Associations of the MIND Diet with Cardiometabolic Diseases and Their Risk Factors: A Systematic Review.

Purpose: Recent studies have expanded the scope of research on the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet beyond its impact on cognitive performance. These investigations have specifically explored its potential to provide protection against cardiometabolic diseases and associated risk factors, including obesity and dyslipidemia. Methods: We systematically summarized and evaluated all existing observational and trial evidence for the MIND diet in relation to cardiometabolic diseases and their risk factors in adults. PubMed, Embase, CINAHL and Cochrane Library databases were systematically searched to extract original studies on humans published until September 2023, without date restrictions. A total of 491 studies were initially retrieved, out of which 23 met the eligibility criteria and were included in the final review. Duplicated and irrelevant studies were screened out by five independent reviewers using the Rayyan platform. Quality assessment was ascertained using the Newcastle-Ottawa scale for observational studies and the Cochrane risk-of-bias tool (RoB 2) for randomized trials. Results: Across the different study designs, the MIND diet was generally associated with an improvement in anthropometric measures and other cardiometabolic outcomes, such as blood pressure, glycemic control, lipid profile, inflammation and stroke. The effects of the MIND eating pattern on some cardiovascular diseases are less conclusive. Conclusion: The findings of this systematic review support the recommendation of the MIND diet as a strategy to reduce cardiometabolic risk in adults. Further well-designed and long-term studies are warranted.

Perfluorooctanoic Acid and Perfluorooctane Sulfonate in Human Milk: First Survey from Lebanon.

Human milk is the primary source of nutrition for infants in their first year of life. Its potential contamination with perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), a group of toxic man-made chemicals, is a health concern that may threatens infants' health. Our study aims to assess the levels of PFOA and PFOS in the breast milk of Lebanese lactating mothers and the maternal factors associated with their presence. High-performance liquid chromatography (HPLC) coupled with a Micromass Quattro micro API triple quadrupole mass spectrometer was used to detect the level of contamination in 57 collected human milk samples. PFOA and PFOS were present in 82.5% and 85.7% of the samples, respectively, while PFOA levels ranged between 120 and 247 pg/mL with a median of 147 pg/mL, and those of PFOS ranged between 12 and 86 pg/mL with a median of 27.5 pg/mL. The median contamination for PFOA exceeded the threshold set by the European Food Safety Authority (EFSA) (60 pg/mL); however, that of PFOS was below the threshold (73 pg/mL). The consumption of bread, pasta, meat, and chicken more than twice per week and that of white tubers and roots at least once per week was significantly associated with higher levels of PFOA (p < 0.05). No significant association was found between maternal age, BMI, parity, level of education, place of residence, source of water used, and smoking with the levels of PFOA and PFOS in the human milk. Additionally, the consumption of cereals at least twice per week was significantly associated with higher levels of PFOS. These findings call for actions to improve the local environmental and agricultural practices, and the regulations and standards for inspecting imported food. It is important to highlight that the benefits of breastfeeding outweigh the reported contamination with PFOS and PFOA in our study.

Relationship between social determinants of health and quality of life in low income adults with diabetes in Lebanon.

BACKGROUND & OBJECTIVE: Global rates of type 2 diabetes (T2DM) are increasing, with the Middle East and North Africa (MENA) region having the second highest prevalence in the world. Populations from the MENA region, including Lebanon, are also witnessing massive waves of immigration to the western hemisphere. Limited data exist about how social determinants of health (SDOH) impact outcomes for T2DM in this population. Thus, the aim of this study was to assess the relationship between SDOH and quality of life (QoL) in Lebanese adults with T2DM. METHODS: Adults with T2DM (n = 300) were recruited from primary healthcare centers in Lebanon. Demographic characteristics and WHO QoL domains (physical health, psychological wellbeing, social relationships, and environment) were assessed. SDOH included socioeconomic, neighborhood/built environment, and psychosocial variables. Partially and fully adjusted regression models were used to test for associations between SDOH and QoL domains. RESULTS: Mean age of the participants was 60.3 years, 48% were women, 73% were married, and 64% had less than high-school education. Results from the fully adjusted regression models showed that psychosocial (i.e. adverse childhood experiences and depression), socioeconomic (i.e. employment, income, family size, insurance, financial status, and financial independence), and neighborhood/built environment (i.e. transportation, number of rooms in the household, and certain household items) variables were independent correlates of different QoL domains. CONCLUSIONS: This study shows that psychosocial, socioeconomic, and neighborhood/built environment variables are differentially associated with different QoL domains, suggesting that SDOH factors are strongly associated with quality of life in low-income adults with T2DM in Lebanon.

