reported being food insecure, with 31% experiencing mild FI, 10% moderate FI, and 1.5% severe FI. Compared to food-insecure participants, food secure participants had a significantly higher income (58.5% vs. 39.2%, p < 0.001), a university education level (96.6% vs. 88.1%, p = 0.002), an average perceived financial status (83.9% vs. 65.9%), higher financial well-being scores (5.14 vs. 3.19, p < 0.001), and lower crowding index (0.94 ± 0.4 vs. 1.09, p = 0.002). Multivariate analysis showed that FI was not associated with physical (Beta = -1.48, 95% CI: -3.10; 0.13) and mental (Beta = -1.46, 95% CI -3.68; 0.75) QOL, after adjusting for other demographic and socioeconomic correlates. This association remained non-significant when introducing the financial well-being variable to the model. Mediation analyses showed that the FI variable mediated the association between financial well-being and physical QOL (Beta = 0.19, 95% CI: 0.02; 0.36), but not the mental QOL (Beta = -0.02, 95% CI: -0.20; 0.14). Conclusion: Food insecurity was prevalent in our study sample, and it mediated the association between financial well-being and physical, but not mental, QOL parameters. These findings call for evidence-based policies and programs to help improve the food security and well-being of Lebanese households amidst these unprecedented circumstances.

Food and nutrient intake of school-aged children in Lebanon and their adherence to dietary guidelines and recommendations.

BACKGROUND: Lebanon, an Eastern Mediterranean country, is witnessing a remarkable nutrition transition, and the diets of school-aged children may be amongst those most affected. However, limited studies have examined the food consumption patterns and nutrient adequacy in this age group. OBJECTIVES: The present study aimed to evaluate the dietary intakes of school-aged children in Lebanon and assess their adherence to nutrition guidelines and recommendations. METHODS: This study used data for 4-13 y-old children (n = 711) from a national cross-sectional survey conducted in 2014-2015 on a representative sample of Lebanese households with children. Dietary intake was assessed using single 24-h recall method. Estimated food group and nutrient intakes were compared to dietary recommendations and age-specific dietary reference intakes (DRI), including Estimated Average Requirements (EAR) and Acceptable Macronutrient Distribution Range (AMDR). Food group, energy, macro- and micro-nutrient intakes were presented for all children in the sample and stratified by age (4-8 y and 9-13 y) and sex. RESULTS: Mean energy intake of 4-13-year-old children was 1804 kcal/d. Almost half of the energy was provided by carbohydrates while 12% of children had protein intakes below EAR. Approximately three-quarters of children (4-13 y) exceeded the AMDR for total fat and saturated fats, and a similar proportion over consumed added sugars. The main sources of energy intake (EI) among children were the sweets, sweetened beverages and desserts followed by grains and mixed dishes. No significant differences were noted in %EI from different food groups, by sex, in either age groups. The highest adherence of children to food group recommendations was observed for the grains' food group (47.2-54.4%EI), while the lowest adherence was found for vegetables (3.1-14.1%EI). A high prevalence of vitamin and mineral inadequacies was noted amongst 4-13 y old children for key micronutrients, including vitamin D (99%), calcium (81%), and vitamin A (69.5%). Risk of inadequate micronutrient intakes was significantly increased among the older age group (p-value < 0.05). CONCLUSION: Nutrient intakes of school-aged children in Lebanon reflect suboptimal nutrition. Educational and public health interventions are needed to promote healthier diets among children and prevent micronutrient deficiencies during this critical phase.

Food consumption patterns and nutrient intakes of infants and young children amidst the nutrition transition: the case of Lebanon.

