The Changing Landscape of Respiratory Viruses Contributing to Hospitalizations in Quebec, Canada: Results From an Active Hospital-Based Surveillance Study.

BACKGROUND: A comprehensive description of the combined effect of SARS-CoV-2 and respiratory viruses other than SARS-CoV-2 (ORVs) on acute respiratory infection (ARI) hospitalizations is lacking. OBJECTIVE: This study aimed to compare the viral etiology of ARI hospitalizations before the pandemic (8 prepandemic influenza seasons, 2012-13 to 2019-20) and during 3 pandemic years (periods of increased SARS-CoV-2 and ORV circulation in 2020-21, 2021-22, and 2022-23) from an active hospital-based surveillance network in Quebec, Canada. METHODS: We compared the detection of ORVs and SARS-CoV-2 during 3 pandemic years to that in 8 prepandemic influenza seasons among patients hospitalized with ARI who were tested systematically by the same multiplex polymerase chain reaction (PCR) assay during periods of intense respiratory virus (RV) circulation. The proportions of infections between prepandemic and pandemic years were compared by using appropriate statistical tests. RESULTS: During prepandemic influenza seasons, overall RV detection was 92.7% (1384/1493) (respiratory syncytial virus [RSV]: 721/1493, 48.3%; coinfections: 456/1493, 30.5%) in children (<18 years) and 62.8% (2723/4339) (influenza: 1742/4339, 40.1%; coinfections: 264/4339, 6.1%) in adults. Overall RV detection in children was lower during pandemic years but increased from 58.6% (17/29) in 2020-21 (all ORVs; coinfections: 7/29, 24.1%) to 90.3% (308/341) in 2021-22 (ORVs: 278/341, 82%; SARS-CoV-2: 30/341, 8.8%; coinfections: 110/341, 32.3%) and 88.9% (361/406) in 2022-23 (ORVs: 339/406, 84%; SARS-CoV-2: 22/406, 5.4%; coinfections: 128/406, 31.5%). In adults, overall RV detection was also lower during pandemic years but increased from 43.7% (333/762) in 2020-21 (ORVs: 26/762, 3.4%; SARS-CoV-2: 307/762, 40.3%; coinfections: 7/762, 0.9%) to 57.8% (731/1265) in 2021-22 (ORVs: 179/1265, 14.2%; SARS-CoV-2: 552/1265, 43.6%; coinfections: 42/1265, 3.3%) and 50.1% (746/1488) in 2022-23 (ORVs: 409/1488, 27.5%; SARS-CoV-2: 337/1488, 22.6%; coinfections: 36/1488, 2.4%). No influenza or RSV was detected in 2020-21; however, their detection increased in the 2 subsequent years but did not reach prepandemic levels. Compared to the prepandemic period, the peaks of RSV hospitalization shifted in 2021-22 (16 weeks earlier) and 2022-23 (15 weeks earlier). Moreover, the peaks of influenza hospitalization shifted in 2021-22 (17 weeks later) and 2022-23 (4 weeks earlier). Age distribution was different compared to the prepandemic period, especially during the first pandemic year. CONCLUSIONS: Significant shifts in viral etiology, seasonality, and age distribution of ARI hospitalizations occurred during the 3 pandemic years. Changes in age distribution observed in our study may reflect modifications in the landscape of circulating RVs and their contribution to ARI hospitalizations. During the pandemic period, SARS-CoV-2 had a low contribution to pediatric ARI hospitalizations, while it was the main contributor to adult ARI hospitalizations during the first 2 seasons and dropped below ORVs during the third pandemic season. Evolving RVs epidemiology underscores the need for increased scrutiny of ARI hospitalization etiology to inform tailored public health recommendations.

Adequacy of Iodine Status and Associations with Gut Health: A Prospective Cohort Study among Infants in 8 Low- and Middle-Income Countries.

