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Kalash N, Kharroubi S, Ballout R, Saleh F. An exploratory study to assess the knowledge, attitudes and practices of Lebanese residents towards acrylamide. PLoS One 2024; 19:e0300617. [PMID: 38625973 PMCID: PMC11020536 DOI: 10.1371/journal.pone.0300617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/03/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION For years, heat treatment has been an essential method for ensuring mature food that meet the desired quality and safety characteristics. However, this process could lead to the formation of harmful compounds such as acrylamide. In this study we aimed to investigate the knowledge, attitudes and practices (KAPs) of the Lebanese population toward the potential risk associated with acrylamide. MATERIALS & METHODS An online survey (n = 598) was conducted among residents in Lebanon aged 18 years and above. The survey was divided into five sections including participants' sociodemographic characteristics, knowledge, attitude and practice sections, and some questions related to consumer's preferences. RESULTS & DISCUSSION The results showed that the majority of the participants had low food safety knowledge regarding acrylamide. Specifically, 82.9% of the consumers had no idea about the chemical, its formation, the foods with a high risk of acrylamide formation and the health risks associated with its exposure. Despite lack of knowledge, good domestic food practices (storage, pre-treatment) were noticed among participants. Moreover, the majority of consumers (> 80%) showed positive attitude towards proper acrylamide labeling. Participants with a bachelor's degree appeared to have a more positive attitude toward food safety compared to those with no qualifications (p<0.001). CONCLUSION Despite the high consumption of acrylamide by the consumers in Lebanon through fried potatoes, bread, and coffee, the majority have no idea about acrylamide's presence in food, its sources and its adverse health effects. Raising awareness among the public, involving policy makers in addressing the issue of clear labeling and encouraging the adoption of alternative practices to reduce acrylamide are all crucial to protect consumers' health in Lebanon and promote healthier food consumption habits.
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Affiliation(s)
- Nour Kalash
- Department of Nutrition & Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Rouba Ballout
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Fatima Saleh
- Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
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Deeb N, Naja F, Nasreddine L, Kharroubi S, Darwiche N, Hwalla N. Nutrition Knowledge, Attitudes, and Lifestyle Practices That May Lead to Breast Cancer Risk Reduction among Female University Students in Lebanon. Nutrients 2024; 16:1095. [PMID: 38613128 PMCID: PMC11013092 DOI: 10.3390/nu16071095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/13/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Research has identified both nonmodifiable and modifiable risk factors for breast cancer (BC), with accumulating evidence showing that adopting adequate dietary practices could decrease the risk of this disease. This study aimed to assess nutrition knowledge, attitudes, and lifestyle practices (KAP) that may lead to BC risk reduction among female university students in Lebanon and examine the determinants of their practices. A cross-sectional survey was conducted using a convenience sampling method, comprising 356 (response rate: 71.2%) female students at the American University of Beirut aged 18 to 25 years with no history of BC. Participants completed a pre-tested questionnaire addressing the objectives of the study. The modified Bloom's cut-off of 75% was used to categorize knowledge and practice scores as poor or good and attitudes as negative or positive. Large proportions of students had poor knowledge (68.3%), negative attitudes (65.4%), and poor practices (98.0%) scores. Pursuing a health-related major and having a higher GPA were associated with better knowledge and attitudes while being older and having a lower degree of stress were associated with positive attitudes only. Having a lower body mass index (BMI) was associated with better practice scores. Better knowledge significantly predicted higher intake of fruits and vegetables. Overall knowledge and attitudes were significantly correlated with each other, but neither was significantly correlated with overall practice. These findings underscore the importance of implementing public health programs geared towards improving nutrition KAP that may lead to BC risk reduction.
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Affiliation(s)
- Nour Deeb
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Farah Naja
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Nadine Darwiche
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
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Abou Jawdah Y, Ezzeddine N, Fardoun A, Kharroubi S, Sobh H, Atamian HS, Skinner M, Parker B. Biological Control of Three Major Cucumber and Pepper Pests: Whiteflies, Thrips, and Spider Mites, in High Plastic Tunnels Using Two Local Phytoseiid Mites. Plants (Basel) 2024; 13:889. [PMID: 38592899 PMCID: PMC10976136 DOI: 10.3390/plants13060889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
To enhance food security, food safety, and environmental health, a bio-based integrated pest management (BIPM) strategy was evaluated at two coastal locations in Lebanon as an alternative to toxic pesticide sprays in commercial high-arched plastic tunnels common in many countries. The evaluation occurred during two cucumber and pepper cropping seasons: spring and fall. At each site, two commercial tunnels were used; farmers' conventional practices were applied in one tunnel, while the BIPM approach was followed in the second tunnel. In the farmers' practices, a total of 14 sprays of insecticide/acaricide mixtures were applied during the spring growing season, and 6 sprays were applied during the fall. In the BIPM tunnels, hotspot releases of local strains of Amblyseius swirskii and Phytoseiulus persimilis were applied. By the end of the spring season, the number of whitefly nymphs (WFNs)/leaf and thrips/leaf in the pesticide treatment were 4.8 and 0.06, respectively, compared to 0.1 and 0.33, respectively, in the BIPM treatment. Similarly, at the end of the fall season, the WFNs reached 19.7/leaf in the pesticide control as compared to 1.2/leaf in the BIPM treatment, proving the efficacy of A. swirskii. Farmers using conventional acaricides during both cropping seasons failed to control Tetranychus urticae, the two-spotted spider mite (TSSM). However, hotspot releases of P. persimilis were successful in controlling TSSM. By the end of June, the number of TSSMs reached 7.8/leaf in the BIPM treatment compared to 53/leaf in the pesticide treatment. Likewise, in December, TSSM numbers reached 9/leaf in the BIPM treatment compared to 40/leaf in the pesticide treatment. Preliminary observations of pepper showed that both predatory mites (A. swirskii and P. persimilis) gave similar or better efficacy against the three pests. The two local predatory phytoseiid mites seem to be effective in controlling these three major pests and to be adapted to local environmental conditions. A rate of increase of 0.86 was observed for P. persimilis and 0.22 for A. swirskii, in June, when maximum temperatures were close to 40 °C. This also shows a compatibility between the two predators. In conclusion, our BIPM approach was efficient under a Mediterranean climate in arched plastic tunnels with relatively poor aeration.
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Affiliation(s)
- Yusuf Abou Jawdah
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon; (N.E.); (A.F.); (H.S.)
| | - Nour Ezzeddine
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon; (N.E.); (A.F.); (H.S.)
| | - Aya Fardoun
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon; (N.E.); (A.F.); (H.S.)