Association between Lebanese Mediterranean Diet and Frailty in Community-Dwelling Lebanese Older Adults-A Preliminary Study.

Discrepancies in the characteristics of the food components of a Mediterranean diet exist based on the country of origin. In Lebanon, a traditional Mediterranean diet emphasizes the high intakes of fruits (including dried), vegetables, burghol, and dairy products. Therefore, this cross-sectional study aimed to explore the association between adherence to the Lebanese Mediterranean diet (LMD) and frailty among older adults in Lebanon. A total of 112 community-dwelling older adults aged ≥65 years were recruited. Demographic and clinical characteristics were collected through face-to-face interviews. A 61-item food frequency questionnaire (FFQ) was used to collect dietary intake data, and adherence to LMD was calculated. Physical frailty was defined by the presence of three out of the five criterion: weight loss, weakness, exhaustion, slowness, and low activity. Binary logistic regression was used to examine the relationship between LMD adherence and frailty while adjusting for several confounders. The participants' mean age was 73 ± 12.8 and 65% were females. Sixteen (14.3%) individuals were identified as frail. Frail individuals were significantly older (p = 0.001), depressed (p < 0.001), at risk of cognitive impairment (p = 0.006), and reported polypharmacy (p = 0.003). No significant association was found between LMD adherence and frailty in fully adjusted models (OR = 0.195; 95% CI: 0.033−1.154; p = 0.071 when categorical and OR = 0.856; 95% CI: 0.668−1.097; p = 0.218 when continuous). We also performed additional analyses with a modified frailty index where house chores were not considered as part of leisure activities of the physical activity criterion. The results showed that a higher LMD adherence was associated with a significantly decreased frailty prevalence (OR = 0.123, 95% CI: 0.022−0.676, p = 0.016 when categorical and OR = 0.773, 95% CI 0.608−0.983, p = 0.036). Larger, longitudinal studies are needed to clarify the relationship between the adherence to the Lebanese Mediterranean diet and frailty in Lebanese older adults.

Macronutrients Intake and Risk of Stomach Cancer: Findings from Case-Control Study.

Studies on the association between gastric cancer (GC) and the intake of nutrients in Jordan are very limited, while findings from other reports on the intake of energy and macronutrients are controversial. This study aimed to examine the associations between intake of energy and macronutrients and the risk of GC in a Jordanian population. A case-control study was carried out between March 2015 and August 2018 in four major hospitals, including an oncology center in Jordan. Study participants were 173 cases with incident and histologically confirmed GC and 314 frequency-matched controls. Interview-based questionnaires were used to obtain the study's information. Data on nutrient intake were collected using a validated Arabic food-frequency questionnaire (FFQ). Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated through multinomial logistic regression and adjusted for potential confounders, including age, marital status, education, body mass index (BMI), smoking, period of smoking, family history of gastric cancer, history of gastric ulcer, and physical activity. Intakes of total fat, saturated fat, monounsaturated fat, polyunsaturated fat, cholesterol, trans-fat, and omega-6 fatty acids were significantly associated with increased risk of GC. The ORs for the highest versus the lowest tertiles were 6.47 (95% Cl: 3.29-12.77), 2.97 (95% CI: 1.58-5.58), 6.84 (95% CI: 3.46-13.52), 6.19 (95% CI: 3.15-12.17), 3.05 (95% CI: 1.58-5.88), 8.11 (95% CI: 4.20-15.69), and 2.74 (95% CI: 1.47-5.09), respectively. No significant association was found for energy, protein, carbohydrate, sugar, fibers, and omega-3 fatty acids. The findings of this study suggest that high intake of selected types of fats was associated with an increased risk of GC.

