Serum levels of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans in a sample of Lebanese pregnant women: The role of dietary, anthropometric, and environmental factors.

Polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) are unintentionally produced, toxic environmental chemicals that persist for long years and bioaccumulate along the food chain, contaminating humans through diet. A particularly critical population subgroup is pregnant women given the adverse health effects on fetuses and newborns. Several anthropogenic sources of exposure to PCDD/Fs exist in Lebanon. Therefore, the aim of the present cross-sectional study is to measure the levels of PCDD/Fs in a sample of pregnant women in Lebanon and to explore potential associated factors. In this study, we measured serum concentrations of seven dioxins and ten furans, among 423 pregnant women recruited at delivery, using gas chromatography MS/MS. Among 269 participants, maternal sociodemographic information was collected including vicinity to landfills, incineration, pesticide use, industrial activity, and smoking. Anthropometric data were registered regarding pre-pregnancy body mass index (BMI), pre-pregnancy weight loss from restrictive diet, and gestational weight gain. Intake of major food groups generally related to PCDD/Fs was reported (fish, red meat, poultry, and dairy). Bivariate and multivariate analyses were performed to identify associations. PCDD/Fs were detected in 0 to 56.1% of the sample. Geometric mean concentrations were 75.5 (2.35) pg/g lipid and 2.25 (1.39) TEQ2005 pg/g lipid for total dioxins, and 2.66 (1.76) pg/g lipid and 0.34 (1.78) TEQ2005 pg/g lipid for total furans. Levels were relatively lower than levels previously observed in France, Germany, Mexico, Ghana, and Japan. Red meat consumption was the most consistently associated factor with a 2.38-2.57 fold increase in PCDD/F levels. Pre-pregnancy weight loss showed inverse associations with PCDD/F congeners. Vicinity to illegal incineration was also associated with a 2.32-2.43 fold increase in PCDD/F levels. In conclusion, results showed the importance of dietary, anthropometric, and environmental factors in the present sample's exposure to PCDD/Fs, in a region that contains anthropogenic sources of contamination.

Development and validation of a quantitative food frequency questionnaire to assess dietary intake among Lebanese adults.

BACKGROUND: The food frequency questionnaire (FFQ) is the most frequently used method to assess dietary intake in epidemiological studies evaluating diet-disease association. The objective of this study was to validate a FFQ for use among Lebanese adults by evaluating various facets of validity and reproducibility. METHODS: The quantitative 164-items FFQ was validated against the average of six 24-h dietary recalls (DRs) in a sample of 238 Lebanese adults. Reproducibility of the FFQ was assessed by administering it twice within 1 month' time interval. RESULTS: Positive statistically significant Pearson correlations were observed in most macro and micronutrients between the FFQ and the six 24-h DRs, ranging from 0.16 to 0.65, with two thirds of the correlation coefficients exceeding 0.3. Energy, gender, and age-adjusted statistically significant Pearson correlation coefficients ranged from 0.14 to 0.64, with two thirds of the coefficients exceeding 0.2. Intakes from the FFQ were mostly higher than those of the 24-h DRs. Mean percent difference between nutrient intakes from both dietary methods decreased remarkably after using energy-adjusted mean intakes. Values were acceptable to good for all macronutrients and several micronutrients. Cross-classification analysis revealed that around 64.3 to 83.9% of participants were classified into the same and adjacent quartile whereas grossly misclassified proportions ranged from 3.7 to 12.2%. Weighted kappa values ranged from 0.02 to 0.36 with most of them exceeding 0.2. In indirect validity analysis, key nutrient mean intakes estimated from the six 24-h DRs were significantly positively associated with tertiles of food groups derived from the FFQ. Bland Altman plots showed that the majority of data points fell within the limits of agreement (LOA) for all nutrients. As for reproducibility analysis, ICC values were all statistically significant ranging from 0.645 to 0.959 and Bland Altman plots confirmed these results. CONCLUSIONS: Based on various aspects of validity and reproducibility, and an extensive range of statistical tests, the present FFQ developed for a Lebanese community is an acceptable tool for dietary assessment and is useful for evaluating diet-disease associations in future studies.

Patterns of PCBs and OCPs exposure in a sample of Lebanese adults: The role of diet and physical activity.