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon;
| | - Hana Sobh
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon; (N.E.); (A.F.); (H.S.)
| | - Hagop S. Atamian
- Biological Sciences Program, Schmid College of Science and Technology, Chapman University, Orange, CA 92866, USA;
| | - Margaret Skinner
- Department of Plant and Soil Science, College of Agriculture and Life Sciences, University of Vermont, Burlington, VT 05405, USA; (M.S.); (B.P.)
| | - Bruce Parker
- Department of Plant and Soil Science, College of Agriculture and Life Sciences, University of Vermont, Burlington, VT 05405, USA; (M.S.); (B.P.)
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Jomaa L, Diab-El-Harake M, Kharroubi S, Mattar L. Associations Between Food Literacy and Food Insecurity Among College Students in Lebanon: A Cross-Sectional Study. Curr Dev Nutr 2022. [PMCID: PMC9193301 DOI: 10.1093/cdn/nzac051.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives The present study aims to explore the eating and food literacy behaviours of college students in Lebanon and to examine their associations with food insecurity (FI). Methods An online survey was administered among college students enrolled in public and private universities in Lebanon. FI was assessed using the Food and Drug Administration (FAO) eight-item Food Insecurity Experience Scale (FIES), previously validated and used in this context. The eating and food literacy behaviors of college students were assessed using the Eating and Food Literacy Behaviors (EFLBQ) tool. Multiple logistic regression analyses were conducted to investigate the associations of food literacy behaviors with FI. Results FI was reported among 39% of study participants. Approximately half of college students in the study sample reported that they “never” or “seldom” ate a balanced diet (55.6%) and consumed healthy food (47.7%). Less frequent food literacy behaviors reported among college students included: “select healthy foods “(37.5%)”, and” plan what I will eat” (33.2%). However, most college students do “often” or “always” eat foods convenient to them (82.9%) and prepare food made quickly (71.9%). Significant differences were observed in several food literacy behaviors between food secure and insecure students. For instance, food insecure students less frequently buy foods that are healthy (p < 0.001), select healthy foods (p = 0.004), cook healthy foods (p = 0.020) and choose nutritionally balanced meals (p < 0.001) compared to food secure ones. Multiple logistic regression analyses showed that behaviors related to nutrition and food preparation were all statistically independently associated with FI. Food insecure participants were significantly less likely to “choose nutritionally balanced meals (OR = 2.10, 95% CI:1.45,3.03), “read nutrition information before” (OR = 1.93, 95% CI:1.31,2.84), or “buy foods that are healthy” (OR = 1.87, 95% CI:1.26,2.78). In terms of food preparation, food insecure participants were 1.85 times more likely to report that they “never” or “seldom” accurately measure dry food ingredients when preparing food (OR = 1.85, 95% CI:1.30,2.64). Conclusions Findings highlight the need for nutrition education interventions to improve food literacy and alleviate FI among college students in Lebanon. Funding Sources American University of Beirut.
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Kelleher D, Kharroubi S, Doherty E, Baio G, O’Neill C. Examining the Association between Polish Migrant Status and Health Preferences Using a Novel Application of a Smaller Design EQ-5D-5L Valuation Study. Pharmacoecon Open 2022; 6:425-435. [PMID: 35080756 PMCID: PMC9043148 DOI: 10.1007/s41669-021-00314-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Migrants have different utilisation of healthcare services and health-related behaviours than host populations. A potential factor that may contribute to the notable differences in healthcare use and health-related behaviours between migrants and host populations is how these groups value health. Those who place a high value on health have greater healthcare-seeking practices than those who do not. OBJECTIVE The aim of this study was to examine how Polish migrants and native Irish differ in health state utility valuations using a novel application of a smaller design EQ-5D-5L valuation study. METHODS This study uses health preferences as a predictor of how one values health. We examined the EQ-5D-5L health preferences of 119 Polish migrants and 123 native Irish, both residing full-time in Ireland. To do so, we used a novel application of a smaller design EQ-5D-5L valuation study that consisted of 30 health states and a targeted sampling strategy coupled with a Bayesian statistical nonparametric model. We collected data from June 2018 to September 2019. RESULTS Our results highlight that Polish migrants and native Irish differ in their health preferences for and valuation of severe health states. Polish migrants place meaningfully higher utility valuations of 0.1 or more on the three most severe health states compared with the native Irish. CONCLUSION This study can provide an understanding of a potential new factor underpinning some of the disparities in healthcare utilisation and health-related behaviours among migrants and host populations in Europe. This study also provides proof of principle for using a smaller design EQ-5D-5L valuation study to explore differences in health preferences among other minority subgroups, which can otherwise be hard to uncover when using the secondary analysis of national EQ-5D-5L valuation studies.
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Affiliation(s)
- Dan Kelleher
- The Institute for Lifecourse and Society, NUI Galway, Room 2007, Upper Newcastle, Galway, H91C7DK Ireland
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El Solh, PO Box 11-0236, Beirut, Lebanon
| | - Edel Doherty
- Health Economics and Policy Analysis Centre, The Institute for Lifecourse and Society, Upper Newcastle, NUI Galway, National University of Ireland, Galway, H91C7DK Ireland
| | - Gianluca Baio
- Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT UK
| | - Ciaran O’Neill
- Institute of Clinical Sciences, Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Block B, Belfast, BT12 6BA Northern Ireland, UK
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Cheikh Ismail L, Al Dhaheri AS, Ibrahim S, Ali HI, Chokor FAZ, O'Neill LM, Mohamad MN, Kassis A, Ayesh W, Kharroubi S, Hwalla N. Nutritional status and adequacy of feeding Practices in Infants and Toddlers 0-23.9 months living in the United Arab Emirates (UAE): findings from the feeding Infants and Toddlers Study (FITS) 2020. BMC Public Health 2022; 22:319. [PMID: 35168591 PMCID: PMC8848814 DOI: 10.1186/s12889-022-12616-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/20/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Infant and young child feeding practices (IYCF) impact the early and later health status of the population. Limited data is available regarding IYCF in the United Arab Emirates (UAE). This study aimed to evaluate the nutritional status and adequacy of feeding practices, energy, food, and nutrient intakes of UAE infants and toddlers ages 0-23.9 months. METHODS This study is a population-based cross-sectional survey of 276 infants and toddlers aged 0-23.9 months of which 180 were nationals and 96 were Arab non-nationals living in the UAE. Data were collected from the three major emirates: Abu Dhabi, Dubai, and Sharjah. Anthropometry was collected and assessed using WHO Anthro-Survey Analyzer, and a multicomponent age-specific questionnaire was used to evaluate IYCF and sociodemographic characteristics. Usual intake of energy, micronutrients, and macronutrients, including supplements, were collected using multiple-pass 24-h dietary recall and analyzed using the PC-side software. IYCF practices were assessed using the WHO indicators. RESULTS Overall, 4% of children were malnourished, 8% wasted, 15% stunted, 18% at risk of overweight, and 7% overweight and obese. 95% of infants were ever breastfed and 37% exclusively breastfed at 6 months. Around 98% of infants had a timely introduction of complementary food. Macronutrient intake exceeded AMDR for fat, carbohydrates, and protein for 27%, 8% and 2% of toddlers respectively. As for the percentage of those exceeding the ESPGHAN cut-off for free sugars set at 5% of energy intake, 28.6% had excessive intakes overall, 10% in 0-5.9, 21.9% in 6-11.9 and 56.7% in 12-23.9 month. Usual iron intake was below the Estimated Average Requirement (EAR) in 47% of infants 6-11.9 months. Above 12 months, the usual intake of iron and vitamin D were below EAR in 11% and 49% of toddlers respectively. Usual intake exceeded the tolerable upper intake levels (UL) for vitamin A (14 to 18%) and zinc (11 to 22%) across all ages. Approximately 93% of toddlers ages 12-23.9 months did not meet food groups' recommendations for vegetables, 87% for fruits, 48% for milk/dairy, 54% for lean meat and beans, and 33% for grains. CONCLUSIONS This study revealed that a high percentage of infants and toddlers aged 0-23.9 m suffer from a double burden of malnutrition, which is the coexistence of both undernutrition, and overweight and obesity in the same population. In addition to suboptimal feeding practices and inadequate/overconsumption of various nutrients. The findings highlight the need for the development of culturally specific programs aiming to improve the nutritional status of infants and toddlers in the UAE.