BACKGROUND: Environmental enteric dysfunction increases the likelihood of micronutrient deficiencies among infants, but few studies have assessed the potential impact of gut health on urinary iodine concentration (UIC) among this vulnerable group. OBJECTIVES: We describe the trends of iodine status among infants from 6 to 24 mo old and examine the associations between intestinal permeability, inflammation, and UIC from 6 to 15 mo of age. METHODS: Data from 1557 children enrolled in this birth cohort study conducted in 8 sites were included in these analyses. UIC was measured at 6, 15, and 24 mo of age by using the Sandell-Kolthoff technique. Gut inflammation and permeability were assessed using the concentrations of fecal neopterin (NEO), myeloperoxidase (MPO) and alpha-1-antitrypsin (AAT), and lactulose-mannitol ratio (LM). A multinomial regression analysis was used to assess the classified UIC (deficiency or excess). Linear mixed regression was used to test the effect of interactions among biomarkers on logUIC. RESULTS: All studied populations had adequate (≥100 µg/L) to excess (≥371 µg/L) median UIC at 6 mo. Between 6 and 24 mo, 5 sites displayed a significant decline in the infant's median UIC. However, median UIC remained within the optimal range. An increase of NEO and MPO concentrations by +1 unit in ln scale reduced the risk of low UIC by 0.87 (95% CI: 0.78-0.97) and 0.86 (95% CI: 0.77-0.95), respectively. AAT moderated the association between NEO and UIC (P < 0.0001). The shape of this association appears to be asymmetric and in a reverse J-shape, with a higher UIC observed at both lower NEO and AAT concentrations. CONCLUSIONS: Excess UIC was frequent at 6 mo and tended to normalize at 24 mo. Aspects of gut inflammation and increased permeability appear to reduce the prevalence of low UIC in children aged 6 to 15 mo. Programs addressing iodine-related health should consider the role of gut permeability in vulnerable individuals.

Prevalence of Breakfast Skippers among Tunisian Preschool and School Children and Association with Weight Status: A Cross-Sectional Study.

Breakfast is considered the most important meal of the day. This study aimed to assess breakfast frequency and quality in Tunisian children and to determine the relationship between breakfast skipping and the weight status of the children. A total of 1200 preschool and school children aged 3 to 9 years were randomly selected under a cross-sectional design. Breakfast habits and socio-economic characteristics were collected using a questionnaire. Participants who consumed breakfast less than five times the previous week were categorized as breakfast skippers. The other breakfast consumers were considered as non-skippers. The overall prevalence of breakfast skipping in Tunisian children was 8.3% and 83% of them consumed breakfast all the weekdays. At least two out of three children had a poor breakfast quality. Only 1% of children consumed breakfast in accordance with the composition guidelines. No relationships between breakfast skipping and weight status were detected in this study after adjustment for age, sex and all socio-economic factors (OR = 1.16, 95% CI = 0.72-1.89, p = 0.541). Further school-based interventions should be implemented to improve breakfast quality and to promote a healthy weight in Tunisian children.

Determination of salt content in traditional and industrial Moroccan white bread by inductively coupled plasma mass spectrometry.

Introduction: evaluating the sodium content of staple foods is essential for implementing a salt reduction strategy. In Morocco, bread is a major contributor to sodium intake. However, currently few studies have been carried out to assess the salt content in bread. Our study aimed to estimate the sodium and salt content of white bread available in artisanal and industrial bakeries in the twelve regions of Morocco. Methods: it is a cross-sectional study of the sodium content of white bread available for sale in artisanal and industrial bakeries in Morocco (N=120). Inductively coupled plasma mass spectrometry (ICP-MS) was used to quantify the sodium content of the bread. The percentage of samples meeting the recommendations and bread contribution to the daily salt intake was calculated. Results: the results of our study show that the mean levels of sodium and salt added to bread samples were 5.7 ± 1.5 g/Kg and 14.5 ± 3.7 g/Kg, respectively. With an average of 4.4 ± 0.5 g/Kg and 11.2 ± 1.2 g/Kg for artisanal bread and an average of 7.0 ± 0.8 g/Kg and 17.8 ± 2.1 g/Kg for industrial bread, respectively. Daily salt intake from bread consumption (500 g/d/person) is estimated at 5.6 g/d (52.8% of total salt intake) for artisanal bread and 8.9 g/d (84% of total salt intake) for industrial bread. Conclusion: bread salt content in Morocco exceeds the recommended threshold of the national federation of bakery and pastry and health authorities. Further efforts are necessary to increase knowledge and awareness of bakers and to teach them how to reduce salt content without affecting the flavor and the quality of their products.

