Assessing the nutritional content and adequacy of food parcels among vulnerable Lebanese during a double crisis: COVID-19 pandemic and an economic meltdown.

OBJECTIVES: This study aimed to explore the nutritional content and quality of food parcels distributed in Lebanon and assess their adherence to dietary guidelines during the COVID-19 pandemic and an unprecedented economic crisis. DESIGN: Cross-sectional study (June-July 2020); phone survey (thirty items). SETTING: Lebanon. PARTICIPANTS: Food parcel providers (FPP; n 72) involved in food parcel distribution (FPD), mainly to Lebanese households. RESULTS: FPP included international non-governmental organizations (INGO) (n 3), local non-governmental organizations (n 45) and personal initiatives (n 24). Overall, low adherence to the World Food Programme (WFP) food parcel guidelines were observed among FPP for specific food items, including vegetables, fish, legumes and cereals, whereas salt content significantly surpassed the guidelines (all P-values <0·001). On average, a food parcel provided 608·4 ± 55 kcal/d/person. The greatest contributors to total energy intake (TE) in the food parcel were carbohydrates (46·4 %) and fats (46·8 %), while protein contributed to 7 %TE. In addition, %TE from fats and sugars significantly surpassed the dietary reference intakes (DRI) for a single person per d (134-234 % and 185 % of DRI, respectively, P-values <0·001). Only 10-15 % of daily needs for key micronutrients, including Fe, Zn, thiamin, riboflavin and dietary folate, were met through the food parcels. Adequate food safety and hygiene practices were reported among FPP, yet dramatic changes in food costs due to overlapping crises affected the quality and quantity of food in parcels. CONCLUSIONS: Findings highlight the need to improve the nutritional content of food parcels and adherence to dietary guidelines to alleviate food and nutrition insecurity while preventing diet-related diseases among vulnerable beneficiaries in Lebanon.

Food insecurity, low dietary diversity and poor mental health among Syrian refugee mothers living in vulnerable areas of Greater Beirut, Lebanon.

Syrian refugees in Lebanon are facing vulnerabilities that are affecting their food insecurity (FI) levels. The objectives of this study were to measure dietary diversity, FI and mental health status of Syrian refugee mothers in Lebanon and to explore its associations with their anaemia and nutritional status. A cross-sectional study was conducted among mothers with children under 5 years (n 433) in Greater Beirut, Lebanon. Dietary diversity was measured using the Minimum Dietary Diversity for Women (MDD-W) of reproductive age and FI using the global Food Insecurity Experience Scale at the individual level. Depression and post-traumatic stress disorder (PTSD) were measured to assess the maternal mental health status. Data on socio-economic characteristics, anthropometric measurements and Hb concentrations were collected. Overall, 63·3 % of the mothers had a low dietary diversity (LDD) and 34·4 % were moderately to severely food insecure, with 12·5 % being severely food insecure. The prevalence of PTSD, moderate depression and severe depression was 13·2, 11·1 and 9·9 %, respectively. A significant correlation was found between LDD and FI (P < 0·001). Low income was significantly associated with LDD and FI. Poor mental health was significantly associated with FI. LDD and FI were not associated with anaemia and nutritional status of mothers. Low-income households had significantly higher intakes of grains and refined starchy staples, whereas high-income households consumed more nutritious foods and sweets. Evidence of inadequate diet quality, FI and poor mental health among Syrian refugee mothers in Lebanon is presented. Multifaceted actions are needed to reduce FI and improve dietary diversity.

Food consumption patterns and nutrient intakes of infants and young children amidst the nutrition transition: the case of Lebanon.