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Affiliation(s)
- Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, 27272, United Arab Emirates.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, OX1 2JD, UK
| | - Ayesha S Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, 15551, United Arab Emirates
| | - Sarah Ibrahim
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, Lebanon
| | - Habiba I Ali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, 15551, United Arab Emirates
| | - Fatima Al Zahraa Chokor
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, Lebanon
| | - Lynda M O'Neill
- Nestlé Institute of Health Sciences, Nestlé Research Center, Société des Produits Nestlé S.A., Vers-chez-les-Blanc, 1000, 26, Lausanne, Switzerland
| | - Maysm N Mohamad
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, 15551, United Arab Emirates
| | - Amira Kassis
- Whiteboard Nutrition Science, Beaconsfield, Quebec, Canada
| | - Wafaa Ayesh
- Public Health Protection Department, Dubai Health Authority, Dubai, United Arab Emirates
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, Lebanon.
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Toufeili I, Itani M, MonaZeidan M, Yamani OA, Kharroubi S. Nutritional and Functional Potential of Carob Syrup Versus Date and Maple Syrup. Food Technol Biotechnol 2022; 60:266-278. [PMID: 35910270 PMCID: PMC9295627 DOI: 10.17113/ftb.60.02.22.7419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/08/2022] [Indexed: 11/12/2022] Open
Abstract
Research background. The carob tree (Ceratonia siliqua L.) is grown primarily for its seeds that are utilized in the production of the highly-prized locust bean gum. The material left after the separation of seeds, from the pods, is utilized in the production of a range of traditional products including carob syrup usually in cottage-type industries. The international market penetration of carob syrup is rather limited and, accordingly, scant information exists on their composition and phytochemical properties in comparison with mainstream syrup. The present study aims to determine key chemical parameters, phenolic profiles, and antioxidant properties of carob syrup and benchmark these against those of date and maple syrup.
Experimental approach. Carob syrup was prepared from 19 accessions of the carob, under laboratory conditions, by a similar procedure to those practiced by small-scale producers. The syrup samples were analyzed along with branded samples of date and maple syrup for pH, browning index, proteins, minerals, hydroxymethylfurfural, sugar composition, total phenols, antioxidant capacity, and phenolic profiles.
Results and conclusions. The pH and sugar compositions of the carob syrup were intermediate to those of date and maple syrup. In general, the carob syrup contained more proteins, minerals, phenolic acids and flavonoids, and total phenols, and exhibited higher antioxidant capacity than the date and maple syrup. The carob syrups exhibited excessive browning and contained more, or comparable levels of, hydroxymethylfurfural than the date and maple syrup. The data indicate that carob syrup provides more nutrients and possesses superior antioxidative potentials to date and maple syrup. The high levels of the carcinogenic hydroxymethylfurfural of the carob syrup warrant milder heating regimens in the concentration step during production.
Novelty and scientific contribution. In contrast to studies based on commercial and/or homemade syrup, this work utilized a relatively large number of laboratory-prepared samples for creating a robust database for carob syrup. The results indicated that carob syrup possesses superior health promotion and disease-protection effects than the widely-traded date and maple syrup. In addition to their potential positive contribution to public health, carob syrup has been shown to be a promising candidate for bolstering the economic returns of farmers in carob-producing countries.
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Affiliation(s)
- Imad Toufeili
- Department of Nutrition and Food Sciences, American University of Beirut, Riad El Solh 1107 2020, Beirut, Lebanon
| | - Marwa Itani
- Department of Nutrition and Food Sciences, American University of Beirut, Riad El Solh 1107 2020, Beirut, Lebanon
| | - Mona MonaZeidan
- Department of Nutrition and Food Sciences, American University of Beirut, Riad El Solh 1107 2020, Beirut, Lebanon
| | - Osama Al Yamani
- Toxicology Research and Training Center, Faculty of Health Sciences, American University of Science and Technology, Beirut, Lebanon
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, American University of Beirut, Riad El Solh 1107 2020, Beirut, Lebanon
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Mutare S, Feehan J, Cheikh Ismail L, Ali HI, Stojanovska L, Shehab A, Khair H, Ali R, Hwalla N, Kharroubi S, Hills AP, Fernandes M, Al Dhaheri AS. The First United Arab Emirates National Representative Birth Cohort Study: Study Protocol. Front Pediatr 2022; 10:857034. [PMID: 35463875 PMCID: PMC9021697 DOI: 10.3389/fped.2022.857034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In recent years, the prevalence of non-communicable diseases (NCDs) has escalated. Evidence suggests that there are strong associations between nutrition in early life and the risk of disease in adulthood. This manuscript describes the study protocol of the First United Arab Emirates National Representative Birth Cohort Study (UAE-BCS), with the objective of investigating nutrition and lifestyle factors in the first 1,000 days of life. The main aims of the study are (1) to address critical issues relating to mother and child nutrition and their effect on growth and development, (2) to profile maternal nutrition, child growth, health, and development outcomes in early life, and (3) to study the associations between these factors among the Emirati population in the UAE. METHODS/DESIGN In this study, a multidisciplinary team of researchers was established including credible researchers from the UAE, Lebanon, Australia, and the United Kingdom to launch the First United Arab Emirates 3-year birth cohort study. We aim to recruit 260 pregnant Emirati women within their first trimester, which is defined by the study as from 8 to 12 weeks pregnant, from obstetrics and gynecology clinics in the UAE. Participants will be recruited via face-to-face interviews and will receive a total of 11 visits with 1 visit in each trimester of pregnancy and 8 visits after delivery. Maternal data collection includes, socio-demographic and lifestyle factors, dietary intake, anthropometric measurements, physical activity, maternal psychological state, and blood samples for biochemical analysis. Post-partum, visits will take place when the child is 0.5, 4, 6, 9, 12, 18, and 24 months old, with data collection including infant anthropometric measurements, young child feeding practices, dietary intake, supplement use and the eating environment at home, as well as all maternal data collection described above, apart from blood samples. Additional data collection for the child includes early child developmental assessments taking place at three timepoints: (1) within 2 weeks of birth, (2) at 10-14 months and (3) at 22-26 months of age. Early child developmental assessments for the infant include vision, hearing, cognition, motor skills, social-emotional reactivity, neurodevelopmental, and sleep assessments. DISCUSSION The United Arab Emirates Birth Cohort study protocol provides a standardized model of data collection methods for collaboration among the multisectoral teams within the United Arab Emirates to enrich the quality and research efficiency in early nutrition, thereby enhancing the health of mothers, infants, and children.
