An overview of the nutritional status of childbearing age women, children and adolescents living in a rural area of Madagascar: preliminary results of the Tany Vao project

OBJECTIVE

To describe the food consumption, nutrition knowledge and nutritional assessment of childbearing age women and their children, living in rural villages in Madagascar. The results presented are related to the Tany Vao research study.

DESIGN

A cross-sectional pilot study.

SETTING

The study was carried out in Ampanitosoha village on Nosy Mitsio island in Madagascar.

PARTICIPANTS

32 women (14-49 years) and 36 children and adolescents (2-17 years).

RESULTS

70 % of the women lacked nutrition knowledge and did not reach the Minimum Dietary Diversity Index for Women cut-off. The median BMI was 21·1 kg/m2 but 55·2 % of the women exceeded the cut-off for waist-to-hip ratio, 51·7 % for waist-to-height ratio and 81·2 % for mid-upper arm circumference (MUAC). Almost all had adequate intake of energy, protein and carbohydrates, while 27·6 % had excessive fat intake and 75·9 % of added sugars. Over half of the women did not meet the micronutrients Reference Daily Intake (RDI). For children, the MUAC z-score was lower for boys than for girls (P-value = 0·041).

CONCLUSIONS

These results underline the importance of increasing women's nutritional knowledge to promote healthy pregnancy and lactation. Moreover, it is fundamental to provide people living in rural areas with sustainable tools to improve dietary diversity and support long-term health.

The Association between Obesity and Reduced Weight-Adjusted Bone Mineral Content in Older Adults: A New Paradigm That Contrasts with the Obesity Paradox

The relationship between body weight and bone mass in the elderly remains unclear, and whether obesity is a protective factor is still a matter of debate. For this reason, the aim of this study is to assess the association between body mass index (BMI) and bone mineral content adjusted by body weight, expressed as a percentage (w-BMC%), and to test the validity of the obesity paradox in this context. A cohort of 1404 older adults was categorized according to the World Health Organization's BMI cut-off points and completed a total and segmental body composition measurement by means of a dual X-ray absorptiometry scan. Individuals with obesity displayed a lower mean w-BMC% (3.06 ± 0.44%; 2.60 ± 0.37%) compared to those who were normal-weight (3.95 ± 0.54%; 3.38 ± 0.48%) and overweight (3.06 ± 0.44%; 3.04 ± 0.37%) in both genders. Linear regression analysis also showed a negative association between BMI and w-BMC% in males (β = -0.09; p < 0.001) and females (β = -0.06; p < 0.001). Finally, among individuals with obesity, and after adjusting for age, the linear regression models revealed a significant decrease of 0.75% and 0.28% in w-BMC% for every one-unit increase in the trunk fat/appendicular lean mass ratio in both males (β = -0.749; p < 0.0001) and females (β = -0.281; p < 0.001). In conclusion, we suggest a new paradigm regarding the impact of obesity on bone mass, in which the former does not appear to be a protective factor of the latter, especially in individuals with central obesity and low muscle mass.

Association between Sarcopenia and Reduced Bone Mass: Is Osteosarcopenic Obesity a New Phenotype to Consider in Weight Management Settings?

Sarcopenic obesity (SO) is a frequent phenotype in people with obesity; however, it is unclear whether this links with an impaired bone status. In this study, we aimed to investigate the association between SO and low bone mass, and to assess the prevalence of a new entity that combines excessive fat deposition, reduced muscle mass and strength, and low bone mass defined as osteosarcopenic obesity (OSO). Body composition was completed by a DXA scan in 2604 participants with obesity that were categorized as with or without SO, and with low or normal bone mineral content (BMC). Participants with both SO and low BMC were defined as OSO. Among the entire sample, 901 (34.6%) participants met the criteria for SO. This group showed a reduced mean BMC (2.56 ± 0.46 vs. 2.85 ± 0.57, p < 0.01) and displayed a higher prevalence of individuals with low BMC with respect to those without SO (47.3% vs. 25.9%, p < 0.01). Logistic regression analysis showed that the presence of SO increases the odds of having low BMC by 92% [OR = 1.92; 95% CI: (1.60-2.31), p < 0.05] after adjusting for age, body weight, and body fat percentage. Finally, 426 (16.4%) out of the total sample were affected by OSO. Our findings revealed a strong association between SO and reduced bone mass in adults with obesity, and this introduces a new phenotype that combines body fat, muscle, and bone (i.e., OSO) and appears to affect 16% of this population.

Personalized Physical Activity Programs for the Management of Knee Osteoarthritis in Individuals with Obesity: A Patient-Centered Approach

Physical activity (PA) plays a vital role in knee osteoarthritis (KOA) management. However, engaging individuals with KOA in regular exercise is challenging, especially when they are affected by obesity. The aim of the current review is to elucidate how to increase adherence to exercise in this population. When implementing a PA program with patients with KOA and obesity, a specific multi-step approach can be adopted. In phase I (the baseline assessment), the patients' eligibility for exercise is ascertained and a physical fitness assessment, sarcopenic obesity screening and quantification of the pain experienced are undertaken. Phase II adopts a patient-centered approach in implementing a PA program that combines an active lifestyle (>6000 steps/day) with land- or water-based exercise programs performed over eight to twelve weeks, with a frequency of three to five sessions per week, each lasting 60 min. In phase III, several strategies can be used to increase the patients' adherence to higher levels of PA, including the following: (i) personalizing PA goal-setting and real-time monitoring; (ii) enhancing physical fitness and the management of sarcopenic obesity; (iii) building a sustainable environment and a supportive social network for an active lifestyle; and (iv) reducing pain, which can ameliorate the clinical severity of KOA and help with weight management in this population.

Personalized Nutritional Strategies to Reduce Knee Osteoarthritis Severity and Ameliorate Sarcopenic Obesity Indices: A Practical Guide in an Orthopedic Setting

Knee osteoarthritis (KOA) is one of the most common joint diseases, especially in individuals with obesity. Another condition within this population, and which presents frequently, is sarcopenic obesity (SO), defined as an increase in body fat and a decrease in muscle mass and strength. The current paper aims to describe recent nutritional strategies which can generally improve KOA clinical severity and, at the same time, ameliorate SO indices. Searches were carried out in the PubMed and Science Direct databases and data were summarized using a narrative approach. Certain key findings have been revealed. Firstly, the screening and identification of SO in patients with KOA is important, and to this end, simple physical performance tests and anthropometric measures are available in the literature. Secondly, adherence to a Mediterranean diet and the achievement of significant body weight loss by means of low-calorie diets (LCDs) remain the cornerstone nutritional treatment in this population. Thirdly, supplementation with certain micronutrients such as vitamin D, essential and non-essential amino acids, as well as whey protein, also appear to be beneficial. In conclusion, in the current review, we presented a detailed flowchart of three different nutritional tracks that can be adopted to improve both KOA and SO based on joint disease clinical severity.

