Nada Adra

Nutrition transition and cardiovascular disease risk factors in Middle East and North Africa countries: reviewing the evidence.

Aim: To examine the burden of cardiovascular disease (CVD) risk factors in Middle East and North Africa countries and their associations with dietary behaviors as nutrition transition is unfolding in the region. Data: Data on CVD risk factors were collected from scholarly papers and a systematic review of published articles was performed. Dietary patterns were derived from the WHO Food and Agriculture Organization Statistical Databases. Results: Wide variations exist across countries in the prevalence of CVD risk factors, namely obesity, diabetes, hypertension, hyperlipidemia, smoking and physical inactivity, with some countries showing high values of certain factors which approach those observed in the developed world. In particular, obesity prevalence rates have reached alarming levels, particularly among women in the oil-rich countries (over 40%), making it the most pressing health concern in the region. Trends in the dietary pattern illustrated a consistent rise in total energy supply by approximately 730 kcal per capita per day between 1970 and 2005. Dietary patterns showed an increased consumption of fat and animal protein and a decreased intake of carbohydrates, particularly whole grain cereals, and fresh fruits and vegetables. Conclusion: Regional differences were attributed to differences in lifestyle, occupation and a shift from traditional food habits. Our understanding of the CVD disparities across various geographic regions is key to our effort in planning relevant intervention programs. Public health efforts should focus on obesity, physical inactivity and unhealthy dietary practices. The success of these interventions depends on governmental commitment, multisectoral partnership and a consideration of the sociocultural norms of the target population.

Trends in overweight and obesity in Lebanon: evidence from two national cross-sectional surveys (1997 and 2009)

BackgroundEven though the obesity epidemic continues to grow in various parts of the world, recent reports have highlighted disparities in obesity trends across countries. There is little empirical evidence on the development and growth of obesity in Lebanon and other countries of the Eastern Mediterranean Region. Acknowledging the need for effective obesity preventive measures and for accurate assessment of trends in the obesity epidemic, this study aims at examining and analyzing secular trends in the prevalence of overweight and obesity over a 12-year period in Lebanon.MethodsBased on weight and height measurements obtained from two national cross-sectional surveys conducted in 1997 and 2009 on subjects 6 years of age and older, BMI was calculated and the prevalence of obesity was determined based on BMI for adults and BMI z-scores for children and adolescents, according to WHO criteria. Age -and sex- adjusted odds ratios for overweight and obesity were determined, with the 1997 year as the referent category. Annual rates of change in obesity prevalence per sex and age group were also calculated.ResultsThe study samples included a total of 2004 subjects in the 1997 survey and 3636 in the 2009 survey. Compared to 1997, mean BMI values were significantly higher in 2009 among all age and sex groups, except for 6–9 year old children. Whereas the prevalence of overweight appeared stable over the study period in both 6–19 year old subjects (20.0% vs. 21.2%) and adults aged 20 years and above (37.0% vs. 36.8%), the prevalence of obesity increased significantly (7.3% vs. 10.9% in 6–19 year olds; 17.4% vs. 28.2% in adults), with the odds of obesity being 2 times higher in 2009 compared to 1997, in both age groups (OR = 1.96, 95% CI:1.29-2.97 and OR = 2.01, 95% CI: 1.67-2.43, respectively). The annual rates of change in obesity prevalence ranged between +4.1% in children and adolescents and +5.2% in adults.ConclusionThe study’s findings highlight an alarming increase in obesity prevalence in the Lebanese population, over the 12-year study period, and alert to the importance of formulating policies and nutritional strategies to curb the obesity rise in the country.

Folate deficiency is associated with nutritional anaemia in lebanese women of childbearing age

OBJECTIVE The objective of this study was to identify the determinants of anaemia in Lebanese women of childbearing age attending health centres in Lebanon. DESIGN Cross-sectional study carried out between May and December 2003. Anthropometric measurements as well as sociodemographic, health and dietary intake data were collected using a questionnaire. Haemoglobin (Hb), plasma ferritin, plasma folate and vitamin B12 were assessed using standard laboratory methods. SETTING Governmental health centres in Lebanon. SUBJECTS Four hundred and seventy non-pregnant Lebanese women aged 15-45 years. RESULTS Anaemia (Hb <12 g dl(-1)) and iron deficiency (ferritin <15 microg l(-1)) were prevalent in 16.0 and 27.2% of the study sample, respectively. Of the total sample, 7.7% had iron-deficiency anaemia. The percentage of women with either Hb or ferritin deficiency or both was 35.6%. Plasma folate and vitamin B12 deficiency was reported in 25.1 and 39.4%, respectively, and 12.6% of the women had both folate and vitamin B12 deficiencies. Of the anaemic group, 48.0% of the women had iron deficiency. The intake of iron was lower in iron-deficient than in non-deficient women and a positive relationship was shown between folate intake and its corresponding serum levels. Regression analysis showed that ferritin, plasma folate and family history of anaemia were significant determinants of the anaemia in the sample of women. CONCLUSIONS Anaemia not related to iron deficiency was partly explained by plasma folate deficiency. Measures to control folate and iron deficiency should be considered.

