Salt: a narrative review and local policy initiatives in Israel

High salt intake is a well-known risk factor for cardiovascular disease (CVD). Some recent prospective studies have challenged the salt-CVD link. We conducted a narrative review based on a systematic search and provided a national policy update. We reviewed 14 observational prospective studies in healthy adults, reporting the association between sodium intake and excretion or reduction and CVD incidence. Validated by cohort studies, recommended sodium consumption levels (< 1.5-2 gram per day) are still relevant for the prevention of CVD in adults. We discussed the findings and policy initiatives implemented in Israel. Such initiatives included voluntary and mandatory food labeling, and culturally tailored educational programs. The Ministry of Health in Israel initiated a salt reduction policy in recent years-aimed for the future of the industry as well as the population.

Food Insecurity in Israeli Elderly is Associated with Sociodemographic Characteristics, Disability, and Depression: Policy Implications

Background

Food insecurity (FI) and poor health can turn into a vicious cycle with detrimental effects, especially in the elderly, however, few studies have examined the relationship between FI and health in this age group.

Objectives

We investigated associations of FI with physical and mental health and health behaviors among community-dwelling elderly.

Methods

We used nationally representative, cross-sectional data from the 2014-2015 Israel National Health and Nutrition Survey of the Elderly (Rav Mabat Zahav) on FI, sociodemographic characteristics, noncommunicable diseases (NCDs), disability, self-assessed physical, oral, and mental health for 1006 individuals aged ≥65 y.

Results

FI affected 12.3% of all households with elderly and was significantly higher among late immigrants and Arabs. Bivariate associations of FI with the number of NCDs, depression, disability in all 6 domains (vision, hearing, mobility, self-care, remembering, communication), poor self-assessed physical and oral health, chewing and swallowing problems, feelings of loneliness, insufficient physical activity, and smoking were significant (P < 0.05). In a multivariable logistic regression controlling for population group, household size, age and sex, FI was significantly associated (P < 0.05) with lack of formal education (OR: 6.26; 95% CI: 1.66, 23.65), being in the lowest (OR: 23.56; 95% CI: 3.71, 149.76) or second-lowest (OR: 16.75; 95% CI: 2.68, 104.52) per capita household income quartile, having one (OR: 2.11; 95% CI: 1.05, 4.23) or several disabilities (OR: 4.04; 95% CI: 1.72, 9.45), and having ever been diagnosed with depression (OR: 3.34; 95% CI: 1.35, 8.28).

Conclusions

FI is associated with physical and mental health problems, multiple disabilities, and loneliness among Israeli elderly. Providing income support could reduce FI, and subsidized congregate and home-delivered meal services could be expanded to meet the needs of elderly with disabilities and counter social isolation. Because low education, disability, and depression are particularly prevalent among the food insecure and vulnerable groups face language barriers, assistance with applications for these services should be increased.

Impact of the COVID-19 pandemic on breastfeeding in Israel: a cross- sectional, observational survey

Background

Since March 2020, the world has been coping with the COVID-19 pandemic. One group particularly affected were mothers of newborns. The Israeli government imposed three lockdowns, with the first from 14 March to 11 May 2020. It had the strictest rules, with effects among mothers including panic and stress. These mothers coped with new challenges as they were often without help from the extended family, could not meet lactation counsellors in person, and stayed longer on maternity leave.

Methods

A cross-sectional, observational study collected data via an online anonymous survey in Israel. From 27 April 2020 to 11 May 2020, the survey was distributed through Facebook groups for breastfeeding mothers. It contained 32 multiple choice and 10 open questions. Multivariate logistic regression analysis, with adjustment for potential factors, was performed to determine the pandemic-related factors influencing breastfeeding, including the decision to breastfeed longer than planned.

Results

Five hundred eighty women participated in the survey. Most mothers were over 30, (mean age 32.55), married with an academic degree (81.5%). 127 (22%) women reported changes in their lactation plans. 85 (15%) responded that due to the COVID -19 pandemic they extended their breastfeeding period and 42 (7%) reported shortening it. A significant relationship was found between this extension and returning to work later than expected adjusted OR = 2.38 95% CI 1.46,3.87). When asked to rank steps national health authorities should take to encourage breastfeeding, the highest agreement (96%) was with maternity leave extension. More than 90% believed that receiving breastfeeding counselling at home and/or in hospital will encourage breastfeeding.

Conclusions

This study demonstrated that most women did not change their breastfeeding patterns because of the lockdown though some did experience difficulties. Some lengthened their breastfeeding period, as, due to the pandemic, they stayed home longer than expected. This finding should be considered for future emergency situations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00505-5.

Comparisons in polypharmacy over a decade in community-dwelling older adults-findings from Israel national health and nutrition surveys

Background

Polypharmacy increases with age and is associated with serious health and economic costs. This study reports changes over a decade in medication-use patterns and polypharmacy, in Israeli community-dwelling older adults aged ≥ 65 years.

Methods

Demographic and health data from two representative national health cross-sectional surveys – MABAT ZAHAV 1 (MZ1) in 2005–2006, and MZ2 in 2014–2015 were analyzed. Polypharmacy was defined as use of ≥ 5 medications. Risk factors for polypharmacy were estimated by multivariable logistic regression with adjusted odds ratios (aOR) and their 95% confidence intervals (CI).

Results

Self-reported data on medications taken were available for 1647 participants (91.5%) in MZ1, and for 833 participants (80.2%) in MZ2, 55% women, and about 20% aged ≥ 80, in both surveys. The prevalence of polypharmacy was significantly lower in MZ2 than in MZ1: 64.2% versus 56.3%, p = .0001; with an aOR (95%CI) of 0.64 (0.52, 0.80). The most commonly taken drugs were for hypertension (27.0%, 25.3%), dyslipidemia (9.7%, 12.4%) and anticoagulation (9.2%, 9.8%). For approximately 10% of drugs, indications were either unknown or incorrect. Polypharmacy was significantly associated with poor self-health assessment 2.47 (1.99, 3.06), ≥ 4 versus 1–3 chronic illnesses 6.36 (3.85, 10.50), and age ≥ 80 versus younger 1.72 (1.32, 2.24). Similar associations were observed with major polypharmacy of ≥ 8 medications.

Conclusion

Polypharmacy, although reduced in the last decade, requires constant attention, especially concerning lack of knowledge of indications which leads to poor adherence and adverse side effects. Health-care teams should carry out regular medicine reconciliation in at-risk elderly patients.

The role of caloric intake in the association of high salt intake with high blood pressure

Since current recommendations call for a substantial reduction in overall sodium consumption, we tested whether or not these recommendations are implemented in common large subpopulations such as those with abnormal weight or hypertension in the current high sodium, high-calorie nutritional environment. In a national representative cross-sectional survey of the community-dwelling subjects aged 25-65 years conducted in Israel between 2015 and 2017, 582 randomly selected subjects completed health and dietary questionnaires, underwent blood pressure and anthropometric measurements and collected 24-h urine specimens, to assess dietary sodium intake. Overall mean 24-h sodium excretion was 3834 mg, more than double the recommended upper intake for adults < 1500 mg/day. Sodium excretion was directly related to caloric intake and blood pressure and linked to the presence of hypertension and overweight/obesity. The highest sodium excretion was seen in overweight/obese hypertensive subjects. This recent national survey shows a high consumption of sodium in the Israeli population and a dose-response association between caloric intake and urinary sodium excretion, independent of BMI and hypertension. Nevertheless, overweight/obese subjects with hypertension consume (excrete) more sodium than other BMI/ blood pressure-related phenotypes and may thus comprise a target subpopulation for future efforts to reduce sodium intake.