Knowledge, attitudes, and practices of pediatricians in relation to breastfeeding support: A national survey in Lebanon

BACKGROUND

Rates of breastfeeding (BF) remain suboptimal despite overwhelming evidence for its benefits to the mother and child. Pediatricians play an important role in supporting breastfeeding (BF). In Lebanon, the rates of both exclusive and continued BF are critically low. The objective of this study is to examine the knowledge, attitudes and practices (KAP) of Lebanese pediatricians in relation to supporting BF.

METHODS

A national survey of Lebanese pediatricians was conducted through Lime Survey (n = 100, response rate 9.5%). The list of pediatricians' emails was obtained from the Lebanese Order of Physicians (LOP). Participants completed a questionnaire covering, in addition to sociodemographic characteristics, the KAP, related to supporting BF. Descriptive statistics and logistic regressions were used in data analysis.

RESULTS

The most prevalent gaps in knowledge were related to the positioning of the baby during BF (71.9%) and the association between the mother's fluid intake and her milk production (67.4%). With regards to attitudes, 34% of participants reported unfavorable attitudes towards BF in public and BF while working (25%). As for practices, more than 40% of pediatricians kept formula samples and 21% had formula-related advertising in their clinics. Half of the pediatricians reported rarely/never referring mothers to lactation consultants. After adjustment, both being a female pediatrician and having done the residency in Lebanon were significant predictors of better knowledge (OR = 4.51 (95%CI: 1.72-11.85) and OR = 3.93 (95%CI: 1.38,11.19) respectively.

CONCLUSION

This study revealed important gaps in the KAP related to BF support among Lebanese pediatricians. Coordinated efforts ought to be exerted to educate and equip pediatricians with needed knowledge and skills to support BF.

The Risk of Sarcopenia among Adults with Normal-Weight Obesity in a Nutritional Management Setting

Normal-weight obesity (NWO) is a phenotype characterized by excessive body fat (BF) despite normal body weight. We aimed to assess the association between NWO and the risk of sarcopenia. Two groups of patients with a normal body mass index [BMI (20-24.9 kg/m²)] were selected from a large cohort of participants. Body composition was measured using dual-energy X-ray absorptiometry (DXA), and 748 participants were categorized as NWO or normal-weight without obesity (NWNO) and were classed according to whether or not they were at risk of sarcopenia. The "NWO group" included 374 participants (cases), compared to 374 participants (controls) in the "NWNO group", all of a similar BMI, age and gender. The participants in the "NWO group" displayed a higher prevalence of the risk of sarcopenia than the control group across both genders (0.6% vs. 14.1% in males; 1.4% vs. 36.5% in females). Regression analysis showed that being in the NWO category increased the risk of sarcopenia 22-fold in males (RR = 22.27; 95%CI: 3.35-147.98) and 25-fold in females (RR = 25.22; 95%CI: 8.12-78.36), compared to those in the NWNO category. In a "real-world" nutritional setting, the assessment of body composition to identify NWO syndrome is vital since it is also associated with a higher risk of sarcopenia.

New BMI Cut-Off Points for Obesity in Middle-Aged and Older Adults in Clinical Nutrition Settings in Italy: A Cross-Sectional Study

Obesity is a major health problem defined as an excess accumulation of body fat (BF). The World Health Organization (WHO) usually relies on a body mass index (BMI) ≥ 30 kg/m2 as an indicator of obesity. Due to changes in body composition that occur across the lifespan, with an increase in BF and a decrease in lean mass, we aimed to test the validity of this BMI cut-off point for adiposity in middle-aged and older adults. This cross-sectional study, composed of 4800 adults of mixed gender aged between 40 and 80 years, included (according to the WHO BMI classification) 1087 normal-weight, 1826 overweight, and 1887 obese individuals who were referred to the Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy. The sample was then categorized by adiposity status based on the total BF% as measured by dual-energy X-ray absorptiometry (DXA), and the best sensitivity and specificity were attained for predicting obesity according to the receiver operating characteristic curve (ROC) analysis. In a real-world clinical setting, a new BMI cut-off point (BMI = 27.27 kg/m2) has been identified for predicting obesity in middle-aged and older adults. Obesity guidelines in Italy therefore need to be revised accordingly.

Approaching Sarcopenic Obesity in Young and Middle-Aged Female Adults in Weight Management Settings: A Narrative Review

This paper presents a review of the available literature on sarcopenic obesity (SO) in young and middle-aged female adults with obesity in weight management settings. A literature review using the PubMed/Medline and Science Direct databases was conducted, and the data were summarized through a narrative approach. Firstly, some physical performance tests and questionnaires are available for screening young and middle-aged female adults with a high risk of SO. Secondly, these patients can undergo instrumental measurements such as dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) to confirm or reject a diagnosis of SO, applying definitions that account for body mass. Thirdly, SO is a prevalent phenotype in females seeking weight management treatment, as well as being strongly associated (vs. non-SO) with obesity-related comorbidities that need to be promptly managed, initially with nutritional programs or/and in combination with medications. Finally, patients with SO have a reduced baseline resting energy expenditure and more sedentary behaviors, which seem to account for the relationship between SO and poorer weight management outcomes, such as a higher early dropout rate and major later difficulties in weight loss maintenance. Therefore, specific strategies for personalized weight management programs for patients with SO should be incorporated to determine a successful management of this phenotype.

Can Intentional Weight Loss Ameliorate Sarcopenia in Individuals with Obesity? A Longitudinal Interventional Study

Little remains known regarding the impact of weight loss on sarcopenic obesity (SO), and for this reason we aimed to assess the relationship between the two during a weight management program. Body composition was measured at baseline and six-month follow-up using the Tanita BC-418, and step measurements were obtained daily over a period of six months using an Omron HJ-320 pedometer, in 41 adults of both genders with obesity. The participants were then categorized according to the presence or absence of SO. After a significant weight loss, an improvement in the appendicular skeletal mass (ASM) to weight ratio (24.5 ± 3.5 vs. 26.2 ± 3.6, p < 0.01), indicated a decrease in the prevalence of SO by 12.2%. Moreover, these findings were confirmed by logistic regression analysis revealing a significant WL% ≥ 5% combined with an active lifestyle (i.e., ≥8000 steps/day), decreased the risk of SO by 91% (OR = 0.09; 95% CI: 0.02–0.56), after adjusting for age and gender. In conclusion, in a weight management setting, a personalized program for individuals with SO that incorporates new strategies in terms of weight loss and physical activity targets may be adopted to improve the sarcopenia-related index and reduce the prevalence of SO in this population.

Relationship between multiple weight cycles and early weight loss in patients with obesity: a longitudinal study

PURPOSE

To assess the relationship between multiple weight cycling (WC) and early weight loss (e-WL).

METHODS

Using a longitudinal prospective design conducted between May 2017 and November 2019, early weight loss was assessed at month 2 of a weight management programme in 100 adult participants with overweight or obesity, at the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Weight cycling was defined as intentional weight loss of ≥ 3 kg followed by involuntary weight regain of ≥ 3 kg and participants were then categorized as multiple WC if they had experienced ≥ 2 cycles.

