Publications by authors named "Farah Naja"

85 Publications

Impact of Ramadan Fasting on Dietary Intakes Among Healthy Adults: A Year-Round Comparative Study.

Front Nutr 2021 5;8:689788. Epub 2021 Aug 5.

Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates.

Religious rituals are considered among the principle factors that impact dietary behaviors and food selections. The main objective of this study is to characterize food intake among Lebanese adults observant of the fasting month of Ramadan and compare it to their intake of the rest of the year. During a year-round study, including the month of Ramadan, Lebanese adults ( = 62), completed multiple (9 to 13) 24-h dietary recalls. Information about sociodemographic and lifestyle characteristics was also obtained. Dietary intake was examined using food groups as well as energy, macro, and micronutrient consumption. Significant differences in dietary intakes were observed for 12 of the 19 food groups (expressed as a percent of total energy) during Ramadan as compared to the rest of the year. More specifically, the intakes of cereals, cereal-based products, pasta, eggs, nuts and seeds, milk and dairy, and fats and oils were lower, while vegetables, dried fruit, Arabic sweets, cakes and pastries, and sugar-sweetened-beverages intakes were higher during Ramadan as compared to the remainder of the year ( < 0.05). Such differences in food groups' intakes were reflected in nutrients intakes, including carbohydrates, cholesterol, calcium, beta-carotene, vitamin C, folate, and magnesium. The findings of this study highlighted major differences in dietary intakes between the fasting month as compared to the rest of the year. With the large number of adults who observe fasting during Ramadan, the particularities of dietary intake during Ramadan ought to be considered in the development of context and culture-specific dietary recommendations.
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http://dx.doi.org/10.3389/fnut.2021.689788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8375294PMC
August 2021

Adherence to the Mediterranean diet during pregnancy is associated with lower odds of excessive gestational weight gain and postpartum weight retention: results of the Mother-Infant Study Cohort.

Br J Nutr 2021 Jul 23:1-12. Epub 2021 Jul 23.

Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.

During the first 1000 d of life, gestational weight gain (GWG) and postpartum weight retention (PPWR) are considered critical determinants of nutritional status. This study examined the effect of adherence to the Mediterranean diet (MD) during pregnancy on GWG and PPWR at 2 and 6 months among women in the United Arab Emirates (UAE), using data from the Mother-Infant Study Cohort. The latter is a prospective study, for which pregnant women were recruited (n 243) during their third trimester and were followed up for 18 months. Data on socio-demographic characteristics and anthropometric measurements were obtained. An eighty-six-item FFQ was used to examine dietary intake during pregnancy. Adherence to the MD was assessed using the alternate MD (aMED) and the Lebanese MD (LMD). Adherence to the MD, PPWR2 (2 months) and PPWR6 (6 months) were considered high if participants belonged to the third tertile of the respective measures. Results indicated that 57·5 % of participants had excessive GWG while 50·7 % and 45 % retained ≥ 5 kg at 2 and 6 months postpartum, respectively. After adjustment, adherence to both MD scores was associated with lower odds of excessive GWG (aMED, OR:0·41, 95 % CI:0·18, 0·93; LMD, OR:0·40, 95 % CI: 0·16, 0·98). Adherence to MD was also associated with PPWR2 (aMED: OR: 0·23, 95 % CI: 0·06, 0·88) and PPWR6 (aMED OR:0·26; 95 % CI:0·08-0·86; LMD, OR:0·32; 95 % CI: 0·1, 0·98). The findings of this study showed that adherence to the MD may reduce GWG and PPWR and, hence, underscored the importance of promoting the MD for better health of the mother and infant.
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http://dx.doi.org/10.1017/S0007114521002762DOI Listing
July 2021

Impact of coronavirus 2019 on mental health and lifestyle adaptations of pregnant women in the United Arab Emirates: a cross-sectional study.

BMC Pregnancy Childbirth 2021 Jul 19;21(1):515. Epub 2021 Jul 19.

Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, 27272, United Arab Emirates.

Background: In light of the pandemic, pregnant women are particularly vulnerable to increased psychological distress and in need of imperative preventive measures. This study aimed to investigate the impact of the pandemic on mental health, lifestyle adaptations, and their determinants among pregnant women in the United Arab Emirates.

Methods: A survey was conducted electronically between June and August 2020. Pregnant women were recruited from prenatal clinics in the UAE and invited to participate in an online survey developed on Google Forms. The questionnaire included socio-demographic characteristics, the Impact of Event Scale- Revised, the Perceived Support Scale and lifestyle-related factors.

Results: A total of 384 pregnant women completed the questionnaire of whom 20.6% were in their 1st trimester, 46.1% in their 2nd and 33.3% in their 3rd trimester. The mean IES-R score for the respondents was 26.15 ± 13.55, corresponding to a mild stressful impact, which did not differ significantly among trimesters of pregnancy. Pregnant women expressed increased stress from staying home (64%), work (40%), feeling frightened (66%) and apprehensive (59%). Women reported increased support and sharing their feelings with family members (59%), mainly in the 1st and 3rd trimester of pregnancy (P < 0.05). There was a greater attention to mental health (48%), resting time (55.3%), and relaxing time (57.3%); while a decreased amount of time was spent engaging in physical activities (53.6%), which differed significantly between trimesters (P = 0.02).

Conclusions: The COVID-19 pandemic was associated with a mild stressful impact among pregnant women in the UAE, braced by strong family support and self-care mental health behaviors.
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http://dx.doi.org/10.1186/s12884-021-03941-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287543PMC
July 2021

Promoting Sustainable and Healthy Diets to Mitigate Food Insecurity Amidst Economic and Health Crises in Lebanon.

Front Nutr 2021 25;8:697225. Epub 2021 Jun 25.

Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical & Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.

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. 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. 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. 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. 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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http://dx.doi.org/10.3389/fnut.2021.697225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270169PMC
June 2021

Association of the Healthy Nordic Food Index with risk of bladder cancer: a case-control study.

Eur J Clin Nutr 2021 Jul 6. Epub 2021 Jul 6.

Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Behehshti University of Medical Sciences, Tehran, Iran.