BACKGROUND: This is the first study on dietary intakes of infants and young children in the Eastern Mediterranean Region, a region that is currently witnessing the nutrition transition. It aims at characterizing food consumption patterns amongst 0-4 year old children in Lebanon, evaluating their macro- and micronutrient intakes and assessing adherence to dietary recommendations. METHODS: Based on a national cross-sectional survey in 2012 (n = 866), the study collected data on sociodemographic and anthropometric characteristics, and one 24-hour dietary recall was administered. Nutrient intakes were compared with reference values: Estimated Average Requirement (EAR), Adequate Intake (AI) and Acceptable Macronutrient Distribution Range (AMDR). RESULTS: Milk was the highest contributor to energy intake (EI) in infants (95.8 and 56.5% in 0-5.9 months and 6-11.9 months old infants, respectively), while its intake was lower among toddlers and preschoolers (35.4 and 15.1%, respectively). In contrast, intakes of sweets and sweetened beverages were the highest in preschoolers compared to younger children, contributing 18.5% EI in preschoolers. Compared to dietary guidelines, the lowest dietary adherence was found for vegetables (17.8-20.7%) and fruits (14.4-34.3%). Protein intake was within the recommendations for the vast majority of children. Although total fat intake was lower in toddlers and preschoolers compared to infants, more than 40% of toddlers and preschoolers exceeded the AMDR for fat and 87.3% of preschoolers exceeded the upper limit for saturated fat. Only 3.6% of toddlers and 11.5% of preschoolers exceeded the AI level for dietary fiber. Micronutrient intake assessment showed that mean intakes in infants exceeded the AI for all micronutrients, except for vitamin D and magnesium. In toddlers, vitamin D and calcium were below the EAR among 84.7, and 44.6%, respectively. In preschoolers, most of the children (91.9%) had inadequate intakes of vitamin D, and a third had inadequate intakes of folate, calcium and vitamin A. CONCLUSIONS: This study identified priority issues for nutrition intervention in infants and young children in Lebanon. Concerted multi-stakeholder efforts are needed to instill heathier food consumption and nutrient intake patterns early in life.

Food insecurity, low dietary diversity and poor mental health among Syrian refugee mothers living in vulnerable areas of Greater Beirut, Lebanon.

Syrian refugees in Lebanon are facing vulnerabilities that are affecting their food insecurity (FI) levels. The objectives of this study were to measure dietary diversity, FI and mental health status of Syrian refugee mothers in Lebanon and to explore its associations with their anaemia and nutritional status. A cross-sectional study was conducted among mothers with children under 5 years (n 433) in Greater Beirut, Lebanon. Dietary diversity was measured using the Minimum Dietary Diversity for Women (MDD-W) of reproductive age and FI using the global Food Insecurity Experience Scale at the individual level. Depression and post-traumatic stress disorder (PTSD) were measured to assess the maternal mental health status. Data on socio-economic characteristics, anthropometric measurements and Hb concentrations were collected. Overall, 63·3 % of the mothers had a low dietary diversity (LDD) and 34·4 % were moderately to severely food insecure, with 12·5 % being severely food insecure. The prevalence of PTSD, moderate depression and severe depression was 13·2, 11·1 and 9·9 %, respectively. A significant correlation was found between LDD and FI (P < 0·001). Low income was significantly associated with LDD and FI. Poor mental health was significantly associated with FI. LDD and FI were not associated with anaemia and nutritional status of mothers. Low-income households had significantly higher intakes of grains and refined starchy staples, whereas high-income households consumed more nutritious foods and sweets. Evidence of inadequate diet quality, FI and poor mental health among Syrian refugee mothers in Lebanon is presented. Multifaceted actions are needed to reduce FI and improve dietary diversity.

Food Insecurity Pre- and Post the COVID-19 Pandemic and Economic Crisis in Lebanon: Prevalence and Projections.

The coronavirus (COVID-19) pandemic has had serious repercussions on the global economy, work force, and food systems. In Lebanon, the pandemic overlapped with an economic crisis, which threatened to exacerbate food insecurity (FI). The present study aims to evaluate the trends and projections of FI in Lebanon due to overlapping health and economic crises. Data from Gallup World Poll (GWP) 2015-2017 surveys conducted in Lebanon on nationally representative adults (n = 3000) were used to assess FI trends and explore its sociodemographic correlates. Predictive models were performed to forecast trends in FI (2018-2022), using GWP data along with income reduction scenarios to estimate the impact of the pandemic and economic crises. Pre crises, trend analyses showed that FI could reach 27% considering wave year and income. Post crises, FI was estimated to reach on average 36% to 39%, considering 50-70% income reduction scenarios among Lebanese population. FI projections are expected to be higher among females compared to males and among older adults compared to younger ones (p < 0.05). These alarming findings call for emergency food security policies and evidence-based programs to mitigate the burden of multiple crises on the FI of Lebanese households and promote resilience for future shocks.