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Affiliation(s)
- Sharon Mutare
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Jack Feehan
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Habiba I Ali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Lily Stojanovska
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Abdullah Shehab
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Howaida Khair
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Raghib Ali
- Public Health Research Centre, New York University, Abu Dhabi, United Arab Emirates
| | - Nahla Hwalla
- Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Samer Kharroubi
- Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Michelle Fernandes
- MRC Lifecourse Epidemiology Centre and Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Ayesha Salem Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Jomaa L, Hamamji S, Kharroubi S, Diab-El-Harakeh M, Al Zahraa Chokor F, Nasreddine L. Dietary intakes, sources, and determinants of free sugars amongst Lebanese children and adolescents: findings from two national surveys. Eur J Nutr 2021; 60:2655-2669. [PMID: 33389083 DOI: 10.1007/s00394-020-02444-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/12/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE To determine the intake levels, dietary sources, and determinants of free sugars (FS) consumption amongst Lebanese children and adolescents. METHODS This study is based on data collected by two national cross-sectional surveys conducted on representative samples of Lebanese children: survey 1 (under-five years (U5) children) (n = 899) and survey 2 (5-18 years-old children) (n = 1133). Multi-component questionnaires were used for data collection. Dietary intakes were assessed using one 24 h dietary recall. Median daily intakes of FS, and percent contribution of various food groups to FS intake were compared between sex and age groups. Logistic regressions were conducted to explore the determinants of high FS intake (> 10% energy intake/d), as per the WHO recommendations. RESULTS Median contribution of FS to daily energy intake was 8.5% in U5 children and 11.9% amongst those aged 5-18 years old. The top contributors to FS in both surveys were sugar-sweetened beverages and biscuits and chocolates. The proportion of children and adolescents exceeding WHO upper limits for FS was estimated at 43 and 62% in survey 1 and survey 2, respectively. Regression models showed females, higher household monthly incomes and higher parental educational levels were associated with significantly lower odds of exceeding the WHO upper limit for FS. CONCLUSION The study showed that a high proportion of Lebanese children and adolescents exceeded the WHO upper limit for FS intake, while also documenting a socioeconomic gradient in FS intake. Findings call for devising food system-based interventions to help reduce FS intake in this nutritionally vulnerable age group.
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Affiliation(s)
- Lamis Jomaa
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Samer Hamamji
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Marwa Diab-El-Harakeh
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Fatima Al Zahraa Chokor
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107-2020, Lebanon.
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10
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Alame M, Kaddoura M, Kharroubi S, Ezzeddine F, Hassan G, Diab El-Harakeh M, Al Ariqi L, Abubaker A, Zaraket H. Uptake rates, knowledge, attitudes, and practices toward seasonal influenza vaccination among healthcare workers in Lebanon. Hum Vaccin Immunother 2021; 17:4623-4631. [PMID: 34292126 DOI: 10.1080/21645515.2021.1948783] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Despite recommendations and their occupational risk to influenza infection vaccine hesitancy remains a challenge among healthcare workers (HCWs). No studies have been conducted in Lebanon to assess the influenza vaccine's acceptance among HCWs. We conducted a survey to assess factors associated with vaccine uptake and practices among HCWs in Lebanon. Only 40.4% of the HCWs reported receiving the 2018-2019 seasonal vaccine and 1 out 5 routinely received the seasonal vaccine. One-third of the HCWs reported having free access to the influenza vaccine. The willingness to receive the vaccine decreased had it been offered for a fee. Self, family and community protection (55.5%) was a key vaccination enabler. While, viral evolution, concerns regarding vaccine efficacy and side effects, and cost of vaccine ranked as top vaccination barriers. The majority of the HCWs (75%) recommended the vaccine to their patients. Past influenza vaccination (Odds ratio (OR) = 2.37, CI 1.48,3.79), willingness to receive the vaccine for free (OR = 6.93, CI 4.27-11.34) or having diagnosed influenza (OR = 1.81, CI 1.12-2.92) were significantly associated with HCWs' willingness to recommend the vaccine to patients. Better knowledge about influenza and vaccination was strongly associated with the willingness to receive and recommend the vaccine (p < .001). The vaccination rate among HCWs in Lebanon was suboptimal despite the positive attitudes toward the influenza vaccine. Interventions that enhance vaccine accessibility and knowledge are warranted to improve vaccination coverage among HCWs.