Relationship between social determinants of health and clinical outcomes in adults with type 2 diabetes in Lebanon.

BACKGROUND: A growing number of ethnic minority populations in the United States are from the Middle East and North Africa (MENA) region, specifically Lebanon. This region is witnessing one of the highest expected increases in diabetes prevalence. However, limited data exists on how social determinants of health impact clinical care for diabetes in this population. The aim of this study was to assess the social determinants of health and their impact on clinical outcomes in Lebanese adults with type 2 diabetes (T2DM). METHODS: A convenience sample of Lebanese patients with T2DM was recruited from primary health care centers in Lebanon. Data on demographics and social determinants of health, including socioeconomic status, neighborhood and built environment, as well as psychosocial variables were collected. Clinical outcomes including Hemoglobin A1c (A1C), systolic (SBP) and diastolic blood pressure (DBP) were measured. Unadjusted and adjusted linear regression models were used to test for associations between the independent variables and each of the outcomes. RESULTS: Out of the 300 adults with T2DM, 52% were men, 73% were married and 64% had an education level below high school. Results from multivariate analyses showed that food insecurity (ß = 0.16, p = 0.01), owning an air conditioner (ß = -0.64, p = 0.01), and commuting by walking (ß = -0.93, p = 0.01) were independently associated with A1C. Predictors of DBP were male gender (ß = 3.59, p = 0.03), age (ß = -0.19, p = 0.005) and lack of confidence in filling medical forms (ß = -4.89, p = 0.007), while male gender was the only predictor of SBP (ß = 7.41, p = 0.008). CONCLUSIONS: This is the first study to examine the relationship between social determinants of health and clinical outcomes for diabetes in the MENA region. Our findings suggest that living in an underprivileged neighborhood and built environment was significantly and independently associated with poor clinical outcomes among adults with T2DM in Lebanon. Findings from this study will inform care for immigrant populations with diabetes from the MENA region.

Relationship between material needs security and clinical outcomes in adults with type 2 diabetes in Lebanon.

BACKGROUND: Despite their documented significance in type 2 diabetes (T2DM) management, social determinants of health (SDOHs) including material needs security are poorly studied in the Middle East and North Africa (MENA) region. This study aims to assess the relation between material needs security and clinical outcomes in Lebanese adults with T2DM. METHODS: Subjects with T2DM (n = 300) were recruited; demographic and material need variables were collected using self-reported questionnaires. Measured clinical outcomes included Hemoglobin A1c (A1C), systolic (SBP) and diastolic blood pressure (DBP). Regression models were used to examine associations between material needs security and clinical outcomes, controlling for relevant confounding variables. RESULTS: Most of the participants were men, married and with lower education levels. Having higher material needs security and being employed predicted better A1C levels (p < 0.05), whereas male sex was associated with poorer A1C(ß = 0.52, p = 0.03) and DBP(ß = 3.06, p = 0.05). Other predictors of DBP included older age and lack of confidence in filling out medical forms, reflecting lower health literacy. CONCLUSIONS: Our study highlights the importance of material needs in achieving optimal T2DM outcomes T2DM in the MENA region. Further research is needed to understand potential pathways/mechanisms and options for effective interventions.

Results from the first culturally tailored, multidisciplinary diabetes education in Lebanese adults with type 2 diabetes: effects on self-care and metabolic outcomes.