Background: Bladder cancer (BC) is the ninth recurrent neoplasm in the world. In Iran, incidence of BC is the third most common among men. Few dietary patterns are related to reduced carcinogenesis and consequently are amenable to modification in order to reduce the BC risk. Adherence to the traditional Nordic diet, as measured by the Healthy Nordic Food Index (HNFI), have shown a beneficial effect on chronic disease prevention, including cancer. The principal objective of this study was to investigate the association between HNFI and the odds of BC in a case-control study, in Iran.

Method: The present case-control study was performed on 100 eligible cases and 200 controls of patients ≥45 years old referred to three referral hospitals in Tehran. Dietary intakes are assessed by a valid 168-item food frequency questionnaire (FFQ). The relationship between HNFI and BC is estimated using the logistic regression tests.

Results: The average age of cases and control were 65.41 and 61.31 years, respectively. After controlling for potential confounders (age, smoke, total energy, and sex), participants in the highest tertile of HNFI (compared to the lowest tertile) have 83% lower BC risk (OR = 0.17; 95%CI = 0.07-0.42). Based on an independent assessment of HNFI component and BC risk, a significant negative association was observed for fish intake (OR = 0.30; 95%CI = 0.15- 0.60) and whole-grain bread intake (OR = 0.33; 95%CI = 0.17-0.63).

Conclusion: The findings of this study suggested that adherence to traditional Nordic diet could decrease the risk of BC. Of the elements of this diet, fish and whole-grain bread consumption seemed to decrease the odds of BC. Such findings ought to be considered in the development of evidence-base intervention for BC prevention in the country.
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http://dx.doi.org/10.1038/s41430-021-00971-wDOI Listing
July 2021

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

Front Nutr 2021 19;8:668901. Epub 2021 May 19.

Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.

To examine the dietary patterns and their associations with the FTO and FGF21 gene variants among Emirati adults. Using a cross-sectional design, healthy adult male and female Emiratis ( = 194) were recruited from primary health care centers in Sharjah, UAE. Participants completed a 61-item semi-quantitative food frequency questionnaire. In addition, a saliva sample was obtained for the genetic analysis. Genotyping was performed for >> > , and > . Dietary patterns were derived using the principal component analysis. Logistic regression analyses were used to examine the association of dietary patterns with genetic variants. Three dietary patterns were identified: "Western": consisting of fast food, sweets, and processed meat; "Traditional Emirati" rich in vegetables, traditional Emirati-mixed-dishes and whole dairy; while whole grains, low-fat dairy, and bulgur were components of the "Prudent" pattern. Subjects carrying the A allele of the were 2.41 times more likely to adhere to the Western pattern compared to subjects with genotype TT (OR:2.41; 95%CI:1.05-5.50). Compared with subjects with A/A, those carrying the G allele of the were more likely to follow a Western diet (OR: 2.19; 95%CI: 1.00-4.97). Participants carrying the risk allele (A) of the were twice more likely to adhere to the Traditional pattern as compared to subjects with genotype GG (OR: 1.9, 95%CI: 1.01-3.57). The findings of this study suggested associations among specific and gene variants with dietary patterns among Emirati adults. These findings could be used to inform evidence-based targeted nutrition preventive recommendations, especially those aiming to limit intake of western type foods.
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http://dx.doi.org/10.3389/fnut.2021.668901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171665PMC
May 2021

Development of national dietary and lifestyle guidelines for pregnant women in Lebanon.

Matern Child Nutr 2021 May 11:e13199. Epub 2021 May 11.

Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon.

Although a number of international diet and lifestyle guidelines during pregnancy (DLGP) exist in the literature, contextualization to low- and middle-income settings is less common. The aim of this study was to present the Lebanese DLGP and to describe the process followed for their development. A mixed-method approach was used including a review and synthesis of existing international DLGP and a consensus building nominal group technique (NGT) with a multidisciplinary group of experts (n = 11). During the meeting, participants identified the themes of the guidelines, formulated the wording of each themes' guideline and translated the guidelines to the Arabic language. Consensus was defined as an agreement of 80%. Reviewing the literature, a list of 17 main topics were found to be common themes for the DLGP. For the Lebanese DLGP, participants in the NGT meeting selected seven themes from this list: gestational weight gain, diet diversity, hydration, food safety, harmful foods, physical activity and breastfeeding. In addition, the group formulated three themes based on merging/modifying existing themes: supplementation, alcohol and smoking and religious fasting. Two context-specific new themes emerged: wellbeing and nutrition resilience. For each of the identified themes, the group agreed upon the wording of its guidelines and description. This study is the first from the Eastern Mediterranean Region to develop through consensus building, context and culture-specific dietary and lifestyle guidelines for pregnant women. Putting maternal nutrition at the heart of tackling malnutrition and its detrimental health outcomes is a core investment for a better maternal and child health.
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http://dx.doi.org/10.1111/mcn.13199DOI Listing
May 2021

The role of pharmacists in complementary and alternative medicine in Lebanon: users' perspectives.

BMC Complement Med Ther 2021 Mar 2;21(1):81. Epub 2021 Mar 2.

Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates.

Background: Customers' expectations and satisfaction are critical to ensure a more effective role of the community pharmacists in promoting the safe use of Complementary and Alternative Medicine (CAM). The aim of this study is to examine the perceptions and practices of customers buying their CAM products from pharmacies and explore their satisfaction with CAM-related services offered by the community pharmacists in Lebanon.

Methods: A national cross-sectional study was conducted among users of CAM (age > =18 years) who obtained their CAM from community pharmacies in Lebanon (n = 832). Within the proximity of the pharmacy, subjects were invited to complete a multi-component questionnaire. The latter consisted of four sections related to CAM: general beliefs, perception of pharmacists' role, practices, satisfaction with services offered by the pharmacists. In addition, the questionnaire included questions about sociodemographic characteristics of participants.

Results: The majority of participants agreed to an active role of the pharmacists' in guiding CAM use, however over half of the participants (61.3%) did not agree that the pharmacist is more knowledgeable in this field than other healthcare providers. As for practices, one in two surveyed customers (47%) did not always give feedback to their pharmacists about the outcomes after using CAM, 20% did not often ask the pharmacists about the safe and effective mode of use of the products and 28.1% did not discuss their medical history. For services offered by the pharmacist, the majority of participants reported receiving good education about the CAM product (87.1%), its side effects (87.1%) and mode of use (93.4%), while significant proportions of participants reported that pharmacists were not asking questions about their medical history before dispensing CAM products (22%) nor were they providing information on CAM-drug interactions (30%).