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Affiliation(s)
- Malak Alame
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Malak Kaddoura
- Department of Experimental Pathology, Immunology & Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Center for Infectious Diseases Research, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Fatima Ezzeddine
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Ghadir Hassan
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Marwa Diab El-Harakeh
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Lubna Al Ariqi
- Infectious Hazards Management Unit, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Abdinasir Abubaker
- Infectious Hazards Management Unit, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Hassan Zaraket
- Department of Experimental Pathology, Immunology & Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Center for Infectious Diseases Research, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
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11
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Dagher LA, Hassan J, Kharroubi S, Jaafar H, Kassem II. Nationwide Assessment of Water Quality in Rivers across Lebanon by Quantifying Fecal Indicators Densities and Profiling Antibiotic Resistance of Escherichia coli. Antibiotics (Basel) 2021; 10:antibiotics10070883. [PMID: 34356804 PMCID: PMC8300662 DOI: 10.3390/antibiotics10070883] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/02/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022] Open
Abstract
The use of contaminated water has been associated with severe disease outbreaks. Due to widespread pollution with untreated sewage, concerns have been raised over water quality in Lebanon, a country with well-documented challenges in infrastructure. Here, we evaluated the water quality of major rivers in Lebanon by quantifying the densities of fecal indicator bacteria (fecal coliforms and Escherichia coli). Additionally, we assessed the dissemination of antibiotic-resistant E. coli in river water. Composite water samples (n = 132) were collected from fourteen rivers, and 378 E. coli were isolated and analyzed. Fecal coliforms and E. coli were detected in 96.29% and 95.5% of the samples, respectively. Additionally, 73.48–61.3% and 31.81% of the samples exceeded the microbiological acceptability standards for irrigation and the fecal coliform limit for recreational activities, respectively. The E. coli exhibited resistance to ampicillin (40% of isolates), amoxicillin + clavulanic acid (42%), cefepime (4%), cefotaxime (14%), cefalexin (46%), cefixime (17%), doripenem (0.3%), imipenem (0.5%), gentamicin (6%), kanamycin (9%), streptomycin (35%), tetracycline (35%), ciprofloxacin (10%), norfloxacin (7%), trimethoprim-sulfamethoxazole (32%), and chloramphenicol (13%). Notably, 45.8% of the isolates were classified as multidrug resistant (MDR). Our results highlight the need to urgently address fecal pollution and the dissemination of antibiotic resistance in Lebanese rivers.
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Affiliation(s)
- Lea A. Dagher
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (L.A.D.); (S.K.)
| | - Jouman Hassan
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223, USA;
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (L.A.D.); (S.K.)
| | - Hadi Jaafar
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon;
| | - Issmat I. Kassem
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (L.A.D.); (S.K.)
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223, USA;
- Correspondence:
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12
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Omais S, Kharroubi S, Zaraket H. No association between the SARS-CoV-2 variants and mortality rates in the Eastern Mediterranean Region. Gene 2021; 801:145843. [PMID: 34274478 PMCID: PMC8282436 DOI: 10.1016/j.gene.2021.145843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 07/13/2021] [Indexed: 01/04/2023]
Abstract
As the novel coronavirus SARS-CoV-2 continues to spread in all countries, there is a growing interest in monitoring and understanding the impact of emerging strains on virus transmission and disease severity. Here, we analyzed SARS-CoV-2 genomic sequences reported in the Eastern Mediterranean Region (EMR) countries, as of 1 January 2021. The majority (~75%) of these sequences originated from three out of 22 EMR countries, and 65.8% of all sequences belonged to GISAID clades GR, GH, G and GV. A delay ranging between 30 and 150 days from sample collection to sequence submission was observed across all countries, limiting the utility of such data in informing public health policies. We identified ten common non-synonymous mutations represented among SARS-CoV-2 in the EMR and several country-specific ones. Two substitutions, spike_D614G and NSP12_P323L, were predominantly concurrent in most countries. While the single incidence of NSP12_P323L was positively correlated with higher case fatality rates in EMR, no such association was established for the double (spike_D614G and NSP12_P323L) concurrent variant across the region. Our study identified critical data gaps in EMR highlighting the importance of enhancing surveillance and sequencing capacities in the region.
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Affiliation(s)
- Saad Omais
- Department of Biology, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Hassan Zaraket
- Faculty of Medicine, Center for Infectious Diseases Research, American University of Beirut, Beirut 1107 2020, Lebanon; Department of Experimental Pathology, Faculty of Medicine, Immunology & Microbiology, American University of Beirut, Beirut 1107 2020, Lebanon.
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13
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Hwalla N, Jomaa L, Hachem F, Kharroubi S, Hamadeh R, Nasreddine L, Naja F. Promoting Sustainable and Healthy Diets to Mitigate Food Insecurity Amidst Economic and Health Crises in Lebanon. Front Nutr 2021; 8:697225. [PMID: 34249999 PMCID: PMC8270169 DOI: 10.3389/fnut.2021.697225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/28/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction: Lebanon, a middle-income Eastern Mediterranean country, continues to face detrimental economic, health and socio-political challenges that are further exacerbated by the COVID-19 pandemic. In parallel, the country has been experiencing a remarkable nutrition transition that has contributed to the burden of malnutrition and non-communicable diseases, all imposing serious repercussions on people's livelihoods, food security, and health. Such circumstances have prodded public demand for guidance on affordable, healthy, and sustainable dietary choices to alleviate the burden to this emerging unfortunate situation. Objective: The purpose of this study is to provide evidence-based sustainable and healthy dietary recommendations which balance the tradeoffs among the health, environmental footprint and cost dimensions of sustainability, while closely resembling the usual food consumption pattern. Methodology: Data from the latest available national food consumption survey was used as the usual food consumption pattern of Lebanese adults. Optimized dietary patterns were calculated using the optimization model Optimeal which produced patterns most similar to the usual diet and simultaneously satisfying the three main sets of constraints: health, environmental footprints, and cost. The identified healthy and sustainable dietary options were vetted by multiple key stakeholders from the government, academia, international, and national non-governmental organizations. Results: Compared to the usual intake, the optimized diet included higher intakes of whole grain bread, dark green vegetables, dairy products, and legumes, and lower intakes of refined bread, meat, poultry, added sugars, saturated fat, as compared to usual national mean consumption. The optimized dietary model resulted in a decrease in the associated environmental footprints: water use (-6%); and GHG (-22%) with no change in energy use. The cost of the optimized diet was not different from that of the usual intake. Conclusion: An evidence-based sustainable and healthy diet was developed for Lebanon providing the population and policy makers with some answers to a complex situation. Findings highlight the need for the development of sustainable food based dietary guidelines for Lebanon to promote diets that are healthy, sustainable, culturally acceptable, and affordable and that can alleviate food insecurity among the general population.
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Affiliation(s)
- Nahla Hwalla
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Lamis Jomaa
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Fatima Hachem
- Nutrition and Food Systems Division, Food and Agricultural Organization of the United Nations, Rome, Italy
| | - Samer Kharroubi
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Rena Hamadeh
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Farah Naja
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical & Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
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14
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Jomaa L, Harake MDE, Kharroubi S, Zabaneh J. Sex-Based Differentials in the Prevalence and Determinants of Food Insecurity and Its Association With Measures of Wellbeing in Arab Countries. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab045_035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
This study aimed to: 1- compare the prevalence and trends of food insecurity (FI) within Arab countries using a gender lens; and 2- explore the sociodemographic determinants of FI and its association with measures of wellbeing, by sex.
