The purpose of this study was to measure the impact of the Ajyal Salima school intervention on nutrition and physical activity outcomes in children aged 9–11 years.

The study was a 1-year cluster-randomised controlled trial. Ajyal Salima used a multi-component approach including classroom activities, family programme and food service adaptation. Outcomes included daily intake of breakfast, frequency of healthy and unhealthy food consumption, frequency of physical activity, knowledge score and self-efficacy score. Intervention and control groups were compared for all main outcomes and a post-intervention qualitative evaluation assessed strengths and limitations of the intervention components.

Schools in five countries – Lebanon, Jordan, Palestine, Saudi Arabia and Bahrain.

Schools were selected by Ministries of Health and Education within their jurisdictions. Forty-five intervention schools (6052 students) and forty-six control schools (6200 students) were included in the analysis.

The intervention group had a significantly higher odds of consuming breakfast daily (OR 95 % CI = 1·60, 1·35, 1·90), consuming healthy foods (OR 95 % CI = 1·60, 1·39, 1·84) and a decreased odds of consuming unhealthy foods and sweetened beverages (OR, 95 % CI = 0·70, 0·60, 0·81). Additionally, school children in the intervention group, as compared with the control group, were 47 % more likely to exercise outside school hours (OR 95 % CI = 1·47, 1·23, 1·76). Lastly, children in the intervention group had a significantly improved nutritional knowledge score and improved self-efficacy by 1·3 score unit and 1·1 score unit, respectively.

The Ajyal Salima intervention led to significant improvements in dietary and physical activity habits among school children and increased nutritional knowledge scores.

To assess infant and young child feeding (IYCF) practices in Lebanon and investigate their associations with socio-demographic and lifestyle factors.

A cross-sectional national survey was conducted in 2012–2013. In addition to a socio-demographic and lifestyle questionnaire, a 24-h dietary recall for the children was collected, with mothers as proxies. IYCF practices were assessed based on the 2021 indicators of the WHO.

Lebanon.

Children aged 0–23 months and their mothers (n 469).

While the majority of infants were ever breastfed (87·6 %), the prevalence of exclusive breast-feeding (BF) in those under 6 months of age was 11·0 %. Early initiation of BF was 28 %. A greater child’s birth order, partner’s support for BF, higher parental education, maternal BF knowledge and non-smoking were associated with higher odds of meeting BF recommendations. As for complementary feeding, 92·8 % of children (6–23 months) met the minimum meal frequency indicator, 37·5 % met the minimum dietary diversity (MDD) and 34·4 % met the minimum adequate diet (MAD). The consumption of unhealthy food was observed amongst 48·9 % of children, with nearly 37 % consuming sweet beverages. Older maternal age and maternal overweight/obesity were associated with lower odds of meeting MDD and MAD, while child’s age and partner’s support for BF were associated with higher odds.

The results documented suboptimal IYCF practices amongst Lebanese children and identified a number of factors associated with these practices. Findings from this study will help guide the development of culture-specific programmes aimed at improving IYCF practices in Lebanon.

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

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)).

Lebanon.

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

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.

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.

Introduction: Micronutrient deficiencies and malnutrition during the first 1000 days of life can have lifelong effects on the physical and cognitive development of the child. Lebanon, host of the world's highest per capita number of refugees, is becoming increasingly vulnerable to micronutrient deficiencies and facing a protracted crisis. Up-to-date, there is a lack of studies assessing hidden hunger, such as anemia and its determinants, particularly in a fragile setting.

Material and methods: A cross-sectional survey was applied to 539 mother-child pairs of Syrian refugees and Lebanese host communities attending primary health care centers in 6 vulnerable areas of Greater Beirut, Lebanon between July and September 2018. The interview was completed by 476 pairs consisting of women of reproductive age (15–49 years) and children (0–59 months). The questionnaire gathered data on socio-economic characteristics, infant and young child feeding practices, and nutritional status. Hemoglobin concentrations were measured using the HemoCue Hb301 + analyzer. Data analysis used descriptive statistics, t-test, and chi-square test.