BACKGROUND: Exposure to persistent organic pollutants (POPs) in the general population is 90% from food intake. Dietary patterns provide a global estimation of exposure to POPs, taking into account multiple food sources of environmental contaminants. OBJECTIVES: To evaluate the association of dietary, socio-demographic, anthropometric, and lifestyle-related variables with clusters of polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs), in a sample of students and employees of Saint Joseph University of Beirut. METHODS: A total of 302 participants were randomly recruited. Questionnaires covering dietary, socio-demographic, and lifestyle-related characteristics were administered. Anthropometric measurements were obtained. Serum concentrations of six indicator PCBs (PCB 28, 52, 101, 138, 153 and 180) and four OCPs, hexachlorobenzene (HCB), ß-hexachlorocyclohexanes (ß-HCH), p,p'-dichlorodiphenyltrichloroethane (DDT) and its metabolite p,p'-dichlorodiphenyldichloroethylene (DDE) were measured, and cluster analysis was applied. We evaluated the association of dietary intake with PCBs/OCPs exposure using two different approaches: food consumption categories and dietary patterns retrieved from principal component analysis (PCA). RESULTS: Three clusters of PCBs/OCPs were obtained: middle-level, high-level, and low-level. Practicing physical activity was associated with a three times higher risk of having high-level PCBs/OCPs, after adjustment for confounding variables (ORa = 2.97; CI = 1.23-7.19; p < 0.05). The highest tertile of fish and shellfish consumption increased by three-folds the odds of having high-level PCBs/OCPs (ORa = 3.41; CI = 1.07-10.84; p < 0.05). PCA revealed six dietary patterns. A "cereals, fats and oils, and eggs" dietary pattern was associated with 50% increase in the risk of having high-level PCBs/OCPs (ORa = 1.48; CI = 1.03-2.13; p < 0.05). CONCLUSION: The present results offer a valuable contribution to the understanding of the factors increasing exposure to POPs, namely fish consumption and the "cereals, fats and oils, and eggs" dietary pattern. We also demonstrated that physical activity was positively associated with a higher risk of exposure to PCBs and OCPs, knowing that data on this matter are scarce.

Validity and reliability of an adapted arabic version of the long international physical activity questionnaire.

BACKGROUND: The International Physical Actvity Questionnaire (IPAQ) is a validated tool for physical activity assessment used in many countries however no Arabic version of the long-form of this questionnaire exists to this date. Hence, the aim of this study was to cross-culturally adapt and validate an Arabic version of the long International Physical Activity Questionnaire (AIPAQ) equivalent to the French version (F-IPAQ) in a Lebanese population. METHODS: The guidelines for cross-cultural adaptation provided by the World Health Organization and the International Physical Activity Questionnaire committee were followed. One hundred fifty-nine students and staff members from Saint Joseph University of Beirut were randomly recruited to participate in the study. Items of the A-IPAQ were compared to those from the F-IPAQ for concurrent validity using Spearman's correlation coefficient. Content validity of the questionnaire was assessed using factor analysis for the A-IPAQ's items. The physical activity indicators derived from the A-IPAQ were compared with the body mass index (BMI) of the participants for construct validity. The instrument was also evaluated for internal consistency reliability using Cronbach's alpha and Intraclass Correlation Coefficient (ICC). Finally, thirty-one participants were asked to complete the A-IPAQ on two occasions three weeks apart to examine its test-retest reliability. Bland-Altman analyses were performed to evaluate the extent of agreement between the two versions of the questionnaire and its repeated administrations. RESULTS: A high correlation was observed between answers of the F-IPAQ and those of the A-IPAQ, with Spearman's correlation coefficients ranging from 0.91 to 1.00 (p < 0.05). Bland-Altman analysis showed a high level of agreement between the two versions with all values scattered around the mean for total physical activity (mean difference = 5.3 min/week, 95% limits of agreement = -145.2 to 155.8). Negative correlations were observed between MET values and BMI, independent of age, gender or university campus. The A-IPAQ showed a high internal consistency reliability with Cronbach's alpha ranging from 0.769-1.00 (p < 0.001) and intraclass correlation coefficient (ICC) ranging from 0.625-0.999 (p < 0.001), except for a moderate agreement with the moderate garden/yard activity (alpha = 0.682; ICC = 0.518; p < 0.001). The A-IPAQ had moderate-to-good test-retest reliability for most of its items (ICC ranging from 0.66-0.96; p < 0.001) and the Bland-Altman analysis showed a satisfactory agreement between the two administrations of the A-IPAQ for total physical activity (mean difference = 99.8 min/week, 95% limits of agreement = -1105.3; 1304.9) and total vigorous and moderate physical activity (mean difference = -29.7 min/week, 95% limits of agreement = -777.6; 718.2). CONCLUSION: The modified Arabic version of the IPAQ showed acceptable validity and reliability for the assessment of physical activity among Lebanese adults. More studies are necessary in the future to assess its validity compared to a gold-standard criterion measure.