RESULTS

Of the 100 participants with a median age of 34.90 (22.94-50.67) years and a median BMI of 35.25 (32.75-39.48) kg/m², 75 met the criteria for WC and displayed a lower e-WL percentage than those without WC (4.69 ± 2.78% vs. 6.58 ± 2.80%; p = 0.006). Linear regression analysis showed that e-WL was lower by ≈ 2% (β = - 1.935; 95% CL - 3.221, - 0.648; p = 0.004) in the WC group compared to the non-WC group after adjusting for age, gender and baseline BMI.

CONCLUSION

In a 'real-world' clinical setting, multiple WC decreases e-WL rates. New strategies could be adopted for these patients to improve this early clinical outcome, since e-WL predicts longer-term success.

LEVEL OF EVIDENCE

III, prospective longitudinal study.

Dietary Patterns and Their Associations With the FTO and FGF21 Gene Variants Among Emirati Adults

Purpose: To examine the dietary patterns and their associations with the FTO and FGF21 gene variants among Emirati adults. Methods: Using a cross-sectional design, healthy adult male and female Emiratis (n = 194) were recruited from primary health care centers in Sharjah, UAE. Participants completed a 61-item semi-quantitative food frequency questionnaire. In addition, a saliva sample was obtained for the genetic analysis. Genotyping was performed for FTOrs9939609(A>T), FTOrs9930506(A>G), FGF21 rs838133 (A > G), and FGF21 rs838145 (A > G). Dietary patterns were derived using the principal component analysis. Logistic regression analyses were used to examine the association of dietary patterns with genetic variants. Results: Three dietary patterns were identified: "Western": consisting of fast food, sweets, and processed meat; "Traditional Emirati" rich in vegetables, traditional Emirati-mixed-dishes and whole dairy; while whole grains, low-fat dairy, and bulgur were components of the "Prudent" pattern. Subjects carrying the A allele of the FTO rs9939609 were 2.41 times more likely to adhere to the Western pattern compared to subjects with genotype TT (OR:2.41; 95%CI:1.05-5.50). Compared with subjects with A/A, those carrying the G allele of the FTO rs9930506 were more likely to follow a Western diet (OR: 2.19; 95%CI: 1.00-4.97). Participants carrying the risk allele (A) of the FGF21 rs838133 were twice more likely to adhere to the Traditional pattern as compared to subjects with genotype GG (OR: 1.9, 95%CI: 1.01-3.57). Conclusions: The findings of this study suggested associations among specific FTO and FGF21 gene variants with dietary patterns among Emirati adults. These findings could be used to inform evidence-based targeted nutrition preventive recommendations, especially those aiming to limit intake of western type foods.

Nutrition Literacy among Adolescents and Its Association with Eating Habits and BMI in Tripoli, Lebanon

(1) Background: Adolescence is a period of increased autonomy and independent decision making; it determines health behaviors that can persist into the future. Individual factors like food choices and unhealthy lifestyle have an essential role in the development and prevention of obesity among adolescents and are associated with the nutrition literacy of parents and other adults. While the association of parents' nutrition literacy with adolescent BMI has been addressed, there is still a scarcity of studies that examine the effect of adolescents' nutrition literacy on their eating habits and body mass index (BMI) status. (2) Methods: A cross-sectional study was conducted that included 189 adolescents (68 with overweight and obesity and 121 with normal weight) aged between 14-19 years from four private schools in Tripoli, Lebanon. A self-administered questionnaire that included the Nutrition Literacy Assessment Instrument (NLAI) and the Adolescent Food Habits Checklist (AFHC) was used. Anthropometrics were measured using standardized procedures. The association between nutrition literacy, food habits and BMI was assessed using a chi squared test for independence and Poisson regression analysis where suitable. (3) Results: Results indicated no association between all five components of nutrition literacy and body mass index categories. Furthermore, there was no association between the Adolescent Food Habits Checklist and overweight or obese BMI status (RR = 0.947, 95%CI: 0.629-1.426) (p = 0.796). No association was observed between nutrition literacy and food habits, except for an inverse association with macronutrients literacy. (4) Conclusions: In conclusion, the study indicated that there was no association between the components of nutrition literacy with body mass index or with food habits, except for macronutrient literacy.

Association between dietary practice, body composition, training volume and sport performance in 100-Km elite ultramarathon runners

BACKGROUND & AIM

Sport performance during competitions is a central goal for athletes, and several factors have been identified that appear to have an association with better performance in different sport disciplines. However, the data are still not conclusive in ultramarathon runners. Accordingly, this study aimed to assess the potential associations between anthropometric, body composition, dietary and training factors and athletic performance in 100-Km elite ultramarathon runners.

METHODS

Body mass index (BMI), body composition, training volume, Mediterranean dietary adequacy score (MDAS) and "100-Km race competition record" were assessed in 10 elite ultramarathon runners from the Italian Ultramarathon and Trail Association (IUTA) of the Italian national team.

RESULTS

The study sample had a mean age of 41.1 ± 7.59 years and BMI of 21.66 ± 1.11 kg/m². Female athletes had a lower appendicular skeletal muscle index (ASMI) and 100-Km race competition record, and a higher trunk fat percentage and MDAS compared to males. Correlation analysis revealed a significant association between the 100-Km race competition record and age, gender, ASMI, training volume, total body and trunk fat percentages. However, after correcting for confounders, partial correlation analysis confirmed only the association between training volume and 100-Km race competition record (ρ = -0.891, p = 0.009).

CONCLUSION

Our findings provide evidence that a higher training volume expressed as Kilometers per week is an independent variable associated with better performance in 100-Km race competitions in elite ultramarathon runners. Future studies are needed to assess the usefulness of programs based on the increase of training volume as a strategy to improve athletic performance in 100-Km races in this specific population.

Strength and Performance Tests for Screening Reduced Muscle Mass in Elderly Lebanese Males with Obesity in Community Dwellings

The reduction in skeletal muscle mass (SMM) is a common phenomenon in older adults. It is associated with several diseases, a reduction in physical fitness, longer periods of hospitalization and high rates of mortality. We aimed to identify the reliability of simple tools for screening for reduced SMM among older adult males in Lebanon. The Tanita MC-780MA bioimpedance analyzer (BIA) was used to assess body composition in a population of 102 community-dwelling elderly males with overweight or obesity, in order to be then categorized as with or without reduced SMM. Participants also performed the handgrip strength test and the 4 m gait speed test. Of the total sample of 102 participants (mean age 67.4 ± 6.96 years; BMI 30.8 6 ± 4.04 kg/m²), 32 (31.4%) met the criteria for reduced SMM. Partial correlation analysis showed that handgrip strength (ρ = 0.308, p = 0.002) and 4 m gait speed (ρ = 0.284, p = 0.004) were both associated with low SMM. Receiver operating characteristic (ROC) curve analysis identified discriminating cut-off points of 1.1 m/s for the 4 m gait speed test and 32.0 kg for the handgrip strength test. Our study showed that participants displayed a substantial prevalence of reduced SMM. Reduced 4 m gait speed and handgrip strength were associated with low SMM. Clear cut-off points for strength and functional tests for screening for this condition in Lebanese older men were identified.