Results: Overall, 45.4% of the women were lactating (LW), 16.6% pregnant (PW), and 38.0% non-pregnant non-lactating (NP/NL). The vast majority of the infants were ever breastfed (96.6%) and received colostrum (90.5%); however, more than half of the infants were offered pre-lacteal feedings (55.0%) and only one third were breastfed within the first hour after birth (35.2%). The rate of exclusive breastfeeding under six months was 22.2%. About half of the children were predominantly breastfed under six months (50.4%). Long-term breastfeeding up to the age of 1 year (47.2%), or even 2 years (19.2%), was practiced in line with the WHO recommendations. Anemia rates among mothers were significantly higher among NP/NL compared to PW and LW (26.1%, 17.7%, 18.8%, respectively, p < 0.05). Whereas, anemia rates among children were significantly higher in LW compared to NP/NL and PW (43.0%, 30.0%, 21,5%, respectively, p < 0.01). Among breastfed children, maternal anemia was significantly higher among anemic children (25.8%) compared to non-anemic children (14.0%, p < 0.05). Mild anemia of children under six months was significantly higher among overweight and obese mothers compared to mothers with a healthy BMI (67.7% vs 32.3%, p < 0.05).

Conclusions: Despite an almost universal initiation of breastfeeding, early onset and exclusive breastfeeding under six months were low. Higher anemia rates were found among breastfed children and this was significantly associated to the maternal nutritional- and anemia status. Further analysis is required to examine the determinants of anemia and breastfeeding in this setting.

Food insecurity (FI) is a major public health problem in Lebanon, a small middle-income country with the highest refugee per capita concentration worldwide and prolonged political and economic challenges. The present study aimed to measure the prevalence and sociodemographic correlates of household FI and to explore the association of household FI with anthropometric measures of children and their mothers.

Cross-sectional survey (2014–2015).

Lebanon.

Nationally representative sample of Lebanese households with 4–18-year-old-children and their mothers (n 1204).

FI prevalence (95 % CI), measured using the Arabic-translated, validated Household Food Insecurity Access Scale, was found to be 49·3 (44·0, 54·6) % in the study sample. Mild, moderate and severe FI were found in 7·0 (5·5, 9·2) %, 23·3 (20·1, 26·8) % and 18·9 (14·9, 23·5) % of households, respectively. Multiple regression analysis showed that low maternal and paternal education, unemployment and crowding were significant correlates of household FI (P<0·05). No significant associations were observed between FI and anthropometric measures of children and their mothers, after adjusting for other socio-economic correlates. Food-insecure households reported various mechanisms to cope with food shortage, such as reducing the number of meals/d (49·6 %), borrowing food (54·4 %), spending savings (34·5 %) and withdrawing children from schools (8·0 %).

FI exists among a remarkable proportion of Lebanese households with children. Correlates of household FI should be considered when designing social welfare policies and public health programmes to promote more sustainable, resilient and healthier livelihoods among vulnerable individuals.

To assess the validity and reliability of the Arabic version of the Household Food Insecurity Access Scale (HFIAS) in rural Lebanon.

A cross-sectional study on a sample of households with at least one child aged 0–2 years. In a one-to-one interview, participants completed an adapted Arabic version of the HFIAS. In order to evaluate the validity of the HFIAS, basic sociodemographic information, anthropometric measurements of the mother and child, and dietary intake data of the child were obtained. In order to examine reproducibility, the HFIAS was re-administered after 3 months.

Rural Lebanon.

Mother and child pairs (n 150).

Factor analysis of HFIAS items revealed two factors: ‘insufficient food quality’ and ‘insufficient food quantity’. Using Pearson's correlation, food insecurity was inversely associated with mother's and father's education levels, number of cars and electrical appliances in the household, income, weight-for-age and length-for-age of the child and the child's dietary adequacy. In contrast, mother's BMI and crowding index were positively associated with food insecurity scores (P < 0·05 for all correlations). Cronbach's α of the scale was 0·91. A moderate correlation was observed between the two administrations of the questionnaire (intra-class correlation = 0·58; P < 0·05).

Our findings indicated that the adapted Arabic version of the HFIAS is a valid and reliable tool to assess food insecurity in rural Lebanon, lending further evidence to the utility of the HFIAS in assessing food insecurity in culturally diverse populations.

