Mediterranean diet adherence amongst adolescents in North Lebanon: the role of skipping meals, meals with the family, physical activity and physical well-being.

The Mediterranean diet (MD) is a model of a healthy diet and healthy lifestyle. Adherence to the MD has been correlated with a reduction in many metabolic disorders including cancers. The factors associated with adolescents' adherence to the MD in North Lebanon using the KIDMED index have never been explored. Therefore, we thought to examine these factors amongst a sample of them. A cross-sectional survey was conducted in the city of Tripoli, North Lebanon. A total of 798 adolescents aged 11-18 years were randomly selected to participate in this study. All participants completed a questionnaire assessing adherence to the MD (KIDMED index), physical activity (physical activity questionnaires for older children and adolescents), health-related quality of life (KIDSCREEN-27 index) and sociodemographic characteristics (age, sex, grade level and parents' educational status). Anthropometric measurements, including weight, height and waist circumference, were also collected. Adherence to the MD was good amongst only 13·3 % of the adolescents. The prevalence rate of overweight and obesity was elevated, affecting 36·9 % of the students. Lower adherence to the MD was significantly correlated with skipping meals (P = 0·001). Meanwhile, adolescents who were engaged in a high level of physical activity, those who consumed more meals with their families and those who benefited from better physical well-being had a better diet quality (P < 0·001). Nutrition intervention programmes, as well as public health policies, would be of interest in order to improve diet quality amongst Lebanese adolescents.

Validity and reliability of a food frequency questionnaire for community dwelling older adults in a Mediterranean country: Lebanon.

BACKGROUND: Food frequency questionnaires (FFQ) is an easy and inexpensive tool that can be used to evaluate nutrient and dietary trends of groups and individuals. Few studies in the East Mediterranean region tailored FFQs to describe dietary intakes of older adults. The purpose of the study is therefore to assess the validity and reproducibility of a FFQ, designed for use with older adults living in a Mediterranean Arabic speaking country, Lebanon. METHODS: The FFQ is composed of a list of 90 food items, commonly consumed by adults above 60 years of age. Validity of the FFQ was tested using the mean of two 24-hours dietary recalls (24HDR), and reproducibility, by repeating the questionnaire within a one-month period, along the second dietary recall. Our study included 42 and 76 participants, for the repoducibility and validity analysis respectively. Subjects were randomly selected from 2 of the 8 governorates in the country. RESULTS: FFQ reproducibility showed a mean relative difference of 1.03% without any significant difference between all paired components of nutrients. Intra class correlation (ICC) showed good and excellent reliability for caloric intake and all macronutrients, moderate to good reliability for all remaining nutrients, except for poly-unsaturated fatty acids, vitamins A, B12 and fibers. Correlation coefficients for all nutrients were fair to strong. Both administrations of the FFQ showed good internal validity. Validation of FFQ showed a mean relative difference between FFQ and mean 24HDR at 19.5%. Agreements between the 2 methods, for classifying individuals in the same or adjacent quartile, for nutrient intake and nutrient adequacy, were 80 and 78.2% respectively. Mean Kappa coefficient was 0.56 and energy-adjusted correlations were within the recommended values for all items except for vitamin A and B12. Adjusting for nutrient-dense food intake improved the agreement for theses 2 vitamins to 0.49 and 0.56, respectively. CONCLUSION: The proposed FFQ can be considered a valid tool to help describe nutrient intake of older individuals in an Arabic speaking Mediterranean country. It could serve for possible use in the East Mediterranean region for the evaluation of regular dietary intake of community-dwelling older adults.

Gender-specific factors associated with risk of depression among Lebanese older adults.