Anemia and Nutritional Status of Syrian Refugee Mothers and Their Children under Five Years in Greater Beirut, Lebanon.

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.

Promoting Sustainable and Healthy Diets to Mitigate Food Insecurity Amidst Economic and Health Crises in Lebanon.

Introduction: Lebanon, a middle-income Eastern Mediterranean country, continues to face detrimental economic, health and socio-political challenges that are further exacerbated by the COVID-19 pandemic. In parallel, the country has been experiencing a remarkable nutrition transition that has contributed to the burden of malnutrition and non-communicable diseases, all imposing serious repercussions on people's livelihoods, food security, and health. Such circumstances have prodded public demand for guidance on affordable, healthy, and sustainable dietary choices to alleviate the burden to this emerging unfortunate situation. Objective: The purpose of this study is to provide evidence-based sustainable and healthy dietary recommendations which balance the tradeoffs among the health, environmental footprint and cost dimensions of sustainability, while closely resembling the usual food consumption pattern. Methodology: Data from the latest available national food consumption survey was used as the usual food consumption pattern of Lebanese adults. Optimized dietary patterns were calculated using the optimization model Optimeal which produced patterns most similar to the usual diet and simultaneously satisfying the three main sets of constraints: health, environmental footprints, and cost. The identified healthy and sustainable dietary options were vetted by multiple key stakeholders from the government, academia, international, and national non-governmental organizations. Results: Compared to the usual intake, the optimized diet included higher intakes of whole grain bread, dark green vegetables, dairy products, and legumes, and lower intakes of refined bread, meat, poultry, added sugars, saturated fat, as compared to usual national mean consumption. The optimized dietary model resulted in a decrease in the associated environmental footprints: water use (-6%); and GHG (-22%) with no change in energy use. The cost of the optimized diet was not different from that of the usual intake. Conclusion: An evidence-based sustainable and healthy diet was developed for Lebanon providing the population and policy makers with some answers to a complex situation. Findings highlight the need for the development of sustainable food based dietary guidelines for Lebanon to promote diets that are healthy, sustainable, culturally acceptable, and affordable and that can alleviate food insecurity among the general population.

Head Start Parents With or Without Food Insecurity and With Lower Food Resource Management Skills Use Less Positive Feeding Practices in Preschool-Age Children.

BACKGROUND: Food resource management (FRM), strategies to stretch limited food resource dollars, may mitigate the impact of household food insecurity (HFI) on family members, including young children. However, little is known about how FRM and HFI are associated with child feeding practices. OBJECTIVES: The study aimed to explore relationships between HFI, FRM, and child feeding practices of low-income parents. METHODS: In a cross-sectional sample of 304 Head Start households, caregivers completed the USDA HFI module [classifying them as either food secure (FS) or food insecure (FI)], FRM behavior subscale (classifying them as being high or low in management skills based on a median score split), Comprehensive Feeding Practices Questionnaire, and Perceived Stress Scale. Households were categorized into 4 HFI-FRM subgroups: FS/high FRM (30.6%), FS/low FRM (31.3%), FI/high FRM (18.8%), and FI/low FRM (19.4%). Multivariable linear regression was used to examine whether feeding practices differed across HFI-FRM categories and whether the addition of parental perceived stress contributed to differences in feeding practices by HFI-FRM group. RESULTS: In our study, 38% of households were FI. Compared to the FS/high FRM group in the adjusted models, the FS/low FRM group used less monitoring (-0.53; 95% CI: -0.78 to -0.28), modeling (-0.38; 95% CI: -0.64 to -0.13), and involvement (-0.57; 95% CI: -0.82 to -0.32) in feeding. A similar pattern emerged for the FI/low FRM group. The use of food as a reward was higher in the FI/high FRM (0.35; 95% CI: 0.02-0.67) and FI/low FRM groups (0.33; 95% CI: 0.01-0.66) compared to the FS/high FRM group. Perceived stress was positively associated with the use of negative, controlling feeding practices, and contributed to differences in using food as a reward within the HFI-FRM group. CONCLUSIONS: Suboptimal child feeding is evident in low-income caregivers with low FRM skills, with or without food insecurity. Promoting high FRM skills, in addition to addressing food insecurity, could potentially synergistically improve child feeding practices in low-income households.