Conclusions: The results of this study highlighted important gaps between the perceptions of customers and the services they received from the pharmacists about CAM use. These findings could be used by concerned stakeholders, including public health authorities and educational bodies, to develop evidence-based interventions aimed at promoting the role of pharmacists in ensuring a safe and effective CAM use Lebanon.
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http://dx.doi.org/10.1186/s12906-021-03256-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944898PMC
March 2021

Indirect Health Effects of COVID-19: Unhealthy Lifestyle Behaviors during the Lockdown in the United Arab Emirates.

Int J Environ Res Public Health 2021 02 18;18(4). Epub 2021 Feb 18.

Department of Clinical Nutrition and Dietetics, Research Institute of Medical & Health Sciences (RIMHS), College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates.

: Lockdown measures were implemented in many countries to limit the spread of the COVID-19 pandemic. However, such restrictions could precipitate unintended negative consequences on lifestyle behaviors. The main objective of this study was to investigate the prevalence and determinants of unhealthy behavior changes during the COVID-19 lockdown among residents of the United Arab Emirates (UAE). : A cross-sectional web-based survey of adults residing in the UAE was carried out during lockdown (n = 2060). Using a multi-component questionnaire, the collected data included questions regarding the following lifestyle changes: Increased dietary intake, increased weight, decreased physical activity, decreased sleep, and increased smoking. An unhealthy lifestyle change score was calculated based on the number of unhealthy lifestyle changes each participant reported. In addition, sociodemographic and living conditions information was collected. Descriptive statistics as well as simple and multiple linear regression analyses were used to examine the prevalence and determinants of the unhealthy lifestyle changes considered in this study. : Among the unhealthy lifestyle changes examined, increased food intake was the most common (31.8%), followed by decreased physical activity (30%), increased weight (29.4%), decreased sleep (20.8%), and increased smoking (21%). In addition to identifying the correlates of each of the aforementioned lifestyle changes, the results of the multiple regression linear analyses revealed the following correlates for the overall unhealthy lifestyle change score: females (β = 0.32, CI: 0.22; 0.42), living in an apartment (β = 0.12, CI: 0.003; 0.23) and being overweight/obese (β = 0.24, CI: 0.15; 0.32) had higher scores, while older adults (>40 years) had lower scores (β = -0.23, CI: -0.34; -0.12). : The COVID-19 lockdown has resulted in a high prevalence of unhealthy lifestyle behaviors and practices among UAE residents. The findings of this study provided the evidence base for officials to design interventions targeting high-risk groups and aiming to improve healthy lifestyle factors among residents during the pandemic.
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http://dx.doi.org/10.3390/ijerph18041964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922937PMC
February 2021

Dynamics of non-communicable disease prevention, diagnosis and control in Lebanon, a fragile setting.

Confl Health 2021 Jan 11;15(1). Epub 2021 Jan 11.

NIHR Global Health Research Unit on Health in Situations of Fragility, Musselburgh, UK.

Background: Non-communicable diseases (NCD) present an increasing global health challenge, particularly for settings affected by fragility where access to care may be disrupted, and where high-quality continuous care delivery is difficult to achieve. This study documents the complex dynamics of NCD prevention and management in the fragile setting of rural Beqaa, Lebanon.

Methods: Participatory system dynamics methods were used, including 30 semi-structured interviews and three Group Model Building (GMB) workshops. Participants included health care providers offering NCD care, and Lebanese host- and Syrian refugees community members affected by NCDs.

Results: Participants across all groups articulated a shared complex understanding of both the structural and direct determinants behind NCD onset. Lebanese and Syrian community members further identified several barriers to health seeking, including restrictions in health coverage, limited availability of services in the Beqaa and perceptions of poor-quality care. Health providers and community members described a health system overtly focused on disease control and overwhelmed by delivery of care to people living with NCD across both communities.

Conclusion: Participants across all groups agreed on the need for health promotion and primary prevention activities and identified priority interventions in these areas.
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http://dx.doi.org/10.1186/s13031-020-00337-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802297PMC
January 2021

Validity and Reproducibility of a Culture-Specific Food Frequency Questionnaire in Lebanon.

Nutrients 2020 Oct 29;12(11). Epub 2020 Oct 29.

Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 11072020, Lebanon.

This study aims to assess the validity and reproducibility of a culture-specific semi-quantitative food frequency questionnaire (FFQ) for Lebanese adults. The 94-item FFQ captures intake of traditional Mediterranean dishes and Western food, reflective of current Lebanese nutrition transition. Among 107 participants (18-65 years), the FFQ was administered at baseline (FFQ-1) and one year thereafter (FFQ-2); 2-3 24-h recalls (24-HRs)/season were collected for a total of 8-12 over four seasons. A subset ( = 67) provided a fasting blood sample in the fall. Spearman-correlation coefficients, Bland-Altman plots, joint-classification and (ICC) were calculated. Mean intakes from FFQ-2 were higher than from the total 24-HRs. Correlations for diet from FFQ-2 and 24-HRs ranged from 0.17 for α-carotene to 0.65 for energy. Joint classification in the same/adjacent quartile ranged from 74.8% to 95%. FFQ-2-plasma carotenoid correlations ranged from 0.18 for lutein/zeaxanthin to 0.59 for β-carotene. Intra-class correlations for FFQ-1 and FFQ-2 ranged from 0.36 for β-cryptoxanthin to 0.85 for energy. 24-HRs carotenoid intake varied by season; combining season-specific 24-HRs proximal to biospecimen collection to the FFQ-2 improved diet-biochemical correlations. By applying dietary data from two tools with biomarkers taking into consideration seasonal variation, we report a valid, reproducible Lebanese FFQ for use in diet-disease research.
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http://dx.doi.org/10.3390/nu12113316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692843PMC
October 2020

Postpartum Weight Retention and Its Determinants in Lebanon and Qatar: Results of the Mother and Infant Nutrition Assessment (MINA) Cohort.