24-h Potassium Excretion Is Associated with Components of the Metabolic Syndrome: Results from a National Survey Based on Urine Collection in Adults

A balanced diet and weight loss are the first lines of treatment for the prevention of metabolic syndrome (MS). Dietary strategies may include changing the composition of macronutrients, adopting a particular dietary pattern as a Mediterranean diet. However, the role of micronutrients, particularly potassium, in the propensity for or treatment of the syndrome is unclear. The study aimed to examine the relationship between the presence of the MS and its risk factors and the 24-h potassium excretion as the most valid proxy for dietary intake. The analyses were performed as part of the national survey estimating sodium and other electrolytes excretion conducted between 2014-2016 in Israel. The survey included urine collection, anthropometric and blood pressure measurements, and a comprehensive medical questionnaire that included details on the intake of medications that may affect electrolyte secretion. A model was constructed to evaluate the probability for the MS. MS score and its probability were examined in relation to potassium excretion at different levels and in stratification to sex. A total of 581 participants were included in the analysis. The mean potassium excretion was 2818 ± 1417 mg. The prevalence of the MS was 18.5% among participants with above-average potassium excretion and about 10.4% among participants with lower-than-average excretion (p = 0.007). A dose-response relationship was observed between MS score and potassium: the higher the score, the lower was the excretion of potassium. Potassium excretion, rather than sodium excretion, correlated with all components of the MS and even predicted MS independently from other variables. This is the first study based on a national survey showing that potassium consumption, as represented by daily excretion in urine, is inversely related to the presence of MS components after adjustment for several leading variables and careful exclusion of participants taking drugs which may interfere in potassium excretion.

The Associations between Diet and Socioeconomic Disparities and the Intestinal Microbiome in Preadolescence

The intestinal microbiome continues to shift and develop throughout youth and could play a pivotal role in health and wellbeing throughout adulthood. Environmental and interpersonal determinants are strong mediators of the intestinal microbiome during the rapid growth period of preadolescence. We aim to delineate associations between the gut microbiome composition, body mass index (BMI), dietary intake and socioeconomic status (SES) in a cohort of ethnically homogenous preadolescents. This cohort included 139 Arab children aged 10-12 years, from varying socioeconomic strata. Dietary intake was assessed using the 24-h recall method. The intestinal microbiome was analyzed using 16S rRNA gene amplicon sequencing. Microbial composition was associated with SES, showing an overrepresentation of Prevotella and Eubacterium in children with lower SES. Higher BMI was associated with lower microbial diversity and altered taxonomic composition, including higher levels of Collinsella, especially among participants from lower SES. Intake of polyunsaturated fatty acids was the strongest predictor of bacterial alterations, including an independent association with Lachnobacterium and Lactobacillus. This study demonstrates that the intestinal microbiome in preadolescents is associated with socioeconomic determinants, BMI and dietary intake, specifically with higher consumption of polyunsaturated fatty acids. Thus, tailored interventions during these crucial years have the potential to improve health disparities throughout the lifespan.

Associations of Feeding Practices in Early Life and Dietary Intake at School Age with Obesity in 10- to 12-Year-Old Arab Children

Understanding the role in pediatric obesity of early life feeding practices and dietary intake at school age is essential for early prevention. The study aimed to examine associations of early life feeding practices, environmental and health-related exposures, and dietary intake at school age as determinants of obesity in children aged 10–12 years. In an earlier study of 233 healthy infants in two Arab towns in northern Israel, neonatal history, feeding practices, and health information were obtained up to age 18 months. This follow-up study assessed dietary intake and anthropometric measurements at age 10–12 years using the 24 h recall method. Overall, 174 children participated in this study. Almost all (98%) the children were breastfed. The prevalence of obesity at school age was 42%. A multivariable model adjusted for energy intake and socioeconomic status showed positive associations of total fat intake and of weight-for-height z score, but not feeding practices in infancy, with obesity. Higher gestational age at birth was associated with lower odds of obesity at age 10–12 years. In conclusion, in a population with near universal breastfeeding, gestational age at birth, weight indicators but not feeding practices in infancy, and total fat intake at school age were associated with increased likelihood of obesity.

The interaction and interference of preformed metal crowns on magnetic resonance imaging: a scoping review with a systematic methodology

Purpose

Preformed metal crowns are widely used to restore primary and permanent teeth. Children may require magnetic resonance imaging (MRI) for diagnosis and monitoring of diseases in the head and neck region. Metallic objects, in the field of view, may compromise the diagnostic value of an MRI. The impact on the diagnostic quality of an MRI in children who have had preformed metal crowns placed has not been assessed. The aim of this systematic review was to evaluate the impact that PFMCs have on MRI imaging quality and thus the overall diagnostic value.

Methods

Electronic searches of the following databases were completed: MEDLINE, EMBASE, Cochrane Library, Web of Science and Open Grey. Primary in vivo studies on children who had at least one preformed metal crown placed and required an MRI investigation were to be included. PRISMA guidelines were followed and screening/data extraction was carried out by two independent calibrated reviewers.

Results

A total of 7665 articles were identified. After removing duplicates, 7062 were identified for title and abstract screening. Thirty-four articles underwent full-text review, of which none met the inclusion criteria. Most common reasons for exclusion were not placing preformed metal crowns (n = 16) or in vitro studies (n = 12).

Conclusion

No in vivo studies were identified to establish the hypothetical impact preformed metal crowns would have on the diagnostic quality of an MRI in the head and neck region. Decision making needs to be guided on a case by case basis. Further high-quality clinical studies are required.

Energy Intake Is Highly Associated with Handgrip Strength in Community-Dwelling Elderly Adults

BACKGROUND

Handgrip strength (HGS) is used to assess muscle strength, which is an important indicator of health status in older adults.

OBJECTIVE

We evaluated associations of demographic, anthropometric, clinical, and nutritional factors with muscle strength in community-dwelling elderly adults.

METHODS

This population-based cross-sectional study employed the 2014-2015 Israeli Health and Nutrition Survey in the Elderly (n = 1039, age ≥65 y, 46.7% males, 9.9% Arabs). Trained personnel performed face-to-face interviews that focused on health and nutrition status, as well as anthropometric measurements and examinations. HGS was measured in the dominant hand 3 times using a digital grip strength dynamometer; the highest result was reported. Dietary intake data were collected using single-day 24-h recall. Multivariable logistic regressions were used to explore factors associated with low HGS (<27 kg for men and <16 kg for women).

RESULTS

HGS measurements were completed by 704 participants. Following adjustment for several factors, higher prevalence of low HGS was significantly associated with age (OR: 1.14; 95% CI: 1.11, 1.18), whereas decreased prevalence was associated with higher levels of education (OR: 0.55; 95% CI: 0.32, 0.94) and meeting physical activity recommendations (OR: 0.53; 95% CI: 0.31, 0.88); P < 0.05 for all. Incremental increases of 100 kcal/d in energy intake and of 1 cm in midarm circumference were associated with decreased prevalence of low HGS (OR: 0.95; 95% CI: 0.91, 0.99 and OR: 0.91; 95% CI: 0.85, 0.97, respectively; P < 0.01 for both). Associations were not found of low HGS with ethnicity, comorbidity, BMI, smoking, or alcohol consumption or with protein, carbohydrate, or fat intakes.

CONCLUSION

Energy intake, physical activity, midarm circumference, and education are associated with HGS in elderly Israeli adults. Further cohort studies are necessary to assess possible causal relations between these factors and HGS. Modifiable factors should be targeted in planning public health strategies for promoting a healthy aging population.

Trends in the adherence to the Mediterranean diet in Israeli adolescents: results from two national health and nutrition surveys, 2003 and 2016

PURPOSE

To compare the adherence to the Mediterranean diet (MD) in Israeli adolescents in 2003-4 and in 2015-6, and associated factors.

METHODS

Adolescents (aged 11-19 years) from two cross-sectional, school-based, nationally representative surveys, Mabat Youth I (2003-4, n 5005) and II (2015-6, n 3906), completed self-administered questionnaires on food frequency, eating behaviors and lifestyle. The Mediterranean Diet Quality Index for Children and Adolescents (KIDMED index), derived from these questionnaires, was used; higher scores indicate better diet quality. The samples comprised eight subgroups, according to population group (Jews/Arabs), school level (middle/high) and sex.