BACKGROUND: Depression among older adults is a frequent and underdiagnosed condition. However, there is a paucity of research on mental health problems among elderly people in Arab countries. The purpose of this study was to describe the risk of depression among a representative sample of older Lebanese adults living in rural areas and to identify gender-specific factors associated with depression risk. METHODS: This study included a randomly selected sample of 823 rural elderly people aged ≥65 years without cognitive decline. Data, including sociodemographic characteristics, living condition, health and functional status, were collected during face-to-face interviews. Depression was assessed by the five-item Geriatric Depression Scale. RESULTS: Risk for depression was significantly higher in women than in men (39.5% vs 26.2%, P < 0.001). Among men, reporting a higher versus a lower income (adjusted odds ratio (AOR) = 0.299) and being physically active significantly decreased the odds of depressive symptoms. In addition, physical disability (AOR = 3.03) and a high level of loneliness (AOR = 41.76) were significantly related to an increased risk of depression. Among women, daily or occasional physical activity was related to a reduced risk of depression compared to sedentary lifestyles (AOR = 0.35; AOR = 0.50). Furthermore digestive symptoms (AOR = 1.98), poor nutritional status (AOR = 1.99), and strong feelings of loneliness (AOR = 10.86) were significantly related to an increased odds of depression. CONCLUSION: Elderly Lebanese people, especially women, were at high risk for depression. Among other gender-specific factors, loneliness was strongly associated with depressive disorders in both genders, with a four times greater odds ratio in men than in women.

Factors associated with oral health-related quality of life among Lebanese community-dwelling elderly.

OBJECTIVE: The purpose of this cross-sectional study was to investigate the association between sociodemographic factors, health-related characteristics, functional status and oral health-related quality of life (OHRQoL) among a representative sample of the community-dwelling Lebanese elderly. METHODS: The study sample included 905 randomly selected community-dwelling elderly Lebanese aged 65 or older living in Greater Beirut. The sample was selected through multi-stage cluster sampling. Participants completed a comprehensive multi-component questionnaire, administrated by trained interviewers, including sociodemographic factors, health characteristics, eating behaviours and functional characteristics. OHRQoL was assessed through the Geriatric Oral Health Assessment Index (GOHAI) questionnaire. RESULTS: Among the participants, 51.6% reported poor OHRQoL. The following variables were significantly associated with poor OHRQoL: lack of health insurance (OR = 1.72, 95% CI: 1.05-2.81); poor or average self-rated general health (OR = 2.58, 95% CI: 1.23-5.41 and OR = 2.27, 95% CI: 1.24-4.16, respectively); monotony of diet (OR = 1.69, 95%CI: 1.02-2.79); absence of dentures (OR = 13.78, 95% CI: 5.02-37.84); insufficient dentures (OR = 18.19, 95%CI: 4.43-74.68); presence of dentures (OR = 2.18, 95%CI: 1.16-4.09); and depression (OR = 2.21, 95%CI: 1.26-3.89). CONCLUSION: The present study revealed that a lack of health insurance, negative perception of general health, monotony of diet, denture use and depression were significantly correlated with poor OHRQoL among community-dwelling Lebanese elderly.

Aging gracefully in Greater Beirut: are there any gender-based differences?

Background: The implications of rapid aging of the Lebanese population are under-researched. No national studies have so far investigated the living conditions and the health status of urban Lebanese elderly across gender. This was a cross-sectional study involving 905 randomly selected community dwelling elderly aged ≥65 years living in Greater Beirut. Gender differences were assessed among participants who completed a standardized questionnaire on socio-demographic factors, nutritional, health, and functional characteristics. The sample included 533 men (59%) and 372 women (41%). Elderly were regrouped into 'younger elderly' (≤70 years), and 'older elderly' (>70 years) which represented respectively 44.3% and 55.7% of the total population. Women, regardless of their age, were less educated and more likely to live alone. Moreover, poor nutritional status, self-perceived health, absence of physical activity, comorbidity, polymedication and depression were significantly higher among women. 'Older elderly' women became significantly more functionally disabled compared with men of their age. This study evidenced that Lebanese elderly women were disadvantaged regarding their socio-economic, health and functional status. It is requested a nationwide effort to improve the socio-economic status and the health of Lebanese elderly, especially women.