Int J Environ Res Public Health 2020 10 27;17(21). Epub 2020 Oct 27.

Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 110236, Lebanon.

Excessive Postpartum Weight Retention (PWR) is postulated to increase the risk of adverse health outcomes for mothers and offspring. Using data from the Mother and Infant Nutritional Assessment (MINA) cohort in Lebanon and Qatar, this study aimed to examine PWR and its determinants at 6 months after delivery. Pregnant women ( = 183) were recruited during their first trimester and were followed up through pregnancy and after delivery. During this period, face-to-face interviews as well as extraction from medical charts were conducted to collect data regarding the socioeconomic, anthropometric and dietary intake of participants. The mean PWR (kg) among participants was 3.1 ± 5.6 at delivery, and 3.3 ± 5.3 and 2.7 ± 4.7 at 4 and 6 months after delivery, respectively. Results of the multiple logistic regression analyses showed that a Qatari nationality and excessive GWG were associated with higher odds of a high PWR (above median) while an insufficient GWG had lower odds. After adjustment for energy, participants with a high PWR reported a greater intake of proteins, Trans fat, cholesterol, sodium and lower intakes of mono and polyunsaturated fat as compared to those with a low PWR (below median). These findings suggested priority areas for interventions to prevent excessive PWR amongst women of childbearing age in Lebanon and Qatar.
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http://dx.doi.org/10.3390/ijerph17217851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672614PMC
October 2020

Diet-dependent acid load and the risk of colorectal cancer and adenoma: a case-control study.

Public Health Nutr 2021 Oct 22;24(14):4474-4481. Epub 2020 Oct 22.

Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran1985711151, Iran.

Objectives: Colorectal cancer (CRC) is the third and second most prevalent cancer in men and women, respectively. Various epidemiological studies indicated that dietary factors are implicated in the aetiology of CRC and its precursor, colorectal adenomas (CRA). Recently, much attention has been given to the role of acid-base balance in the development of chronic diseases including cancers. Therefore, the aim of the current study is to examine the association of diet-dependent acid load and the risk of CRC and CRA.

Design: In this case-control study, potential renal acid load (PRAL) was computed based on dietary intake of participants assessed via a validated FFQ. Negative PRAL values indicated a base-forming potential, while positive values of PRAL implied acid-forming potential of diet. Logistic regression was used to derive OR and 95 % CI after adjusting for confounders.

Setting: Tehran, Iran.

Participants: A total of 499 participants aged 30-70 years were included in the study (240 hospital controls, 129 newly diagnosed CRC and 130 newly diagnosed CRA). The current study was conducted between December 2016 and September 2018.

Results: After adjusting for potential confounders, a higher PRAL was associated with increased odds of CRC and CRA. The highest v. the lowest tertile of PRAL for CRC and CRA was OR 4·82 (95 % CI 2·51-9·25) and OR 2·47 (95 % CI 1·38-4·42), respectively.

Conclusions: The findings of the current study suggested that higher diet-dependent acid load is associated with higher risk of CRC and CRA.
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http://dx.doi.org/10.1017/S1368980020003420DOI Listing
October 2021

Nutrition and Breast Cancer Research in Arab Countries: Gaps, Opportunities, and Recommendations.

Nutr Cancer 2020 Sep 24:1-17. Epub 2020 Sep 24.

Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon.

According to the WHO, Arab countries have the highest relative increase in Breast Cancer (BC) rates worldwide. Current shifts in dietary patterns in these countries are postulated as important modifiable risk factors of the disease. The objectives of this review were to examine the gaps and opportunities in the extent, range and nature of nutrition-related BC research in Arab countries. Studies ( = 286) were identified through searching 14 electronic databases. Among the gaps identified were limited international collaborations, preponderance of laboratory-based research at the expense of population-based research, focus on single supplement/nutrient/food research, limited use of dietary assessment tools, and studying nutrition in isolation of other environmental factors. Despite these gaps, several opportunities appeared. The distribution of papers among Arab countries suggested that collaboration between high and middle income countries could create a positive synergy between research expertise and wealth. In addition, the steady increase in the number of articles published during the last two decades reflected a promising momentum in nutrition and BC research in the Arab world. These gaps and opportunities constituted context-specific evidence to orient nutrition and BC research in Arab countries which could ultimately lead to development of effective interventions for prevention of BC in these countries.
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http://dx.doi.org/10.1080/01635581.2020.1823435DOI Listing
September 2020

Gaussian Graphical Models Identified Food Intake Networks among Iranian Women with and without Breast Cancer: A Case-Control Study.

Nutr Cancer 2020 Sep 14:1-8. Epub 2020 Sep 14.

Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Dietary patterns may be an important predictor of breast cancer risk. However, they cannot completely explain the pairwise correlations among foods. The purpose of this study is to compare food intake networks derived by Gaussian Graphical Models (GGMs) for women with and without breast cancer to better understand how foods are consumed in relation to each other according to disease status.

Methods: A total of 134 women with breast cancer and 267 hospital controls were selected from referral hospitals of Tehran, Iran. Dietary intakes were evaluated by using a validated 168 food-items semi-quantitative food frequency questionnaire. GGMs were applied to log-transformed intakes of 28 food groups to construct outcome-specific food networks.

Results: Among cases, a main network containing intakes of 12 central food groups (vegetables, fruits, nuts and seeds, olive oil and olive, processed meat, sweets, salt, soft drinks, fried potatoes, pickles, low-fat dairy, pizza) was detected. In controls, a main network including six central food groups (liquid oils, vegetables, fruits, sweets, fried potatoes and soft drinks) was identified.

Conclusions: The findings of this study revealed a difference in GGM-identified networks graphs between cases and controls. Overall, GGM may provide additional understanding of relationships between diet and health.
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http://dx.doi.org/10.1080/01635581.2020.1820051DOI Listing
September 2020

Food insecurity is associated with compromised dietary intake and quality among Lebanese mothers: findings from a national cross-sectional study.

Public Health Nutr 2020 10 20;23(15):2687-2699. Epub 2020 Jul 20.

Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, PO Box 11-0236, Beirut, Lebanon.

Objective: Examine the associations between household food insecurity (HFI) with sociodemographic, anthropometric and dietary intakes of mothers.