RESULTS

The percentages with poor, average and good KIDMED scores were 11.6, 45.3 and 43.1% in 2015-6, compared to 25.5, 55.2 and 19.3%, respectively, in 2003-4. Significant improvement was seen in all subgroups (all p < 0.001), and was attributed to increased consumption of fruits, vegetables, cereals, dairy products, and decreased negative eating behaviors. In Mabat Youth II, physical activity at least 1 h/day was positively associated with good KIDMED scores among Jewish adolescents; dieting and sleeping at least 7 h/day were associated with good MD adherence in Jewish boys; always/often reading food labels predicted good MD adherence among Jewish boys and Arab girls. Overweight and obesity were negatively associated with better KIDMED scores in Jewish boys.

CONCLUSION

MD adherence in Israeli adolescents has improved overall. The changes in MD components and the associated behavioral factors indicate the initiatives, relevant to the different subgroups, that are necessary to promote healthier nutrition and lifestyles.

Involuntary human exposure to carbamazepine: A cross-sectional study of correlates across the lifespan and dietary spectrum

Treated wastewater (TWW) is increasingly used for agricultural irrigation, especially in arid and semi-arid regions. Carbamazepine is among the most frequently detected pharmaceuticals in TWW. Moreover, its uptake and accumulation have been demonstrated in crops irrigated with TWW. A previous controlled trial found that urine concentrations of carbamazepine were higher in healthy volunteers consuming TWW-irrigated produce as compared to freshwater-irrigated produce. The aim of the current study was to assess whether carbamazepine is quantifiable in urine of Israelis consuming their usual diets and whether concentrations vary according to age, personal characteristics and diet. In this cross-sectional study, we recruited 245 volunteers, including a reference group of omnivorous healthy adults aged 18-66; pregnant women; children aged 3-6 years; adults aged >75 years; and vegetarians/vegans. Participants provided spot urine samples and reported 24-hour and "usual" dietary consumption. Urinary carbamazepine levels were compared according to group, personal characteristics, health behaviors, and reported diet. Carbamazepine was detectable (≥1.66 ng/L) in urine of 84%, 76%, 75.5%, 66%, and 19.6% of the reference group, vegetarians, older adults, pregnant women, and children, respectively. Quantifiable concentrations (≥5.0 ng/L) of carbamazepine were found in 58%, 46%, 36.7%, 14%, and 0% of these groups, respectively (p = 0.001 for comparison of proportions across groups). In adults, higher carbamazepine concentrations were significantly associated (p < 0.05) with self-defined vegetarianism, usual consumption of dairy products and at least five vegetables/day, and no meat or fish consumption in the past 24-hours. This study demonstrates that people living in a water-scarce region with widespread TWW irrigation, are unknowingly exposed to carbamazepine. Individuals adhering to recommended guidelines for daily fresh produce consumption may be at higher risk of exposure to TWW-derived contaminants of emerging concern.

Association between abdominal obesity and fragility fractures among elderly Israeli women

BACKGROUND

Obesity has been traditionally viewed as a protective factor for fractures. Recent studies have challenged this concept, particularly regarding abdominal obesity. We aimed to investigate the association between abdominal obesity, body mass index (BMI) and fragility fractures prevalence in a sample of community-dwelling elderly Israeli women.

METHODS

The data in this cross-sectional study were based on 'Mabat Zahav'-a survey of a nationally representative sample of elderly Israelis. The study population included 669 women. Data on fragility fractures site and circumstances were self-reported, and height, weight, waist and calf circumferences were measured. Waist circumference (WC) variable was divided into tertiles: < 88 cm, 88-99 cm and > 99 cm.

RESULTS

Sixty-five women reported fragility fractures (14 hip fractures, 18 vertebral fractures and 39 wrist fractures). Mean age was 73.9 ± 5.9 years, mean BMI was 29.9 ± 5 kg/m² and mean WC was 93.9 ± 12 cm. While BMI was not associated with osteoporotic fractures, abdominal obesity (WC > 88 cm) was positively associated with fragility fractures, independently of age, smoking, physical activity [middle and high WC tertiles {3.15 (95% CI 1.41-7.02), 2.78 (95% CI 1.05-7.31), respectively}].

CONCLUSIONS

Among this sample of elderly women, abdominal obesity was positively associated with fragility fractures, independently of age, smoking, physical activity and BMI. Waist circumference, an easily measured anthropometric indicator, may be useful for assessing the risk of fragility fractures in elderly women, particularly among those with normal or high BMI-a vast population which has been traditionally considered as having lower fracture risk.

Organophosphate pesticide exposure in children in Israel: Dietary associations and implications for risk assessment

BACKGROUND

Human biomonitoring (HBM) data is increasingly being compared to risk-based screening values to assess human health risk. However, as screening values have not been established for assessing biomarker concentrations of organophosphate (OP) pesticide metabolites, there are few studies using HBM data on urinary OP concentrations to assess human health risk. The purpose of the current study was to measure OP exposure in a sample of children in Israel; to explore associations between dietary patterns and OP exposure; and to assess risk of OP pesticides using urinary metabolite concentrations.

METHODS

We recruited 103 children in Israel and collected demographic and dietary data and urinary samples, and measured creatinine and dialkyl phosphate (DAP) concentrations. We compared urinary DAP concentrations to international populations and analysed associations between fruit and vegetable consumption and urinary DAP concentrations. Using urinary DAP concentrations, we calculated estimated daily intakes (EDI) of OP pesticides in each child and compared those to the acceptable daily intake (ADI).

RESULTS

Concentrations of several dialkyl phosphate metabolites (dimethylphosphate (DMP) and dimethylthiophosphate (DMTP)) were higher in our study population of Israeli children (geometric mean concentrations of DMP and DMTP were 6.6 μg/L and 7.6 μg/L, respectively) compared to children in the US, Canada, Spain, and Denmark. We found positive correlations between total fruit consumption and creatinine adjusted log transformed urinary DMP, DMTP, diethylthiophopshate (DETP), total dimethyl (DM) and total DAP concentrations (p < 0.05), positive correlations between cucumber consumption and diethylphosphate (DEP), DETP and diethyl (DE) concentrations (p < 0.05), and positive correlations between apple consumption and DETP concentrations (p = 0.02). Based on urinary DAP concentrations, we found that a portion of the children in our study had EDIs above the ADI, ranging from 2.9% to 79.4% of the children, depending on the active OP ingredient.

CONCLUSIONS

We found that Israeli children in our study are widely exposed to OP pesticides; that levels of dimethyl metabolites were high compared to other international populations; and that fruit consumption was associated with higher urinary DAP levels. Using urinary DAP concentration data, we found that a portion of the children in our study may be exposed to OP pesticides at levels above those considered safe.

Improved meals service and reduced food waste and costs in medical institutions resulting from employment of a food service dietitian - a case study

BACKGROUND

A recurring problem in medical institutions is patients not always receiving food meeting their nutritional and medical needs. A proposed contributing factor is non- inclusion of dietitians in food service staff. Recently, positions for food service dietitians in hospitals were created. For the newly defined role of "Food Service Dietitian", comprehensive training courses were developed (70 dietitians participated).

OBJECTIVE

To examine the impact of the addition of the role of a "Food Service Dietitian" in medical institutions on suitability of foods served, food costs and food waste.

METHODS

A three years (2014-2017) national case study to examine the new role's impact was carried out, in 18 hospitals, nine of which employ a food service dietitian (intervention), and 9 without (control). The number of nutritional analyses of menus was checked, as was the extent of kitchen staff training, and how often night meals were served for all patients. Data were gathered regarding food costs and waste with respect to food distributed to staff and patients. Food costs savings and waste reduction were calculated, based on reduction in provision of unnecessary meals, at a cost of 18 NIS per day per meal.