OBJECTIVE: Diabetes self-management education (DSME) is an essential component of lifestyle management needed for diabetes care. This pilot-study tested the effect of culturally-tailored education targeting diabetes selfcare on glycemia and cardiovascular risk factors of Lebanese with type 2 diabetes mellitus (T2DM) (n = 27; Age: 61 ± 10 yrs, 59% males, HbA1c: 8.98 ± 1.38%). RESULTS: Diabetes self-care (Diet, Self-Monitoring Blood Glucose and foot care) improved after 6 months, which was reflected in a significant drop in glycemic levels (HbA1c:-0.5%; FPG: - 38 mg/dl), and cholesterol/HDL ratio (4.45 ± 1.39 vs. 4.06 ± 1.29). Waist circumference decreased at 6 months compared to 3 months (p < 0.05). This is the first effective culturally-tailored intervention that improved self-care, glycemic control, body adiposity and lipid profile of Lebanese with T2DM. Larger scale implementation with representative sample is warranted.

Persistent Organic Pollutants in Human Milk: Exposure Levels and Determinants among Lactating Mothers in Lebanon.

ABSTRACT: Exposure of newborns to persistent organic pollutants (POPs) is a public health concern. The objective of this study was to assess the prevalence of POPs in human milk collected from lactating mothers in Lebanon and to investigate the sociodemographic, nutritional, and other lifestyle determinants. Fifty-four breast milk samples were collected as per World Health Organization guidelines. A survey was used to assess the anthropometric and demographic characteristics of participants. Dietary habits were evaluated based on a semiquantitative food frequency questionnaire. Organochlorine pesticides and polychlorinated biphenyls were measured in milk samples with liquid-liquid extraction and gas chromatography. Among the screened POPs, dichlorodiphenyldichloroethylene (DDE) was the only POP detected in breast milk samples and was found in only 17.9% of the samples, with a mean (SD) of 11.6 (5.0) µg/L and a range of 5.7 to 21.4 µg/L. Prepregnancy body mass index and age were positively associated with DDE contamination in breast milk. Women who consumed cereals at least two times per week had detectable DDE contamination in their breast milk. Consumption of potatoes and beans at least once per week was also associated with DDE contamination. Our study is the first to assess the presence of POPs in breast milk in Lebanon. The benefits of breastfeeding compensate for the low prevalence of DDE in the breast milk. Our findings highlight the high need to implement monitoring policies, good agricultural practices, and education programs for breastfeeding mothers.

The Role of Herbal and Nutritional Treatments in the Fight against COVID-19 and Other Respiratory Tract Infections.

With the growing spread of COVID-19 worldwide, the appeal to alternative and nutritional therapies in conjunction with medical therapies has been heightened. This article aims to review studies assessing the roles of Chinese traditional medicine and nutrition in upper respiratory infections, including COVID-19. Various Chinese herbal protocols have been shown to fight respiratory infections, with several having been tested on the novel coronavirus. Additionally, promising findings have been reported when medical treatments were complemented with nutritional interventions. Supplementation with vitamins C and D, Zinc and Selenium are discussed, in addition to certain phytochemicals and food that also possess immunoregulatory and antiviral properties. Further clinical studies are needed to establish these alternative treatments as part of the management of emerging respiratory infections.

Validation of the European Prospective Investigation into Cancer (EPIC) FFQ for use among adults in Lebanon.

OBJECTIVE: To validate the European Prospective Investigation into Cancer (EPIC) FFQ in Lebanon. DESIGN: Validation of the EPIC FFQ was done against three 24-h recalls (24-HR). Unadjusted and energy-adjusted correlations, Bland-Altman plots and weighed kappa statistics were used to assess the agreement between the two methods. SETTING: Lebanon. PARTICIPANTS: 119 adults (staff and students) at a Lebanese University. RESULTS: Good unadjusted and energy-adjusted correlation coefficients were found between data from the two methods which ranged from -0·002 (vitamin A) to 0·337 (carbohydrates) and were all statistically significant except for vitamin D, vitamin E, vitamin A, Se and niacin. Slight/fair agreement was reported through weighed kappa estimates for unadjusted data ranging from -0·05 (vitamin C) to 0·248 (Mg) and for energy-adjusted data ranging from -0·034 (vitamin A) to 0·203 (P). Individuals were categorised into exact and adjacent quartiles with an average of 78 % for unadjusted data and 70 % for energy-adjusted data, indicating a very good agreement between the EPIC FFQ and the average of the 24-HR data. The visual inspection of the Bland-Altman plots revealed an overestimation of energy, carbohydrates, protein and fat intakes by the FFQ method. CONCLUSION: Overall, when all tests were taken into consideration, the current study demonstrated an acceptable agreement of the EPIC FFQ with the 24-h dietary recall method and significantly good correlations between dietary intakes. Therefore, the EPIC FFQ can be considered a valid tool for assessing diet in epidemiological studies among Lebanese adults.