Body Composition in Adolescents and Young Adults with Anorexia Nervosa: A Clinical Review

BACKGROUND

Anorexia nervosa is a serious health condition characterized by a significant low body weight and alteration in body composition components.

AIM

In the current paper, we aim to summarize the available literature concerning changes in body fat, lean, and bone masses, during anorexia nervosa and after complete weight restoration.

METHODS

Data were summarized using a narrative approach based on clinical expertise in the interpretation of the available evidence base in the literature.

RESULTS

The available data revealed three main findings. Firstly, anorexia nervosa causes a significant reduction in body fat mass, however it is completely restored after short-term weight normalization but with a central adiposity phenotype that does not seem to negatively influence treatment outcomes and appears to normalize after 1 year of normal weight maintenance. Secondly, anorexia nervosa causes a significant reduction in bone mineral density, but weight restoration is associated first (≈12 months) with stabilization of bone mineral density, followed by improvements (after ≈16 months); and finally, with complete normalization (after ≈30 months) after normal-weight maintenance. Thirdly, during anorexia nervosa loss of lean and skeletal body mass occurring in particular from the extremities rather than the central regions has been consistently reported, especially in patients with a Body Mass Index (BMI) ≤ 16.5 Kg/m2 however short-term weight restoration is associated with complete normalization.

CONCLUSION

Anorexia nervosa adversely affects body composition, however this medical complication seems to be reversible through the main treatment strategy of body weight restoration followed by normal weight maintenance, and this should be openly discussed with patients.

Cross-validation of prediction equations for estimating the body fat percentage in adults with obesity

BACKGROUND & AIM

An accurate estimation of the body fat percentage (BF%) in patients with obesity is of clinical importance. Therefore, we aim to assess the validity of anthropometric-based BF predictive equations in treatment-seeking patients in an outpatient setting.

METHODS

BF% was assessed by Tanita MC-780MA bioimpedance (BIA) and considered as a reference method, and anthropometric-based predictive equations were used in BF% estimations among 275 adults of both genders, in the outpatient clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). The mean differences between the measured and estimated BF% values were calculated to assess the accuracy of five equations, and the Bland-Altman method was used to assess the level of agreement.

RESULTS

In both males and females, all predictive equations gave significantly different estimates of BF% when compared to those measured by BIA. On the other hand, in both genders, the mean difference between the BF% value estimated by the Jackson equation and that measured using BIA, was not significant, and agreement was confirmed using Bland-Altman plots.

CONCLUSION

We suggest the Jackson equation for accurate BF% estimation in both genders of patients with obesity in the Lebanese population. However, future studies are still urgently needed to develop and validate new predictive equations suitable for BF% estimations, taking into account ethnicity (i.e., the Arab population).

Development of an Easy-to-Use Prediction Equation for Body Fat Percentage Based on BMI in Overweight and Obese Lebanese Adults

An accurate estimation of body fat percentage (BF%) in patients who are overweight or obese is of clinical importance. In this study, we aimed to develop an easy-to-use BF% predictive equation based on body mass index (BMI) suitable for individuals in this population. A simplified prediction equation was developed and evaluated for validity using anthropometric measurements from 375 adults of both genders who were overweight or obese. Measurements were taken in the outpatient clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). A total of 238 participants were used for model building (training sample) and another 137 participants were used for evaluating validity (validation sample). The final predicted model included BMI and sex, with non-significant prediction bias in BF% of −0.017 ± 3.86% (p = 0.946, Cohen’s d = 0.004). Moreover, a Pearson’s correlation between measured and predicted BF% was strongly significant (r = 0.84, p < 0.05). We are presenting a model that accurately predicted BF% in 61% of the validation sample with an absolute percent error less than 10% and non-significant prediction bias (−0.028 ± 4.67%). We suggest the following equations: BF% _females = 0.624 × BMI + 21.835 and BF% _males = 1.050 × BMI − 4.001 for accurate BF% estimation in patients who are overweight or obese in a clinical setting in Lebanon.

Association Between Sarcopenic Obesity and Metabolic Syndrome in Adults: A Systematic Review and Meta-Analysis

Background

In the last two decades, a new phenotype termed Sarcopenic Obesity (SO), in which sarcopenia and obesity coexist, has emerged.

Objective

The aim of this systematic review and meta-analysis was first to assess the prevalence of Metabolic syndrome (Mets) among individuals with and without SO, and second, to determine if SO may increase the relative risk of Mets.

Methods

This study was conducted in adherence to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and the data were collated by means of meta-analysis and narrative synthesis.

Results

Twelve studies including a total of 11,308 adults with overweight or obesity of both genders met the inclusion criteria and were reviewed, revealing two main findings. First, a similar overall prevalence of Mets in individuals with SO (61.49%; 95% CI: 52.19-70.40) when compared to those without SO (56.74%; 95% CI: 47.32-65.93) was identified. Second, the presence of SO appears not to increase the risk of Mets with respect to those without SO (RR = 1.08, 95% CI: 0.99-1.17, p = 0.07).

Conclusion

No higher prevalence of Mets among individuals with SO when compared to those with obesity only, nor a significant association between SO and a higher risk of Mets was found.

Revising BMI Cut-Off Points for Obesity in a Weight Management Setting in Lebanon

Obesity is defined by the World Health Organization (WHO) as a body mass index (BMI) ≥ 30 Kg/m2. This study aimed to test the validity of this BMI cut-off point for adiposity in a weight management clinical setting in Lebanon. This cross-sectional study of 442 adults of mixed gender, categorized by the WHO BMI classification, included: 66 individuals of normal weight, 110 who were overweight and 266 with obesity. The clinical sample was referred to the Outpatient Clinic in the Department of Nutrition and Dietetics at Beirut Arab University (BAU) in Lebanon. All participants underwent anthropometric evaluation. The gold standard for defining obesity was based on the National Institutes of Health (NIH)/WHO guidelines for total body fat percentage (BF%). The best sensitivity and specificity were attained to predict obesity, according to the receiver operating characteristic curve (ROC) analysis. The BMI cut-off point for predicting obesity in the clinical sample was nearly 31.5 Kg/m2, and more than 90% of individuals with obesity and cardiometabolic disease were above this cut-off point. In conclusion, this new BMI cut-off point, an obesity definition higher than suggested in Western populations, was demonstrated to have clinical usefulness. Obesity guidelines in Lebanon, therefore, need revising.

Dietary patterns and their associations with gestational weight gain in the United Arab Emirates: results from the MISC cohort

Background

Suboptimum weight gain during pregnancy may carry long term health consequences for the infant or mother. Nutritional imbalances are well recognized as a determinant of gestational weight gain. Few studies examined the effect of dietary patterns on gestational weight gain, especially in countries undergoing nutrition transition, such as the United Arab Emirates.

Objectives

To characterize dietary patterns among pregnant women living in the UAE and examine their associations with gestational weight gain and gestational weight rate.