Is fat taste associated with diet quality? A cross-sectional study conducted among Tunisian adults.

The Tunisian population has experienced a nutrition transition with an increase in the incidence of obesity. As obesity has been associated with a poor orosensory detection of fat. We hypothesized that poor fat detection could be a driver of poor diet quality. This study examined the association between linoleic acid (LA) detection and adherence to a healthy diet among adult participants. A total of 104 LA taster participants were recruited for this study. Dietary assessment was conducted using the 24 h dietary recall method. Diet quality was assessed by determining the Mediterranean diet (MD) score and Health diet indicator (HDI). The relationship between diet quality and log LA detection threshold was done using adjusted linear regression for age, sex, and daily energy intake (only in the fully adjusted model). The predictive margins model (interaction: anthropometric status x LA threshold) was used to assess the difference between non-obese and subjects with obesity adherence to MD across LA detection values. We have observed that the increase in the concentration of linoleic acid detection by 1 log(mmol/L) is associated with an increase of HDI score by 0.12-point [95% CI: 0.02-0.21] and a decrease of the MD score by -0.14-point [-0.25 to -0.03] in the partially adjusted model. However, only the MD score remained negatively associated with LA detection threshold in the fully adjusted model. The subjects with obesity adherence to the Mediterranean diet was lower than subjects with normal weight for LA concentration less than 0 log(mmol/L). The present study suggests that poor orosensory detection of dietary lipids might be a driver for worsening diet quality. Hence, These subjects might be at risk for obesity and, consequently, exposed cumulatively to the harmful effects of excess adiposity and an unhealthy diet.

Adaptation and Psychometric Evidence of the ARABIC Version of the Diabetes Self-Management Questionnaire (A-DSMQ).

(1) Background: Diabetic patients must engage in self-care practices in order to maintain optimal glycemic control, hence reducing the likelihood of developing complications, and enhance the overall quality of their lives. The Diabetes Self-care Management Questionnaire (DSMQ) is a tool for assessing self-management habits that may be used to predict glycemic control in people with diabetes. However, no Arabic language version of the instrument has been found. Therefore, we adapted an Arabic language version of the instrument in Tunisia. The purpose of the current research aimed to assess the psychometric features of the Tunisian version of the DSMQ in patients with type 2 diabetes. (2) Method: Two samples including both genders, one exploratory (n = 208, mean age 53.2 ± 8.3) and one confirmatory (n = 441, mean age 53.4 ± 7.4), completed an adapted Arabic language version of the DSMQ, a sociodemographic questionnaire and information about their HbA1C levels. (3) Results: The exploratory factor analysis revealed that the 15 items of the A-DSMQ fit well with the data. Likewise, the alpha coefficients for the A-DSMQ factors were above 0.80: for "Glucose Management" (GM), "Dietary Control" (DC), "Physical Activity" (PA), and "Heath-Care Use" (HU). The fit indices for the CFA were good, and the four-factor solution was confirmed. The Average Variance Extracted values and Fornell-Larcker criterion established the convergent and discriminant validity, respectively. The concurrent validity of the tool was established through the statistically significant negative relationships between the A-DSMQ factors and HbA1C, in addition to its positive association with the practice of physical activity measured by the IPAQ. (4) Conclusions: Given the high EFA factor loadings, the CFA fit indices, the correlation matrix, the sensitivity analysis, the convergent validity, and the excellent internal consistency of the A-DSMQ, it can be concluded that the A-DSMQ is an effective psychometric tool for diabetes self-management in Tunisia.