Methods
Data for the present study were drawn from four waves of the Gallup World Poll (GWP) surveys for years 2014–2017, covering 18 Arab countries (n = 65,903). Surveys included questions about FI, socio-demographic characteristics, social support, well-being indices (e.g., global well-being index). For this analysis, mild+ (mild, moderate and severe FI), moderate+ (moderate and severe FI), and severe FI were calculated. Multiple logistic regression analyses were performed to explore the association of socioeconomic variables (e.g., education, employment and social support), emotional wellbeing and sex interactions with the likelihood of experiencing FI in the study population, whilst controlling for country and year.
Results
On average, 42%, 24%, and 11% of the study population experienced mild+, moderate + and severe FI, respectively. Significant sex-differences in FI prevalence were observed across Arab countries. Multiple regression analyses showed that older age females, unemployed, or those with low social support had significantly higher odds of experiencing mild+, moderate + and severe FI, whereas females with higher educational or those who were married had lower odds of FI (P < 0.05). Further, females experiencing mild+, moderate + and severe FI had significantly lower odds of reporting a thriving global well-being compared to food secure males (OR = 0.43, 95% CI: 0. 38, 0.48; OR = 0.43, 95% CI: 0. 37, 0.49; OR = 0.51, 95% CI: 0.41, 0.64, respectively).
Conclusions
Females in the Arab region experience different forms of FI and have significantly lower subjective wellbeing compared to males. Findings highlight the need for developing policies and programs that address gender disparities in employment; land and asset ownership; and access to services such as education, health care and technology. Negative gender social norms and attitudes need to be also challenged to alleviate FI and improve overall wellbeing of women in the Arab world.
Funding Sources
This study was partially funded by the University Research Board at the American University of Beirut.
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15
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Daghir N, Diab-El-Harake M, Kharroubi S. Poultry production and its effects on food security in the Middle Eastern and North African region. J APPL POULTRY RES 2021. [DOI: 10.1016/j.japr.2020.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Kharroubi S, Nasser NA, El-Harakeh MD, Sulaiman AA, Kassem II. First Nation-Wide Analysis of Food Safety and Acceptability Data in Lebanon. Foods 2020; 9:foods9111717. [PMID: 33266478 PMCID: PMC7700422 DOI: 10.3390/foods9111717] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022] Open
Abstract
The challenges to food safety in Lebanon are numerous and have coalesced to pose a serious public health concern. This is evident in well-documented food poisoning outbreaks and adulteration cases. In response, the Lebanese government initiated an unprecedented food safety campaign (2015–2017) that aimed to test food samples that were randomly collected from foodservices and industries across the country. The data were made available publicly, but they were never analyzed to prioritize and determine high risk foods and most prevalent contaminants nationally or across governorates. To answer these questions, we performed an in-depth statistical analysis of the data, which included 11,625 individual food samples. Our analysis showed that water (55% of tested water samples), spices (49.3%), red meat (34.4%), poultry (30.9%) and dairy (28.3%) were the main foods associated with the highest rejection rates. The most common biological contaminants detected in rejected foods were sulfate-reducing bacteria (34.7%), Escherichia coli (32.1%), coliforms (19.6%), Staphylococcus aureus (12.8%), and Salmonella (11.6%). We conclude that Lebanon needs rigorous and sustainable programs to monitor the quality and safety of foods. Given the lack of resources, we recommend putting emphasis on extensive outreach programs that aim at enhancing food safety knowledge from farm to fork.
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Affiliation(s)
- Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (S.K.); (M.D.E.-H.); (A.A.S.)
| | - Nivin A. Nasser
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223-1797, USA;
| | - Marwa Diab El-Harakeh
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (S.K.); (M.D.E.-H.); (A.A.S.)
| | - Abdallah Alhaj Sulaiman
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (S.K.); (M.D.E.-H.); (A.A.S.)
| | - Issmat I. Kassem
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (S.K.); (M.D.E.-H.); (A.A.S.)
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223-1797, USA;
- Correspondence: or
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17
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Abstract
As the Coronavirus Disease 2019 (COVID-19) pandemic progresses, countries around the world are increasingly implementing a range of responses that are intended to help prevent the transmission of this disease. In the absence of a COVID-19 vaccine, we assess the potential role of containment measures to suppress the virus transmission, thereby slowing down the growth rate of cases and rapidly reducing case incidence. The aim of this study is to show that country lockdown has a critical and significant impact on the pandemic. This is explored using real time incidence data in Lebanon. We analyze COVID-19 cases in Lebanon before and after lockdown measures have been implemented. The findings show that the nationwide lockdown was effective in reducing cases and has been successful in, so far, containing the virus. This study could be an evidence-based call to continue with the lockdown measures, based on real time incidence data. Further research is encouraged.
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Affiliation(s)
- Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Fatima Saleh
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
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18
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Habib-Mourad C, Ghandour LA, Maliha C, Dagher M, Kharroubi S, Hwalla N. Impact of a Three-Year Obesity Prevention Study on Healthy Behaviors and BMI among Lebanese Schoolchildren: Findings from Ajyal Salima Program. Nutrients 2020; 12:nu12092687. [PMID: 32899135 PMCID: PMC7551295 DOI: 10.3390/nu12092687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022] Open
Abstract
Most school-based obesity prevention programs in low- to middle-income countries are of short duration, and few undertake follow-up analyses after the termination of the project. The aims of the current study are to investigate (1) the long-term effects of a school-based intervention program when implemented over two years on body mass index (BMI), healthy dietary behaviors, and physical activity (PA); and (2) whether the effects are sustained after one-year washout. The study is a cluster-randomized trial; 36 public and private schools were randomized into either intervention or control groups. Students (8–12 years) completed pre-and post-assessment anthropometric measurements and questionnaires about their eating and physical activity habits. Students in the intervention groups received the program components for two consecutive years. Multiple logistic regression models were used to examine the effect of the intervention on BMI and healthy behaviors. Students in the intervention groups were less likely to be overweight at washout, only in public schools. The number of children reporting change in dietary behaviors significantly increased in intervention groups, with a sustained effect only in public schools. Policies aiming at securing a positive nutrition environment in schools, and adoption of nutrition programs, are needed for achieving sustained behavior and prompting BMI changes in children.
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Affiliation(s)
- Carla Habib-Mourad
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
| | - Lilian A. Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut 11-0236, Lebanon;
| | - Carla Maliha
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
| | - Michèle Dagher
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
- Correspondence: ; Tel.: +961-1-35-0000 (ext. 4443)
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Jomaa L, Hamamji S, Kharroubi S, Harake MDE, Nasreddine L. Dietary Intakes, Sources, and Determinants of Total and Free Sugar Consumption Among Lebanese Children and Adolescents: Findings from a National Study. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa061_049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
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.