RESULTS

Kitchen staff training was carried out in all intervention institutions, and not in the controls. In most controls, nutritional analyses were not performed, whereas in the intervention hospitals, full analyses were performed and tailoring of menus to specific department requirements improved significantly. In most intervention hospitals, late night snacks were provided, this not being so in the controls. Total food cost savings of $229,569 per annum was seen in the six intervention hospitals, attributable to 4 factors: 1.Meals not delivered to fasting patients, or those receiving parenteral/enteral nutrition- cost savings of 328,500 NIS ($93,857)2.Better tailoring and monitoring of food delivered to the wards and staff (bread, cheese, milk etc)- annual cost savings of 235,000 NIS ($67,142) in the hospitals with a food service dietitian.3.Checking expiry dates of medical foods, and improved communication between the wards, the kitchen and the food distribution centers, has lessened food waste with savings of 5% from the medical food budget per annum of 40,000 NIS ($11,428).4.As a result of dietitian-performed nutritional analyses, tailoring of food provided according to the patient's medical and nutrition needs was improved. In one hospital, after re-evaluation of serve sizes in high protein diets, sizes were reduced while retaining adequacy, with immediate cost savings of 200,000 NIS ($57,142) per annum.

CONCLUSIONS

Implementation of the new role of Food Service Dietitian led to cost savings and significant improvements in adherence to the nutritional care plan.

Dental status, visits, and functional ability and dietary intake of elderly in Israel

Background

Epidemiological studies have shown deterioration in dental health accompanying the ageing process. Tooth loss increases with age. Chewing ability is closely correlated with number of natural teeth present: there is a threshold of 20–21 teeth, below which chewing ability declines. The government of Israel is currently considering adding dental treatment for elderly to the basket of services of the National Health Insurance Law. Information on the influence of elderly’s dental health on nutrition and general health status can contribute to the decision making process.

Methods

Secondary analysis of data collected on a subsample (N = 1776) of the cross-sectional Mabat Zahav - National Health and Nutrition Survey of the Elderly was done. Intakes of energy, fiber, protein, fruits and vegetables, associations with dental visits, dentures presence and functional ability were analyzed. Linear regression adjusted for confounders was performed.

Results

Statistically significant differences in dietary intake of energy, fiber, protein and vegetables were found between elderly who visited a dentist in the last year and those who did not. Elderly who possessed dentures had lower dietary intakes than their dentate counterparts. Elderly with functional problems such as impaired chewing had worse dietary intakes than the others. This was so after controlling for education, degree of interest in the relationship between nutrition and health and reading the nutrition label.

Conclusions

The findings in our study suggest that those who visited a dentist in the last year, had natural teeth and no denture/s and reported no chewing problems had better dietary intake. The results emphasize the importance of maintaining adequate dental health, preserving natural teeth and regular dental visits in the elderly to assure adequate nutrient status in this age group.

Socioeconomic inequalities in exposure to environmental tobacco smoke in children in Israel

BACKGROUND

Environmental tobacco smoke (ETS) exposure in infants and children causes more frequent and severe asthma attacks, respiratory infections, ear infections, and sudden infant death syndrome. The aim of this study was to measure ETS exposure in children in Israel (ages 4-11 years) using urinary cotinine measurements, in order to compare exposure levels to other international populations, and to assess predictors of ETS exposure in children in Israel.

METHODS

A subset of children who participated in the National Health and Nutrition Survey (RAV- MABAT) in 2015-2016 were invited to participate in the Second Israel Biomonitoring Survey. We analyzed urinary cotinine and creatinine concentrations in 103 children. Parents of study participants were interviewed in person on children's exposure to ETS at home and in other environments and on sociodemographic variables. We calculated creatinine-adjusted and unadjusted urinary cotinine geometric means in children and analyzed associations in univariable and multivariable analyses, between sociodemographic variables and parental - reported exposure, and urinary cotinine concentrations.

RESULTS

Based on urinary creatinine measurement, over 60% of children are exposed to ETS (compared to <40% based on parental report). Linear regression showed a positive association between urinary cotinine concentration and reported ETS exposure (p = 0.001). Mean cotinine concentration among children whose parents reported that they are exposed to ETS at home (5.1 μg/l) was significantly higher than the concentration among children whose parents reported they are not exposed to ETS at home (1.6 μg/l, p < 0.001). There was an inverse relationship between total family income and urinary cotinine concentration (p < 0.05). In a multivariable model adjusted for ethnicity and other factors, family income was a significant predictor of urinary cotinine level (p = 0.04, slope = -0.49). Geometric mean creatinine adjusted concentrations in children in the current study were higher than in children in Canada and selected European countries.

CONCLUSIONS

We found evidence of widespread exposure to ETS in children in the study. There is an urgent need to protect children in Israel from exposure to ETS.

The demographic and morbidity characteristics of a population receiving food support in Israel

BACKGROUND

Food supply to poor populations is a big challenge, particularly in periods of economic stress and in an era of chronic diseases epidemics. In Israel more than 4000 poor families are currently receiving food support. Many of the food support products given to the family have low nutrient values, therefore not appropriately ensuring food security of the population. The aim of the current study was to examine for the first time the demographic, nutritional and chronic diseases profiles of food support beneficiaries, so as to aid in planning future food support components in Israel. In addition, the study examined associations between levels of food insecurity status and selected morbidities among food support recipients.

METHODS

In 2016, 3000 families (classified as very poor) in 24 municipalities received food support in Israel from the "National Food Security Project" (NFSP), under the guidance of the National Food Security Council. The 400 new families who joined the program in 2016 were requested to complete a questionnaire regarding the demographic and health characteristics of their families. Three hundred sixty-two of them completed the questionnaire for a response rate of 90%. The current study includes these families only.

RESULTS

The disposable income per capita of the surveyed families was very low - less than NIS 1100 a month ($280). About half the families were working families and 40% of them were in debt. Of the 362 responding families, about 82% of them were food insecure, with more than half severely food-insecure; this, despite receiving food support. About one-third of the families had at least one member with anemia, and a quarter of the families had a member with hyperlipidemia. Hypertension is present in about 22% of the families, diabetes in 17%, and there is a 12% incidence of at least one family member with heart disease. These rates are markedly higher than those in the general population. Higher levels of food insecurity were associated with higher levels of hyperlipidemia, heart disease and hypertension.

DISCUSSION AND CONCLUSIONS

The nutrition and medical status of the population receiving food support is much worse than in the general population. There is a need to improve the nutritional value of food support; this could include greater emphasis on whole grains, fruits and vegetables. There is also a need for a nationwide education program to focus on healthy nutrition and to subsidize healthy foods. Many health and nutrition promotion models show that in order to effect changes in dietary habits and behaviors related to improving nutrition, there is a need for nutrition education (Kamp et al., J Nutr Educ Behav 42:72-82, 2010).

Low Iodine Intake from Dairy Foods Despite High Milk Iodine Content in Israel

BACKGROUND

Milk is a major source of iodine in human nutrition. Because both iodine content and the consumption of milk and dairy vary widely over time and populations, their contribution to iodine intake must be evaluated regularly. A recent national iodine survey found Israel's population to be mildly iodine deficient, possibly due to unmonitored changes in the food content of dietary iodine. Accounting for dairy iodine content can help guide efforts to prevent iodine deficiency.

OBJECTIVES

This study aimed to determine the iodine concentration of dairy products typically consumed in the Israeli diet, and to estimate iodine intake from dairy products among Israeli adults.

METHODS

Iodine was analyzed in 33 selected dairy products that account for 89% of the total population's dairy intake according to the "MABAT" Israeli National Health and Nutrition survey. Based on these data, the distribution of iodine intake from milk, dairy, and dairy-based foods in the adult population was calculated.

RESULTS

Israeli milk is rich in iodine, with a mean concentration of 22 μg/100 g. However, due to low dairy consumption, the mean iodine intake from milk and dairy was only 34 μg/day (median 23 μg/day; range: 0-337 μg/day) or 22% of the recommended daily allowance. Self-reported intake among poor, male, and Arab subgroups was even lower.

CONCLUSIONS

Because Israeli milk and dairy products are iodine rich, their contribution to the population's iodine intake would increase if they were consumed in greater amounts, particularly by high-risk groups. Dairy's potential contribution to iodine nutrition should be considered in recommendations for dairy consumption and iodine prophylaxis.