Methodology

Data were drawn from the Mother-Infant Study Cohort, a two-year prospective cohort study of pregnant women living in the United Arab Emirates, recruited during their third trimester (n = 242). Weight gain during pregnancy was calculated using data from medical records. The Institute of Medicine’s recommendations were used to categorize gestational weight gain and gestational weight gain rate into insufficient, adequate, and excessive. During face-to-face interviews, dietary intake was assessed using an 89-item culture-specific semi-quantitative food frequency questionnaire that referred to usual intake during pregnancy. Dietary patterns were derived by principal component analysis. Multiple logistic regression analyses were used to evaluate the associations of derived dietary patterns with gestational weight gain/gestational weight gain rate.

Results

Two dietary patterns were derived, a “Diverse” and a “Western” pattern. The “Diverse” pattern was characterized by higher intake of fruits, vegetables, mixed dishes while the “Western” pattern consisted of sweets and fast food. The “Western” pattern was associated with excessive gestational weight gain (OR:4.04,95% CI:1.07–15.24) and gestational weight gain rate (OR: 4.38, 95% CI:1.28–15.03) while the “Diverse” pattern decreased the risk of inadequate gestational weight gain (OR:0.24, 95% CI:0.06–0.97) and gestational weight gain rate (OR:0.28, 95% CI:0.09–0.90).

Conclusion

The findings of this study showed that adherence to a “Diverse” pattern reduced the risk of insufficient gestational weight gain/gestational weight gain rate, while higher consumption of the “Western” pattern increased the risk of excessive gestational weight gain/gestational weight gain rate. In view of the established consequences of gestational weight gain on the health of the mother and child, there is a critical need for health policies and interventions to promote a healthy lifestyle eating through a life course approach.

Sarcopenic Obesity Predicts Early Attrition in Treatment-Seeking Patients with Obesity: A Longitudinal Pilot Study

Attrition is a major cause of failure in obesity treatment, which is still not fully understood. The identification of factors related to this outcome is of clinical relevance. We aimed to assess the relationship between sarcopenic obesity (SO) and early attrition. Early attrition was assessed at six months, and two groups of patients were selected from a large cohort of participants with overweight or obesity enrolled at the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Body composition was measured using a bioimpedance analyser (Tanita BC-418) and participants at baseline were categorized as having or not having SO. The “dropout group” included 72 participants (cases) compared to 31 participants (controls) in the “completer group”, with the former displaying a higher prevalence of SO than the latter (51.0% vs. 25.8%; p = 0.016). In the same direction, Poisson regression analysis showed that SO increased the relative risk of dropout by nearly 150% (RR = 1.45; 95% CI = 1.10–1.89; p = 0.007) after adjustment for age, gender, body mass index (BMI), age at first dieting, sedentary habits and weight-loss expectation. In conclusion, in a “real-world” outpatient clinical setting, the presence of SO at baseline increases the risk of dropout at six months. New directions of future research should be focused on identifying new strategies to reduce the attrition rate in this population.

Lifestyle Modification in Rheumatoid Arthritis: Dietary and Physical Activity Recommendations Based on Evidence

BACKGROUND

Rheumatoid arthritis is a systemic autoimmune disease, considered the most common inflammatory articular disease among the general population. However, not only the joints are affected; rheumatoid arthritis also has an extra-articular manifestation. As for many other chronic diseases, rheumatoid arthritis may be exacerbated by poorer lifestyle choices. In fact, recent studies emphasize the role of nutrition and physical activity in this disease.

AIM

In the current paper, we aim to describe lifestyle modifications based on diet and physical activity and other recommendations that seem to improve the clinical management and the disease outcome of Rheumatoid arthritis.

RESULTS

A three-component lifestyle modification programme has been considered based on: (i) A low-fat low-sodium Mediterranean diet rich in fruits, vegetables, whole grains and nuts and poor in sugar-sweetened beverages, red and processed meat and trans fats, and the supplementation with omega-3 fatty acids, non-essential amino acids and probiotics, (ii) An appropriate physical activity programme based on an active daily lifestyle, aerobic exercise and resistance training and (iii) Adequate sleep hygiene and smoking reduction/cessation, that seems to have positive effects in terms of disease progression and related outcomes.

CONCLUSION

Lifestyle modification programme should be considered as the basis of any treatment, (i.e., pharmacological treatment), in patients with rheumatoid arthritis.

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 (β = - 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.

The Impact of Sarcopenic Obesity on Health-Related Quality of Life of Treatment-Seeking Patients with Obesity

BACKGROUND

There is a paucity of studies on health-related quality of life (HRQoL) and sarcopenic obesity (SO).

OBJECTIVE

This study aimed to assess the potential association between SO and impaired HRQoL.

METHODS

The ORWELL 97 questionnaire was used to assess HRQoL and body composition was measured using a bioimpedance analyser (Tanita BC-418) in 130 patients with obesity, referred to the Nutritional and Weight Management outpatient clinic of Beirut Arab University in Lebanon. Participants were then categorized on the basis of the absence or presence of SO.

RESULTS

Sixty-four of the 130 participants met the criteria for SO (49.2%) and displayed significantly higher total ORWELL 97 scores than those in the group without SO (64.00 vs. 41.00, p=0.001), indicative of poorer HRQoL. Linear regression analysis showed that SO was associated with an increase in ORWELL 97 scores by nearly 24 units (β=24.35, 95% CI=11.45-37.26; p<0.0001). Moreover, the logistic regression analysis showed that SO increased the odds of clinically significant impairment of HRQoL (ORWELL 97 score ≥74.25) by nearly seven-fold (OR=7.37, 95% CI=1.92-28.39; p=0.004).

CONCLUSION

Our findings show that the presence of SO was associated with increased impairment of HRQoL that reaches clinical significance when compared to obesity only. Future studies are needed to clarify whether this may influence clinical outcomes. If this is shown to be the case, weight management programs should incorporate additional strategies to improve HRQoL in individuals with SO.

Reduction of Resting Energy Expenditure and Sarcopenic Obesity in Adults with Overweight and Obesity: A Brief Report

BACKGROUND AND AIM

The last decade has seen the emergence of a new condition, describing the coexistence of obesity and sarcopenia, termed Sarcopenic Obesity (SO). The aim of this study was to assess the potential association between SO and reduced Resting Energy Expenditure (REE).

METHODS

Body composition and REE were measured using a bioimpedance analyser (Tanita BC-418) and Indirect Calorimeter (Vmax Encore 229), respectively in 89 adults with overweight or obesity of both genders, referred to the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Participants were then categorized on the basis of having SO or not.

RESULTS

Thirty-nine of the 89 participants met the criteria for SO (43.8%), and these participants displayed a significantly lower REE per unit body weight than those in the group without SO (19.02 ± 2.26 vs. 20.87 ± 2.77; p = 0.001). Linear regression analysis showed that the presence of SO decreases REE by 1.557 kcal/day for each kg of body weight (β = -1.557; CI = -0.261 - (-0.503); p = 0.004), after adjusting for age and gender.

CONCLUSION

SO appears to be present in a high proportion of treatment-seeking adults with overweight or obesity of both genders, and it seems to be associated with a reduced REE, compared with those without SO. Future studies are needed to clarify whether this may influence clinical outcomes.