BACKGROUND: This is the first study on dietary intakes of infants and young children in the Eastern Mediterranean Region, a region that is currently witnessing the nutrition transition. It aims at characterizing food consumption patterns amongst 0-4 year old children in Lebanon, evaluating their macro- and micronutrient intakes and assessing adherence to dietary recommendations. METHODS: Based on a national cross-sectional survey in 2012 (n = 866), the study collected data on sociodemographic and anthropometric characteristics, and one 24-hour dietary recall was administered. Nutrient intakes were compared with reference values: Estimated Average Requirement (EAR), Adequate Intake (AI) and Acceptable Macronutrient Distribution Range (AMDR). RESULTS: Milk was the highest contributor to energy intake (EI) in infants (95.8 and 56.5% in 0-5.9 months and 6-11.9 months old infants, respectively), while its intake was lower among toddlers and preschoolers (35.4 and 15.1%, respectively). In contrast, intakes of sweets and sweetened beverages were the highest in preschoolers compared to younger children, contributing 18.5% EI in preschoolers. Compared to dietary guidelines, the lowest dietary adherence was found for vegetables (17.8-20.7%) and fruits (14.4-34.3%). Protein intake was within the recommendations for the vast majority of children. Although total fat intake was lower in toddlers and preschoolers compared to infants, more than 40% of toddlers and preschoolers exceeded the AMDR for fat and 87.3% of preschoolers exceeded the upper limit for saturated fat. Only 3.6% of toddlers and 11.5% of preschoolers exceeded the AI level for dietary fiber. Micronutrient intake assessment showed that mean intakes in infants exceeded the AI for all micronutrients, except for vitamin D and magnesium. In toddlers, vitamin D and calcium were below the EAR among 84.7, and 44.6%, respectively. In preschoolers, most of the children (91.9%) had inadequate intakes of vitamin D, and a third had inadequate intakes of folate, calcium and vitamin A. CONCLUSIONS: This study identified priority issues for nutrition intervention in infants and young children in Lebanon. Concerted multi-stakeholder efforts are needed to instill heathier food consumption and nutrient intake patterns early in life.

Food and nutrient intake of school-aged children in Lebanon and their adherence to dietary guidelines and recommendations.

BACKGROUND: Lebanon, an Eastern Mediterranean country, is witnessing a remarkable nutrition transition, and the diets of school-aged children may be amongst those most affected. However, limited studies have examined the food consumption patterns and nutrient adequacy in this age group. OBJECTIVES: The present study aimed to evaluate the dietary intakes of school-aged children in Lebanon and assess their adherence to nutrition guidelines and recommendations. METHODS: This study used data for 4-13 y-old children (n = 711) from a national cross-sectional survey conducted in 2014-2015 on a representative sample of Lebanese households with children. Dietary intake was assessed using single 24-h recall method. Estimated food group and nutrient intakes were compared to dietary recommendations and age-specific dietary reference intakes (DRI), including Estimated Average Requirements (EAR) and Acceptable Macronutrient Distribution Range (AMDR). Food group, energy, macro- and micro-nutrient intakes were presented for all children in the sample and stratified by age (4-8 y and 9-13 y) and sex. RESULTS: Mean energy intake of 4-13-year-old children was 1804 kcal/d. Almost half of the energy was provided by carbohydrates while 12% of children had protein intakes below EAR. Approximately three-quarters of children (4-13 y) exceeded the AMDR for total fat and saturated fats, and a similar proportion over consumed added sugars. The main sources of energy intake (EI) among children were the sweets, sweetened beverages and desserts followed by grains and mixed dishes. No significant differences were noted in %EI from different food groups, by sex, in either age groups. The highest adherence of children to food group recommendations was observed for the grains' food group (47.2-54.4%EI), while the lowest adherence was found for vegetables (3.1-14.1%EI). A high prevalence of vitamin and mineral inadequacies was noted amongst 4-13 y old children for key micronutrients, including vitamin D (99%), calcium (81%), and vitamin A (69.5%). Risk of inadequate micronutrient intakes was significantly increased among the older age group (p-value < 0.05). CONCLUSION: Nutrient intakes of school-aged children in Lebanon reflect suboptimal nutrition. Educational and public health interventions are needed to promote healthier diets among children and prevent micronutrient deficiencies during this critical phase.

Head Start Parents With or Without Food Insecurity and With Lower Food Resource Management Skills Use Less Positive Feeding Practices in Preschool-Age Children.