Variations in nutritional status of elderly men and women according to place of residence.

Objective: The purpose of this study was to assess comprehensively the nutritional status of elderly individuals in institutions and to compare it with that of community based dwellers in an urban setting in Lebanon. Methods: Participants included 100 elderly men and women (aged 65 years and older) selected randomly from four institutions who were based on sex and neighborhood with 100 free-living individuals. Subjects were mentally and physically capable of responding to an interview schedule. Their nutritional status was assessed by anthropometric measurements, dietary food intake for a 3-day period, and hematological and biochemical variables. Energy and macro- and micronutrient intakes were compared with the US recommended dietary allowances (RDA) or dietary reference intakes (DRI) as appropriate. Results: Elderly living at home had significantly higher mean body mass index and waist circumference than those living in institutions. Although the total energy intake was comparable between the two groups, the elderly in the institutions consumed more fat and had lower intake of dietary fibers. Deficiencies (below 2/3rd RDA/DRI intakes) in zinc, magnesium, α-tocopherol, vitamins A and D, and pyridoxine were noted in both study groups with overall higher proportions observed among the institutionalized elderly. These were also anemic (42.5%) and had low levels of albumin (27.5%). In contrast, those living at home showed a higher prevalence of obesity and a lower calcium intake. Multivariate analysis controlling for a number of potential covariates did not change the results observed. Conclusions: The results of the present study showed a higher prevalence of obesity in those living at home and varying deficiencies by place of residence with no evidence that duration of institutionalization in itself being associated with poor nutritional status. Awareness of the risks associated with these deficiencies and excesses should address the lay and health professionals working in the community and institutions alike.

Adolescent obesity in Syria: prevalence and associated factors

Abstract Background Data on the prevalence of overweight and obesity in Eastern Mediterranean countries remain scarce, particularly for children and adolescents. The objective of this study is to estimate the prevalence of obesity and examine associated factors and covariates amongst school adolescents in Syria. Methods A cross-sectional survey of a representative sample of 776 adolescents (386 males and 390 females), aged 15-18 years, was conducted in six randomly chosen secondary schools in Damascus, the capital city of Syria. Anthropometric measurements and dietary assessment data were collected using standard methods and techniques. Overweight and obesity were defined according to World Health Organization 2007 child growth standards. Results The prevalence rates of overweight and obesity were estimated at 18.9 and 8.6%, respectively. Carbohydrate and saturated fatty acid intakes were significantly higher amongst overweight and obese (250.66 and 32.82 g/day, respectively) as compared with normal weight adolescents (218.12 and 26.10 g/day, respectively). Regression analysis showed that the likelihood of obesity was significantly greater amongst adolescent boys than girls (OR = 2.30, P < 0.05) and amongst subjects reporting family history of obesity (OR = 2.98, P < 0.05). The odds of obesity increased consistently with increasing educational attainment of both parents and was higher (OR = 1.63) amongst adolescents reporting lower crowding index than their counterparts. Conclusion Our findings of a positive association between obesity and socio-economic status measured by parental education and crowding index call for intervention strategies for the promotion of healthy dietary practices not only amongst school adolescents but also parents, targeting families as the unit of intervention. Further studies are needed to examine nutritional habits and food choices amongst families of different socio-economic strata.

Obesity is associated with insulin resistance and components of the metabolic syndrome in Lebanese adolescents

Background: Prevalence of metabolic syndrome (MS) in obese adolescents has been reported to range between 18–42%, depending on country of origin, thus suggesting an ethnic-based association between obesity and MS. Aim: This study aims to investigate the magnitude of the association between obesity, insulin resistance and components of MS among adolescents in Lebanon. Subjects and methods: The sample included 263 adolescents at 4th and 5th Tanner stages of puberty (104 obese; 78 overweight; 81 normal weight). Anthropometric, biochemical and blood pressure measurements were performed. Body fat was assessed using dual-energy X-ray absorptiometry. Results: According to International Diabetes Federation criteria, MS was identified in 21.2% of obese, 3.8% of overweight and 1.2% of normal weight subjects. The most common metabolic abnormalities among subjects having MS were elevated waist circumference (96.2%), low HDL (96.2%) and hypertriglyceridemia (73.1%). Insulin resistance was identified in all subjects having MS. Regression analyses showed that percentage body fat, waist circumference and BMI were similar in their ability to predict the MS in this age group. Conclusions: MS was identified in a substantial proportion of Lebanese obese adolescents, thus highlighting the importance of early screening for obesity-associated metabolic abnormalities and of developing successful multi-component interventions addressing adolescent obesity.