Association Between Reduced Daily Steps and Sarcopenic Obesity in Treatment-Seeking Adults With Obesity

Objectives: Understanding the condition that describes the coexistence of obesity and sarcopenia, termed sarcopenic obesity (SO), is becoming a scientific and clinical priority. In this study, we aimed to assess the prevalence of SO in treatment-seeking adults with obesity and investigate any potential association between SO and a sedentary lifestyle, expressed in terms of daily steps. Methods: In this cross-sectional, prospective observational study, body composition and daily steps measurements were obtained using a segmental body composition analyser (Tanita BC-418) and an Omron HJ-320 pedometer, respectively, in 111 adults of both genders with obesity (body mass index; BMI ≥ 30 kg/m²), referred to the Outpatient Clinic in the Department of Nutrition and Dietetics at Beirut Arab University (BAU) in Lebanon. The participants were then categorized according to the presence of absence of SO, defined as an appendicular lean mass divided by body weight (ALM/weight) × 100%) of less than 23.40 and 29.60 in females and males, respectively. Results: Fifty-five of the 111 participants with obesity, with a mean age of 39.62 ± 16.55 years and a mean BMI of 38.05 ± 5.33 kg/m² met the criteria for SO and displayed a significantly higher prevalence of inactivity (<5,000 daily steps), i.e., nearly double (54.5% vs. 32.1%; p = 0.017) and they had a lower mean number of daily steps than those in the group without SO (5,279 ± 2,641 vs. 6,732 ± 2,989; p = 0.008). Linear regression analysis showed that SO is associated with a lower number of daily steps by 1,421 (β = -1421.4; -2508.9, -333.9; p = 0.011) after adjusting for age, gender employment and the presence of cardiometabolic disease. Conclusion: Sarcopenic obesity affects nearly 50% of treatment-seeking adults with obesity. Moreover, it seems to be associated with a lower number of daily steps and a sedentary lifestyle. Future studies are needed to clarify whether this may influence clinical outcomes. If this is shown to be the case, weight management programmes should incorporate additional physical activity strategies in this population.

Predictive Equations Based on Body Composition for Resting Energy Expenditure Estimation in Adults with Obesity

BACKGROUND AND AIM

An accurate estimation of Resting Energy Expenditure (REE) in patients with obesity is crucial. Therefore, our aim was to assess the validity of REE predictive equations based on body composition variables in treatment-seeking Arab adults with obesity.

METHODS

Body composition and REE were measured by Tanita BC-418 bioimpedance and Vmax Encore 229 IC, respectively, and predictive equations based on fat mass and fat-free mass were used in REE estimations among 87 adults of both genders, in the Outpatient Clinic in the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). The mean differences between the measured and estimated REE values were calculated to assess the accuracy, and the Bland-Altman method was used to assess the level of agreement.

RESULTS

Ten predictive equations were included. In males, all the predictive equations gave significantly different estimates of REE when compared to that measured by IC. On the other hand, in females, the mean difference between the REE value estimated by Huang and Horie-Waitzberg equations and that measured using IC was not significant, and the agreement was confirmed using Bland-Altman plots.

CONCLUSION

Huang and Horie-Waitzberg equations are suggested for accurate REE estimation in females; however, new validated REE estimation equations for males in this population are still needed.

Understanding Sarcopenic Obesity in Terms of Definition and Health Consequences: A Clinical Review

BACKGROUND AND AIM

Research interests in a new phenotype termed as sarcopenic obesity (SO), which refers to a decrease in lean body mass and muscle strength associated with an increase in body fat deposition, have grown. However, neither SO definition nor its impact on health outcomes is clear. In the current paper, we aim to summarize the available literature on the dilemma surrounding the definition of SO, and the potential health consequences of this phenomenon on individuals with overweight and obesity.

METHODS

A literature review using the PubMed/Medline database was conducted and data were summarized by applying a narrative approach, based on clinical expertise in the interpretation of the available evidence base in the literature.

RESULTS

Some definitions that account for body mass (i.e., body weight, body mass index) seem to be more suitable for screening of SO and revealed as clinically useful. The association between SO and certain health outcomes has also been investigated, especially those related to obesity; however, little is known about the association of SO with psychosocial distress and health-related quality of life impairment, as well as harsh outcomes such as mortality.

CONCLUSION

International consensus regarding SO definition is needed, which would allow for a better understanding of its prevalence. Moreover, future investigations should be conducted in order to determine whether SO has an adverse effect (i.e., cause-effect relationship, in addition to association) on health. Once these issues are achieved, confirmed and clarified, evidenced-based protocols of treatment may become necessary to address the increase in the prevalence of obesity and sarcopenia worldwide.

Association Between Smoking Hookahs (Shishas) and Higher Risk of Obesity: A Systematic Review of Population-Based Studies

The American Heart Association has published a scientific statement on the effect of hookah smoking on health outcomes; nevertheless, hookah smoking continues to be popular worldwide, especially among the young. Recent reports mention a potential link between hookah smoking and obesity; however, uncertainties still surround this issue. The aim of the current study was to conduct a systematic review to clarify whether hookah smoking is associated with a higher risk of obesity among the general population. This study was conducted in compliance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and data were collated by means of a meta-analysis and a narrative synthesis. Of the 818 articles retrieved, five large-population and low-bias studies comprising a total of 16,779 participants met the inclusion criteria and were reviewed. All included studies reported that, regardless of gender, hookah smoking increases the risk of obesity among all ages and observed an association between the two after a correction for several confounders or reported a higher prevalence of obesity among hookah smokers. This was confirmed by the meta-analysis. Therefore, hookah smoking seems to be associated with a higher risk of obesity. Public health policymakers should be aware of this for the better management of obesity and weight-related comorbidities.

A Lebanese Mediterranean Dietary Pattern Is Associated with Lower Food Insecurity Among Lebanese Adolescents: A Cross-Sectional National Study (P04-055-19)

Objectives

To derive dietary patterns (DPs) of Lebanese adolescents (10–18 years) and evaluate associations between identified DPs and household food insecurity (HFI).

Methods

Data was drawn from a national survey on a representative sample of Lebanese households (n = 1204, 2015). HFI was assessed using a locally-validated, Arabic-translated version of the Household Food Insecurity Access Scale. Dietary intake was assessed using a 187-item locally-validated food frequency questionnaire. Principal component factor analysis was used to derive the DPs. Partial correlations were conducted to investigate the associations between DPs and macro- and micron-nutrient intakes (energy-adjusted). Multiple linear regression models were applied to examine the association between HFI scores and derived DPs.