Utilizing machine learning to classify persistent organic pollutants in the serum of pregnant women: a predictive modeling approach.

Polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs), and per- and poly-fluoroalkyl substances (PFAS) are persistent organic pollutants (POPs) that remain detrimental to critical subpopulations, namely pregnant women. Required tests for biomonitoring are quite expensive. Moreover, statistical models aiming to discover the relationships between pollutants levels and human characteristics have their limitations. Therefore, the objective of this study is to use machine learning predictive models to further examine the pollutants' predictors, while comparing them. Levels of 33 congeners were measured in the serum of 269 pregnant women, from whom data was collected regarding sociodemographic, dietary, environmental, and anthropometric characteristics. Several machine learning algorithms were compared using "Python" for each pollutant: support vector machine (SVM), random forest, XGBoost, and neural networks. The aforementioned characteristics were included in the model as features. Prediction, accuracy, precision, recall, F1-score, area under the ROC curve (AUC), sensitivity, and specificity were retrieved to compare the models between them and among pollutants. The highest performing model for all pollutants was Random Forest. Results showed a moderate to acceptable performance and discriminative power among all POPs, with OCPs' model performing slightly better than all other models. Top related features for each model were also presented using SHAP analysis, detailing the predictors' negative or positive impact on the model. In conclusion, developing such a tool is of major importance in a context of limited financial and research resources. Nevertheless, machine learning models should always be interpreted with caution by exploring all evaluation metrics.

Dioxins and furans maternal transfer: A study of breast milk and cord serum levels among Lebanese mothers and associations with newborn anthropometric measurements.

Dioxins and furans (PCDD/Fs) are anthropogenic pollutants that persist in the environment for long years, bioaccumulating in food & contaminating humans. In pregnancy, they can transfer through the placenta and reach the fetus, which negatively affects fetal growth. They can also reach newborns through breastfeeding. In this study, we focused on this critical subpopulation and identified the presence of PCDD/Fs among pregnant women in breast milk (n = 41) and cord serum (n = 49); we assessed the correlation between different matrices, evaluated the predictors and associations with newborn anthropometric measurements. Over 70.7 % of PCDD/Fs were detected in breast milk and 46.9-55.1 % in cord serum. Cord/maternal serum and breast milk to maternal serum ratios were > 1 with a significant positive Spearman correlation (0.669-0.729). Breast milk & maternal serum PCDD/Fs were associated inversely with age and positively with red meat intake. Cord serum PCDD/Fs were inversely associated with pre-pregnancy weight loss and passive smoking. Parity and gestational weight gain showed positive associations with Z-scores at birth. Z-score differences showed negative and positive associations with passive smoking and pre-pregnancy BMI respectively.

Physical Activity Levels and Predictors during COVID-19 Lockdown among Lebanese Adults: The Impacts of Sociodemographic Factors, Type of Physical Activity and Work Location.

BACKGROUND: Although effective against COVID-19, national lockdowns have several deleterious behavioral and health effects, including physical inactivity. The objective of this study is to assess physical activity (PA) levels during lockdown and the predictors of PA among Lebanese adults, while comparing classical statistics to machine learning models. METHODS: Data were collected using an online questionnaire, with PA being evaluated through the "International Physical Activity Questionnaire" (IPAQ)-long form. Machine learning models were applied to predict total PA ≥ 600 MET·min/week. RESULTS: Among 795 participants, while 67.5% auto-declared a decrease in PA level during lockdown, 36.2% did not meet the minimum recommendations for PA. Multivariate analysis showed that participants who went to their workplace during lockdown had significantly higher total and job-related PA, higher walking and moderate PA, and lower sitting time. PA level and intensity increased with age, while sitting time decreased. Participants who practiced a combination of both outdoor and at-home workouts had higher total, housework and leisure-related PA, and higher moderate and vigorous-intensity PA. Machine learning models confirmed these findings as well as the importance of outdoor activity for total PA levels, with Random Forest being the highest-performing model. CONCLUSIONS: Bringing to light the levels of physical inactivity and sedentary behavior, this study highlighted the importance of outdoor activity in contributing to PA.

Maternal Serum, Cord and Human Milk Levels of Per- and Polyfluoroalkyl Substances (PFAS), Association with Predictors and Effect on Newborn Anthropometry.

