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.

PROTOCOL: Measuring diet-related consumer behaviours relevant to low- and middle-income countries to advance food systems research: An evidence and gap map.

This is the protocol for a evidence and gap map. The main objective of this evidence and gap map is to provide access to a systematic overview of available indicators for diet-related consumer behaviours relevant to LMICs, to support policy makers and researchers to develop, monitor and revise food policies and programmes to leverage food systems transformations for healthier and more sustainable diets.

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.

Territorial and Sustainable Healthy Diets.

The rapid changes that societies have gone through in the last few decades have led to the increase in the prevalence of malnutrition in all its forms and to the degradation of natural resources and the environment. The change in the dietary habits and production systems are responsible for much of this change. Some territorial diets have been shown as potentially capable of reversing these trends by positively contributing to the health of people and the environment such as the Mediterranean Diet and the New Nordic Diet. In this paper, we review the contribution of these 2 diets to health and nutrition and to environmental, sociocultural, and economic sustainability proposing pertinent indicators. Learning from a culturally established diet and a constructed one, tradeoff could be reached to ensure better health and sustainability outcomes. Strong factors for achieving this goal lie in building on the sociocultural appropriation of diets, having the proper tools and indicators, investing in cross-sector collaboration and policy coherence, and having the necessary political support to push the agenda of sustainability forward.

Breast-feeding and lactational amenorrhea in the United Arab Emirates.

This study was designed to investigate the relation of breast-feeding and weaning practices with the duration of lactational amenorrhea among breast-feeding mothers in the United Arab Emirates. A total of 593 mothers were interviewed in the Maternal and Child Health Centers in three areas: Abu Dhabi, Dubai, and Al Ain. The total mean duration of lactational amenorrhea in this study was 6.1 months, and there was a direct relation with the length of exclusive breast-feeding. The duration of postpartum amenorrhea was the longest in Al Ain (7.2 months), as compared with Dubai (6.9 months) and Abu Dhabi (4.3 months). The age of the infant when formula milk and solid supplements were introduced was significantly related to the duration of lactational amenorrhea. This study confirms the results of other studies concerning the effectiveness of the lactational amenorrhea method as a natural method of contraception for the first 6 months postpartum, especially for mothers who breast-feed exclusively and more frequently and who delay the introduction of food supplements.

Differences in Dietary Intakes among Lebanese Adults over a Decade: Results from Two National Surveys 1997-2008/2009.

Amidst the ongoing societal and economic shifts in the Eastern Mediterranean region (EMR), this study aims at investigating temporal trends in food consumption and nutrient intakes among Lebanese adults, by age and sex. Data were derived from two national cross-sectional surveys conducted in Lebanon during two time periods (1997; 2008/2009). In both surveys, dietary assessment was based on 24-h recalls. The results, expressed as % energy intake (%EI), revealed a significant decrease (p < 0.001) in the consumption of bread, fruits, fresh fruit juices, milk and eggs, whereas the consumption of added fats and oils, poultry, cereals and cereal-based products, chips and salty crackers, sweetened milk and hot beverages increased over time (p < 0.001). A significant increase in dietary energy (kcal/day) and fat intake (%EI) was observed, coupled with decreases in carbohydrate intake (%EI) and dietary density of vitamin A and vitamin C (per 1000 kcal) (p < 0.001). These changes were noted in both genders and across age groups, albeit there were some disparities between groups. In conclusion, based on national nutrition surveys, this study is the first to characterize the nutrition transition in a middle-income country of the EMR, shedding light on priority areas for nutrition policies and interventions.

Promoting a healthy diet for the WHO Eastern Mediterranean Region: user-friendly guide

Promoting a healthy diet for the WHO Eastern Mediterranean Region provides dietary advice to promote health and reduce the risk of major chronic diseases through diet and physical activity. This user-friendly guide presents a set of dietary recommendations that are compatible with the different cultures and eating patterns of consumers in the Region based on the availability of local and affordable foods. This publication represents an essential tool in supporting national and regional strategies to improve nutrition outcomes and health in the Region. It is primarily intended for use by policymakers, health care providers, nutritionists, nutrition educators and anyone involved in food distribution and food service. It can also be used by schools, homes, cafeterias and businesses to improve the food choices of a range of consumers