Trajectories of beverage consumption during adolescence.

Beverages contribute substantially to daily energy and nutrient intakes. However, little is known about the co-development of beverage consumption throughout adolescence. This study aimed to investigate the presence of naturally occurring sub-groups of girls and boys following distinct trajectories of various types of beverage consumption (i.e. sugary beverages, tea and coffee, water, and milk) throughout adolescence. During the Monitoring Activities for Teenagers to Comprehend their Habits study, data were collected from 744 Canadian youths followed for six years (2013-2019). The participants were asked yearly (start-age 10-11 years old) to report how many times they consumed sugary beverages, tea and coffee, water, and milk in a week. Trajectories of beverage consumption were identified from age 11 to 18 using a person-centred approach, namely group-based multi-trajectory modelling. For girls, three different groups were identified: 'Water consumers' (62.7%), 'High beverage consumers' (20.9%), and 'Water and milk consumers' (16.4%). For boys, four different groups were identified: 'Water consumers' (39.1%), 'Water and milk consumers' (30.5%), 'Sugary drinks, coffee and tea consumers' (20.1%), and 'High beverage consumers' (10.4%). This study illustrates the complexity of beverage consumption patterns in adolescence. Various types of public health messaging and interventions may be required to promote healthier beverage consumption patterns among all adolescents.

Ultra-Processed Foods Are the Major Sources of Total Fat, Saturated and Trans-Fatty Acids among Tunisian Preschool and School Children: A Cross-Sectional Study.

Excessive fat and fatty acids intake are associated with significant health hazards such as obesity or chronic diseases. This study aimed to provide the first data on total fat, saturated fatty acids (SFA) and trans fatty acids (TFA) intakes and their major food sources in Tunisian children. A total of 1200 children, aged 3 to 9 years old, were randomly selected from primary schools and kindergartens under a cross-sectional design. The 24-h dietary recall method and diet history for the month preceding the survey were used to assess dietary intake. The energy percentages of total fat, SFA and TFA in Tunisian children were 29.6%, 11.4% and 0.15%, respectively. No sex differences were found. The WHO recommendations for total fat, SFA and TFA were adopted by 58%, 39% and 89% of the study population, respectively. The leading food groups of fat and fatty acids were ultra-processed foods, breakfast cereals and dairy products. The meat, fish, eggs, and fish alternatives were the fifth main contributors to Tunisian children's total fat and SFA intakes. The implementation of a relevant strategy for fat reduction, especially from ultra-processed foods, considered as low nutrient energy-dense products, is needed to promote health among children and prevent diet-related chronic diseases.

Prevalence of Hypertension and Adherence to Dietary Approaches to Stop Hypertension Diet Score in Childbearing Age Tunisian Women: A Cross-Sectional Study.

BACKGROUND AND AIMS: The prevalence, awareness, and treatment of hypertension, along with their sociodemographic, anthropometric, and lifestyle associations, were evaluated in a cross-sectional survey of childbearing age Tunisian women. Adherence to the Dietary Approaches to Stop Hypertension diet score was also assessed for hypertensive versus nonhypertensive women. METHODS AND RESULTS: A total of 1689 nonpregnant women, aged 20-49 years, were randomly sampled a regional (Greater Tunis), two-stage, stratified, cross-sectional cluster survey from March 2009 to January 2010. Data on medical history and sociodemographic characteristics were collected using a questionnaire. The average daily intake of energy and nutrients was computed using a specific Tunisian food composition database. The Dietary Approaches to Stop Hypertension diet score (0 to 10) was assessed by adding the individual scores (0 to 1) of ten nutrient components according to dietary guidelines. The overall prevalence of hypertension was 21.4%. Age, obesity, abdominal fat, parity, and family history were significantly associated with hypertension. The mean Dietary Approaches to Stop Hypertension accordance score was 4.93 for hypertensive women and 4.86 for nonhypertensive women (P = 0.0556). After adjustment for age, energy intake, and all nutritional covariates, no associations were observed between hypertension and Dietary Approaches to Stop Hypertension diet components. CONCLUSION: Though no clear-cut associations between hypertension and environmental or behavioral factors were identified in the study, the association with abdominal obesity and multiparity suggests that interventions aimed at lifestyle modifications to reduce these risk factors could be also useful in the prevention of hypertension.