WHAT IS THE HEALTH STATUS OF INSTITUTIONALIZED ELDERLY IN LEBANON? A Preliminary Cross-Sectional National Survey.

BACKGROUND: Medical conditions and depen- dency levels of the elderly in the Lebanese long-term care institutions have not been described. This may undermine care commissioning and development to institutionalized elderly. Data to inform policy and practice are needed. OBJECTIVE: To identify clinical diagnoses and dependency levels among elderly residents in long-term care institutions in Lebanon. METHODS: Cross-sectional survey of long-term care institutions throughout Lebanon as identified by the Mihistry of Social Affairs. RESULTS: Thirty-one out of 42 long- term care institutions have been included in this survey. Among them, 1371 elderly subjects were included in the analysis; 75.6% were over the age of 75, and female repre- sented 67%. Medical morbidities and associated disabilities have driven admission in 70.5% of residents; 45.6% of resi- dents reported dernentia, stroke or other neurodegenerativb disease. Overall, 60% of residents required locomotor assis- tance. CONCLUSIONS: Elderly residents in long-term carb institutions are predominantly females, with mental and/or locomotor disabilities resulting fror neurological and ar- thritic conditions. Targeting healthcare for such health condi- tions remains a challenge for the institutions.

The AMEL study, a cross sectional population-based survey on aging and malnutrition in 1200 elderly Lebanese living in rural settings: protocol and sample characteristics.

BACKGROUND: Lebanon is faced with a particular challenge because of large socioeconomic inequality and accelerated demographic transition. Rural residents seem more vulnerable because of limited access to transport, health and social services. No information is available regarding health, nutrition and living conditions of this specific population. The purpose of the AMEL (Aging and Malnutrition in Elderly Lebanese) study is to assess the nutritional status of community dwelling elderly people, aged 65 years and above, living in a rural settings in Lebanon, in line of socioeconomic factors, health and living conditions. The present paper will describe the gender specific characteristics of the study population. METHODS: AMEL is a cross-sectional population based study conducted between April 2011 and April 2012 including 1200 elderly individuals living in the 24 rural Caza (districts) of Lebanon. People aged greater than or equal to 65 y were randomly selected through multistage cluster sampling. Subjects were interviewed at their homes by trained interviewers. The questionnaire included the following measures: socio-demographic factors, nutritional status (Mini Nutritional Assessment, MNA), health related characteristics, functional ability, cognitive status, mood and social network. RESULTS: The sample included 591 men (49.3%) and 609 women (50.8%). Mean age was 75.32 years and similar between genders. Malnutrition (MNA < 17) and risk of malnutrition (MNA between 17 and 23.5) were present in 8.0% (95%CI 4.9%-11.1%) and 29.1% (95%CI 24.0%-34.2%) respectively of the participants, and more frequent in women (9.1% and 35.3% respectively). Regarding socio-demographic status, among women the level of illiteracy and poor income was significantly higher than in men. Moreover, chronic diseases, poor self perceived health, frailty, functional disability, depressive symptoms and cognitive impairment were particularly high and significantly more frequent in women than in men. CONCLUSION: The present study provides unique information about nutritional status, health and living conditions of community dwelling rural residents of Lebanon. These findings may alert policy makers to plan appropriate intervention in order to improve the quality of life and increase successful aging.

Effect of Mediterranean Dietary Pattern on Cognitive Status in Community-Dwelling Older Adults.

Modifiable factors associated with cognitive decline (CD) require more attention, particularly dietary patterns. This study aimed to investigate the link between cognitive decline and associated factors, particularly dietary patterns (DPs), in community-dwelling older Lebanese of modest economic status. Our cross-sectional national study included 352 participants above 60 years old, from the medico-social centers of the ministry of social affairs all over the country. CD was screened based on literacy. Nutritional and dietary data were collected through a validated food frequency questionnaire. DPs were extracted by the K-mean cluster analysis. CD was found in 32.7% and 61.5% of literate and illiterate groups, respectively. Identified DPs included a Westernized type and Mediterranean type, with high and moderate food intakes. In the context of literacy, independent factors associated with CD were age above 80 years, living in Beirut, frailty, and adopting a Westernized (OR = 3.08, 95% CI: 1.22-7.8) and a high-intake Mediterranean DP (OR = 2.11, 95% CI: 1.05-4.22). In the context of illiteracy, the same factors were associated with CD, but not DP nor frailty, with an age cut-off at 78 years. In a Lebanese sample of older adults, factors associated with CD depend on the level of literacy, with DP only associated with CD in the context of literacy.