BACKGROUND: The understanding of per- and polyfluoroalkyl substances (PFAS) health effects is rapidly advancing among critical populations. Therefore, the objective of this study was to assess PFAS serum levels among Lebanese pregnant women, cord serum and human milk levels, their determinants, and effects on newborn anthropometry. METHODS: We measured concentrations of six PFAS (PFHpA, PFOA, PFHxS, PFOS, PFNA and PFDA) using liquid chromatography MS/MS for 419 participants, of which 269 had sociodemographic, anthropometric, environmental and dietary information. RESULTS: The percentage of detection for PFHpA, PFOA, PFHxS and PFOS was 36.3-37.7%. PFOA and PFOS levels (95th percentile) were higher than HBM-I and HBM-II values. While PFAS were not detected in cord serum, five compounds were detected in human milk. Multivariate regression showed that fish/shellfish consumption, vicinity to illegal incineration and higher educational level were associated with an almost twice higher risk of elevated PFHpA, PFOA, PFHxS and PFOS serum levels. Higher PFAS levels in human milk were observed with higher eggs and dairy products consumption, in addition to tap water (preliminary findings). Higher PFHpA was significantly associated with lower newborn weight-for-length Z-score at birth. CONCLUSIONS: Findings establish the need for further studies, and urgent action to reduce exposure among subgroups with higher PFAS levels.

Association between dietary quality indices and serum polychlorinated biphenyls and organochlorine pesticides levels among Lebanese adults.

Polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) remain a global concern in both developed and developing countries. Given that diet constitutes the major route of exposure to these pollutants, the objective of the current study is to investigate PCBs and OCPs serum levels in relation to dietary quality indices in a sample of Lebanese adults. Sociodemographic, nutritional, and anthropometric data were obtained from 302 participants in face-to-face interviews. Nutritional intakes from a previously validated quantitative 164-item food frequency questionnaire were used to calculate six a priori dietary indices: Healthy Eating Index (HEI-2015), alternate Healthy Eating Index (aHEI), Diet Quality Index-International (DQI-I), Mediterranean Diet Quality Index (Med-DQI), Med-DQIf, Mediterranean Diet Scale (MDS), and Mediterranean Diet Score (MedDietScore). Serum levels of six indicator PCBs (PCBs 28, 52, 101, 138, 153, 180) and four OCPs (HCB, ß-HCH, DDT, and DDE) were investigated in relation to diet quality indices. Individuals with a higher adherence to the HEI-2015 and to the Mediterranean diet assessed by the Med-DQI/Med-DQIf displayed increased levels of OCPs (HCB, ßHCH, DDT, and DDE). An inverted U-shaped association was observed between DQI-I and PCBs serum levels (PCBs 138, 153, 180, and Æ©PCBs). This is the first study in the Middle East and North Africa region to investigate the association between POPs serum levels and a substantial number of a priori dietary indices. The impact of different food combinations and nutrient interactions on pollutants body burden and toxicity remains to be established in future studies.

Maternal and cord serum levels of polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) among Lebanese pregnant women and predictors of exposure.

In this study, the six indicator non-dioxin-like polychlorinated biphenyls NDL-PCBs (PCB28, PCB52, PCB101, PCB138, PCB153, PCB180), as well as four organochlorine pesticides (OCPs), hexachlorobenzene (HCB), ß-hexachlorocyclohexane (ß-HCH), dichlorodiphenyltrichloroethane (DDT), and dichlorodiphenyldichlorethylene (DDE) were measured in 98 maternal and 49 cord sera samples of a group of Lebanese women who gave birth in three hospitals in Greater Beirut, between March and July 2018. Results showed that the levels of these persistent organic pollutants (POPs) in maternal serum were below critical limits as well as those in other countries (Tunisia, France, Portugal, Spain, Poland, Greenland, Canada, Brazil, and China). The ratios of cord serum concentrations to maternal serum concentrations of analyzed POPs were higher than 1. PCB maternal serum concentrations were found to be linked to illegal incineration (OR = 5.78; p = 0.004) as well as eggs (OR = 4.68; p = 0.027) and fruits and vegetables consumption (OR = 3.92; p = 0.016). OCP concentrations were linked to red meat and cold cuts intake (OR = 3.67-4.59; p = 0.001-0.004). While PCB levels were not correlated to newborns anthropometric measurements, OCP levels in cord serum were found to be positively linked to the birth length of newborns (p = 0.014-0.027).

Combined effect of physical activity and sedentary behavior on body composition in university students.