BACKGROUND: Food resource management (FRM), strategies to stretch limited food resource dollars, may mitigate the impact of household food insecurity (HFI) on family members, including young children. However, little is known about how FRM and HFI are associated with child feeding practices. OBJECTIVES: The study aimed to explore relationships between HFI, FRM, and child feeding practices of low-income parents. METHODS: In a cross-sectional sample of 304 Head Start households, caregivers completed the USDA HFI module [classifying them as either food secure (FS) or food insecure (FI)], FRM behavior subscale (classifying them as being high or low in management skills based on a median score split), Comprehensive Feeding Practices Questionnaire, and Perceived Stress Scale. Households were categorized into 4 HFI-FRM subgroups: FS/high FRM (30.6%), FS/low FRM (31.3%), FI/high FRM (18.8%), and FI/low FRM (19.4%). Multivariable linear regression was used to examine whether feeding practices differed across HFI-FRM categories and whether the addition of parental perceived stress contributed to differences in feeding practices by HFI-FRM group. RESULTS: In our study, 38% of households were FI. Compared to the FS/high FRM group in the adjusted models, the FS/low FRM group used less monitoring (-0.53; 95% CI: -0.78 to -0.28), modeling (-0.38; 95% CI: -0.64 to -0.13), and involvement (-0.57; 95% CI: -0.82 to -0.32) in feeding. A similar pattern emerged for the FI/low FRM group. The use of food as a reward was higher in the FI/high FRM (0.35; 95% CI: 0.02-0.67) and FI/low FRM groups (0.33; 95% CI: 0.01-0.66) compared to the FS/high FRM group. Perceived stress was positively associated with the use of negative, controlling feeding practices, and contributed to differences in using food as a reward within the HFI-FRM group. CONCLUSIONS: Suboptimal child feeding is evident in low-income caregivers with low FRM skills, with or without food insecurity. Promoting high FRM skills, in addition to addressing food insecurity, could potentially synergistically improve child feeding practices in low-income households.

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.

Dietary intakes, sources, and determinants of free sugars amongst Lebanese children and adolescents: findings from two national surveys.

PURPOSE: To determine the intake levels, dietary sources, and determinants of free sugars (FS) consumption amongst Lebanese children and adolescents. METHODS: This study is based on data collected by two national cross-sectional surveys conducted on representative samples of Lebanese children: survey 1 (under-five years (U5) children) (n = 899) and survey 2 (5-18 years-old children) (n = 1133). Multi-component questionnaires were used for data collection. Dietary intakes were assessed using one 24 h dietary recall. Median daily intakes of FS, and percent contribution of various food groups to FS intake were compared between sex and age groups. Logistic regressions were conducted to explore the determinants of high FS intake (> 10% energy intake/d), as per the WHO recommendations. RESULTS: Median contribution of FS to daily energy intake was 8.5% in U5 children and 11.9% amongst those aged 5-18 years old. The top contributors to FS in both surveys were sugar-sweetened beverages and biscuits and chocolates. The proportion of children and adolescents exceeding WHO upper limits for FS was estimated at 43 and 62% in survey 1 and survey 2, respectively. Regression models showed females, higher household monthly incomes and higher parental educational levels were associated with significantly lower odds of exceeding the WHO upper limit for FS. CONCLUSION: The study showed that a high proportion of Lebanese children and adolescents exceeded the WHO upper limit for FS intake, while also documenting a socioeconomic gradient in FS intake. Findings call for devising food system-based interventions to help reduce FS intake in this nutritionally vulnerable age group.

Food insecurity is associated with lower adherence to the Mediterranean dietary pattern among Lebanese adolescents: a cross-sectional national study.