To identify and characterize dietary patterns in Lebanon and assess their association with sociodemographic factors, BMI and waist circumference (WC).

A cross-sectional population-based survey. In a face-to-face interview, participants completed a brief sociodemographic and semiquantitative FFQ. In addition, anthropometric measurements were obtained following standard techniques. Dietary patterns were identified by factor analysis. Multivariate linear regression was used to assess determinants of the various patterns and their association with BMI and WC.

National Nutrition and Non-Communicable Disease Risk Factor Survey (2009), Lebanon.

A nationally representative sample of 2048 Lebanese adults aged 20–55 years.

Four dietary patterns were identified: ‘Western’, ‘Traditional Lebanese’, ‘Prudent’ and ‘Fish and alcohol’. Factor scores of the identified patterns increased with age, except for the Western pattern in which a negative association was noted. Women had higher scores for the prudent pattern. Adults with higher levels of education had significantly higher scores for the prudent pattern. The frequency of breakfast consumption was significantly associated with scores of both traditional Lebanese and prudent patterns. Multivariate-adjusted analysis revealed a positive association between scores of the Western pattern and the BMI and WC of study participants.

The findings show the presence of four distinct dietary patterns in the Lebanese population, which were associated with age, sex, education and meal pattern. Only the Western pattern was associated with higher BMI.

To investigate, measure and assess the food consumption pattern of the adult population living in Beirut, Lebanon, and to identify inadequate or excessive intake of food groups particularly linked to non-communicable diseases.

A cross-sectional food consumption survey was conducted in 2001. Dietary habits were assessed by means of a quantitative food-frequency questionnaire.

Dietary survey of the urban population (Beirut).

Random sample of 444 adult subjects (aged 25–54 years) in Beirut.

The mean consumption of food by the study population was estimated to be 3030 g day−1, providing an energy intake of 2523.57 kcal day−1. Fat contributed 38.9% to the average daily energy intake, protein 13.4% and carbohydrates 47.2%. Mean consumption of fruits and vegetables was approximately 367 g day−1 and 45.3% of subjects consumed less than the recommended 400 g daily. Cereals contributed 324.5 g day−1, providing 35.0% of daily energy intake, with bread being the most highly consumed (146.2 g day−1) in this food group. The mean intake of meat and poultry products was 91.7 g day−1 and provided 8.8% of daily energy intake, with consumption of butchery products especially beef being the highest (47.6 g day−1) followed by poultry (36.1 g day−1). A low consumption of fish was noted (19.7 g day−1), with 73.6% of subjects consuming less than the recommended 2 servings of fish per week. Dairy products contributed 243.1 g day−1 or 10.9% of daily energy intake, and milk was the least consumed dairy product (56.8% of consumers). The intake of added fats and oils, excluding those in cooked recipes, was 20.4 g day−1; olive oil was not used in cooking but was added solely at the table and its mean intake was 5 g day−1. The consumption of butter was low (0.86 g day−1) and vegetable oil was the type of fat mostly used in cooking. The average intake of alcoholic beverages was low (33.6 g day−1), accounting for 0.7% of total energy intake. Women had significantly higher intakes of milk, dairy products, vegetables and coffee than men (P < 0.05). The percentage of women who reported the use of low-fat items was significantly higher than that of men. Younger people (25–34 years) ate significantly more meat, sugar, alcoholic beverages and soft drinks, and consumed significantly less cooked vegetables and legumes, than older ones (P < 0.05).

The rather high contribution of fat to daily energy intake, the low intake of fish and the relatively high percentage of people consuming less than the recommended amount of fruits and vegetables observed in this study suggest that the adult Lebanese population is at increased risk of cardiovascular diseases, obesity and other non-communicable diseases, which provides the basis for recommending increased intakes of fish, particularly fatty fish, and fruits and vegetables.

The objective of this study was to identify the determinants of anaemia in Lebanese women of childbearing age attending health centres in Lebanon.

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.

Governmental health centres in Lebanon.

Four hundred and seventy non-pregnant Lebanese women aged 15–45 years.

Anaemia (Hb <12 g dl−1) and iron deficiency (ferritin <15 μg 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.

Anaemia not related to iron deficiency was partly explained by plasma folate deficiency. Measures to control folate and iron deficiency should be considered.