BACKGROUND & AIMS: This study aimed to evaluate the domain-specific physical activity (PA) levels and sitting time of a sample of university students and examine the association of PA with percent body fat. METHODS: Two hundred and twenty-one students were included in the analysis. We administered the long form of the International Physical Activity Questionnaire (IPAQ) twice within one-month interval. Total PA as well as occupational, transportation-, housework-, and leisure-related PA were assessed, in addition to sitting time. Dietary intake was derived from six non-consecutive 24-hour dietary recalls. Percent body fat (dependent variable) was analyzed using a bioelectrical impedance analyzer (BIA). Multivariate logistic regression, adjusted for potential confounders, examined the associations of domain-specific PA and sitting time with percent body fat. RESULTS: Men had higher levels of total and leisure PA than women. All participants had prolonged sitting time, with 48% having a sitting time of more than 10.15 hours/day. In multivariate analysis, moderate leisure PA, compared to vigorous PA was associated with a lower percent body fat. This association remained statistically significant even after adjustment for energy intake and sitting time. Housework-related PA was associated with a higher percent body fat. CONCLUSION: Moderate leisure PA was highly associated with percent body fat even after adjustment for confounding variables. Adequate interventions targeting this kind of leisure should be promoted among universities students.

A review of organochlorine pesticides and polychlorinated biphenyls in Lebanon: Environmental and human contaminants.

The country of Lebanon banned organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) in 1982 and 1997, respectively, and adopted the Stockholm Convention on persistent organic pollutants (POPs) in 2003. Compliance with the Stockholm Convention began immediately, and research related to POPs in Lebanon had already been completed. A National Implementation Plan for POPs was formulated and updated several times, and includes a national inventory of PCBs that were mainly detected in insulating oils and equipment in power stations. High levels of PCBs have also been detected in sediments from the Port of Tripoli, the second major sea port in Lebanon. High levels of OCPs, which are illegally smuggled into Lebanon and improperly handled and used by farmers, have been detected in underground and surface waters for many years. There have also been human biomonitoring studies of PCBs and OCPs; for example, in 1999, measurable amounts of DDE were found in breast milk, and a 2018 study reported measurable amounts of PCBs and OCPs in human serum. While these levels were well below concentrations observed in other countries, they were slightly higher than the levels observed by the National Health and Nutrition Examination Survey (NHANES). This review provides an overview of the available PCB and OCP data from Lebanon between 1999 and 2017. In total, 12 studies of PCBs and OCPs in environmental samples, human serum samples, and human milk samples are included in this review, and the results of these studies are compared in terms of geography and chronology.

Serum concentrations of selected organochlorine pesticides in a Lebanese population and their associations to sociodemographic, anthropometric and dietary factors: ENASB study.

Organochlorine pesticides (OCPs) were banned by the Stockholm Convention many years ago; however, they are still detected in the environment due to their high persistence, their current illegal use, and their import from countries where they have not been banned. We evaluated the serum concentrations of selected OCPs (hexachlorobenzene (HCB), ß-hexachlorocyclohexanes (ß-HCH), p,p'-dichlorodiphenyltrichloroethane (DDT) and its metabolite p,p'-dichlorodiphenyldichloroethylene (DDE) in a sample of Lebanese adults using gas chromatography coupled to an ion trap mass spectrometer detector. The mean concentrations of HCB, ß-HCH, DDT, and DDE were 7.1, 8.6, 2.1, and 18.9 ng/g of lipids, respectively, and the major contributor among the four OCPs was DDE. The OCP levels in the present study were in general lower than the values observed in several countries worldwide and their concentrations at the 95th percentile were lower than the biomonitoring equivalents (BEs) excluding any appreciable health risk. We observed an inverse association between HCB concentrations and body mass index (BMI) as well as HCB, ß-HCH, and DDE levels, and smoking habits. Milk consumption however was positively associated with an increased serum level of ß-HCH. This study, which was the first to investigate OCP serum levels in a Lebanese population, provides a baseline to which future measurements can be compared.

Serum concentrations of polychlorinated biphenyls (PCBs) in a Lebanese population: ENASB study.

Polychlorinated biphenyls (PCBs) are persistent organic pollutants that are still routinely detected 30 years after their restriction in many countries. PCBs have been associated with several non-communicable diseases. They are best measured via human biomonitoring (HBM). The concentrations of six indicator PCBs (PCBs 28, 52, 101, 138, 153, and 180) were measured in the serum samples of 316 Lebanese students and employees from Saint Joseph University of Beirut, Lebanon, using gas chromatography coupled to an iron trap mass spectrometer detector. PCBs were detected in 56.3 to 59.2% of the serum samples. The sum of PCB (∑PCBs) levels ranged from