Design: Cross-sectional survey (2014-2015). In addition to a sociodemographic questionnaire, data collection included the validated Arabic version of the Household Food Insecurity Access Scale, which was used to evaluate HFI. Dietary intake was assessed using 24-h dietary recall of a single habitual day, and maternal BMI was calculated based on weight and height measurements. Associations between HFI and maternal dietary intake (food groups, energy and macronutrients' intake) were examined. Simple and multiple logistic regression analyses were conducted to explore the associations between HFI status with odds of maternal overweight and measures of diet quality and diversity (Healthy Eating Index (HEI) and Minimum Dietary Diversity for Women of Reproductive Age (MDD-W)).

Setting: Lebanon.

Participants: Mothers, nationally representative sample of Lebanese households with children (n 1204).

Results: HFI was experienced among almost half of the study sample. Correlates of HFI were low educational attainment, unemployment and crowding. Significant inverse associations were observed between HFI and dietary HEI (OR 0·64, 95 % CI 0·46, 0·90, P = 0·011) and MDD-W (OR 0·6, 95 % CI 0·42, 0·85, P = 0·004), even after adjusting for socioeconomic correlates. No significant association was observed between HFI and odds of maternal overweight status.

Conclusions: HFI was associated with compromised maternal dietary quality and diversity. Findings highlight the need for social welfare programmes and public health interventions to alleviate HFI and promote overall health and wellbeing of mothers.
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http://dx.doi.org/10.1017/S1368980020000567DOI Listing
October 2020

Erosion of the Mediterranean diet among adolescents: evidence from an Eastern Mediterranean Country.

Br J Nutr 2021 02 20;125(3):346-356. Epub 2020 Jul 20.

Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut1107-2020, Lebanon.

At a time when the health benefits of the Mediterranean diet (MD) are pervasively recognised, a paradoxical observation is the decreasing adherence to this dietary pattern in its native countries. This study aims to investigate temporal trends in adherence to the MD among adolescents (10-19 years old) in Lebanon. Data were drawn from three national cross-sectional surveys conducted at three points in time: 1997 (n 2004), 2009 (n 3656) and 2015 (n 1204). Dietary intake was assessed using 24-h dietary recalls, and adherence to the MD was assessed using two country-specific indexes: the composite Mediterranean diet (c-MED) index and Lebanese Mediterranean diet (LMD) index. Significant decreases in c-MED and LMD scores and in the proportion of adolescents adhering to the MD were observed between 1997 and 2015, with more consistent results among females (P < 0·05). Projections for the year 2030 showed further decreases, with less than a quarter of adolescents remaining adherent to the MD. Based on linear regression analyses, belonging to the year 2009 was associated with significantly lower MD scores compared with 1997, even after adjustment for potential covariates (c-MED β = -0·16, 95 % CI -0·30, -0·01; LMD β = -0·42, 95 % CI -0·67, -0·17). Similar results were obtained when comparing survey year 2015 with 1997 (c-MED score β = -0·20, 95 % CI -0·33, -0·06; LMD score β = -0·60, 95 % CI -0·82, -0·37). Findings highlight the erosion of the MD among Lebanese adolescents and underline the need for a comprehensive food system approach that fosters the promotion of the MD as a nutritionally balanced and sustainable dietary pattern.
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http://dx.doi.org/10.1017/S0007114520002731DOI Listing
February 2021

Complementary and alternative medicine use among patients with type 2 diabetes living in the United Arab Emirates.

BMC Complement Med Ther 2020 Jul 10;20(1):216. Epub 2020 Jul 10.

Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates.

Background: The use of Complementary and Alternative Medicine (CAM) among Type 2 Diabetes Mellitus (T2DM) patients is increasing to manage the complexities of their condition, enhance their health, and ease complications. The burden of T2DM in the United Arab Emirates (UAE) coupled with the high prevalence of CAM use and its associated risks among patients with T2DM necessitated the investigation of the use of CAM by this patients' population. The aim of this study is to examine the prevalence, types, and correlates of CAM use among T2DM patients in the UAE.

Methods: Patients with T2DM attending the outpatient clinics in the two governmental hospitals in Dubai and Sharjah, UAE were invited to participate in a cross-sectional survey. Face-to-face interviews were conducted with participants to complete a multi-component questionnaire. The questionnaire comprised of three main sections: demographic data, diabetes-related information, and CAM use details. Data analysis employed descriptive statistics, univariate and multivariate logistic regression to assess the prevalence and correlates of CAM use.

Results: Two hundred forty-four T2DM patients completed the questionnaire (response rate: 80%). A total of 39.3% of participants were CAM users since diagnosis. After adjustment; the logistic regression results showed that CAM use was significantly associated with age, sex, education, employment, and having health insurance. The most commonly used type of CAM by participants were folk foods and herbs followed by spiritual and natural healing and vitamins and minerals supplements. The majority of CAM users were referred or encouraged to use CAM by family (42.7%), friends (25%) or social media (17.7%). Only 13.5% of participants used CAM because it was suggested by health care practitioners. Only 1 in four of CAM users disclosed CAM use to their treating physician.

Conclusion: CAM use among T2DM patients in the UAE is considerably high. Health policy and decision-makers are encouraged to dedicate particular attention to facilitating proper regulation and integration of CAM within conventional medicine to protect the health and wellbeing of patients. A concerted effort by medical schools and public health authorities should be committed to educating health care providers and patients on the safe and effective use of CAM therapies.
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http://dx.doi.org/10.1186/s12906-020-03011-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350641PMC
July 2020

Role of community pharmacists in weight management: results of a national study in Lebanon.

BMC Health Serv Res 2020 May 7;20(1):386. Epub 2020 May 7.

Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences American, University of Beirut, Beirut, Lebanon.

Background: Ideally situated within the community, pharmacists can be involved in a broad range of health promotion campaigns including prevention of obesity. Limited evidence is available regarding their involvement in weight management in Lebanon, a country with escalating prevalence rate of obesity.

Objective: To examine the role of community pharmacists in weight management in Lebanon, specifically studying their beliefs, current practices, services, and knowledge.