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Naja F, Itani L, Kharroubi S, Diab El Harake M, Hwalla N, Jomaa L. Food insecurity is associated with lower adherence to the Mediterranean dietary pattern among Lebanese adolescents: a cross-sectional national study. Eur J Nutr 2020; 59:3281-3292. [PMID: 31900578 DOI: 10.1007/s00394-019-02166-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Farah Naja
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon
| | - Leila Itani
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, PO Box 11-5020, Riad El Solh, Beirut, 1107-2809, Lebanon
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon
| | - Marwa Diab El Harake
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon
| | - Lamis Jomaa
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon.
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Nasreddine L, Bachir N, Kharroubi S, Chamieh MC, Mehio Sibai A, Hwalla N, Naja F. Anthropometric Cutoffs for Increased Cardiometabolic Risk Among Lebanese Adults: A Cross-Sectional Study. Metab Syndr Relat Disord 2019; 17:486-493. [DOI: 10.1089/met.2019.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Nivine Bachir
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Marie Claire Chamieh
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Abla Mehio Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Farah Naja
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
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Jomaa L, Naja F, Kharroubi S, Itani L, Hwalla N. A Lebanese Mediterranean Dietary Pattern Is Associated with Lower Food Insecurity Among Lebanese Adolescents: A Cross-Sectional National Study (P04-055-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz051.p04-055-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
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.
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Hijazi MA, Shatila H, El-Lakany A, Aboul Ela M, Kharroubi S, Alameddine M, Naja F. Beliefs, practices and knowledge of community pharmacists regarding complementary and alternative medicine: national cross-sectional study in Lebanon. BMJ Open 2019; 9:e025074. [PMID: 30852542 PMCID: PMC6429928 DOI: 10.1136/bmjopen-2018-025074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Pharmacists are uniquely positioned to provide patients with evidence-based information in order to ensure effective and safe use of Complementary and alternative medicine (CAM) products. OBJECTIVE Assess beliefs, practices and knowledge related to CAM products among community pharmacists in Lebanon. DESIGN, METHODS AND SETTING Using stratified random sampling, a nationally representative survey was conducted among community pharmacists in Lebanon. Through face-to-face interviews, pharmacists completed a multicomponent questionnaire consisting of four sections: (1) sociodemographic characteristics; (2) beliefs related to regulation of CAM products, role of media in promoting their safe use, availability of resources and continuing education; (3) practices including selling CAM products, providing advice for patients and reporting adverse effects and (4) knowledge about specific CAM products, their uses, side effects and interactions. RESULTS A total of 341 pharmacists agreed to participate (response rate: 86%). Only pharmacists with complete data were included in this study (n=310). Pharmacists agreed that CAM products are effective (63.8%) and that they should be exclusively sold in pharmacies (80.3%), but disagreed that commercially marketed CAM products are well regulated (63.5%) and that media plays a positive role in educating users about these products (55.8%). As for practices, 64.5% of pharmacists were always or often advising patients on safe use; however, 74.2% of participants rarely or never reported adverse effects. Regarding knowledge, although the majority of pharmacists were aware of the uses of CAM products, fewer knew about their side effects and their interactions with drugs. After adjustment for covariates, receiving education/training on CAM products during university was the sole predictor of higher knowledge score (ß=0.68, 95% CI 0.29 to 1.07). CONCLUSIONS This study revealed positive beliefs of pharmacists in Lebanon towards CAM products and indicated important gaps in their practice and knowledge. Deliberate efforts to enhance the education of pharmacists are warranted to ensure the safe integration and use of CAM products in Lebanon.
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Affiliation(s)
- Mohamad Ali Hijazi
- Department of Pharmaceutical Sciences, Beirut Arab University, Beirut, Lebanon
| | - Hibeh Shatila
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Abdalla El-Lakany
- Department of Pharmaceutical Sciences, Beirut Arab University, Beirut, Lebanon
| | - Maha Aboul Ela
- Department of Pharmaceutical Sciences, Beirut Arab University, Beirut, Lebanon
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Mohamad Alameddine
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Strategy & Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences College of Medicine, Dubai, Dubai, United Arab Emirates
| | - Farah Naja
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
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El Harake MD, Kharroubi S, Hamadeh SK, Jomaa L. Impact of a Pilot School-Based Nutrition Intervention on Dietary Knowledge, Attitudes, Behavior and Nutritional Status of Syrian Refugee Children in the Bekaa, Lebanon. Nutrients 2018; 10:E913. [PMID: 30018221 PMCID: PMC6073287 DOI: 10.3390/nu10070913] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/10/2018] [Accepted: 07/13/2018] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Marwa Diab El Harake
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0.236, Riad El Solh, Beirut 11072020, Lebanon.
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0.236, Riad El Solh, Beirut 11072020, Lebanon.
| | - Shadi K Hamadeh
- Environment and Sustainable Development Unit, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0.236, Riad El Solh, Beirut 11072020, Lebanon.
| | - Lamis Jomaa
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0.236, Riad El Solh, Beirut 11072020, Lebanon.
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Naja F, Shivappa N, Nasreddine L, Kharroubi S, Itani L, Hwalla N, Mehio Sibai A, Hebert JR. Role of inflammation in the association between the western dietary pattern and metabolic syndrome among Lebanese adults. Int J Food Sci Nutr 2017; 68:997-1004. [PMID: 28420273 DOI: 10.1080/09637486.2017.1312297] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Farah Naja
- a Nutrition and Food Sciences Department, Faculty of Agricultural and Food Sciences , American University of Beirut , Beirut , Lebanon
| | - Nitin Shivappa
- b Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,c Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA.,d Connecting Health Innovations LLC (CHI) , Columbia , SC , USA
| | - Lara Nasreddine
- a Nutrition and Food Sciences Department, Faculty of Agricultural and Food Sciences , American University of Beirut , Beirut , Lebanon
| | - Samer Kharroubi
- a Nutrition and Food Sciences Department, Faculty of Agricultural and Food Sciences , American University of Beirut , Beirut , Lebanon
| | - Leila Itani
- e Department of Nutrition and Dietetics, Faculty of Health Sciences , Beirut Arab University , Beirut , Lebanon
| | - Nahla Hwalla
- a Nutrition and Food Sciences Department, Faculty of Agricultural and Food Sciences , American University of Beirut , Beirut , Lebanon
| | - Abla Mehio Sibai
- f Department of Epidemiology and Population Health, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - James R Hebert
- b Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,c Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA.,d Connecting Health Innovations LLC (CHI) , Columbia , SC , USA
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Abstract
Partial expected value of perfect information (EVPI) calculations can quantify the value of learning about particular subsets of uncertain parameters in decision models. Published case studies have used different computational approaches. This article examines the computation of partial EVPI estimates via Monte Carlo sampling algorithms. The mathematical definition shows 2 nested expectations, which must be evaluated separately because of the need to compute a maximum between them. A generalized Monte Carlo sampling algorithm uses nested simulation with an outer loop to sample parameters of interest and, conditional upon these, an inner loop to sample remaining uncertain parameters. Alternative computation methods and shortcut algorithms are discussed and mathematical conditions for their use considered. Maxima of Monte Carlo estimates of expectations are biased upward, and the authors show that the use of small samples results in biased EVPI estimates. Three case studies illustrate 1) the bias due to maximization and also the inaccuracy of shortcut algorithms 2) when correlated variables are present and 3) when there is nonlinearity in net benefit functions. If relatively small correlation or nonlinearity is present, then the shortcut algorithm can be substantially inaccurate. Empirical investigation of the numbers of Monte Carlo samples suggests that fewer samples on the outer level and more on the inner level could be efficient and that relatively small numbers of samples can sometimes be used. Several remaining areas for methodological development are set out. A wider application of partial EVPI is recommended both for greater understanding of decision uncertainty and for analyzing research priorities.