Texture-modified foods and thickened fluids used in dysphagia: Israeli standardised terminology and definitions

BACKGROUND

Texture-modified foods and thickened fluids are used as a strategy that aims to compensate for dysphagia and improve the safety and efficiency of swallowing. Currently, in Israel, there are no standardised terminologies and definitions for texture-modified diets. The inconsistent terminology adversely affects patient safety and the efficiency of communication between staff members both within and between health institutions. This present study describes a project of the Israeli Ministry of Health in which the labels and definitions of prevalent foods and fluids used in health institutions are mapped to develop a consensus on national standards.

METHODS

A multidisciplinary committee of speech-language pathologists (SLPs) and registered dietitians (RDs) was appointed. A questionnaire was developed to identify the labels of texture-modified foods and fluids used in the Israeli healthcare system. The questionnaire included questions on knowledge, attitudes and barriers related to the need for a consistent national terminology for texture-modified diets. Questionnaires were sent to 120 institutions. The project was conducted between September 2016 and December 2017.

RESULTS

Twenty-six SLPs and 42 RDs responded. The answers revealed that there were 50 labels in use for texture-modified foods. When asked to describe the texture of a particular food item, up to 17 different labels were used. There was broad support for a standardised terminology.

CONCLUSIONS

The results of the present study confirm the lack of national standards in clinical practice and the need for a consistent terminology. A consensus was achieved between the committee members and the committee adopted the International Dysphagia Diet Standardization Initiative (IDDSI) recommendations and adapted the terminology to Hebrew.

Exposure to environmental tobacco smoke in non - smoking adults in Israel: results of the second Israel biomonitoring survey

BACKGROUND

Exposure to environmental tobacco smoke (ETS) increases the risk of heart and respiratory disease, cancer, and premature mortality in non-smoking individuals. Results from the first Israel Biomonitoring Study in 2011 showed that over 60% of non-smoking adults are exposed to ETS. The purpose of the current study was to assess whether policies to restrict smoking in public places have been associated with reductions in exposure to ETS, and to examine predictors of exposure.

METHODS

We analyzed urinary cotinine and creatinine concentrations in 194 adult participants in the National Health and Nutrition (RAV MABAT) Survey in 2015-2016. Study participants were interviewed in person on smoking status and exposure to ETS. We calculated creatinine-adjusted and unadjusted urinary cotinine geometric means and medians among smokers and non-smokers. We analyzed associations in univariable analyses, between socio-demographic variables and self - reported exposure, and urinary cotinine concentrations.

RESULTS

There was no reduction in geometric mean urinary cotinine levels in non-smokers in the current study (1.7 μg/g) compared to that in 2011 (1.6 μg/g). Median cotinine levels among the non - smoking Arab participants were higher in comparison to the Jewish and other participants (2.97 versus 1.56 μg/l, p = 0.035). Participants who reported that they were exposed to ETS at home had significantly higher median levels of creatinine adjusted urinary cotinine than those reporting they were not exposed at home (4.19 μg/g versus 2.9 μg/g, p = 0.0039).

CONCLUSIONS

Despite additional restrictions on smoking in public places in 2012-2016, over 60% of non-smoking adults in Israel continue to be exposed to ETS. Urinary cotinine levels in non-smokers have not decreased compared to 2011. Results indicate higher exposure to ETS in Arab study participants and those reporting ETS exposure at home. There is an urgent need: (1) to increase enforcement on the ban on smoking in work and public places; (2) for public health educational programs and campaigns about the adverse health effects of ETS; and (3) to develop and disseminate effective interventions to promote smoke free homes. Periodic surveys using objective measures of ETS exposure (cotinine) are an important tool for monitoring progress, or lack thereof, of policies to reduce exposure to tobacco smoke in non-smokers.

Cognitive impairment and the association between frailty and functional deficits are linked to abdominal obesity in the elderly

OBJECTIVE

To evaluate whether specific obesity phenotypes in community-dwelling elderly: (a) affect differently the relationship between frailty and functional impairment and (b) are related to cognitive impairment.

STUDY DESIGN

A post-hoc cross-sectional analysis of the last Israeli national health and nutrition survey of the elderly (≥ 65 yrs.; n = 1619).

MAIN OUTCOME MEASURES

We implemented a previously validated frailty model based on frailty-related variables that were obtained in the survey. Mild cognitive impairment was defined using the Mini-Mental State Examination (a score <24 and >17). The Katz's scale of activities of daily living was used for functional assessment. Data were clustered according to different obesity phenotypes using measured body mass index (BMI) and waist circumference (WC).

RESULTS

The link between frailty and disability was most prominent in subjects with abdominal obesity who were non-obese by BMI: compared with non-obese subjects as defined by WC and BMI, the odds ratio (OR) for functional limitations in this phenotype was 8.34 (95 % CI, 2.14-32.48) for pre-frail subjects and 69.26 (10.58-453.55) for frail subjects. The rate of cognitive impairment was 3.3 times higher (p = .023) in women who were obese by WC but not by BMI.

CONCLUSIONS

In elderly people with a large WC and BMI < 30 kg/m², disability is more tightly linked to frailty than for any other form of obesity. Cognitive impairment was more prominent in women with central obesity and BMI < 30 kg/m² than in the other anthropometric phenotypes. WC should be used for early detection of individuals at risk of progression of frailty to functional incapacity.

Estimated frailty prevalence among Israeli elderly - results from a cross sectional national survey

Background

Increasing longevity presents new social and medical challenges in developed countries. The prevalence of frailty is of interest because of its association with health prognosis and outcomes, but so far there is no single best diagnostic tool for this entity. Therefore, estimated prevalence of frailty in countries varies considerably and ranges between 5% and 58%. In Israel, the nation-wide prevalence of frailty in the elderly population is presently unknown. The objective of our study was to assess the rate of the frailty in elderly Israelis.

Methods

A post-hoc analysis based on the results of a national Health and Nutrition Survey in Israeli elderly (MABAT Zahav). A non-direct model to estimate frailty was based on five components that were most similar to the common frailty assessment suggested by Morley et al. The frailty state was then reclassified according to different explanatory variables.

Results

Data collected from 1619 subjects (F/M = 52.9/47.1%) with an average age of 74.6 years were analyzed. Estimated frailty prevalence in the elderly population was 4.9%. Frail people were more likely to have a lower income, be unemployed and have a lower education level. Frailty rates were higher in women, in Jews and in subjects more prone to low physical function.

Conclusions

The estimated frailty prevalence in the Israeli elderly population, while relatively low, is comparable to some of the rates suggested in the literature. The factors associated with frailty in the Israeli population are in accordance with the existing literature. The suggested model may be helpful in identifying frailty in Israeli elderly.

Image-guided fine-needle aspiration cytology of deep-seated enlarged lymph nodes

Purpose: To evaluate the role of image-guided fine-needle aspiration cytology (FNAC) of deep-seated lymph nodes.

Material and Methods: Image-guided FNACs were performed on 242 patients of deep-seated lymph nodes which included thoracic, retroperitoneal and abdominal nodes. A sterile 3.5/5-MHz micro convex sector probe was used for localisation of the node. The FNAC was performed using a 0.7- to 0.9-mm needle with the stylet removed and attached to a 20-ml syringe and FNAC handle after the needle was visualised in the lesion. For each case a minimum of 4-5 smears were made, and two observers without bias interpreted the smears.

Results: A total of 242 patients were aspirated, of which 216 (90%) aspirations were US-guided and the remaining 26 (10%) were CT-guided. Adequate material for cytologic diagnosis was obtained in 208 (86%) patients with a similar diagnostic accuracy. The aspirate material was non-representative or scanty in 34 (14%) patients. The most common cytological diagnosis was tuberculosis/consistent with tuberculosis seen in 108 (45%) patients followed by metastasis (17%) and reactive hyperplasia (10%). Non-Hodgkin lymphoma was diagnosed in 22 (9%) patients. All patients were briefly followed for a period of 1 1/2 to 2 years (mean 1 year).