PURPOSE: To derive dietary patterns (DPs) of Lebanese adolescents (10-18 years) and evaluate associations between identified DPs and household food insecurity (HFI). METHODS: Data on adolescents (n = 693) were drawn from a national survey conducted in 2015 on a representative sample of Lebanese households with children. In addition to a sociodemographic questionnaire, data collection included the validated Arabic-version of the Household Food Insecurity Access Scale, used to evaluate HFI. Dietary intake was assessed using a 187-item validated food frequency questionnaire. Associations between HFI scores and DPs were examined using multiple linear regressions. RESULTS: HFI was observed in 55.2% of the study sample. Two DPs were derived among adolescents: Western and Lebanese-Mediterranean (LM). The Western DP was characterized by higher consumption of sweetened beverages, fast foods, sweets, and refined grains, whereas the LM DP was characterized by higher intakes of fruits, vegetables, dairy products, and whole grains. Scores of the Western DP were negatively associated with fiber, calcium, iron, and vitamins A and D, while the LM DP scores were positively correlated with fiber, proteins, iron, calcium, and vitamins A and D (p < 0.01). LM DP scores were also negatively correlated with total fat, saturated and polyunsaturated fats, p < 0.05. After adjustment for sociodemographics, multiple linear regression showed that higher HFI scores were associated with lower adherence to LM DP among adolescents (ß = - 0.026, 95% CI - 0.046, - 0.006). CONCLUSIONS: HFI was associated with lower adherence to the Mediterranean pattern among Lebanese adolescents. Preventive strategies are needed to promote better diet quality among food-insecure youth.

Food insecurity is associated with suboptimal sleep quality, but not sleep duration, among low-income Head Start children of pre-school age.

OBJECTIVE: To examine the association between food insecurity and child sleep outcomes and to investigate whether parent psychosocial factors mediate such associations. DESIGN: Cross-sectional study. Usual wake time and bedtime, bedtime routine and sleep quality were reported by parents using the adapted Brief Infant Sleep Questionnaire. Food insecurity was assessed using the eighteen-item US Department of Agriculture Household Food Security Module. Parent psychosocial factors, including perceived stress, parenting self-efficacy and depressive symptomology, were assessed using validated scales. Multivariable logistic regression models were performed to determine the association between food insecurity and sleep outcomes controlling for potential confounders. Mediation analyses and Sobel tests were applied to test the mediating effect of psychosocial factors. SETTING: Head Start pre-school classrooms in four regions across central Pennsylvania, USA. PARTICIPANTS: Low-income children of pre-school age (n 362) and their caregivers. RESULTS: Prevalence of household, adult and child food insecurity was 37·3, 31·8 and 17·7 %, respectively. Food security status at any level was not associated with child sleep duration or bedtime routine. Child food insecurity, but not household or adult food insecurity, was associated with 2·25 times increased odds (95 % CI 1·11, 4·55) of poor child sleep quality in the adjusted model. Perceived stress, self-efficacy and depressive symptomology mediated less than 2 % of the observed effect (all Sobel test P > 0·6). CONCLUSION: Food insecurity, particularly at the child level, is a potential modifiable risk factor for reducing sleep-related health disparities in early childhood. Future studies are needed to explore the plausible mechanisms underlying the associations between food insecurity and adverse child sleep outcomes.

Food insecurity is associated with compromised dietary intake and quality among Lebanese mothers: findings from a national cross-sectional study.

OBJECTIVE: Examine the associations between household food insecurity (HFI) with sociodemographic, anthropometric and dietary intakes of mothers. DESIGN: Cross-sectional survey (2014-2015). In addition to a sociodemographic questionnaire, data collection included the validated Arabic version of the Household Food Insecurity Access Scale, which was used to evaluate HFI. Dietary intake was assessed using 24-h dietary recall of a single habitual day, and maternal BMI was calculated based on weight and height measurements. Associations between HFI and maternal dietary intake (food groups, energy and macronutrients' intake) were examined. Simple and multiple logistic regression analyses were conducted to explore the associations between HFI status with odds of maternal overweight and measures of diet quality and diversity (Healthy Eating Index (HEI) and Minimum Dietary Diversity for Women of Reproductive Age (MDD-W)). SETTING: Lebanon. PARTICIPANTS: Mothers, nationally representative sample of Lebanese households with children (n 1204). RESULTS: HFI was experienced among almost half of the study sample. Correlates of HFI were low educational attainment, unemployment and crowding. Significant inverse associations were observed between HFI and dietary HEI (OR 0·64, 95 % CI 0·46, 0·90, P = 0·011) and MDD-W (OR 0·6, 95 % CI 0·42, 0·85, P = 0·004), even after adjusting for socioeconomic correlates. No significant association was observed between HFI and odds of maternal overweight status. CONCLUSIONS: HFI was associated with compromised maternal dietary quality and diversity. Findings highlight the need for social welfare programmes and public health interventions to alleviate HFI and promote overall health and wellbeing of mothers.