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Affiliation(s)
- Alan Brennan
- School of Health and Related Research, The University of Sheffield, Sheffield, England.
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McCabe C, Edlin R, Meads D, Brown C, Kharroubi S. Constructing indirect utility models: some observations on the principles and practice of mapping to obtain health state utilities. Pharmacoeconomics 2013; 31:635-41. [PMID: 23832811 DOI: 10.1007/s40273-013-0071-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The construction of mapping models is an increasingly popular mechanism for obtaining health state utility data to inform economic evaluations in health care. There is great variation in the sophistication of the methods utilized but to date very little discussion of the appropriate theoretical framework to guide the design and evaluation of these models. In this paper, we argue that recognizing mapping models as a form of indirect health state valuation allows the use of the framework described by Dolan for the measurement of social preferences over health. Using this framework, we identify substantial concerns with the method for valuing health states that is implicit in indirect utility models (IUMs), the conflation of two sets of respondents' values in such models, and the lack of a structured and statistically reasonable approach to choosing which states to value and how many observations per state to require in the estimation dataset. We also identify additional statistical challenges associated with clustering and censoring in the datasets for IUMs, additional to those attributable to the descriptive systems, and a potentially significant problem with the systematic understatement of uncertainty in predictions from IUMs. Whilst recognizing that IUMs appear to meet the needs of reimbursement organizations that use quality-adjusted life years in their appraisal processes, we argue that current proposed quality standards are inadequate and that IUMs are neither robust nor appropriate mechanisms for estimating utilities for use in cost-effectiveness analyses.
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Affiliation(s)
- Christopher McCabe
- Capital Health Endowed Research Chair, Faculty of Medicine and Dentistry, University of Alberta, Suite 736 University Terrace, 8303 112 Street, Edmonton, AB, T6G 2T4, Canada.
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Abstract
The Expected Value of Information Framework has been proposed as a method for identifying when health care technologies should be immediately reimbursed and when any reimbursement should be withheld while awaiting more evidence. This framework assesses the value of obtaining additional evidence to inform a current reimbursement decision. This represents the burden of not having the additional evidence at the time of the decision. However, when deciding whether to reimburse now or await more evidence, decision makers need to know the value of investing in more research to inform a future decision. Assessing this value requires consideration of research costs, research time, and what happens to patients while the research is undertaken and after completion. The investigators describe a development of the calculation of the expected value of sample information that assesses the value of investing in further research, including an only-in-research strategy and an only-with-research strategy.
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Affiliation(s)
- Peter S Hall
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK (PSH, RE, CM),Clinical Trials Research Unit, University of Leeds, Leeds, UK (PSH, WG),St James Institute of Oncology, Leeds Teaching Hospitals NHS Trust (PSH)
| | - Richard Edlin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK (PSH, RE, CM)
| | - Samer Kharroubi
- Department of Mathematics, University of York, York, UK (SK)
| | - Walter Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds, UK (PSH, WG)
| | - Christopher McCabe
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK (PSH, RE, CM)
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Brazier JE, Fukuhara S, Roberts J, Kharroubi S, Yamamoto Y, Ikeda S, Doherty J, Kurokawa K. Estimating a preference-based index from the Japanese SF-36. J Clin Epidemiol 2009; 62:1323-31. [PMID: 19615856 DOI: 10.1016/j.jclinepi.2009.01.022] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 01/22/2009] [Accepted: 01/27/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The main objective of the study was to estimate a preference-based Short Form (SF)-6D index from the SF-36 for Japan and compare it with the UK results. STUDY DESIGN AND SETTING The SF-6D was translated into Japanese. Two hundred and forty-nine health states defined by this version of the SF-6D were then valued by a representative sample of 600 members of the Japanese general population using standard gamble (SG). These health-state values were modeled using classical parametric random-effect methods with individual-level data and ordinary least squares (OLS) on mean health-state values, together with a new nonparametric approach using Bayesian methods of estimation. RESULTS All parametric models estimated on Japanese data were found to perform less well than their UK counterparts in terms of poorer goodness of fit, more inconsistencies, larger prediction errors and bias, and evidence of systematic bias in the predictions. Nonparametric models produce a substantial improvement in out-of-sample predictions. The physical, role, and social dimensions have relatively larger decrements than pain and mental health compared with those in the United Kingdom. CONCLUSION The differences between Japanese and UK valuations of the SF-6D make it important to use the Japanese valuation data set estimated using the nonparametric Bayesian technique presented in this article.
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Kharroubi S, Brazier JE, O'Hagan A. Modelling covariates for the SF-6D standard gamble health state preference data using a nonparametric Bayesian method. Soc Sci Med 2006; 64:1242-52. [PMID: 17157971 DOI: 10.1016/j.socscimed.2006.10.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Indexed: 10/23/2022]
Abstract
It has long been recognised that respondent characteristics can impact on the values they give to health states. This paper reports on the findings from applying a non-parametric approach to estimate the covariates in a model of SF-6D health state values using Bayesian methods. The data set is the UK SF-6D valuation study, where a sample of 249 states defined by the SF-6D (a derivate of the SF-36) was valued by a sample of the UK general population using standard gamble. Advantages of the nonparametric model are that it can be used to predict scores in populations with different distributions of characteristics and that it allows for an impact to vary by health state (whilst ensuring that full health passes through unity). The results suggest an important age effect, with sex, class, education, employment and physical functioning probably having some effect, but the remaining covariates having no discernable effect. Adjusting for covariates in the UK sample made little difference to mean health state values. The paper discusses the implications of these results for policy.
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