Glucose and protein metabolic responses to an energy- but not protein- restricted diet in type 2 diabetes.

AIMS: To test the effect of energy restriction with maintained protein intake on body composition and on insulin sensitivity of glucose and protein metabolism in adults with type 2 diabetes (T2D). MATERIALS AND METHODS: After 3 days of an isoenergetic diet with 1.2 g/kg/d protein, obese adults with T2D (three women, two men) followed a 5-week diet providing 60% of energy requirements with 45% carbohydrate, and with protein maintained at pre-intervention level. Isotopic tracers were used to quantify whole-body glucose (3-3 H-glucose) and protein (13 C-leucine) metabolism pre- (day 4) and post-intervention (day 39), in the postabsorptive state and during a hyperinsulinaemic, isoglycaemic, isoaminoacidaemic clamp. Body composition was measured using dual-energy x-ray absorptiometry. RESULTS: After energy restriction, 6% weight loss occurred via total body (11%) and visceral fat losses (25%), but lean mass was preserved. Fasting glucose level, serum insulin level, homeostatic model assessment of insulin resistance index and C-peptide level decreased significantly (29%, 38%, 54% and 38%, respectively) as did other cardiometabolic risk factors. Between clamp studies, postabsorptive protein turnover and oxidation rates decreased (12% and 32%), resulting in less negative net balance, consistent with protein conservation. The rates of glucose turnover decreased, and glucose metabolic clearance rate improved (24%). During the clamp, protein flux was lower (9%) and breakdown suppressed (12%), and net balance became less negative but not different. Although glucose turnover did not differ, metabolic clearance improved by 47%. CONCLUSIONS: In obese adults with T2D, an energy-restricted diet with maintained protein intake of ~1.2 g/kg/d improved the kinetics of protein metabolism (particularly in the postabsorptive state), and preserved lean body mass and increased glucose metabolic clearance rate.

Branched-chain amino acids mediate resilience to chronic social defeat stress by activating BDNF/TRKB signaling.

How individuals respond to chronic stress varies. Susceptible individuals ultimately develop depression; whereas resilient individuals live normally. In this study, our objective was to examine the effect of branched-chain amino acids (BCAA), commonly used by athletes, on susceptibility to stress. Male C57BL/6 mice were subjected to daily defeat sessions by a CD1 aggressor, for 10 days. On day11, the behavior of mice was assessed using the social interaction test, elevated plus maze and open field. Mice received the BCAA leucine, isoleucine or valine before each defeat session. Furthermore, we examined whether BCAA regulate brain derived neurotrophic factor (BDNF) signaling by using a brain-permeable tropomyosin receptor kinase B (TRKB) inhibitor, ANA-12. We also tested the effect of voluntary exercise and high protein diets on susceptibility to stress. Mice exposed to chronic stress displayed increased susceptibility and social avoidance. BCAA promoted resilience to chronic stress, rescued social avoidance behaviors and increased hippocampal BDNF levels and TRKB activation. Inhibition of TRKB signaling abolished the ability of BCAA to promote resilience to stress and to rescue social avoidance. Interestingly, we found that BCAA activate the exercise-regulated PGC1a/FNDC5 pathway known to induce hippocampal BDNF signaling. Although both voluntary exercise and BCAA promoted resilience to stress, combining them did not yield synergistic effects confirming that they affect similar pathways. We also discovered that high protein diets mimic the effect of BCAA by rescuing social deficits induced by chronic stress and increase Bdnf expression in the hippocampus. Our data indicate that BCAA, exercise and high protein diets rescue susceptibility to stress by activating the hippocampal BDNF/TRKB signaling.