Methods: Using a stratified random sampling approach, a cross sectional national survey of community pharmacists was conducted (n = 341, response rate 89%). At the pharmacy, and through a face-to-face interview, pharmacists completed a multi-component questionnaire that addressed, in addition to socio-demographic and work characteristics, their beliefs, practices, knowledge in relation to weight management. Frequencies and proportions were used to describe the data. Simple and multiple linear regression analyses were used to examine the determinants of knowledge in the study population.

Results: Over 80% of study participants agreed that they have an important role to play in weight management. However, 50% of pharmacists did not agree that weight loss products are well regulated and 81.1% thought that companies marketing weight loss products are making false promises. The majority of pharmacists always/often sold weight loss products (84.7%) and counseled their patients for diet (86.3%) and physical activity (91.7%). Despite taking weight and height measurements, 50% of pharmacists rarely/never calculated BMI. Among the pharmacists who reported side effects of weight loss products (46.5%), the majority (91.3%) did so to the pharmaceutical company. The knowledge of pharmacists was better for the use of weight loss products as opposed to their side effects and interactions. Significant predictors of knowledge were holding a Masters/ PhD degree in Pharmacy, graduating from a university inside Lebanon, obtaining weight management training within the academic degree, and receiving inquiries about weight management in the pharmacy more than once daily.

Conclusions: The results of the study provided important insights on the beliefs, practices and knowledge of community pharmacists in weight management in Lebanon. These findings could be used to inform the development of future evidence-based community pharmacists led weight management service provision nationally and internationally.
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http://dx.doi.org/10.1186/s12913-020-05258-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204056PMC
May 2020

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

Nutr J 2020 04 21;19(1):36. Epub 2020 Apr 21.

Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon.

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

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

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

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

Conclusion: The findings of this study showed that adherence to a "Diverse" pattern reduced the risk of insufficient gestational weight gain/gestational weight gain rate, while higher consumption of the "Western" pattern increased the risk of excessive gestational weight gain/gestational weight gain rate. In view of the established consequences of gestational weight gain on the health of the mother and child, there is a critical need for health policies and interventions to promote a healthy lifestyle eating through a life course approach.
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http://dx.doi.org/10.1186/s12937-020-00553-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175557PMC
April 2020

Nutrition amid the COVID-19 pandemic: a multi-level framework for action.

Eur J Clin Nutr 2020 08 20;74(8):1117-1121. Epub 2020 Apr 20.

Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon.

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http://dx.doi.org/10.1038/s41430-020-0634-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7167535PMC
August 2020

Sex disparities in dietary intake across the lifespan: the case of Lebanon.

Nutr J 2020 03 26;19(1):24. Epub 2020 Mar 26.

Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.

Background: Little is known about sex-based dietary differences in middle-income countries, particularly those undergoing the nutrition transition. This study aims at examining sex disparities in energy and macronutrients' intakes, food consumption patterns, and micronutrients' adequacy in Lebanon, while adopting a life course approach.

Methods: Data were derived from a national cross-sectional survey conducted in Lebanon in 2008/2009. The study sample consisted of 3636 subjects: 956 children and adolescents aged 6-19.9 years; 2239 adults aged 20-59.9 years and 441 older adults aged above 60 years. At the households, trained nutritionists conducted face-to-face interviews with participants to complete a sociodemographic questionnaire and one 24-h diet recall. Food items were categorized into 25 food groups. The Nutritionist Pro software was used for the analysis of dietary intake data and the estimation of energy, macronutrients', and micronutrients' intakes.

Results: In all age groups, males had significantly higher energy intakes, while females had significantly higher fiber intakes. In addition, in adolescents aged 12-19.9 years, females had higher fat intakes as compared to males (37.02 ± 0.6% vs 35.03 ± 0.61%), and in adults aged 20-59.9 years, females had significantly higher total fat (37.73 ± 0.33% vs 36.45 ± 0.38%) and saturated fat intakes (11.24 ± 0.15% vs 10.45 ± 0.18%). These differences in macronutrient intakes were not observed in younger children nor in older adults. Sex-based differences in food groups' intakes were also observed: men and boys had significantly higher intakes of red and processed meat, bread, fast food, soft drinks, and alcohol, while girls and women had higher intakes of fruits, vegetables, milk, and sweets. In all age groups, females had lower micronutrient intakes compared to males, including calcium, iron, and zinc.

Conclusions: This study identified sex-specific priorities that ought to be tackled by context-specific interventions to promote healthier diets in Lebanon. The fact that sex-based differences in nutrient intakes and food consumption patterns were the most noticeable in the adolescent and adult years, hence women's reproductive years call for concerted efforts to improve nutrition for women and girls as this would lay the foundation not only for their future education, productivity, and economic empowerment, but also for the health of future generations.
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http://dx.doi.org/10.1186/s12937-020-00543-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098147PMC
March 2020

Dietary total antioxidant capacity and colorectal cancer and colorectal adenomatous polyps: a case-control study.

Eur J Cancer Prev 2021 01;30(1):40-45

Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology, Research Institute, Shahid Beheshti University of Medical Sciences.

Colorectal cancer (CRC) is the third most common and the third most deadly cancer worldwide. In Iran, CRC is the third and fifth most common cancer in females and males, respectively. Chronic oxidative stress has been implicated in the development of CRC and its precursor, colorectal adenomatous polyps (CAP). While there were a few studies that suggested a favorable role of individuals antioxidants on the CRC risk, the total antioxidant capacity (TAC) of diet has been less investigated. Consequently, the aim of this study is to investigate the association of TAC with the odds of CRC and CAP. This is a case-control study. The participants were 130 cases with incident, histologically confirmed CRC, 134 cases with incident of CAP and 243 hospital-based controls. TAC has been assessed with dietary ferric-reducing antioxidant potential and oxygen radical absorbance capacity method based on collected dietary intake data through a reproducible and valid food frequency questionnaire. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between the TAC and CRC and CAP odds were estimated by multiple logistic regression. After controlling for potential confounders, TAC was significantly associated with CRC and CAP odds. (ORQ3-Q1 for CRC = 0.25, 95% CI: 0.13-0.46, Ptrend = 0.001. ORQ3-Q1 for CAP = 0.48, 95% CI: 0.27-0.85, Ptrend = 0.01). The findings of this study suggested an inverse association between TAC and CRC and CAP risk.
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http://dx.doi.org/10.1097/CEJ.0000000000000577DOI Listing
January 2021

Food insecurity is associated with lower adherence to the Mediterranean dietary pattern among Lebanese adolescents: a cross-sectional national study.