Conclusion: Image-guided FNAC has a pivotal role, and is a cost-effective tool for establishing tissue diagnosis as a primary investigative modality. It is also helpful and accurate in follow-up of patients with a known malignant disease, thereby avoiding surgical intervention.

Oral Health-Related Quality of Life in the Elderly in Israel--Results from the National Health and Nutrition Survey of the Elderly 2005-2006

PURPOSE

To assess the oral health-related quality of life of the Israeli elderly.

MATERIALS AND METHODS

Data were collected from a subsample of those interviewed for the cross-sectional Mabat Zahav National Health and Nutrition Survey of the Elderly, carried out in 2005 and 2006 by the Ministry of Health in Israel. In-person interviews were conducted in the interviewees' homes using a structured questionnaire which included 7 questions on subjective dental health status and the 14 questions of the Oral Health Impact Profile 14 (OHIP-14). Statistical significance of continuous variables was assessed with the Student t-test; categorical variables with normal distribution were analysed using the chi-square test and those with non-normal distribution with the Wilcoxon Mann-Whitney two-sample test.

RESULTS

828 Jews and 159 Arabs from the total survey population of 1852 elderly (1536 Jews and 316 Arabs) completed the OHIP-14 questionnaire. An impact of oral health on the quality of life was reported by 16.6% of the respondents, 19.2% of females and 13.9% of males (p<0.05). There were statistically significant differences in impact prevalence by gender, place of birth and economic status. No such differences were found by age group, population group or education. Significant statistical correlation was found between subjective assessment of general and dental health and OHIP impact prevalence, with poorer assessment correlated with increased prevalence of impact.

CONCLUSIONS

The quality of life of 17% of Israeli elderly is affected by oral health. The OHIP-14 findings emphasise the importance of including basic dental treatment (treatment of dental pain and infections) in the range of services covered by the National Health Insurance Law.

Urinary concentrations of polycyclic aromatic hydrocarbons in Israeli adults: demographic and life-style predictors

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental pollutants associated with adverse health outcomes, including cancer, asthma, and reduced fertility. Because data on exposure to these contaminants in Israel and the Middle East are very limited this study was conducted to measure urinary levels of PAHs in the general adult population in Israel and to identify demographic and life-style predictors of exposure. We measured concentrations of five PAH metabolites: 1-hydroxypyrene (1OH_pyrene) and four different hydroxyphenanthrenes (1-hydroxyphenanthrene, 2-hydroxyphenanthrene, 3-hydroxyphenanthrene, 4-hydroxyphenanthrene), as well as cotinine in urine samples collected from 243 Israeli adults from the general population. We interviewed participants using structured questionnaires to collect detailed demographic, smoking and dietary data. For over 99% of the study participants, urinary concentration of at least one of the PAHs was above both the limit of detection (LOD) and the limit of quantification (LOQ). All PAHs were significantly correlated (rho=0.67-0.92). Urinary concentration of hydroxyphenanthrenes, but not 1OH_pyrene, was significantly higher among Arabs and Druze study participants (N=56) compared to Jewish participants (N=183). For 4-hydroxyphenanthrene, concentration in Arabs and Druze was 1.95 (95% CI 1.50-2.52) that of Jews, after controlling for creatinine, age and cotinine levels. Urinary concentrations of all PAHs were significantly higher among current smokers or participants with higher cotinine levels and increased significantly with smoking frequency. While PAHs concentrations were not associated with cotinine concentrations in nonsmokers in the overall study population, PAHs concentration was significantly higher among nonsmoking Jews with cotinine ≥LOQ (1μg/L), which represents exposure to environmental tobacco smoking, compared to nonsmoking Jews with cotinine concentrations <LOQ, with the highest ratio for 1OH_pyrene (Ratio=2.38, 95% CI 1.47-3.85). Among nonsmoking Arabs and Druze, higher hydroxyphenanthrenes concentrations were found for those consuming grilled food once a month or more. For 3-hydroxyphenanthrene, concentration in those consuming grilled food once a month or more was 2.72 (95% CI 1.01-4.98) times that of those consuming grilled food less than once a month or not at all, after controlling for creatinine, age and cotinine levels. In conclusion, we found that the general adult population in Israel is widely exposed to PAHs. Exposure differed by ethnic sub-groups both in magnitude and sources of exposure. The finding of higher exposure among Arabs and Druze highlights disparities in environmental exposures across subpopulations and suggests that further research and preventive measure are warranted to reduce PAHs exposure and associated health outcomes, especially in the Arab population in the Middle East.

Mediterranean diet and functional indicators among older adults in non-Mediterranean and Mediterranean countries

BACKGROUND/OBJECTIVES

The Mediterranean diet (MEDDIET) has been shown to be related to longevity. This study aimed to determine the association between adherence to MEDDIET and physical function of older adults in the United-States and Israel.

METHODS

Data from the US National Health and Nutrition Survey (NHANES) 1999-2002 and from the Israeli National Health and Nutrition Survey (MABAT ZAHAV) 2005-2006 were used. Participants with nutritional and functional data were included. Adherence to the MEDDIET was assessed by a 9-unit score (MDS).

RESULTS

Among 2791 NHANES and 1786 MABAT ZAHAV participants, mean age=71.2 y and 74.9 y, 20% and 27% had low MDS (0-2), 66% and 62% had a medium score (3-5), and 14% and 11% had a high score (6-9), respectively. Higher MDS was associated with higher education and better lifestyle behaviors. Cognitive and physical functions were significantly better in NHANES and MABAT ZAHAV among the highest MDS. In NHANES, MDS (high vs. low) was associated with faster walking speed after adjusting for confounders in a logistic regression model [Odds Ratio (OR)=0.71, P=0.034, Cl 95% 0.511-0.974]. When cognitive function was added, the association was attenuated (OR=0.75, P=0.093, Cl 95% 0.540-1.049). In MABAT ZAHAV, in a logistic regression model adjusted among other to cognitive function, MDS (high vs. low) was associated with fewer disabilities (OR=0.51, P=0.029, Cl 95% 0.276-0.934).

CONCLUSIONS

Adherence to the MEDDIET is associated with better health characteristics and better functioning. Further cohort and intervention studies may shed light on temporal and causal relationships between MEDDIET and these parameters.

Exposure to tobacco smoke based on urinary cotinine levels among Israeli smoking and nonsmoking adults: a cross-sectional analysis of the first Israeli human biomonitoring study

Background

Cotinine levels provide a valid measure of exposure to environmental tobacco smoke (ETS). The goal of this study was to examine exposure to tobacco smoke among smoking and nonsmoking Israeli adults and to identify differences in ETS exposure among nonsmokers by socio-demographic factors.

Methods

We analyzed urinary cotinine data from the first Israeli human biomonitoring study conducted in 2011. In-person questionnaires included data on socio-demographic and active smoking status. Cotinine levels were measured using a gas chromatography–mass spectrometry procedure. We calculated creatinine-adjusted urinary cotinine geometric means (GM) among smokers and nonsmokers, and by socio-demographic, smoking habits and dietary factors. We analyzed associations, in a univariable and multivariable analysis, between socio-demographic variables and proportions of urinary cotinine ≥1 μg/l (Limit of Quantification = LOQ) or ≥4 μg/l.

Results

Cotinine levels were significantly higher among 91 smokers (GM = 89.7 μg/g creatinine; 95% confidence interval [CI]: 47.4-169.6) than among 148 nonsmokers (GM = 1.3; 1.1-1.7). Among exclusive waterpipe smokers, cotinine levels were relatively high (GM = 53.4; 95% CI 12.3-232.7). ETS exposure was widespread as 62.2% of nonsmokers had levels ≥ LOQ, and was higher in males (75.8%) than in females (52.3%). In a multivariable model, urinary cotinine ≥ LOQ was higher in males (Prevalence ratio [PR] = 1.30; 95% CI: 1.02-1.64, p = 0.032) and in those with lower educational status (PR = 1.58; 1.04-2.38, p = 0.031) and decreased with age (PR = 0.99; 0.98-1.00, p = 0.020, per one additional year). There were no significant differences by ethnicity, residence type or country of birth.