Dietary intakes, sources, and determinants of free sugars amongst Lebanese children and adolescents: findings from two national surveys.

PURPOSE: To determine the intake levels, dietary sources, and determinants of free sugars (FS) consumption amongst Lebanese children and adolescents. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Erosion of the Mediterranean diet among adolescents: evidence from an Eastern Mediterranean Country.

At a time when the health benefits of the Mediterranean diet (MD) are pervasively recognised, a paradoxical observation is the decreasing adherence to this dietary pattern in its native countries. This study aims to investigate temporal trends in adherence to the MD among adolescents (10-19 years old) in Lebanon. Data were drawn from three national cross-sectional surveys conducted at three points in time: 1997 (n 2004), 2009 (n 3656) and 2015 (n 1204). Dietary intake was assessed using 24-h dietary recalls, and adherence to the MD was assessed using two country-specific indexes: the composite Mediterranean diet (c-MED) index and Lebanese Mediterranean diet (LMD) index. Significant decreases in c-MED and LMD scores and in the proportion of adolescents adhering to the MD were observed between 1997 and 2015, with more consistent results among females (P < 0·05). Projections for the year 2030 showed further decreases, with less than a quarter of adolescents remaining adherent to the MD. Based on linear regression analyses, belonging to the year 2009 was associated with significantly lower MD scores compared with 1997, even after adjustment for potential covariates (c-MED ß = -0·16, 95 % CI -0·30, -0·01; LMD ß = -0·42, 95 % CI -0·67, -0·17). Similar results were obtained when comparing survey year 2015 with 1997 (c-MED score ß = -0·20, 95 % CI -0·33, -0·06; LMD score ß = -0·60, 95 % CI -0·82, -0·37). Findings highlight the erosion of the MD among Lebanese adolescents and underline the need for a comprehensive food system approach that fosters the promotion of the MD as a nutritionally balanced and sustainable dietary pattern.

Voices of the vulnerable: Exploring the livelihood strategies, coping mechanisms and their impact on food insecurity, health and access to health care among Syrian refugees in the Beqaa region of Lebanon.

Lebanon has approximately one million Syrian refugees (SR) registered with the United Nations High Commission on Refugees (UNHCR) and an unknown number of unregistered SR, who cannot benefit from formal assistance. This study aimed to examine the livelihoods, coping strategies, and access to healthcare among SR based on registration status and accompanying formal assistance. A mixed-method approach with more emphasis on the qualitative design was adopted. A purposive convenient sampling approach was used to recruit SR from informal tented settlements (ITS) in the Beqaa region in Lebanon. Data collection included 19 focus group discussions (FGDs) that were conducted with participants, who were further divided into three groups: registered refugees with assistance, registered without assistance and unregistered. Twelve in-depth interviews were conducted with key informants from humanitarian organizations. All interviews and FGDs were audio recorded, transcribed, and thematically analyzed. SR were highly dependent on formal assistance when received, albeit being insufficient. Regardless of registration status, refugees resorted to informal livelihood strategies, including informal employment, child labor, early marriage, and accruing debt. Poor living conditions and food insecurity were reported among all SR. Limited healthcare access and high out-of-pocket costs led to limited use of antenatal care services, prioritizing life-threatening conditions, and resorting to alternative sources of healthcare. Severity of these conditions and their adverse health consequences were especially pronounced among unregistered refugees. Our findings shed light on the economic and health disparities among marginalized SR, with the lack of registration and formal assistance increasing their vulnerability. More tailored and sustainable humanitarian programs are needed to target the most vulnerable and hard-to-reach groups.

Caregiver's Self-Confidence in Food Resource Management Is Associated with Lower Risk of Household Food Insecurity among SNAP-Ed-Eligible Head Start Families.