Understanding Fatal and Non-Fatal Drug Overdose Risk Factors: Overdose Risk Questionnaire Pilot Study-Validation.

Background: Drug overdoses (fatal and non-fatal) are among the leading causes of death in population with substance use disorders. The aim of the current study was to identify risk factors for fatal and non-fatal drug overdose for predominantly opioid-dependent treatment-seeking population. Methods: Data were collected from 640 adult patients using a self-reported 25-item Overdose Risk (OdRi) questionnaire pertaining to drug use and identified related domains. The exploratory factor analysis (EFA) was primarily used to improve the interpretability of this questionnaire. Two sets of EFA were conducted; in the first set of analysis, all items were included, while in the second set, items related to the experience of overdose were removed. Logistic regression was used for the assessment of latent factors' association with both fatal and non-fatal overdoses. Results: EFA suggested a three-factor solution accounting for 75 and 97% of the variance for items treated in the first and second sets of analysis, respectively. Factor 1 was common for both sets of EFA analysis, containing six items (Cronbach's α = 0.70) focusing around "illicit drug use and lack of treatment." In the first set of analysis, Factors 2 (Cronbach's α = 0.60) and 3 (Cronbach's α = 0.34) were focusing around "mental health and emotional trauma" and "chronic drug use and frequent overdose" domains, respectively. The increase of Factor 2 was found to be a risk factor for fatal drug overdose (adjusted coefficient = 1.94, p = 0.038). In the second set of analysis, Factors 2 (Cronbach's α = 0.65) and 3 (Cronbach's α = 0.59) as well as Factor 1 were found to be risk factors for non-fatal drug overdose ever occurring. Only Factors 1 and 3 were positively associated with non-fatal overdose (one in a past year). Conclusion: The OdRi tool developed here could be helpful for clinical studies for the overdose risk assessment. However, integrating validated tools for mental health can probably help refining the accuracy of latent variables and the questionnaire's consistency. Mental health and life stress appear as important predictors of both fatal and non-fatal overdoses.

Association between Overweight and Diet Diversity Score: A Cross-Sectional Study Conducted among Tunisian Children.

AIM: This study explored the association between the diet diversity score (DDS) and overweight among Tunisian children. METHODS: A representative sample of children living in Greater Tunis was selected based on a two-stage clustered sampling design. A total of 1200 children (3-9 years) were recruited. Dietary assessment was realized using a 24 h dietary recall. Anthropometric measurements were realized, and overweight was defined according to the World Health Organization standards. Logistic regression was used for the association between DDS with overweight. RESULTS: A quarter of children were found to be overweight. Overweight prevalence was found to decrease with the increase of mother education level (p = 0.010) among children <6 years. Crude DDS score was higher among non-overweight children irrespective of the age class (p = 0.002). Tunisian children appeared to consume much more than six food groups, corresponding to a more than recommended intake of most nutrients. Intriguingly, DDS was positively associated with the occurrence of overweight children <6 years, adjusted odd ratio = 1.37, 95% CI (1.03-1.82). CONCLUSION: Overweight is a public health problem among Tunisian children. A high DDS signifies adequate nutrient intake. An increase of DDS was found to be a positive predictor of overweight only in pre-school children.

Trend and Causes of Overweight and Obesity among Pre-School Children in Kuwait.

