Dietary Intakes, Sources, and Determinants of Total and Free Sugar Consumption Among Lebanese Children and Adolescents: Findings from a National Study

Objectives

To determine the intake levels and main sources of total sugars (TS) and free sugars (FS) among Lebanese children and adolescents and to investigate the determinants of high FS consumption.

Methods

In a national cross-sectional survey, data on socio-demographic, anthropometric, and lifestyle characteristics of Lebanese children and adolescents (5–18 years-old) were collected (n = 1133). Dietary intake (24-hr recall) was analyzed using Nutri Pro software to determine average daily energy intake in kilocalories (kcal/d), TS and FS in grams (g/d) and as % of total energy intake (% kcal/d). FS content of foods was defined as 100% of added sugars for non-fruit juice sources and 100% of TS for fruit juice and drinks. Independent t -tests were used to compare mean daily intakes of TS and FS by sex and age groups. Logistic regressions were conducted to explore determinants of high FS intake (>10% kcal/d), as per the World Health Organization recommendations.

Results

Children and adolescents consumed, on average, 1899.9 ± 25.2 kcal/d of which 17 ± 0.2% kcal/d from TS and 16 ± 0.2% kcal/d from FS. Percentage of children and adolescents having high FS consumption was 62%. Main contributors to TS and FS were sweetened beverages, biscuits/chocolates, and syrups, jams and honey. Per consumer basis, intakes of FS from all food groups were significantly higher in older boys and girls than younger ones, except for candies, ice cream and fresh fruit juices. Multiple logistic regression showed children with higher paternal educational level and highest household monthly income had significantly lower odds of high FS intake (OR = 0.79, 95% CI: 0.64, 0.96 and OR = 0.70, 95% CI: 0.58, 0.83, respectively). Children meeting physical activity recommendations had higher odds of high FS compared to their counterparts (OR = 1.12, 95% CI: 1.003, 1.23).

Conclusions

High proportion of Lebanese children and adolescents exceeded upper limits for FS intake. Findings highlight the need for developing culture-specific interventions aimed at reducing the intake of TS and FS among adolescents, particularly those from low-income families, to curb rising obesity rates.

Funding Sources

This project was funded by the Lebanese National Council for Scientific Research and the University Research Board at the American University of Beirut.

Self-Confidence in Food Resource Management Is Associated with Lower Risk of Household Food Insecurity Among SNAP-Ed Eligible Head Start Families

Objectives

To examine the associations between food resource management (FRM) self-confidence and behaviors that help maximize the use of food dollars by household food insecurity (HFI) status.

Methods

Cross-sectional survey on SNAP-Ed eligible Head Start families in Pennsylvania, US (n = 366). HFI status was assessed using the 18-item USDA Household Food Security Module. FRM self-confidence was measured using 5-questions (e.g., “How confident are you that you can buy healthy foods for your family on a budget?”) and FRM behaviors were assessed using 6-questions (e.g., “How often do you plan meals before shopping for groceries?”). The associations between FRM self-confidence and behavior by HFI status were explored using chi-square and simple logistic regression analyses.

Results

The average FRM self-confidence score of respondents was 3.02(SD: 0.71) and FRM behavior score was 3.7(SD: 0.8). Participants with high FRM self-confidence had lower odds of HFI (OR = 0.36, 95% CI: 0.23, 0.56, P < 0.001), yet the association between FRM behaviors with HFI status was not found to be statistically significant (P = 0.91). When individual FRM questions were explored, results showed that all FRM self-confidence questions significantly differed by HFI status (highest p-value < 0.046); e.g., a higher proportion of food secure households were moderately confident or very confident to buy healthy foods on a budget compared to food insecure households (75% vs 58%, P < 0.001). For individual FRM behaviors, one of the 6 behaviors differed by HFI status; food insecure households were more likely to report never or rarely using a shopping list when grocery shopping vs their food secure counterparts (12% vs 9%, P = 0.016).

Conclusions

Higher confidence in FRM skills may protect against food insecurity among SNAP-Ed eligible households. Nutrition education programs designed to assist low-income households in stretching their food dollars need to target self-confidence in FRM skills, and address what factors may affect their FRM behaviors, in an attempt to alleviate food insecurity.

Funding Sources

This material was funded by USDA's Supplemental Nutrition Assistance Program (SNAP) through the PA Department of Human Services (DHS). This institution is an equal opportunity provider.

Examining the Feasibility and Acceptability of Valuing the Arabic Version of SF-6D in a Lebanese Population

Objectives: The SF-6D is a preference-based measure of health developed to generate utility values from the SF-36. The aim of this pilot study was to examine the feasibility and acceptability of using the standard gamble (SG) technique to generate preference-based values for the Arabic version of SF-6D in a Lebanese population. Methods: The SF-6D was translated into Arabic using forward and backward translations. Forty-nine states defined by the SF-6D were selected using an orthogonal design and grouped into seven sets. A gender-occupation stratified sample of 126 Lebanese adults from the American University of Beirut were recruited to value seven states and the pits using SG. The sample size is appropriate for a pilot study, but smaller than the sample required for a full valuation study. Both interviewers and interviewees reported their understanding and effort levels in the SG tasks. Mean and individual level multivariate regression models were fitted to estimate preference weights for all SF-6D states. The models were compared with those estimated in the UK. Results: Interviewers reported few problems in completing SG tasks (0.8% with a lot of problems) and good respondent understanding (5.6% with little effort and concentration), and 25% of respondents reported the SG task was difficult. A total of 992 SG valuations were useable for econometric modeling. There was no significant change in the test–retest values from 21 subjects. The mean absolute errors in the mean and individual level models were 0.036 and 0.050, respectively, both of which were lower than the UK results. The random effects model adequately predicts the SG values, with the worst state having a value of 0.322 compared to 0.271 in the UK. Conclusion: This pilot confirmed that it was feasible and acceptable to generate preference values with the SG method for the Arabic SF-6D in a Lebanese population. However, further work is needed to extend this to a more representative population, and to explore why no utility values below zero were observed.

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.

Impact of a Pilot School-Based Nutrition Intervention on Dietary Knowledge, Attitudes, Behavior and Nutritional Status of Syrian Refugee Children in the Bekaa, Lebanon

This study evaluated the impact of a 6-month school nutrition intervention on changes in dietary knowledge, attitude, behavior (KAB) and nutritional status of Syrian refugee children. A quasi-experimental design was followed; Syrian refuge children in grades 4 to 6 were recruited from three informal primary schools (two intervention and one control) located in the rural Bekaa region of Lebanon. The intervention consisted of two main components: classroom-based education sessions and provision of locally-prepared healthy snacks. Data on household socio-demographic characteristics, KAB, anthropometric measures and dietary intake of children were collected by trained field workers at baseline and post-intervention. Of the 296 school children enrolled, 203 (68.6%) completed post-intervention measures. Significant increases in dietary knowledge (β = 1.22, 95% CI: 0.54, 1.89), attitude (β = 0.69, 95% CI: 0.08, 1.30), and body mass index-for-age-z-scores (β = 0.25, 95% CI = 0.10, 0.41) were observed among intervention vs. control groups, adjusting for covariates (p < 0.05). Compared to the control, the intervention group had, on average, significantly larger increases in daily intakes of total energy, dietary fiber, protein, saturated fat, and several key micronutrients, p < 0.05. Findings suggest a positive impact of this school-based nutrition intervention on dietary knowledge, attitude, and nutritional status of Syrian refugee children. Further studies are needed to test the feasibility and long-term impact of scaling-up such interventions.