A traditional dietary pattern is associated with lower odds of overweight and obesity among preschool children in Lebanon: a cross-sectional study.

PURPOSE: The high burden of preschool overweight in the Middle East and North Africa highlights the need for rigorous investigations of its determinants. This study aims at identifying dietary patterns amongst preschoolers in Lebanon and assessing their association with overweight and obesity. METHODS: A national cross-sectional survey was conducted amongst 2-5-year-old children (n = 525). Socio-demographic, dietary, lifestyle and anthropometric variables were collected. Dietary patterns were derived by factor analysis. Overweight/obesity was defined based on the World Health Organization 2006 criteria (BMI-for-age z-score > + 2). RESULTS: Two patterns, "Fast Food and Sweets" and "Traditional Lebanese", were identified. The "Fast Food and Sweets" pattern was characterized by higher consumption of sweetened beverages, fast foods, salty snacks and sweets. The "Traditional Lebanese" was driven by higher intakes of cereals, dairy products, fruits and vegetables. Children belonging to the 3rd tertile of the Traditional pattern scores had significantly lower odds of overweight/obesity compared to the 1st tertile (OR 0.33; 95% CI 0.11, 0.97). Higher maternal education and higher frequency of eating with family predicted adherence to the traditional pattern, while the presence of a household helper was a negative determinant. Adherence to the Fast Food and Sweets pattern was positively associated with the child's age, and negatively associated with female gender and maternal education. CONCLUSIONS: The "Traditional Lebanese" pattern was associated with decreased risk of preschool overweight. Policies aiming at re-anchoring this traditional dietary pattern in contemporary lifestyles may be developed as potential preventive strategies against overweight in this age group.

Prevalence and correlates of food insecurity among Lebanese households with children aged 4-18 years: findings from a national cross-sectional study.

OBJECTIVE: Food insecurity (FI) is a major public health problem in Lebanon, a small middle-income country with the highest refugee per capita concentration worldwide and prolonged political and economic challenges. The present study aimed to measure the prevalence and sociodemographic correlates of household FI and to explore the association of household FI with anthropometric measures of children and their mothers. DESIGN: Cross-sectional survey (2014-2015). SETTING: Lebanon.ParticipantsNationally representative sample of Lebanese households with 4-18-year-old-children and their mothers (n 1204). RESULTS: FI prevalence (95 % CI), measured using the Arabic-translated, validated Household Food Insecurity Access Scale, was found to be 49·3 (44·0, 54·6) % in the study sample. Mild, moderate and severe FI were found in 7·0 (5·5, 9·2) %, 23·3 (20·1, 26·8) % and 18·9 (14·9, 23·5) % of households, respectively. Multiple regression analysis showed that low maternal and paternal education, unemployment and crowding were significant correlates of household FI (P<0·05). No significant associations were observed between FI and anthropometric measures of children and their mothers, after adjusting for other socio-economic correlates. Food-insecure households reported various mechanisms to cope with food shortage, such as reducing the number of meals/d (49·6 %), borrowing food (54·4 %), spending savings (34·5 %) and withdrawing children from schools (8·0 %). CONCLUSIONS: FI exists among a remarkable proportion of Lebanese households with children. Correlates of household FI should be considered when designing social welfare policies and public health programmes to promote more sustainable, resilient and healthier livelihoods among vulnerable individuals.

Environmental footprints of food consumption and dietary patterns among Lebanese adults: a cross-sectional study.