Identifying life risk factors of obesity early will help inform policymakers to design evidence-based interventions. The following study aims to assess the trend of overweight and obesity over four years among pre-school Kuwait children, and to examine their association with breakfast skipping (BF), sugary and sweetened beverage (SSB) consumption, and screen time. Children aged 2-5 years (n = 5304) were selected from 2016 to 2019 national surveys. Overweight and obesity were defined according to the World Health Organization references. The children's mothers were asked about the BF of their children the day of the survey, their frequency of SSB consumption, and their weekly screen time use. Logistic regression was used to identify the risk factors associated with overweight/obesity. No significant decline (p values ≥ 0.12) was found for both overweight and obesity. Contrastingly, BF skipping, SSB consumption, and screen time declined (p < 0.0001). The BF skippers were found to have a 31% lower risk of being overweight. Daily TV watching, for 2-3 h, increases the odds of obesity by 5.6-fold. Our findings are encouraging regarding the decline in risky behaviours over time. However, more effort should be made both at the micro- and macro-level for a sustainable reduction in overweight and obesity.

Prevalence of High HDL Cholesterol and Its Associated Factors Among Tunisian Women of Childbearing Age: A Cross-Sectional Study.

The protective role of high high-density lipoprotein cholesterol (HDL-C) against cardiovascular risk has been questioned recently. Due to the increasing trend of cardiovascular diseases (CVD) in Tunisia, this study aimed to determine the prevalence of high HDL-C and its associated factors in Tunisian women of childbearing age. A cross-sectional survey was conducted among a subsample of 1689 women, aged 20 to 49 years, in the Great Tunis region. Data on socio-demographic and lifestyle factors were collected by a questionnaire. Overall adiposity was assessed by body mass index (BMI). All biological variables were assayed in blood samples coated with anticoagulant ethylene diamine tetra acetic acid (EDTA) by enzymatic methods. Stata software (2015) was used for data management and statistical analysis. High HDL-C values were recorded in 26.6% of selected women. After adjustment for all socio-demographic and lifestyle factors, age, hypertension, and smoking were negatively associated with high HDL-C levels, while family history of cancer was positively associated with high HDL-C in women. An additional investigation on the relationship between high HDL-C and cancer risk should be performed due to controversial results.

Meta-Analysis and Systematic Review of Micro- and Macro-Nutrient Intakes and Trajectories of Macro-Nutrient Supply in the Eastern Mediterranean Region.

The Eastern Mediterranean Region (EMR) is experiencing a nutrition transition, characterized by the emergence of overnutrition and micro-nutrient deficiencies. No previous study has comparatively examined nutrient intake in adults across countries in the EMR. This review examined the adequacy of nutrients in adults living in the EMR. Moreover, it analyzed the food balance sheets (FBS) for 1961-2018 to identify the trajectory of energy supply from macro-nutrients in the EMR. A systematic search was conducted from January 2012 to September 2020. Only observational studies were retained with a random sampling design. An assessment of the methodological quality was conducted. Levels of nutrient daily intake and their adequacy compared to the daily reference intake of the Institute of Medicine were reported across the region. No studies were identified for half of the region's countries. Although nutrient energy intake was satisfactory overall, fat and carbohydrate intake were high. Intake of vitamin D, calcium, potassium, zinc, and magnesium were below that recommended. The analysis of the FBS data allowed for the identification of four linear patterns of trajectories, with countries in the EMR best fitting the 'high-energy-supply from carbohydrate' group. This systematic review warrants multi-sectorial commitment to optimize nutrient intake.

Unbalanced intakes of sodium and potassium among Tunisian adults: A cross-sectional study.