Diabetes fatalism and its emotional distress subscale are independent predictors of glycemic control among Lebanese patients with type 2 diabetes.

Background: Achieving and sustaining optimal glycemic control in type 2 diabetes (T2DM) is difficult because of socio-cultural and psychosocial factors including diabetes fatalism. Diabetes fatalism is 'a complex psychological cycle characterized by perceptions of despair, hopelessness, and powerlessness'. Purpose: The purpose of this paper is to explore whether diabetes fatalism and other psychosocial and socio-cultural variables are correlates of glycemic control in Lebanese population with T2DM. Methods: A convenience sample of 280 adult participants with T2DM were recruited from a major hospital in greater Beirut-Lebanon area and from the community. Diabetes fatalism was assessed using the Arabic version of 12-item Diabetes Fatalism Scale. Multiple linear regression models were used to assess the relationship between HbA1c and psychosocial and socio-cultural characteristics including diabetes fatalism. Four models were run to examine the independent association between HbA1c and diabetes fatalism and to identify which of the 3 subscales (emotional distress, spiritual coping and perceived self-efficacy) were associated with HbA1c. Results: The mean age of the participants was 58.24(SD = 13.48) and the majority were females (53.76%), while 32.73% of the sample had diabetes for more than 10 years. Fully adjusted multiple linear regression models showed that higher scores on diabetes fatalism and the emotional distress subscale (P = 0.018) were significantly associated with higher HbA1c values. In addition, having diabetes for more than 11 years (P = 0.05) and a higher number of diabetes complications (P < 0.001) were associated with higher HbA1c levels. However, advanced age (P = 0.055), female gender (P = 0.003), and diabetes education (P = 0.011) were significantly associated with lower HbA1c levels. Conclusion: This is the first study in the Arab region that identifies diabetes fatalism as an independent predictor of glycemic control among Lebanese. Future studies should further investigate this construct to guide interventions that can address it for better diabetes outcomes.

Personality, emotion-related variables, and media pressure predict eating disorders via disordered eating in Lebanese university students.

PURPOSE: Disordered eating behaviors are on the rise among youth. The present study investigates psychosocial and weight-related variables as predictors of eating disorders (ED) through disordered eating (DE) dimensions (namely restrained, external, and emotional eating) in Lebanese university students. METHODS: The sample consisted of 244 undergraduates (143 female) aged from 18 to 31 years (M = 20.06; SD = 1.67). Using path analysis, two statistical models were built separately with restrained and emotional eating as dependent variables, and all possible direct and indirect pathways were tested for mediating effects. The variables tested for were media influence, perfectionism, trait emotional intelligence, and the Big Five dimensions. RESULTS: In the first model, media pressure, self-control, and extraversion predicted eating disorders via emotional eating. In the second model, media pressure and perfectionism predicted eating disorders via restrained eating. DISCUSSION: Findings from this study provide an understanding of the dynamics between DE, ED, and key personality, emotion-related, and social factors in youth. Lastly, implications and recommendations for future studies are advanced.

Implementing an interprofessional education programme in Lebanon: overcoming challenges.