BACKGROUND: Following the release of the Sustainable Development Goals, dietary patterns and guidelines are being revised for their effect on the environment in addition to their health implications. The objective of this study was to evaluate and compare the Environmental Footprints (EFPs) of food consumption patterns among Lebanese adults. METHODS: For this study, data for adults aged > 18 years (n = 337) were drawn from a previous national survey conducted in Lebanon (2008-2009), where dietary intake was assessed using a 61-item Food Frequency Questionnaire. Dietary patterns previously derived in the study sample included: Western, Lebanese-Mediterranean and High-Protein. In this study, food consumption and dietary patterns were examined for their EFPs including water use, energy use, and greenhouse gas (GHG) emissions, using review of life cycle analyses. RESULTS: In the study population, the EFPs of food consumption were: water use: 2571.62 ± 1259.45 L/day; energy use: 37.34 ± 19.98 MJ/day and GHGs: 4.06 ± 1.93 kg CO2 eq / day. Among the three dietary patterns prevalent in the study population, the Lebanese-Mediterranean diet had the lowest water use and GHG per 1000 Kcal (Water (L/Kg): 443.61 ± 197.15, 243.35 ± 112.0, 264.72 ± 161.67; GHG (KG CO2 eq/day) 0.58 ± 0.32, 0.38 ± 0.24, 0.57 ± 0.37, for the Western, Lebanese-Mediterranean and High- Protein, respectively). The scores of the High-Protein dietary pattern were associated with higher odds of the three EFPs, whereas the Lebanese-Mediterranean dietary pattern was associated with lower odds of energy use. Furthermore, scores of the Western pattern were associated with higher water use. CONCLUSIONS: The findings of this study showed that, among Lebanese adults, the Western and High-Protein dietary patterns had high EFPs, whereas the Lebanese-Mediterranean dietary pattern had lower water use and GHG emissions. Coupled to our earlier findings of the Lebanese-Mediterranean pattern's beneficial effects on health, the findings of this study lend evidence for the notion that what is healthy for people may also be healthy for ecosystems and highlight the need for nutrition recommendations to take into consideration the nexus of water, food, energy, in addition to health.

Household food insecurity is associated with a higher burden of obesity and risk of dietary inadequacies among mothers in Beirut, Lebanon.

BACKGROUND: Mixed evidence exists with respect to the association between household food insecurity (HFIS) and obesity in low-to-middle income countries (LMICs), particularly among women. This study aimed to measure socioeconomic correlates of HFIS and explores its association with dietary intake and odds of obesity among mothers in Lebanon, a middle-income country undergoing nutrition transition. METHODS: A cross-sectional study was conducted among a representative sample of households (n = 378) in Beirut, Lebanon. Surveys were completed with mothers of children <18 years. HFIS was measured using a locally-validated, Arabic-translated Household Food Insecurity Access Scale (HFIAS). Dietary intake was assessed using the multiple pass 24-h recall method. Associations between HFIS (food vs food insecure) and socio-demographic characteristics were reported using crude and adjusted odds ratios. The odds of consuming <2/3rd Dietary Reference Intakes (DRIs) for nutrients among mothers from food secure and food insecure households were explored. In addition, logistic regression analyses were conducted to explore the association of HFIS with obesity (BMI ≥ 30 kg/m2) and at-risk waist circumference (WC ≥ 80 cm) among mothers. RESULTS: HFIS was found among 50% of study sample and was inversely associated with household income and mother's educational level, even after adjusting for other socioeconomic variables (p < 0.01). Mothers in food insecure households reported consuming significantly less dairy products, fruits, and nuts yet more breads and sweets; and they had higher odds of consuming <2/3rd the DRI's for key micronutrients (potassium, folate, and vitamin C) compared to secure ones. Adjusting for socioeconomic correlates, food insecure mothers had 1.73 odds of obesity (95% CI: 1.02-2.92) compared to food secure mothers. CONCLUSIONS: High HFIS prevalence was reported among urban Lebanese households. Mothers from food insecure households had a high risk of dietary inadequacy and obesity. Adequate evidence-based public health strategies are needed to reduce the vulnerability of mothers to food insecurity in LMIC settings and alleviate their risk of a high burden of nutrient insecurity and obesity.

A Lebanese dietary pattern promotes better diet quality among older adults: findings from a national cross-sectional study.