The prevention and management of hypertension are untimely associated with a lowering of sodium intake. The present study aimed to evaluate the sodium and potassium intake levels of Tunisian population through measurement of 24-hr urinary sodium excretions. A randomly, multistage, cross-sectional study was conducted in an urban region (Bizerte) in Tunisia during 2015. The target population involved adults aged from 25 to 64 years. Sodium, potassium, and creatinine concentrations were determined in each urine sample using indirect potentiometric method. From the 420 selected participants, only 194 gave urine samples complying completeness criteria. A multivariate regression model was used to assess the variables related to sodium and potassium excretion. The daily mean excretion of sodium and potassium was 138.3 ± 46.5 mmol/d (corresponding to 8.1 ± 2.7 g/d of salt intake) and 61.0 ± 22.7 mmol/d, respectively. More than 87.1% of the participants (89.8% for men vs. 84.9% for women; p = .31) exceeded the WHO recommendation of 5 g/d. The upper limit of 10 g salt intake per day was still exceeded by 26.3%. After adjusted analysis, sex (for women, coef = -1.6; (95% CI: -2.4, -0.7)), level of instruction (≥30 kg/m2, coef = +1.1; (95% IC: 0.4-2.0)), and body mass index (≥30 kg/m2, coef = +1.1; (95% CI: 0.1, 2.0)) were associated with the sodium excretion. High sodium intake and inadequate potassium intake were found among participants. This consumption profile complies with the diet westernization context occurring in Tunisia. The initiated strategy focused on the downward of sodium in bread (the main source of salt intake) seems to be promising.

Trajectories of Eating Behaviour Changes during Adolescence.

Adolescence represents a critical transition phase during which individuals acquire eating behaviours that can track into adulthood. This study aims to characterise trends in eating behaviours throughout adolescence by investigating the presence of sub-groups of individuals presenting distinct trajectories of vegetable and fruit, sugary beverage, breakfast and fast-food consumption. Data from 744 MATCH study Canadian participants followed from 11 to 18 Years old (2013-2019) were included in the analyses. Participants reported how often they ate breakfast and consumed vegetables and fruits, sugary beverages and fast foods. Trajectories of eating behaviours over seven years were identified using group-based multi-trajectory modelling. For girls, three different groups were identified, namely 'stable food intake with a decline in daily breakfast consumption' (39.9%), 'moderate food intake and worsening in overall eating behaviours' (38.0%) and 'stable high food intake' (22.1%). For boys, five different groups were identified, namely 'low food intake with stable daily breakfast consumption' (27.3%), 'breakfast-skippers and increasing fast food intake' (27.1%), 'low food intake with a decline in daily breakfast consumption' (23.9%), 'high food intake with worsening of eating behaviours' (13.3%) and 'average food intake with consistently high breakfast consumption' (8.4%). Eating behaviours evolve through various distinct trajectories and sub-group-specific strategies may be required to promote healthy eating behaviours among adolescents.

Are Countries of the Eastern Mediterranean Region on Track towards Meeting the World Health Assembly Target for Anemia? A Review of Evidence.

Anemia is a multifactorial condition, with a complex etiology that involves nutritional and non-nutritional factors. The misconception that iron deficiency is equivalent to anemia may mask the need to address other potential causative factors. This review paper aims to (1) assess the burden of anemia vs. iron deficiency anemia (IDA) amongst women of reproductive age (WRA), pregnant women (PW), and children under five years old (underfive children, U5C) in the Eastern Mediterranean region (EMR); (2) evaluate trends in anemia prevalence and whether countries are on track towards meeting the World Health Assembly (WHA) target for 2025; and (3) characterize anemia reduction efforts and provide a road map for future programs. A search of pertinent literature and databases was conducted. Anemia prevalence in the EMR ranged between 22.6% and 63% amongst PW, 27% and 69.6% amongst WRA, and 23.8% and 83.5% amongst U5C. Data showed that the EMR is not on course towards meeting the WHA target. The contribution of IDA to anemia was found to be less than half. Other potential contributors to anemia in the region were identified, including micronutrient deficiencies, parasitic infestations, and poor sanitation. A framework of action was proposed as a roadmap to meet the targets set by the WHA.

Parental control and support for physical activity predict adolescents' moderate to vigorous physical activity over five years.