BACKGROUND: The Lebanese American University has a well-functioning inter-professional education (IPE) programme; this is a fundamental pedagogical approach in healthcare education in which students from different professions learn together, ultimately leading to improving the skills of the health care workforce and thus improving patient outcomes. The programme includes nursing, nutrition, medicine, pharmacy and social work students, and has now been running for 6 years. AIMS: This paper aims at describing the implementation of an IPE programme in Lebanon by focusing on how to overcome the main challenges. METHODS: We describe our experience using the categories of challenges developed by Sunguya et al. (2014), where they analysed published reports of IPE programmes in developed countries. We identified three additional challenges that might be relevant throughout the Middle East/North Africa (MENA) region or in countries with similar socioeconomic characteristics. RESULTS: The challenges encountered in designing and implementing the IPE programme were similar to other programmes: curriculum, leadership, resources, stereotypes and attitudes, variety of students, IPE concept, teaching, enthusiasm, professional jargon and accreditation as well as assessment of learning, security and logistics. CONCLUSIONS: This paper provides data and successful strategies that can be used by planned or implemented programmes in similar socioeconomic contexts in the MENA region.

Psychometric properties of the Arabic version of the 12-item diabetes fatalism scale.

BACKGROUND: There are widespread fatalistic beliefs in Arab countries, especially among individuals with diabetes. However, there is no tool to assess diabetes fatalism in this population. This study describes the processes used to create an Arabic version of the Diabetes Fatalism Scale (DFS) and examine its psychometric properties. METHODS: A descriptive correlational design was used with a convenience sample of Lebanese adults (N = 274) with type 2 diabetes recruited from a major hospital in Beirut, Lebanon and by snowball sampling. The 12- item Diabetes Fatalism Scale- Arabic (12-item DFS-Ar) was back-translated from the original version, pilot tested on 22 adults with type 2 diabetes and then administered to 274 patients to assess the validity and reliability of the scale. Confirmatory factor analysis (CFA) was used to test the hypothesized factor structure. Cronbach's alpha was used to test for reliability. RESULTS: CFA supported the existence of the three factor hypothesis of the original DFS scale. The five items measuring "emotional distress" loaded under Factor 1, the four items measuring "spiritual coping" loaded under factor 2 and the last three items measuring "perceived self-efficacy" of the original scale loaded under Factor 3 (p <0.001 for all three subscales). Goodness of fit indices confirmed adequateness of the CFA model (CFI = 0.97, TLI = 0.96, RMSEA = 0.067 and pclose = 0.05). The 12-item DFS-Ar showed good reliability (Cronbach's alpha of 0.86) and significantly predicted HbA1c (ß = 0.20, p < 0.01). After adjusting for the demographic characteristics and the number of diabetes comorbid conditions, the 12-item DFS-Ar score was independently associated with HbA1c in a multivariable model (ß = 0.16, p < 0.05). CONCLUSIONS: The 12-item DFS-Ar demonstrated good psychometric properties that are comparable to the original scale. It is a valid and reliable measure of diabetes fatalism. Further testing with larger and non-Lebanese Arabic population is needed.

Lead, cadmium and arsenic in human milk and their socio-demographic and lifestyle determinants in Lebanon.

INTRODUCTION: Exposure of newborns to toxic metals is of special interest due to their reported contamination in breast milk and potential harm. The aim of this study was to assess the occurrence and factors associated with lead, cadmium and arsenic contamination in breast milk collected from lactating mothers in Lebanon. METHODS: A total of 74 breast milk samples were collected from primaparas according to guidelines set by the World Health Organization. A survey was administered to determine the demographic and anthropometric characteristics of participating lactating mothers. Dietary habits were assessed using a semi-quantitative food frequency questionnaire. The milk samples were analyzed for the presence of arsenic, cadmium and lead using microwave-assisted digestion and atomic absorption spectrophotometry. RESULTS: Arsenic contamination was found in 63.51% of breast milk samples (mean 2.36 ± 1.95 µg/L) whereas cadmium and lead were detected in 40.54% and 67.61% of samples respectively (means 0.87 ± 1.18 µg/L and 18.18 ± 13.31 µg/L). Regression analysis indicated that arsenic contamination was associated with cereal and fish intake (p = 0.013 and p = 0.042 respectively). Residence near cultivation activities (p = 0.008), smoking status before pregnancy (p = 0.046), potato consumption (p = 0.046) and education level (p = 0.041) were associated with lead contamination. Cadmium contamination was significantly associated with random smoke exposure (p = 0.002). CONCLUSION: Our study is the first in Lebanon to report toxic metal contamination in breast milk. Although estimated weekly infant intake of these metals from breast milk was found to be lower than the limit set by international guidelines, our results highlight the need for developing strategies to protect infants from exposure to these hazardous substances.