Conclusions

Our findings indicate widespread ETS exposure in the nonsmoking Israeli adult population, especially among males, and younger and less educated participants. These findings demonstrate the importance of human biomonitoring, were instrumental in expanding smoke-free legislation implemented in Israel on July 2012 and will serve as a baseline to measure the impact of the new legislation.

Urinary concentrations of organophosphate pesticide metabolites in adults in Israel: demographic and dietary predictors

Exposure to organophosphate pesticides (OPs) in agricultural and urban populations has been associated with a range of adverse health effects. The purpose of the current study was to estimate exposure to OPs in the general adult population in Israel and to determine dietary and demographic predictors of exposure. We measured six non-specific organophosphate pesticide metabolites (dialkyl phosphates) in urine samples collected from 247 Israeli adults from the general population. We collected detailed demographic and dietary data from these individuals, and explored associations between demographic and dietary characteristics and urinary dialkyl phosphate concentrations. OP metabolites were detectable in all urine samples. Concentrations of several dialkyl phosphate metabolites (dimethylphosphate, dimethylthiophosphate, diethylphosphate) were high in our study population relative to the general populations in the US and Canada and were comparable to those reported in 2010 in France. Total dialkyl phosphates were higher in individuals with fruit consumption above the 75th percentile. In a multivariate analysis, total molar dialkyl phosphate concentration increased with age and was higher in individuals with high income compared to individuals with the lowest income. Total diethyl metabolite concentrations were higher in females and in study participants whose fruit consumption was above the 75th percentile. In conclusion, we found that levels of exposure to OP pesticides were high in our study population compared to the general population in the US and Canada and that intake of fruits is an important source of exposure.

Urinary concentrations of environmental contaminants and phytoestrogens in adults in Israel

BACKGROUND

The Ministry of Health Biomonitoring Study estimated exposure of individuals in the Israeli population to bisphenol A (BPA), organophosphate (OP) pesticides, phthalates, cotinine, polycyclic aromatic hydrocarbons (PAHs), and the phytoestrogenic compounds genistein and daidzein.

METHODS

In 2011, 250 individuals (ages 20-74) were recruited from five different regions in Israel. Urine samples were collected and questionnaire data were obtained, including detailed dietary data (food frequency questionnaire and 24hour recall). Urinary samples were analyzed for BPA, OP metabolites (dialkyl phosphates), phthalate metabolites, cotinine, PAH metabolites, genistein, and daidzein.

RESULTS AND DISCUSSION

BPA urinary concentrations were above the limit of quantification (LOQ) in 89% of the samples whereas urinary concentrations of phthalate metabolites were above the LOQ in 92-100% of the samples. PAH metabolites were above the LOQ in 63-99% of the samples whereas OP metabolites were above the LOQ in 44-100% of the samples. All non-smoking participants had detectable levels of cotinine in their urine; 63% had levels above the LOQ, and the rate of quantification was high compared to the general non-smoking population in Canada. Median creatinine adjusted concentrations of several OP metabolites (dimethyl phosphate, dimethyl thiophosphate) were high in our study population compared to the general US and Canadian populations. Median creatinine adjusted urinary BPA concentrations in the study population were comparable to those in Belgium and Korea; higher than those reported for the general US, German, and Canadian populations; and very low compared to health-based threshold values. Phthalate concentrations were higher in our study population compared to the general US population but values were very low compared to health-based threshold values. Median creatinine adjusted PAH concentrations were generally comparable to those reported for the general US population; median creatinine adjusted daidzein concentrations were high in our population compared to the general US population whereas genistein concentrations were comparable.

CONCLUSIONS

We interpreted observed urinary contaminant levels observed in our study by comparing values with health-based threshold values and/or values from international human biomonitoring studies. Using this data interpretation scheme, we identified two contaminants as being of potential public health concern and high priority for public health policy intervention: environmental tobacco smoke (ETS) and OP pesticides. We used the data collected in this study to support public health policy interventions. We plan to conduct a follow-up biomonitoring study in 2015 to measure ETS and OP exposure in the general population in Israel, to evaluate the effectiveness of relevant policy interventions.

Loneliness is associated with an increased risk of sedentary life in older Israelis

OBJECTIVES

Both loneliness and insufficient physical activity are common in old age. This study investigated the association between loneliness and adherence to recommended guidelines of physical activity in a national sample of Israelis, and examined whether loneliness was a risk factor for insufficient physical activity independent of other variables.

METHODS

A random sample of 1663 (799 men) older adults aged 65+ reported their physical activity routine, and based on official guidelines were categorized as sufficiently active, insufficiently active, and inactive. In addition, they were divided into lonely or not lonely based on a single question from the Center for Epidemiologic Studies Depression Scale.

RESULTS

Chi-square analyses indicated that loneliness, but not living alone, were inversely related to level of physical activity in both genders. Based on multinomial stepwise logistic regressions body mass index, being religious versus secular, self-rated health, and education were associated with engaging in physical activity in men (Cox & Snell R(2) = 0.202). Loneliness contributed significantly to explaining the level of participation in physical activity beyond these variables in women, but not in men (Cox & Snell R(2) = 0.197).

CONCLUSIONS

Loneliness is associated with an increasing risk of inactivity in advanced age in women. Further research inquiring into whether loneliness is the cause of reduced physical activity or whether physical activity acts as a protective factor against loneliness is needed. Developing and implementing tailored intervention programs that encourage social interaction in combination with a physical activity program are recommended.

Desalination of water: nutritional considerations

BACKGROUND

Desalination of seawater and brackish water (mixed seawater and freshwater) provides an increasing portion of the Israeli drinking water supply. However, desalinated water contains little calcium (Ca) and magnesium (Mg), and consumers may be at risk for deficiencies of these essential minerals.

OBJECTIVES

To assess intakes of Mg and Ca from water, other beverages, and food in communities with different water supplies, and assess the proportion of individuals with intakes below the Estimated Average Requirement (EAR).

METHODS

Telephone interviews were conducted using a food frequency questionnaire to assess Mg and Ca intakes by adults in four communities. The proportion of individuals with Mg and Ca intakes below the EAR were evaluated based on current intakes and on potential intakes assuming that desalinated water had been introduced countrywide.

RESULTS

The proportion of individuals with Mg intake below the EAR was higher in Kibbutz Maagan Michael (30.6%), an agricultural settlement supplied with desalinated water, than in Hadera (16.7%), a city supplied by the National Water Carrier (NWC) (P < 0.05). The proportion of individuals with Ca intake below the EAR was higher in Maagan Michael (61.7%) than in the communities supplied with water from the NWC or mixed water (37.9%-48.2%), P < 0.05.

CONCLUSIONS

Returning Mg and Ca to desalinated water may be beneficial for raising intakes in Israeli communities supplied with desalinated water. Individuals with intake of Mg and/or Ca below the EAR may be at risk for cardiac abnormalities and other medical conditions.

Adolescents' physical activity habits--results from a national health survey

BACKGROUND

  The MABAT Youth National Health and Nutrition Survey was conducted in Israel by the Ministry of Health and the Center for Disease Control. This article presents results of physical activity (PA) habits in Israel, in relation to recommendations by world health organizations.

METHODS

  Participants were 6274 adolescents, grades 7-12, enrolled in a cross-sectional, representative, school-based survey. Sufficient level of PA was defined as any moderate and vigorous level of PA that adds up daily to 60 min/day. Light PA was considered to be an insufficient level of PA.

RESULTS

  Only 10.5% of the participants reported performing sufficient PA. Large gender differences were found, with 17.7% of boys versus only 4.6% of girls meeting the guidelines.

CONCLUSIONS

  Results highlight the need to develop programmes for school children in Israel to promote PA. Such programmes have been initiated in many countries that have a large percentage of adolescents with a sedentary lifestyle.