Iron deficiency is an important contributor to anemia among reproductive age women in Lebanon

The objective of this study was to gain knowledge about anemia is it relates to program planning. No recent data exist on anemia [hemoglobin (Hb)<120g/L, plasma ferritin (PF) normal], Fe deficiency (ID) [PF<15microg/L, Hb normal], or Fe deficiency anemia [Hb<120g/L, PF<15microg/L] in Lebanese women. A national survey of 540 nonpregnant women aged 15–49 years was conducted to find the prevalence and determinants of anemia and ID in Lebanon. Sociodemographic, health, and dietary data were collected. Hb and ferritin were assessed. Thirty-three percent of the subjects had ID and 13.5 per cent had Fe deficiency anemia. Eight percent were anemic (Hb<120g/L) with PF values>15microg/L. Women consuming<67 per cent of the RDA of hematinic nutrients had lower Hb and Fe levels. Strategies to improve Fe and anemia status are discussed.

Metabolic syndrome and insulin resistance in obese prepubertal children in Lebanon: a primary health concern.

Background/Aims: Ethnic-based associations between obesity and the metabolic syndrome (MS) have been suggested. The prevalence of MS in obese children was found to range between 13.9 and 48.8%, depending on the country of origin. This study was conducted to investigate the relationship between obesity and various components of MS in prepubertal children in Lebanon. Methods: Eighty-seven obese children (Tanner stage 1), 25 overweight and 28 normal-weight controls were recruited from private and public schools. Anthropometric, biochemical and blood pressure measurements were performed. Results: According to the modified Adult Treatment Panel III definition, the MS was identified in 26.4 and 4% of obese and overweight children, respectively, with a higher prevalence among girls than boys. The most common abnormalities among subjects with MS were elevated waist circumference (WC) (100.0%), high triglyceride (91.7%) and low high-density lipoprotein cholesterol (66.7%) levels. Insulin resistance was identified in 70% of obese children and 75% of those having the MS. Body mass index, WC and homeostasis model assessment of insulin resistance were significant determinants of the MS in this age group. Conclusion: MS was found in 26.4% of obese Lebanese children, thus underscoring the importance of early screening of obesity and its associated metabolic abnormalities and of developing successful multicomponent interventions addressing pediatric obesity and MS.

Nutritional status of Lebanese school children from different socioeconomic backgrounds

This paper examines the nutritional status of school children in private and public schools in West Beirut. The objectives of the study were to measure the impact of the socio‐economic status on the magnitude and severity of malnutrition in school children. Anthropometric data (height and weight) were collected on 400 children from private and public schools. The private schools were considered to house children from high socio‐economic status whereas the public schools children were considered as coming from a low socio‐economic background. The indices studied were height for age, weight for height and weight for age, the cutoff point to indicate malnutrition was taken as values below ISD of a reference population. The United States National Center for Health Statistics Standards (NCHS) were used. Results showed that children classified as low socio‐economic status (public schools) had low weight for age and height for age indices indicating higher occurrence of stunting and wasting in that population as...

Trends in nutritional intakes and nutrition-related cardiovascular disease risk factors in Lebanon: the need for immediate action.

AIM To examine the burden of cardiovascular disease (CVD) risk factors and their association with dietary variables in the Lebanese population while reviewing secular trends in the populations nutritional intakes and nutrition-related CVD risk factors. METHODS Data on CVD risk factors and food consumption patterns in Lebanon were collected from scholarly papers, including individual studies and systematic review articles. Electronic databases were searched using combinations of key terms. RESULTS The prevalence of obesity in Lebanon followed an alarming increasing trend over time, paralleled by an escalation in the prevalence of hypertension, diabetes and hyperlipidemia. Food consumption surveys illustrate an increasing trend in energy intake and the proportion of energy derived from fat and animal products, with a concomitant decrease in carbohydrates and cereals intakes. CONCLUSION The shift towards an atherogenic diet coupled with the alarming increase in nutrition-related cardiovascular risk factors suggest that the Lebanese population is at an increased risk for CVDs. This should alert to the importance of formulating multicomponent intervention strategies at both the individual and population levels to halt the progression of nutrition-related diseases in the country, while highlighting the need for immediate public health efforts to promote the adoption of healthy dietary habits.