Food resource management (FRM) behaviors are key components within nutrition education programs designed to help food insecure households maximize their food dollars. However, little is known about the association between FRM self-confidence and financial practices with household food insecurity (HFI) among families with young children. Using a sample of SNAP-Ed-eligible Head Start families, this study examined associations between FRM self-confidence, FRM behaviors and financial practices by HFI. A needs assessment survey was conducted with caregivers of Head Start children (n = 365). HFI was measured using the US Household Food Security Survey Module. Chi-square and logistic regression analyses were conducted to examine if FRM self-confidence, FRM behaviors, and financial practices differed by HFI. Participants with high FRM self-confidence had lower odds of HFI (OR = 0.54, 95%CI: 0.33, 0.87), yet FRM behaviors, financial practices, and HFI were not related after adjusting for covariates. All FRM self-confidence questions significantly differed by HFI, whereas only one of six FRM behaviors and two of three financial practices differed by HFI (all p-values < 0.05). Promoting caregivers' self-confidence in FRM skills within nutrition education programs may be explored as a potential strategy to assist low-income households to stretch their food dollars in an attempt to address HFI.

Food insecurity is associated with compromised dietary intake and quality among Lebanese mothers: findings from a national cross-sectional study.

OBJECTIVE: Examine the associations between household food insecurity (HFI) with sociodemographic, anthropometric and dietary intakes of mothers. DESIGN: Cross-sectional survey (2014-2015). In addition to a sociodemographic questionnaire, data collection included the validated Arabic version of the Household Food Insecurity Access Scale, which was used to evaluate HFI. Dietary intake was assessed using 24-h dietary recall of a single habitual day, and maternal BMI was calculated based on weight and height measurements. Associations between HFI and maternal dietary intake (food groups, energy and macronutrients' intake) were examined. Simple and multiple logistic regression analyses were conducted to explore the associations between HFI status with odds of maternal overweight and measures of diet quality and diversity (Healthy Eating Index (HEI) and Minimum Dietary Diversity for Women of Reproductive Age (MDD-W)). SETTING: Lebanon. PARTICIPANTS: Mothers, nationally representative sample of Lebanese households with children (n 1204). RESULTS: HFI was experienced among almost half of the study sample. Correlates of HFI were low educational attainment, unemployment and crowding. Significant inverse associations were observed between HFI and dietary HEI (OR 0·64, 95 % CI 0·46, 0·90, P = 0·011) and MDD-W (OR 0·6, 95 % CI 0·42, 0·85, P = 0·004), even after adjusting for socioeconomic correlates. No significant association was observed between HFI and odds of maternal overweight status. CONCLUSIONS: HFI was associated with compromised maternal dietary quality and diversity. Findings highlight the need for social welfare programmes and public health interventions to alleviate HFI and promote overall health and wellbeing of mothers.

Energy drinks consumption and perceptions among University Students in Beirut, Lebanon: A mixed methods approach.

BACKGROUND: Energy drinks (ED) are caffeine- and sugar-rich beverages with other ingredients that are marketed for their energy-boosting and performance-enhancing effects. The consumption of these drinks, with and without alcohol, is dramatically increasing worldwide, despite the reported side effects and potential harms to consumers. Few studies, to date, have explored the perceptions and experiences of young adults towards these beverages. OBJECTIVE: The present study aimed to explore the consumption patterns and correlates of ED consumption, as well as the perceptions and experiences of university students in Lebanon towards these beverages. METHODS: A sequential explanatory mixed-methods approach was adopted. Data collection was conducted in two private universities in Beirut, Lebanon. A self-administered 36-item quantitative survey was first used to explore the prevalence and correlates of ED consumption among a convenience sample of university students (n = 226). The survey included questions related to socio-demographic characteristics, anthropometric measurements, and other lifestyle behaviors, including physical activity of university students. The subsequent qualitative phase consisted of focus group discussions (FGD) conducted to further examine the perceptions and experiences of university students towards ED. Descriptive statistics and logistic regression analyses were conducted using survey data, whereas the transcribed FGD were analyzed thematically. RESULTS: A total of 226 university students completed the survey. Results showed that 45% of survey respondents consumed ED at least once in their life (ever consumers), among which 30% reported consumption of ED mixed with alcohol (AmED). Adjusting for socio-demographic and anthropometric characteristics, coffee and sports drinks consumption were significantly associated with ED (OR = 2.45, 95% CI = 1.20, 5.00, and OR = 4.88, 95%CI = 2.41, 9.88, respectively). In addition, physically active participants were 1.89 times (95%CI = 1.01, 3.51) more likely to consume ED compared to their inactive counterparts. During the qualitative phase, a total of six FGD were conducted with 29 university students, who reported consuming ED at least once per month. Three main themes were derived reflecting individual-, interpersonal/social- and environmental-level factors affecting ED consumption among university students. These themes were further supported by eight subthemes, including: perceived benefits of ED, experienced side effects, misinformation about content of ED, peer pressure and social image, as well as affordability and accessibility of ED. CONCLUSION: Findings highlight the need for public health policies and programs to curb the growing public health phenomenon of ED consumption amongst university students. Such programs should consider the multi-level factors affecting ED consumption at the individual, interpersonal/social, and environmental levels, including educational campaigns on ED potential harms, regulating ED content and labeling, as well as restricting sales and marketing of these beverages, especially among young consumers.