Relation of Dietary Patterns and Nutritional Profile to Hepatic Fibrosis in a Sample of Lebanese Non-Alcoholic Fatty Liver Disease Patients.

Non-alcoholic fatty liver disease (NAFLD) is considered the most common liver injury worldwide. NAFLD can evolve into non-alcoholic steatohepatitis (NASH) with or without fibrosis. The objectives of this study were to determine the nutritional profile and dietary patterns of NAFLD Lebanese patients and to report the type of diet-related to the presence of hepatic fibrosis. We hypothesized that the traditional pattern was related to a low risk of fibrosis. This cross-sectional study included 320 eligible Lebanese NAFLD patients. Three dietary patterns were identified: the Traditional diet, the High Fruit diet, and the Westernized diet. Multivariate analysis showed a significant relationship between high adherence to the traditional diet and absence of hepatic fibrosis with a decreased risk of 82%, p = 0.031 after adjusting for its covariables. Fruits were absent from this dietary pattern. Although our results pointed to a possible relationship between fibrosis in NAFLD patients and fruit intake, experimental studies are needed to show whether this is a causal relationship. However, the results obtained in this study may contribute to the planning of dietary interventions and recommendations and enable a better follow-up for NAFLD patients with fibrosis.

Dietary Patterns and Risk Factors of Frailty in Lebanese Older Adults.

Factors associated with frailty, particularly dietary patterns, are not fully understood in Mediterranean countries. This study aimed to investigate the association of data-driven dietary patterns with frailty prevalence in older Lebanese adults. We conducted a cross-sectional national study that included 352 participants above 60 years of age. Sociodemographic and health-related data were collected. Food frequency questionnaires were used to elaborate dietary patterns via the K-mean cluster analysis method. Frailty that accounted for 15% of the sample was twice as much in women (20%) than men (10%). Identified dietary patterns included a Westernized-type dietary pattern (WDP), a high intake/Mediterranean-type dietary pattern (HI-MEDDP), and a moderate intake/Mediterranean-type dietary pattern (MOD-MEDDP). In the multivariate analysis, age, waist to height ratio, polypharmacy, age-related conditions, and WDP were independently associated with frailty. In comparison to MOD-MEDDP, and after adjusting for covariates, adopting a WDP was strongly associated with a higher frailty prevalence in men (OR = 6.63, 95% (CI) (1.82-24.21) and in women (OR = 11.54, 95% (CI) (2.02-65.85). In conclusion, MOD-MEDDP was associated with the least prevalence of frailty, and WDP had the strongest association with frailty in this sample. In the Mediterranean sample, a diet far from the traditional one appears as the key deleterious determinant of frailty.

Nutritional Risk Factors, Microbiota and Parkinson's Disease: What Is the Current Evidence?

Parkinson's disease (PD) is a frequent neurodegenerative disease among elderly people. Genetic and underlying environmental factors seem to be involved in the pathogenesis of PD related to degeneration of dopaminergic neurons in the striatum. In previous experimental researches oxidative stress, mitochondrial dysfunction, homocysteine, and neuroinflammation have been reported as potential mechanisms. Among environmental factors, nutrition is one of the most investigated areas as it is a potentially modifiable factor. The purpose of this review is to provide current knowledge regarding the relation between diet and PD risk. We performed a comprehensive review including the most relevant studies from the year 2000 onwards including prospective studies, nested case-control studies, and meta-analysis. Among dietary factors we focused on specific nutrients and food groups, alcoholic beverages, uric acid, and dietary patterns. Furthermore, we included studies on microbiota as recent findings have shown a possible impact on neurodegeneration. As a conclusion, there are still many controversies regarding the relationship between PD and diet which, beside methodological differences among studies, may be due to underlying genetic and gender-specific factors. However, some evidence exists regarding a potential protective effect of uric acid, poly-unsaturated fatty acids, coffee, and tea but mainly in men, whereas dairy products, particularly milk, might increase PD risk through contaminant mediated effect.