Eur J Nutr 2020 Oct 3;59(7):3281-3292. Epub 2020 Jan 3.

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.

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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http://dx.doi.org/10.1007/s00394-019-02166-3DOI Listing
October 2020

Gestational weight gain and gestational diabetes among Emirati and Arab women in the United Arab Emirates: results from the MISC cohort.

BMC Pregnancy Childbirth 2019 Dec 3;19(1):463. Epub 2019 Dec 3.

Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon.

Background: Nutritional status of women during pregnancy has been considered an important prognostic indicator of pregnancy outcomes.

Objectives: To investigate the pattern of gestational weight gain (GWG) and gestational diabetes mellitus (GDM) and their risk factors among a cohort of Emirati and Arab women residing in the United Arab Emirates (UAE). A secondary objective was to investigate pre-pregnancy body mass index (BMI) and its socio-demographic correlates among study participants.

Methods: Data of 256 pregnant women participating in the cohort study, the Mother-Infant Study Cohort (MISC) were used in this study. Healthy pregnant mothers with no history of chronic diseases were interviewed during their third trimester in different hospitals in UAE. Data were collected using interviewer-administered multi-component questionnaires addressing maternal sociodemographic and lifestyle characteristics. Maternal weight, weight gain, and GDM were recorded from the hospital medical records.

Results: Among the study participants, 71.1% had inadequate GWG: 31.6% insufficient and 39.5% excessive GWG. 19.1% reported having GDM and more than half of the participants (59.4%) had a pre-pregnancy BMI ≥ 25 kg/m. The findings of the multiple multinomial logistic regression showed that multiparous women had decreased odds of excessive gain as compared to primiparous [odds ratio (OR): 0.17; 95% CI: 0.05-0.54]. Furthermore, women with a pre-pregnancy BMI ≥ 25 kg/m had increased odds of excessive gain (OR: 2.23; 95%CI: 1.00-5.10) as compared to those with pre-pregnancy BMI < 25 kg/m. Similarly, women who had a pre-pregnancy BMI ≥ 25 kg/m were at higher risk of having GDM (OR: 2.37; 95%CI: 1.10-5.12). As for the associations of women's characteristics with pre-pregnancy BMI, age and regular breakfast consumption level were significant predictors of higher pre-pregnancy BMI.

Conclusions: This study revealed alarming prevalence rates of inadequate, mainly excessive, GWG and GDM among the MISC participants. Pre-pregnancy BMI was found a risk factor for both of these conditions (GWG and GDM). In addition, age and regular breakfast consumption were significant determinants of pre-pregnancy BMI. Healthcare providers are encouraged to counsel pregnant women to maintain normal body weight before and throughout pregnancy by advocating healthy eating and increased physical activity in order to reduce the risk of excessive weight gain and its associated complications.
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http://dx.doi.org/10.1186/s12884-019-2621-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892062PMC
December 2019

Nutrition in the Prevention of Breast Cancer: A Middle Eastern Perspective.

Front Public Health 2019 8;7:316. Epub 2019 Nov 8.

Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.

This paper reviews the escalating burden of breast cancer (BC) in the Middle East (ME) and the prevalence of modifiable risk factors and underscores opportunities to promote the prevention of the disease. Similar to more developed countries, BC is the most frequent cancer among women in countries of the ME, accounting for one-third of total cancer cases and 24% of total cancer deaths. Average age at BC diagnosis appears to be a decade earlier in Middle Eastern countries compared to the Western countries, and its incidence is predicted to further increase. Although incidence rates of BC are still lower in Middle Eastern countries than Western ones, mortality rates are similar and at times even higher. It is estimated that 30% of BC cases are due to environmental and lifestyle factors, such as obesity and diet and hence can be preventable. The ME suffers from surging rates of obesity, with eight of its countries ranking among the highest worldwide in obesity prevalence among adults aged 18 and above. ME countries with the highest prevalence of obesity that are among the top 20 worldwide include United Arab Emirates (UAE), Lebanon, Egypt, Libya, Qatar, Saudi Arabia, Jordan, and Kuwait with rates ranging from 30% in UAE to 37% in Kuwait. In parallel, studies in the ME have consistently showed a shift in dietary intake whereby traditional diets, rich in fruits and vegetables, are progressively eroding and being replaced by westernized diets high in energy and fat. Accumulating evidence is reporting convincing association between consumption of such westernized diets and higher BC risk. Addressing these risk factors and studying their association with BC in terms of their nature and magnitude in Middle Eastern countries could provide the basis for intervention strategies to lower the risk and alleviate the burden of BC in these countries.
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http://dx.doi.org/10.3389/fpubh.2019.00316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856137PMC
November 2019

Healthy Eating Index-2010 and Mediterranean-Style Dietary Pattern Score and the risk of colorectal cancer and adenoma: a case-control study.

Nutr Cancer 2020 5;72(8):1326-1335. Epub 2019 Nov 5.

Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology, Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Several studies have examined the relationship between diet quality indices and colorectal cancer (CRC). However, data on the association of these indices and colorectal adenomas (CRA) as a precursor of CRC are scarce. Our objective was to investigate the association of Healthy Eating Index (HEI-2010) and Mediterranean-Style Dietary Pattern Score (MSDPS) with CRC and CRA risk. This is a hospital-based case-control study including 259 cases (129 CRC and 130 CRA patients) and 240 controls with non-neoplastic conditions. Dietary intake of subjects was examined using a valid and reliable food frequency questionnaire. The HEI-2010 and MSDPS were then calculated based on a-priori methods. Multivariate logistic regression analyses were conducted to estimate the relationship between HEI-2010 and MSDPS and the risk of CRC and CRA. After adjustment for confounders, compared with the first tertiles, the highest tertiles of HEI-2010 and MSDPS were significantly associated with lower odds of CRC (OR = 0.04; 95% CI = 0.01-0.12, OR = 0.19; 95% CI = 0.09-0.38, respectively). Similarly, the highest tertiles of HEI-2010 (OR = 0.04; 95% CI = 0.08-0.32) and MSDPS (OR = 0.19; 95% CI = 0.17-0.58) were associated with reduced odds of CRA compared to the lowest tertiles. The findings of this study suggested that a high-quality diet assessed by HEI-2010 and MSDPS is inversely associated with the risk of CRC and CRA.
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http://dx.doi.org/10.1080/01635581.2019.1683212DOI Listing
June 2021

Human Milk Oligosaccharide, Phospholipid, and Ganglioside Concentrations in Breast Milk from United Arab Emirates Mothers: Results from the MISC Cohort.