Prediction of standing height among Israeli older adults: results from a national survey

BACKGROUND

An accurate measurement of full height while standing is sometimes not possible among older adults, in particular among the frail elderly. For such cases, the use of knee height (KH) and ulna bone length (UL) has been suggested for standing height estimation. Studies have shown that predictive equations of height were ethnic-specific.

AIM

This study attempted to develop representative equations to predict standing height based on KH, UL and waist circumference (WC) for older adult Israeli women and men.

SUBJECTS AND METHODS

A random sample of 1500 older adults (aged 74.48 ± 6.09 years old). Participants were interviewed in their homes and measurements of Standing height, KH, UL and WC were taken. A quadratic regression analysis, for each sex separately, was performed to predict standing height based on age, KH, UL and WC.

RESULTS

The adjusted r (2) standing height prediction equations were 0.51 and 0.67 for women and men, respectively.

CONCLUSIONS

The prediction of the standing height of frail elderly Israelis, by KH, UL, WC and age, may be an alternative method when actual standing height is difficult or not possible to measure.

Ethnic differences in patterns of secondhand smoke exposure among adolescents in Israel

INTRODUCTION

Adolescent secondhand smoke exposure (SHSe) is associated with smoking initiation and independently damages health.

METHODS

We used data from the school-based 2003-2004 Israel National Health and Nutrition Youth survey (MABAT) to examine patterns and determinants of SHSe in a multiethnic sample of Israeli adolescents. School and child response rates were high (school: 91.8%, child: 87.9%), with 6,274 participants. We used generalized estimating equations to examine SHSe determinants.

RESULTS

Most Israeli adolescents were exposed to SHS (total: 85.6%; home: 40%; school: 31.4%; entertainment: 73.3%; other: 16.3%). Exposure patterns differed between the Jewish and non-Jewish sectors. Jews were more frequently exposed at school and entertainment venues than were non-Jews but were less frequently exposed at home. Druze were the least exposed and non-Arab Christians the most exposed. Secular Jews were more exposed than were religious Jews; the opposite was true among Arabs. Children of less-educated fathers were exposed more than children of more-educated fathers. Adolescents who smoked were more exposed than were nonsmokers.

CONCLUSIONS

The high levels of SHSe among Israeli adolescents were characterized by different patterns of exposure among different population groups. Interventions to reduce adolescent SHSe, with appropriate tailoring, are urgently needed. These findings provide support for sustainable implementation of the recent governmentally approved tobacco control plan, which includes extended legislation for, and increased enforcement of, laws about smoking bans in schools and entertainment venues. Researchers elsewhere should be aware that levels and patterns of SHSe may vary greatly by subpopulation.

Role of leisure-time physical activity in nonalcoholic fatty liver disease: a population-based study

Physical activity (PA) is commonly recommended for nonalchoholic fatty liver disease (NAFLD) patients. However, there is limited evidence on the independent role of PA in NAFLD. The aim of this study was to examine the association between PA and NAFLD. We conducted a cross-sectional study of a subsample (n = 375) of the Israeli National Health and Nutrition Survey. Exclusion criteria were any known etiology for liver disease. Participants underwent an abdominal ultrasound examination; biochemical tests, including leptin, adiponectin, and resistin; and the noninvasive biomarker SteatoTest and anthropometric evaluations. A semiquantitative food frequency questionnaire and a detailed PA questionnaire were administered. Three hundred forty-nine patients (52.7% men, 30.9% primary NAFLD) were included. The NAFLD group engaged in less aerobic, resistance, or other kinds of PA (P </= 0.03). The SteatoTest was significantly lower among subjects engaging in any PA or resistance PA at least once a week (P </= 0.01). PA at least once a week in all categories was associated with a reduced risk for abdominal obesity. Adjusting for sex, engaging in any kind of sports (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.44-0.96 per 1 standard deviation increment in PA score) and resistance exercise (OR 0.61, 95% CI 0.38-0.85) were inversely associated with NAFLD. These associations remained unchanged after adjusting for homeostasis model assessment, most nutritional factors, adiponectin, and resistin. Only the association with resistance PA remained significant with further adjustment for body mass index (OR 0.61, 95% CI 0.44-0.85). Adding leptin or waist circumference to the model eliminated the statistical significance.

CONCLUSION

Habitual leisure-time PA, especially anaerobic, may play a protective role in NAFLD. This association appears to be mediated by a reduced rate of abdominal obesity.

Relationship between dietary calcium intake, body mass index, and waist circumference in MABAT--the Israeli National Health and Nutrition Study

BACKGROUND

It has been suggested that increased calcium intake plays a role in preventing obesity and promoting weight loss.

OBJECTIVES

To assess the association between calcium intake, body mass index and waist circumference in Israel.

METHODS

MABAT was a cross-sectional survey based on a random sample of 3246 Israelis aged 25 to 64. Of the 3246 survey participants, height and weight measurements were recorded for 2782 (1371 men and 1411 women). These were divided into three groups according to their BMI (group A < or = 24.9, group B 25-29.9, and group C > or = 30) and given a 24 hour dietary recall questionnaire. Waist circumference was measured in 2601 participants (1760 men and 841 women) and was considered to be excessive if > or = 102 cm for men or > or = 88 cm for women.

RESULTS

The mean calcium intake was 511.5 +/- 301.8 mg for group A, 499.4 +/- 283.7 mg for group B, and 464.7 +/- 280.1 mg for group C (group A significantly differed from group C, P < 0.002). The mean daily milk consumption in group A was higher than in groups B and C (103.4 +/- 147.5, 85.7 +/- 122.25, and 84.5 +/- 135.1 g, respectively; P< 0.01). There was no correlation between daily dietary calcium intake and waist circumference for men, but women with a waist circumference below 88 cm consumed significantly more dietary calcium than those with a waist circumference > or = 88 cm (P< 0.03).

CONCLUSIONS

The study confirms the inverse relationship between daily dietary calcium intake and obesity. This linkage relates to the intake of milk, but not to other dairy products.

Determinants of disordered eating behaviors among Israeli adolescent girls

Eating behaviors were assessed by a modified SCOFF questionnaire in a National representative cross-sectional study among 2978 Israeli schoolgirls. The mean age was 14.7. Thirty percent met the criteria for disordered eating. Being Jewish or underweight reduced the odds for disordered eating. The following increased the risk: dieting, early onset of menarche, being overweight or obese, and suffering from constipation. School socio-economic status, physical activity, and smoking status were not contributory. These results help identify possible interventions to prevent the development of disordered eating behaviors.

Long term nutritional intake and the risk for non-alcoholic fatty liver disease (NAFLD): a population based study

BACKGROUND/AIMS

Weight loss is considered therapeutic for patients with NAFLD. However, there is no epidemiological evidence that dietary habits are associated with NAFLD. Dietary patterns associated with primary NAFLD were investigated.

METHODS

A cross-sectional study of a sub-sample (n=375) of the Israeli National Health and Nutrition Survey. Exclusion criteria were any known etiology for secondary NAFLD. Participants underwent an abdominal ultrasound, biochemical tests, dietary and anthropometric evaluations. A semi-quantitative food-frequency questionnaire was administered.

RESULTS

After exclusion, 349 volunteers (52.7% male, mean age 50.7+/-10.4, 30.9% primary NAFLD) were included. The NAFLD group consumed almost twice the amount of soft drinks (P=0.03) and 27% more meat (P<0.001). In contrast, the NAFLD group consumed somewhat less fish rich in omega-3 (P=0.056). Adjusting for age, gender, BMI and total calories, intake of soft drinks and meat was significantly associated with an increased risk for NAFLD (OR=1.45, 1.13-1.85 95% CI and OR=1.37, 1.04-1.83 95% CI, respectively).

CONCLUSIONS

NAFLD patients have a higher intake of soft drinks and meat and a tendency towards a lower intake of fish rich in omega-3. Moreover, a higher intake of soft drinks and meat is associated with an increased risk of NAFLD, independently of age, gender, BMI and total calories.