BACKGROUND: Proper nutrition is critical for healthy aging and maintaining functional independence. Limited research has been done on the assessment of dietary patterns of older adults and their association with diet quality indices. This study was conducted to identify, characterize, and evaluate the dietary patterns and diet quality of older adults in Lebanon, a middle-income country undergoing nutrition transition. METHODS: A cross-sectional population-based study was conducted on a nationally representative sample of community-dwelling older adults aged >50 years (n = 525). Socio-demographic, anthropometric, and lifestyle variables were collected through interviews, and dietary intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). Five commonly used diet quality indices (DQIs) were calculated, including the Alternative Healthy Eating Index (AHEI), the alternate Mediterranean diet score (aMed), the Dietary Approach to Stop Hypertension (DASH) style diet score, and the Lebanese Mediterranean Diet index. Dietary patterns (DPs) were derived using exploratory factor analysis. Associations of identified DPs with energy, energy-adjusted nutrients, and DQIs were evaluated by Pearson's correlations. Multiple linear regression analyses were used to examine correlates of DPs. RESULTS: Three DPs were derived: Lebanese, Western, and High Protein/Alcohol patterns. The Lebanese pattern had highest correlations with fiber, folate, vitamin C, and all five DQIs. The Western was positively associated with energy and sodium and was inversely correlated with fiber, most vitamins, and a number of DQIs, namely AHEI, aMED, and DASH-style diet score. Highest correlations with intakes of proteins and fat were observed for the High Protein/Alcohol pattern. The Lebanese pattern was associated with female gender, education, nonsmoking and physical activity, whereas the Western pattern was associated with adverse health behaviors, including smoking, skipping breakfast, and physical inactivity. CONCLUSIONS: Of the three identified patterns, the Lebanese DP was associated with better diet quality and healthier lifestyle behaviors while the Western pattern implicated a lower quality diet. Public health programs promoting prudent diets, including the Mediterranean and Lebanese DPs, are needed to improve the diet quality of middle-aged and older adults in an attempt to improve their functionality and quality of life.

Anemia among Syrian Refugee Children Aged 6 to 23 Months Living in Greater Beirut, Lebanon, including the Voices of Mothers' and Local Healthcare Staff: A Mixed-Methods Study.

Globally, the prevalence of anemia among children during the period of complementary feeding is high. A cross-sectional, mixed-methods study was conducted to examine the main determinants of anemia among Syrian refugee children aged 6 to 23 months (n = 215) and to illuminate the knowledge, attitudes and perceptions of their mothers and Lebanese healthcare staff on its causes and available treatment options. 42% of the children and 20% of their mothers were anemic. Determinants of child anemia were the mother having anemia or not knowing that fish/seafood is a source of iron; the child having been acutely ill the last two weeks or receiving cow's milk, but not consuming iron-rich infant formula, added fats/oils, or fruits in the previous 24 hours. Several Syrian mothers knew some causes of anemia and named dizziness as a leading symptom but did not mention flesh foods as a key source of heme iron. They reported financial constraints in accessing iron-rich foods and supplements. Lebanese doctors largely gave appropriate dietary advice and prescribed iron supplements as treatment. Multisectoral interventions are needed that combine medical and financial support with nutrition counseling for mothers to reduce the high burden of anemia among young children living in a multiple crises situation.

Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study.

The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.

Financial Wellbeing and Quality of Life Among a Sample of the Lebanese Population: The Mediating Effect of Food Insecurity.