Factors Associated with Functional Disability Among Lebanese Elderly Living in Rural Areas: Role of Polypharmacy, Alcohol Consumption, and Nutrition-based on the Aging and Malnutrition in Elderly Lebanese (AMEL) Study.

The objective is to describe disability risk factors in Lebanese elderly living in rural settings, focusing on the role of polypharmacy, alcohol consumption, and nutrition. The Aging and Malnutrition in Elderly Lebanese study, a cross-sectional population-based one (April 2011-April 2012), included 1200 individuals aged ≥65 years from 24 Lebanese rural districts. The results showed that 288 (24%) were disabled and 287 (23.9%) exposed to polypharmacy. More disabled participants were found among patients exposed to polypharmacy (40.8%) than those who were not (18.8%). Major classes associated with disability were "Parkinson" and "Alzheimer" medications, with "alcohol consumption" being responsible for a major interaction with medications. Chronic diseases, nutrition, and socioeconomic status also had a large effect on disability. Skin ulcer (ORa = 8.569; CI 5.330-14.823), followed by dementia (ORa = 3.667; CI 1.167-8.912), and anti-gout drugs (ORa = 3.962; CI 1.290-7.622) were found to be significantly associated with increased odds of disability the most. Many factors are associated with disability among elderly, including polypharmacy and the association of medications with alcohol. Counseling of the elderly caregivers is warranted.

Social isolation and risk for malnutrition among older people.

AIM: Social isolation and loneliness are emerging issues among the geriatric population. The relationships between both, and their impact on health and nutritional status in older people are complex. The purpose of the present study was to evaluate the association between three components of social isolation: social network, feeling of loneliness, commensality and nutritional status. METHODS: A total of 1200 randomly selected elderly individuals aged ≥65 years and living in rural areas of Lebanon participated in the present study. Data were collected during a face-to-face interview including nutritional status (Mini-Nutritional Assessment), measures of social isolation (Lubben Social Network Scale), subjective loneliness (Jong-Gierveld Loneliness Scale), sociodemographic conditions, and health and functional status. RESULTS: Both social isolation and loneliness were independently associated with a higher risk of malnutrition (OR 1.58, P = 0.011; OR 1.15, P = 0.020, respectively). However no association was found between the frequency of sharing meals and the risk of malnutrition. CONCLUSIONS: The present study showed that social isolation and subjective loneliness are two independent risk factors for malnutrition among older people. Geriatr Gerontol Int 2017; 17: 286-294.

Determinants of the nutritional status of older adults in urban Lebanon.

AIM: To assess the nutritional status, and its association with sociodemographic factors, health and functional status of community-dwelling older adults living in the Greater Beirut area. METHODS: This was a cross-sectional study involving 905 randomly selected community dwelling older adults aged ≥65 years living in Greater Beirut (Beirut and surrounding suburbs). Participants completed a standardized questionnaire on sociodemographic factors, health characteristics, and functional and nutritional status, based on the Mini Nutritional Assessment. RESULTS: Among the older adults who participated in the study, 2.8% (95% CI 0.01-0.03) were malnourished, and 45.5% (95% CI 0.42-0.48) were at risk of malnutrition. Sociodemographic variables were not associated with the nutritional status. Variables significantly associated with poorer nutritional status were: poor perception of general health (OR 1.58, 95%CI 1.28-1.97), more chronic diseases (OR 2.05, 95% CI1.26-3.33), poor perception of oral health (OR 1.36, 95% CI 1.14-1.61), depressive disorders (OR 1.76, 95% CI 1.30-2.40), higher body mass index (OR 1.98, 95% CI1.67-2.34) and disability (OR 5.80, 95% CI 1.96-17.11). CONCLUSIONS: The present study showed an unacceptable risk of malnutrition among Lebanese older adults, independent of age, sex and socioeconomic status. The presence of comorbidities, treated or not, affecting general and oral health emerged as major determinants of poor nutrition. Geriatr Gerontol Int 2017; 17: 424-432.