Food insecurity is associated with lower adherence to the Mediterranean dietary pattern among Lebanese adolescents: a cross-sectional national study.

PURPOSE: To derive dietary patterns (DPs) of Lebanese adolescents (10-18 years) and evaluate associations between identified DPs and household food insecurity (HFI). METHODS: Data on adolescents (n = 693) were drawn from a national survey conducted in 2015 on a representative sample of Lebanese households with children. In addition to a sociodemographic questionnaire, data collection included the validated Arabic-version of the Household Food Insecurity Access Scale, used to evaluate HFI. Dietary intake was assessed using a 187-item validated food frequency questionnaire. Associations between HFI scores and DPs were examined using multiple linear regressions. RESULTS: HFI was observed in 55.2% of the study sample. Two DPs were derived among adolescents: Western and Lebanese-Mediterranean (LM). The Western DP was characterized by higher consumption of sweetened beverages, fast foods, sweets, and refined grains, whereas the LM DP was characterized by higher intakes of fruits, vegetables, dairy products, and whole grains. Scores of the Western DP were negatively associated with fiber, calcium, iron, and vitamins A and D, while the LM DP scores were positively correlated with fiber, proteins, iron, calcium, and vitamins A and D (p < 0.01). LM DP scores were also negatively correlated with total fat, saturated and polyunsaturated fats, p < 0.05. After adjustment for sociodemographics, multiple linear regression showed that higher HFI scores were associated with lower adherence to LM DP among adolescents (ß = - 0.026, 95% CI - 0.046, - 0.006). CONCLUSIONS: HFI was associated with lower adherence to the Mediterranean pattern among Lebanese adolescents. Preventive strategies are needed to promote better diet quality among food-insecure youth.

Food insecurity is associated with suboptimal sleep quality, but not sleep duration, among low-income Head Start children of pre-school age.

OBJECTIVE: To examine the association between food insecurity and child sleep outcomes and to investigate whether parent psychosocial factors mediate such associations. DESIGN: Cross-sectional study. Usual wake time and bedtime, bedtime routine and sleep quality were reported by parents using the adapted Brief Infant Sleep Questionnaire. Food insecurity was assessed using the eighteen-item US Department of Agriculture Household Food Security Module. Parent psychosocial factors, including perceived stress, parenting self-efficacy and depressive symptomology, were assessed using validated scales. Multivariable logistic regression models were performed to determine the association between food insecurity and sleep outcomes controlling for potential confounders. Mediation analyses and Sobel tests were applied to test the mediating effect of psychosocial factors. SETTING: Head Start pre-school classrooms in four regions across central Pennsylvania, USA. PARTICIPANTS: Low-income children of pre-school age (n 362) and their caregivers. RESULTS: Prevalence of household, adult and child food insecurity was 37·3, 31·8 and 17·7 %, respectively. Food security status at any level was not associated with child sleep duration or bedtime routine. Child food insecurity, but not household or adult food insecurity, was associated with 2·25 times increased odds (95 % CI 1·11, 4·55) of poor child sleep quality in the adjusted model. Perceived stress, self-efficacy and depressive symptomology mediated less than 2 % of the observed effect (all Sobel test P > 0·6). CONCLUSION: Food insecurity, particularly at the child level, is a potential modifiable risk factor for reducing sleep-related health disparities in early childhood. Future studies are needed to explore the plausible mechanisms underlying the associations between food insecurity and adverse child sleep outcomes.