Background: Lebanon is undergoing multiple overlapping crises, affecting the food security, financial well-being, and quality of life (QOL) of its residents. Objective: The primary objective was to assess the food insecurity (FI) status of a sample of the Lebanese population. The second objective was to explore factors related to QOL parameters and evaluate the mediating effect of food security between financial well-being and QOL. Methods: The study was cross-sectional and enrolled 412 participants recruited online using the snowball sampling technique. The survey included questions related to sociodemographic and economic characteristics of Lebanese households and validated scales to assess FI, QOL measures, financial well-being, and fear of COVID-19. Results: Almost 43% of the study participants reported being food insecure, with 31% experiencing mild FI, 10% moderate FI, and 1.5% severe FI. Compared to food-insecure participants, food secure participants had a significantly higher income (58.5% vs. 39.2%, p < 0.001), a university education level (96.6% vs. 88.1%, p = 0.002), an average perceived financial status (83.9% vs. 65.9%), higher financial well-being scores (5.14 vs. 3.19, p < 0.001), and lower crowding index (0.94 ± 0.4 vs. 1.09, p = 0.002). Multivariate analysis showed that FI was not associated with physical (Beta = -1.48, 95% CI: -3.10; 0.13) and mental (Beta = -1.46, 95% CI -3.68; 0.75) QOL, after adjusting for other demographic and socioeconomic correlates. This association remained non-significant when introducing the financial well-being variable to the model. Mediation analyses showed that the FI variable mediated the association between financial well-being and physical QOL (Beta = 0.19, 95% CI: 0.02; 0.36), but not the mental QOL (Beta = -0.02, 95% CI: -0.20; 0.14). Conclusion: Food insecurity was prevalent in our study sample, and it mediated the association between financial well-being and physical, but not mental, QOL parameters. These findings call for evidence-based policies and programs to help improve the food security and well-being of Lebanese households amidst these unprecedented circumstances.

Food insecurity and mental health of college students in Lebanon: a cross-sectional study.

The present study aimed to assess the prevalence of food insecurity (FI) among college students and explore its association with indicators of mental and psychosocial health. Data were collected using a cross-sectional online survey from college students in different universities in Lebanon during the Spring 2021 semester. FI was assessed using the validated eight-item food insecurity experience scale. The mental health of college students was assessed using validated screening tools for depression, anxiety and well-being, namely the Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder-7 (GAD-7) and the World Health Organization (WHO-5) index, respectively. Multiple linear regression models were conducted to assess the relationship of FI with PHQ-9, GAD-7 and WHO-5 scores. A total of 745 students completed the online survey. Approximately 39 % of students in the sample were experiencing FI of which 27·4, 8·1, and 3·5 % were experiencing mild, moderate and severe FI , respectively. Low maternal education, low household monthly income and high levels of stress were significant correlates of FI among college students (P-trend < 0·001). In addition, 22·6 and 34·4 % of students showed severe symptoms of depression and anxiety, respectively. Regression models showed that FI was associated with higher scores on PHQ-9 and GAD-7 (ß = 2·45; 95 % CI [1·41, 3·49]) and (ß = 1·4; 95 % CI [1·1, 2·2], respectively) and lower scores on WHO-5 (ß = -4·84; 95 % CI [-8·2, -1·5]). In conclusion, a remarkable proportion of college students reported experiencing different forms of FI, which was associated with poorer mental health and well-being outcomes. Public health programmes and interventions are needed to mitigate FI and improve student health-related outcomes.

Food Insecurity Pre- and Post the COVID-19 Pandemic and Economic Crisis in Lebanon: Prevalence and Projections.

The coronavirus (COVID-19) pandemic has had serious repercussions on the global economy, work force, and food systems. In Lebanon, the pandemic overlapped with an economic crisis, which threatened to exacerbate food insecurity (FI). The present study aims to evaluate the trends and projections of FI in Lebanon due to overlapping health and economic crises. Data from Gallup World Poll (GWP) 2015-2017 surveys conducted in Lebanon on nationally representative adults (n = 3000) were used to assess FI trends and explore its sociodemographic correlates. Predictive models were performed to forecast trends in FI (2018-2022), using GWP data along with income reduction scenarios to estimate the impact of the pandemic and economic crises. Pre crises, trend analyses showed that FI could reach 27% considering wave year and income. Post crises, FI was estimated to reach on average 36% to 39%, considering 50-70% income reduction scenarios among Lebanese population. FI projections are expected to be higher among females compared to males and among older adults compared to younger ones (p < 0.05). These alarming findings call for emergency food security policies and evidence-based programs to mitigate the burden of multiple crises on the FI of Lebanese households and promote resilience for future shocks.