Malnutrition and frailty in community dwelling older adults living in a rural setting.

BACKGROUND & AIMS: Malnutrition and frailty are frequent and serious conditions within the geriatric population. Both are of multifactorial origin and linked to adverse outcomes. The purpose of this study was to analyze the relationships between these two concepts in a representative sample of rural elderly Lebanese with a high prevalence of malnutrition. METHODS: A cross-sectional study including a representative sample of 1200 elderly Lebanese aged 65 and over living in the community. The following measurements were recorded: information on socio-demographic status, comorbidities, Activities of Daily Living (ADL), screening for depression (5 item Geriatric Depression Scale [GDS]) and cognitive status (Mini-Mental-State [MMS]). Frailty was assessed through the Study of Osteoporotic Fractures (SOF) index whereas nutritional status was measured through the Mini Nutritional Assessment (MNA). Stepwise backwards multinomial logistic regression was used to analyze the association between nutritional status and frailty, independent of these covariates. RESULTS: Frailty or prefrailty were present in respectively 36.4% and 30.4% of the participants. The proportion of individuals suffering from poor nutritional status increased with growing level of frailty (p < 0.001). Fourteen out of the 18 MNA items were associated with frailty in age-adjusted analyses. In the final multinominal logistic regression, both malnutrition and risk of malnutrition were related to a significantly increased risk of frailty, respectively (OR: 3.72, 95% IC: 1.40-9.94/OR: 3.66, 95% IC: 2.32-5.76), whereas the relation between poor nutritional status and prefrailty was not significant, independently of reporting less than three comorbidities, being ADL independent, depressive symptoms, illiteracy, and low cognitive status. CONCLUSION: Frailty and malnutrition are two closely related but distinct concepts that share common determinants in this elderly population.

Prevalence of malnutrition and its correlates in older adults living in long stay institutions situated in Beirut, Lebanon.

BACKGROUND: Malnutrition represents an important issue in older adults; unfortunately, there is lack of data concerning this topic in Lebanon. This paper aims to provide a description of nutritional status and its correlates in older adults living in long stay institutions situated in Beirut. METHODS: This cross-sectional study was conducted in three long stay institutions in Beirut in 2012. The study population was composed of people aged 65 years and above, having a score of Folstein Mini Mental State Examination (MMSE) greater than 14 and without renal failure requiring dialysis. Subjects meeting inclusion criteria filled out a questionnaire consisting of nutritional status scale (Mini Nutritional Assessment: MNA) and several other parts (demographic, self-assessment of the state health, smoking and alcohol, physical dependence, quality of life, frailty, depression, social isolation and loneliness). Data were entered and analyzed using the statistical software SPSS (Statistical Package for Social Sciences), version 17.0 (Chicago, IL, USA). RESULTS: Among 111 older adults (55 men and 56 women), 14 (12.6%) were malnourished, 54 (48.7%) were at risk of malnutrition and 43 (38.7%) had an adequate nutritional status. Multivariate analysis showed that physical exercise, depression, frailty and cognitive function were independent correlates of nutritional status of older adults. This model explained 42.2% (adjusted R2 = 0.422) of the older adults nutritional status variability. CONCLUSIONS: We found a moderate percentage of malnutrition in older adults living in long stay institutions situated in Beirut, and the correlates of malnutrition in older adults were low physical exercise, depression, frailty and low cognitive function.