Predictors of Diabetes Fatalism Among Arabs: A Cross-Sectional Study of Lebanese Adults with Type 2 Diabetes.

Fatalism is a grounded cultural belief that is common among Arabs and is known to hinder self-care in chronic diseases including diabetes (Nabolsi and Carson in Scand J Caring Sci 25(4):716-724, 2011). The purpose of this study is to identify predictors of diabetes fatalism in this population. Data on 280 Lebanese patients with type 2 diabetes (mean age 58.24 ± 13.48 years; mean HbA1c 7.90 ± 1.90%; 53.76% females) recruited from one hospital in greater Beirut, Lebanon, and from the community using snowballing technique were examined. Multiple linear regression was used to assess the independent association between diabetes fatalism and demographic and patient characteristics. Age (ß = -.14, 95% CI -.27, -.002), BMI (ß = .35, 95% CI .15; .54), level of education (ß = -3.98, 95% CI -7.64; -.32) and number of diabetes problems (ß = -5.03, 95% CI -9.89; -.18) were significantly associated with diabetes fatalism in the regression model. The combination of demographic and patient characteristics accounted for 14.5% of the variance in diabetes fatalism scores' change. Patients with type 2 diabetes who exhibited more fatalistic attitudes were younger, of lower education levels, had higher BMI and had fewer diabetes comorbidities. Such findings are crucial for healthcare practitioners to identify fatalistic patients and to tailor culturally appropriate strategies in diabetes management. Further studies are warranted to explore other potential determinants of diabetes fatalism with larger sample and non-Lebanese Arabic population.

Plasma Amino Acids vs Conventional Predictors of Insulin Resistance Measured by the Hyperinsulinemic Clamp.

CONTEXT: Specific plasma amino acid (AA) profiles including elevated postabsorptive branched-chain amino acids (BCAAs) have been associated with insulin resistance (IR), mostly estimated by homeostatic model assessment. This study assessed the associations of postabsorptive AAs with IR directly measured by insulin-mediated glucose disposal and determined the quantitative value of AAs and conventional IR predictors. DESIGN: Fifty-one healthy, 31 overweight or obese (Ow/Ob), and 52 men and women with type 2 diabetes (T2D) were studied retrospectively. The main outcome measures were the glucose disposal (M/I) index (using 3-[3H]-glucose) during a hyperinsulinemic-euglycemic clamp and whole-body protein turnover (using 1-[13C]-leucine). RESULTS: Compared with healthy participants, M/I was lower in Ow/Ob participants and lowest in those with T2D. BCAAs, glutamate, and lysine were higher in the Ow/Ob and T2D groups than in healthy participants; glycine and threonine were lower. Most AAs were higher in men. Principal component analysis identified component 1 (C1: BCAAs, methionine) and C3 (glycine, threonine, serine). Glutamate, C1, ornithine, lysine, methionine, and tyrosine correlated negatively with M/I; C3 and glycine correlated positively. Waist circumference and sex strongly influenced AA-IR relationships; only glutamate correlated after these factors were controlled for. From regression analysis, waist circumference, fasting glucose, insulin, and free fatty acids (FFAs) negatively predicted 64% of the M/I variance; glutamate added 2% more. In nondiabetic participants, IR was predicted by waist circumference, insulin, and FFAs, without contribution from AAs. CONCLUSION: Several postabsorptive AAs correlated with IR but added limited predictive value to conventional markers because levels were determined largely by abdominal adiposity. Data suggest a sex-specific regulation of AA metabolism by excess adiposity, particularly the BCAAs, warranting investigation.