Results

Two DPs were derived from the study population: Western and Lebanese-Mediterranean (LM). The Western DP was characterized by higher consumption of sweetened beverages, fast foods, sweets, salty snacks and refined grains; whereas the Lebanese DP was characterized by higher intakes of fruits, vegetables, dairy products, and whole grains. The Western DP was positively associated with alcohol (r = 0.3) and negatively associated with fiber (−0.35), calcium (−0.31), iron (−0.17), vitamins A (−0.31) and D (−0.15); P < 0.05. LM pattern was positively and highly correlated with fiber, proteins, iron, Vitamin A (r ≥ 0.30); moderately correlated with carbohydrates, calcium and Vitamin D (r < 0.3); and negatively correlated with total fat, saturated and polyunsaturated fats (r ≥ −0.26, P < 0.05). After adjustment for socio-demographics, Multiple linear regression analysis showed that the higher HFI score was associated with lower adherence to LM DP among adolescents (β = −0.026, P = 0.012, 95% CI −0.046, −0.006). No significant association was observed between HFI and the Western DP.

Conclusions

In conclusion, adolescents in food insecure households are less likely to consume the LM DP; the latter being associated with better nutrients’ intake vs. Western DP. Findings of this study can guide the development of preventive strategies emphasizing the adoption of a LM pattern among food insecure households and youth to promote better dietary quality and prevent risk of chronic diseases.

Funding Sources

Lebanese National Council for Scientific Research.

Metabolically Healthy Overweight and Obesity Is Associated with a Healthy Lifestyle Pattern in Lebanese Adults Hwalla N, Naja F, Itani L, Nasrallah M, Tamim H, Nasreddine L (P04-177-19)

Objectives

The study aims to identify lifestyle patterns in a sample of Lebanese adults and examine the association of these patterns with Metabolically Healthy Overweight and Obesity (MHOv/O).

Methods

This study is based on a cross-sectional survey of Lebanese adults living in Greater Beirut area (n = 305), and which was conducted in 2014. Dietary intake assessment was performed using an 80-item semi-quantitative food frequency questionnaire. The identification of MHOv/O was based on the ATP-III criteria. Principal Component Factor Analysis was implemented to derive lifestyle patterns, including variables related to dietary intake, eating at home, alcohol consumption, drinking water, sleeping difficulties, smoking and physical activity.

Results

Two lifestyle patterns were identified in the study population: the “Unhealthy” pattern which was characterized by cigarette smoking, fast food, soft drinks and alcohol consumption . Eating at home loaded negatively on this pattern. The “Healthy” lifestyle pattern was characterized by positive loadings of food groups such as milk and dairy products, fruits and vegetables. Sleeping difficulties loaded negatively on this pattern, while physical activity had a positive loading. Multiple logistic regression analyses was performed. The results showed that subjects belonging to the 4th quartile of the “Healthy” pattern scores had higher odds of MHOv/O as compared to those in the 1st quartile (OR: 4.04, CI:1.26–13.01).

Conclusions

The findings of this study provided evidence on the combined effect of lifestyle factors in relation to cardiometabolic abnormalities that are complex and multifactorial in nature. The results highlighted the importance of focusing on ‘holistic’ lifestyle patterns modifications in designing and implementing culturally sensitive interventions in overweight and obese subjects.

Funding Sources

Lebanese National Council for Scientific Research; University Research Board at the American University of Beirut); Medical Practice Plan at the American University of Beirut.

Association between sarcopenic obesity and higher risk of type 2 diabetes in adults: A systematic review and meta-analysis

BACKGROUND

The coexistence of sarcopenia and obesity is referred to as sarcopenic obesity (SO) and it has been hypothesized that the two components of SO may synergistically increase their negative effects. However, many uncertainties still surround this condition especially with regard to its potential negative effects on health outcomes.

AIM

To conduct a systematic review to determine the prevalence of sarcopenia among adults with overweight and obesity and to investigate whether SO was associated with a higher risk of type 2 diabetes (T2D).

METHODS

This study was conducted in adherence with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Literature searches, study selection, methodology development and quality appraisal were performed independently by two authors and the data were collated by means of meta-analysis and narrative synthesis.

RESULTS

Of the 606 articles retrieved, 11 studies that comprised a total of 60118 adults with overweight and obesity of both genders met the inclusion criteria and were reviewed, revealing two main findings. First, the overall prevalence of sarcopenia is 43% in females and 42% in males who are with overweight and obesity. Secondly, the presence of SO increases the risk of T2D by 38% with respect to those without SO (OR = 1.38, 95%CI: 1.27-1.50).

CONCLUSION

A high prevalence of sarcopenia has been found among adults with overweight and obesity regardless of their gender and this condition seems to be associated with a higher risk of T2D. Clinician should be aware of this scenario in their clinical practice for the better management of both obesity and T2D.

Nutritional Knowledge and Dietary Practice in Elite 24-Hour Ultramarathon Runners: A Brief Report

Several factors contribute to athletes’ sporting performance and diet is a key component. Higher levels of nutritional knowledge seem to correlate with a higher quality of diet, but this remains poorly explored and findings are still not conclusive. The aim of our study was to assess nutritional knowledge and dietary adequacy, detecting any potential association between these two factors in elite 24-hour ultramarathon runners, a sport which seems to have been increasing in popularity over the last decade. Nutritional knowledge and Mediterranean dietary adequacy scores were assessed by means of validated questionnaires given to 10 elite ultramarathon runners (six males and four females) from the Italian Ultramarathon and Trail Association (IUTA). The overall nutritional knowledge in the entire sample of athletes seemed to be good, especially in terms of “dietary recommendations” and “nutrient sources” knowledge. However, females had higher total nutritional knowledge scores when compared to males. Finally, linear regression analysis showed that greater nutritional knowledge was positively associated with an increase in Mediterranean dietary adequacy scores (β = 1.27; 95% CI = 0.039–2.494; p = 0.045) after adjusting for level of education. Our findings provide evidence that higher nutritional knowledge is associated with better dietary practice in elite 24-hour ultramarathon runners. Future studies are needed to assess the usefulness of educational programs as a strategy to improve the adequacy of dietary intake in this specific population.

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.

Validation of an Arabic Version of the Obesity-Related Wellbeing (ORWELL 97) Questionnaire in Adults with Obesity

BACKGROUND

No specific questionnaire that evaluates Health-Related Quality Of Life (HRQOL) in individuals with obesity is available in the Arabic language. The aim of this study was therefore to propose and examine the validity and reliability of an Arabic language version of the ORWELL 97, a validated obesity-related HRQOL questionnaire.

METHODS

The ORWELL 97 questionnaire was translated from English to Arabic language and administered to 318 Arabic-speaking participants (106 from clinical and 212 from community samples), and underwent internal consistency, test-retest reliability, construct and discriminative validity analysis.

RESULTS

Internal consistency and the test-retest reliability were excellent for ORWELL 97 global scores in the clinical sample. Participants with obesity displayed significantly higher ORWELL 97 scores than participants from the community sample, confirming the good discriminant validity of the questionnaire. Confirmatory factor analysis in the clinical sample revealed a good fit for a modified two-factor structure.

CONCLUSION

Overall, the Arabic version of the ORWELL 97 can be considered validated in Arabic adult patients with obesity, paving the way to further assessment of its responsiveness in measuring changes in health-related quality of life associated with obesity treatment.

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.