Nutrients 2019 Oct 8;11(10). Epub 2019 Oct 8.

Fonterra Research and Development Centre, Dairy Farm Road, Private Bag 11029, Palmerston North 4442, New Zealand.

Human milk oligosaccharides (HMOs), phospholipids (PLs), and gangliosides (GAs) are components of human breast milk that play important roles in the development of the rapidly growing infant. The differences in these components in human milk from the United Arab Emirates (UAE) were studied in a cross-sectional trial. High-performance liquid chromatography‒mass spectrometry was used to determine HMO, PL, and GA concentrations in transitional (5-15 days) and mature (at 6 months post-partum) breast milk of mothers of the United Arab Emirates (UAE). The results showed that the average HMO (12 species), PL (7 species), and GA (2 species) concentrations quantified in the UAE mothers' transitional milk samples were (in mg/L) 8204 ± 2389, 269 ± 89, and 21.18 ± 11.46, respectively, while in mature milk, the respective concentrations were (in mg/L) 3905 ± 1466, 220 ± 85, and 20.18 ± 9.75. The individual HMO concentrations measured in this study were all significantly higher in transitional milk than in mature milk, except for 3 fucosyllactose, which was higher in mature milk. In this study, secretor and non-secretor phenotype mothers showed no significant difference in the total HMO concentration. For the PL and GA components, changes in the individual PL and GA species distribution was observed between transitional milk and mature milk. However, the changes were within the ranges found in human milk from other regions.
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http://dx.doi.org/10.3390/nu11102400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835464PMC
October 2019

Anthropometric Cutoffs for Increased Cardiometabolic Risk Among Lebanese Adults: A Cross-Sectional Study.

Metab Syndr Relat Disord 2019 12 30;17(10):486-493. Epub 2019 Sep 30.

Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.

Obesity is associated with increased risk for metabolic syndrome (MetS). Anthropometric cutoffs derived for Caucasians may not be applicable to identify obesity in Middle Eastern populations. This study aims to (1) determine optimal cutoff values of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) for the prediction of MetS among Lebanese adults and (2) to evaluate the ability of the derived cutoffs in predicting MetS, in comparison with published cutoffs. A cross-sectional study involving adults aged ≥20 years ( = 305) with no history of chronic diseases was conducted. Data collection included sociodemographic characteristics, anthropometric measurements, and fasting blood samples. The International Diabetes Federation criteria were used to identify MetS. Receiver operating characteristic analyses were performed to determine optimal cutoff values. The ability of the derived cutoffs in predicting MetS was examined using multiple logistic regression analyses. The derived cutoff values for men and women were 26.35 and 25.74 kg/m for BMI, 94 and 83 cm for WC, and 0.54 and 0.53 for WHtR, respectively. The use of the derived cutoffs improved the prediction of MetS compared to reference published cutoffs. In men, abdominal adiposity indicators performed better than BMI in predicting MetS, while in women, BMI, WC, and WHtR were all strong predictors. The study identified, for three anthropometric indices, the optimal cutoff values that identify MetS among Lebanese adults, hence responding to the need for ethnic-and population-specific cutoffs. Of interest, the study results documented gender differences in the association between anthropometric indices and MetS.
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http://dx.doi.org/10.1089/met.2019.0033DOI Listing
December 2019

Identification of dietary patterns associated with elevated blood pressure among Lebanese men: A comparison of principal component analysis with reduced rank regression and partial least square methods.

PLoS One 2019 16;14(8):e0220942. Epub 2019 Aug 16.

Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.

Background: To examine the associations of dietary patterns with odds of elevated Blood Pressure (BP) among Lebanese adult males using principal component analysis (PCA), and compare the results to two other data reduction methods, including reduced rank regression (RRR) and partial least-squares (PLS) regression.

Methods: Data from the National Nutrition and Non-Communicable Disease Risk Factor Survey conducted in Lebanon between years 2008 and 2009 were used. Dietary intake data were collected by a 61-item food frequency questionnaire (FFQ). In addition, anthropometric and blood pressure measurements were obtained following standard techniques. For the purpose of this study, data of males older than 20 years with no history of chronic diseases were selected (n = 673). Elevated BP was indicated if the systolic blood pressure was > = 130mm Hg and/or the diastolic blood pressure > = 85 mm Hg. Dietary patterns were constructed using PCA, PLS and RRR and compared based on the performance to identify plausible patterns associated with elevated BP. For PLS and RR, the response variables were BMI, waist circumference and percent body fat. Multiple logistic regression was used to evaluate the associations between the dietary pattern scores of each method and risk of elevated BP.

Results: Three dietary patterns were identified using PCA: Western, Traditional Lebanese, and Fish and alcohol. Both the Western and the Traditional Lebanese patterns were associated with higher odds of elevated BP in the study population (OR = 1.23, CI 1.03, 1.46; OR = 1.29, CI 1.09, 1.52 respectively). The comparison among the three methods for dietary patterns derivation showed that PLS and RRR derived patterns explained greater variance in the outcome (PCA: 1.2%; PLS: 14.1%; RRR: 15.36%) and were significantly associated with elevated BP, while the PCA dietary patterns were descriptive of the study population's real dietary habits (PCA: 23.6%; PLS: 19.8%; RRR: 11.3%).

Conclusions: The Western and Traditional Lebanese dietary patterns were associated with higher odds of elevated BP among Lebanese males. The findings of this study showed that, compared to PCA, the use of RRR method resulted in more significant associations with the outcome while the PCA-derived patterns were more related to the real habits in the study population.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220942PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697315PMC
April 2020
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