BACKGROUND: Social factors are important determinants of youth physical activity (PA), but the longitudinal association between parental behaviours and adolescent PA has not been clearly assessed. This prospective study examined average and lagged associations between perceived parental support and control with adolescents' moderate to vigorous PA (MVPA); and assessed the independent associations between specific parental support and control behaviours and adolescents' MVPA. METHODS: Data from three cycles of the MATCH study, when 374 participants were 12, 16 and 17 years old, were included in this analysis. At each cycle, participants self-reported questionnaires on perceived tangible parental support, intangible support, and control behaviours as well as number of days per week attaining at least 60 min of MVPA. Mixed effect models were used to assess the longitudinal relationship between parental behaviours and MVPA. Cross-lagged panel design was used to assess the association of parental behaviours during early adolescence with MVPA during late adolescence. RESULTS: Overall parental support (coef. = 0.46, P < 0.0001), tangible support (coef. = 0.37, P < 0.0001), encouragement (coef. = 0.12, P = 0.025) and transportation (coef. = 0.25, P < 0.0001) were positively associated with MVPA, whereas parental control was a negative predictor of MVPA (coef. = - 0.18, P = 0.003). Perceived parental behaviours appeared to have long term associations (5 y.) with MVPA as parent support (coef. = 0.40, P = 0.006) and co-participation (coef. = 0.33, P = 0.017) reported around age 12 were positively associated with MVPA measured 5 years later. CONCLUSIONS: Parental support for PA, particularly in the form of tangible support, may be a key factor to include in interventions aiming to promote PA during adolescence. In contrast, parents should be encouraged to avoid control behaviours as these appear to lead to lower MVPA among adolescents.

Assessment of Vitamin A Supplementation Practices in Countries of the Eastern Mediterranean Region: Evidence to Implementation.

Vitamin A is an essential nutrient necessary for human growth and development, with critical roles in vision, immune function reproduction and maintenance of epithelial cellular integrity. Inadequate intake of vitamin A places populations at risk of developing diseases associated with vitamin A deficiency (VAD). VAD is highly prevalent across the Eastern Mediterranean Region (EMR) in children under 5 y and women of childbearing age. Therefore, infants and young children, pregnant women and postpartum women are commonly targeted by supplementation programs. Although, vitamin A supplementation has been shown to decrease preventable childhood diseases and deaths related to VAD, supplementation of vitamin A has been greatly misused in several countries within the EMR raising concern around the process of supplementing the target population. Countries across the EMR have reported different supplementation practices depending on the income level of the country, the availability of vitamin A and the prevalence rates of VAD. Although some countries had higher supplementation rates than others, the concern lies in the middle-income countries and their supplementation practices. Some of the countries across the region do not follow the World Health Organization's (WHO) guidelines for vitamin A supplementation for the recommended age groups. The objective of this study is to assess the vitamin A supplementation practices across the countries in the EMR, determine the gaps in the supplementation practices and the issue with supplementing to healthy populations where VAD is not a public health concern, and provide recommendations for proper vitamin A supplementation within the region.

Association between chronic psychoactive substances use and systemic inflammation: A systematic review and meta-analysis.

This systematic review and meta-analysis assess the change in inflammation biomarkers level among chronic psychoactive substance users. To meet the required inclusion criteria, all studies had to describe human participants with an age ≥18y., experiencing chronic psychostimulant (nicotine, amphetamine, cocaine), sedative (benzodiazepine, opioids) and/or cannabinoid use. The comparison group was defined as healthy participants. Studies where included if they reported at least one of the pro/inflammatory biomarkers. Study bias was examined by Funnel plots and heterogeneity by computing the I2 statistics. Only 21 eligible studies were selected based on 26,216 study participants. A small and significant effect size of 0.18 mg/l (95 % CI:0.10-0.27) was detected in favour of chronic smokers (z = 4.33;P < 0.0001). There was evidence of publication bias for studies measuring IL-6 and IL-10 association with cocaine and IL-6 in association with cannabis. In summary, except for chronic tobacco users, there was no evidence of association between other chronic substances abuse and inflammatory levels. More studies are needed to inform policy and decision makers about the utility of anti-inflammatory based targeted intervention programmes.