Electronic supplementary material

The online version of this article (10.1186/s12937-018-0393-3) contains supplementary material, which is available to authorized users.

Adipose-derived Mesenchymal Stem Cells in the Treatment of Obesity: A Systematic Review of Longitudinal Studies on Preclinical Evidence

BACKGROUND

Obesity is an increasing global health problem, but its treatment is not yet optimal, especially in the long term. For this reason, preclinical studies have been conducted relating to a new therapeutic strategy for obesity based on adipose-derived mesenchymal stem cells (AD-MSCs). The aim of our systematic review is to summarize these findings deriving from the animal model in order to establish whether there is sufficient evidence to justify going forward to clinical studies.

METHODS

Literature searches, study selection, methods and quality appraisal were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were collated using a narrative approach.

RESULTS

Of the 578 articles retrieved, seven studies met the inclusion criteria, and their analysis revealed several main findings. There was a strong evidence of the positive effect of AD-MSCs in obesity treatment in terms of body weight, glucose metabolism homeostasis, lipid profiles, non-alcoholic fatty liver disease and systemic inflammation. Moreover, there was recent evidence from a few studies for a significant effect of AD-MSCs transplantation on the improvement of obesity-related hormonal status, (i.e., leptin) and body composition patterns, though these investigations may need further replication.

CONCLUSION

The effects of AD-MSCs transplantation on obesity, in terms of weight loss and obesityrelated diseases, are promising in animal models. In the future, further well-designed studies should be performed to understand the mechanism of action and to overcome some methodological limitations such as the small sample sizes and risk of bias evidenced in our systematic review, before moving forward to assess AD-MSCs as a potential strategy for human obesity management.

Long-term Lifestyle-modification Programs for Overweight and Obesity Management in the Arab States: Systematic Review and Meta-analysis

BACKGROUND

Obesity is a growing health problem worldwide. It is associated with serious medical and psychosocial comorbidities that increase the risk of mortality. However, strong evidence confirms lifestyle-modification programs as the cornerstone treatment for excess weight and obesity. The aim of this systematic review was to assess the effectiveness of the lifestyle-modification programs for weight management delivered in Arabic-speaking countries.

METHODS

The PubMed database was searched, and studies conducted in humans were identified and screened as per the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data were collated using meta-analysis and a narrative approach.

RESULTS

Of the 1057 articles retrieved, six studies, conducted in four Arab countries, comprising a total of 444 adolescent and adult participants of both genders with overweight and obesity, met the inclusion criteria and were reviewed. Most studies that assessed weight loss at 6-month follow-up showed no significant reduction in body weight. Meta-analysis confirmed that the lifestyle-modification programs delivered were no more effective than other treatments. Only one article reported significant weight-loss maintenance after 12 months of follow-up. However this was a prospective non-controlled study in which the weight loss maintained (=4%) did not conform to the standard for clinical significance (>10%).

CONCLUSION

Lifestyle-modification programs for weight management delivered in Arabic-speaking countries seem lacking in effectiveness due to methodological weaknesses in program adaptation, a lack of expert clinical supervision before and during implementation, and the presence of barriers to lifestyle modification, especially for women. Future studies should bear these features in mind.

Role of inflammation in the association between the western dietary pattern and metabolic syndrome among Lebanese adults

The aim of this study was to investigate whether inflammation mediates the previously observed direct association between the western dietary pattern (WDP) and metabolic syndrome (MetS) among Lebanese adults. Sociodemographic, lifestyle, dietary pattern scores, anthropometric and biochemical data of 331 adults were used in this study. Inflammation indicators considered were: serum C-reactive protein (CRP) and the dietary inflammatory index (DII). The scores of the WDP were significantly associated with DII (r = .64) but not with serum CRP. Higher CRP levels increased the odds of MetS and four out of five of its components, while no association was found between the DII and MetS.

CONCLUSION

The findings of this study confirmed the association of serum CRP with MetS but did not support mediation effect of inflammation on the association between the WDP and MetS. These findings are important to direct future investigations on diet, inflammation and association with diseases risk.

Development and validation of an Arabic questionnaire to assess psychosocial determinants of eating behavior among adolescents: a cross-sectional study

BACKGROUND

There is a scarcity of studies that evaluate the psychosocial determinants of eating behavior among adolescents in the Eastern Mediterranean region. The availability of such data is limited by the lack of valid culturally appropriate tools. The current study aims to develop and validate an Arabic questionnaire that measures psychosocial determinants of eating behavior among adolescents.

METHODS

A cross-sectional study was carried out to validate a five-scale questionnaire developed to measure nutrition-related knowledge, attitude, practices, and self-efficacy and social norms. Content validity was assessed by Lawshe's method, factor analysis was used to assess construct validity, and Cronbach's α was used to test internal consistency. Temporal stability was assessed by test-retest reliability. A random sample of public and private school students participated in the validation study.

RESULTS

All the five scales demonstrated excellent content validity (content validity ratio, CVR ≥0.778). Factor analysis revealed several dimensions for each scale. Cronbach's α for the identified dimensions or subscales ranged between 0.495 and 0.809 indicating acceptable internal consistency. Cronbach's α for the total scales ranged between 0.759 and 0.836. Test-retest analysis revealed good temporal stability (intraclass correlation, ICC >0.7).

CONCLUSIONS

A psychometrically valid tool to measure psychosocial determinants of eating behavior was developed. This tool can serve as a potential instrument for pretest and impact evaluation of ongoing nutrition education interventions and curricula. Based on results obtained from this tool, efficacious modifications can be instilled for nutrition policies and interventions.

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.

A novel Mediterranean diet index from Lebanon: comparison with Europe

PURPOSE

To propose an index for assessing adherence to a Middle Eastern version of the Mediterranean diet as represented by the Traditional Lebanese Mediterranean diet (LMD), to evaluate the association between the LMD and selected European Mediterranean diets (EMD), and to examine socio-demographic and lifestyle correlates of adherence to Mediterranean diet (MD) among Lebanese adults.

METHODS

Using nationally representative dietary intake data of Lebanese adults, an index to measure Adherence to the LMD was derived. The choice of foods/food groups used for calculating the LMD score was based on results of previous factor analyses conducted on the same dataset. These foods/food groups included fruits, vegetables, legumes, olive oil, burghol, dairy products, starchy vegetables, dried fruits and eggs. Using Pearson's correlation and scores tertiles distributions agreement, the derived LMD index was compared to previously published EMD indexes from Greece, Spain, Italy, France and EPIC/Europe.

RESULTS

Fruits, vegetables and olive oil were common denominators to most MD scores. Food groups, specific to the LMD, included burghol, dried fruits, and eggs. The LMD score significantly correlated with the EMD scores, while being closest to the Italian (r = 0.56) and farthest from the French (r = 0.21). Percent agreement between scores' tertile distributions and Kappa statistics confirmed these findings. Multivariate linear regressions showed that older age and higher educational levels were associated with increased adherence to all MDs studied.

CONCLUSION

A novel LMD index was proposed to assess adherence to a Middle Eastern version of MD, complementing international efforts to characterize the MD and its association with disease risk.