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

Food insecurity is associated with low diet quality and unhealthy cooking and eating habits in Iranian women

BACKGROUND

Food insecurity affects diet and nutrition intakes. We explored the relationship between food insecurity and dietary intakes in a group of Iranian women.

METHODS

The cross-sectional study was performed on 190 healthy females aged 20-55 years attending primary healthcare centers in Shiraz. Food insecurity was evaluated by Household Food Insecurity Access Scale, which is a validated tool for assessing food insecurity in developing countries. Diet was assessed using a food frequency questionnaire. The association of dietary patterns and food insecurity was assessed by linear regression.

RESULTS

Assessment of dietary intakes revealed that consumption of red meat, poultry, fish, dairy, fruits, non-starchy vegetables, and nuts decreased whereas that of grains, processed meats, potato, and sugary foods increased with increasing food insecurity. Among nutrients, carbohydrates, fiber, vitamin A, vitamin C, folic acid, potassium, calcium, and magnesium decreased while fat and sodium increased as food insecurity increased. Three major dietary patterns were detected. Healthy dietary patterns showed inverse associations with food insecurity in the crude (β = -0.422 and - 0.435, P < 0.001) and adjusted (adjusted for age, marital status, and educational level) (β = -0.475 and - 0.341, P < 0.001) models of regression analysis but unhealthy pattern did not show an association with food insecurity. Compared to food secure participants, a higher percentage of food insecure individuals indicated unhealthy eating habits, such as skipping breakfast, lower snack ingestion, more fast and fried food consumption, and using unhealthy cooking methods.

CONCLUSION

Overall, this study showed that food insecurity was associated with less healthy diet and unhealthy cooking and eating habits.

Evolution of adolescents' dietary patterns in Northeast Brazil from 2008 to 2018

OBJECTIVE

To evaluate the evolution of the dietary patterns of adolescents in the northeast region of Brazil.

METHODS

Secondary analysis of data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Surveys), collected by the Brazilian Institute of Geography and Statistics (IBGE) in the years 2008-2009 and 2017-2018. A total of 3,095 adolescents were evaluated in 2008-2009 and 3,015 in 2017-2018. Food consumption was assessed using two dietary records in 2008-2009 and two 24-hour recalls in 2017-2018, applied on non-consecutive days. Based on these data, principal components factor analysis (PCFA) was performed, followed by orthogonal rotation of the varimax type, to derive dietary patterns, stratified by sex. The results were described as means or percentage frequencies, with their respective 95% confidence intervals.

RESULTS

Three main dietary patterns were identified among adolescents from the northeast region of Brazil. Among boys, in 2008-2009, the patterns were called snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and mixed, in this order of representativeness of the group's eating habits. Among female adolescents, in 2008-2009, the patterns were snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and processed meats.

CONCLUSION

The dietary patterns identified in 2008-2009 and 2017-2018 were similar in both genders; however, the snacks pattern, which explained most of the data variability in 2008-2009, was replaced by the traditional Brazilian.

Association between Socioeconomic Factors, Food Insecurity, and Dietary Patterns of Adolescents: A Latent Class Analysis

Socioeconomic factors and food insecurity play a fundamental role in the food choices of adolescents, and in addition to influencing access to food, they also have significant effects on dietary patterns. The objectives of this study were to identify the dietary patterns of adolescents through the application of latent class analysis and to evaluate their association with socioeconomic variables and food insecurity. This cross-sectional study was conducted with adolescents aged between 11 and 17 years from public schools. Latent class analysis was used to identify the dietary patterns. Associations between socioeconomic factors, food insecurity and dietary patterns were assessed using multinomial logistic regression (odds ratio (OR); 95% confidence interval (CI)). Among the 1215 participants in the study, four dietary patterns were identified: "Mixed", "Low consumption", "Prudent" and "Diverse". A "Diverse" dietary pattern was associated with a lower economic stratum (OR:2.02; CI:1.26-3.24). There was no association between food insecurity and identified dietary patterns. These results highlight the importance of promoting healthy eating in this age group at all socioeconomic levels, especially the lowest level.

Assessing the nutritional content and adequacy of food parcels among vulnerable Lebanese during a double crisis: COVID-19 pandemic and an economic meltdown

OBJECTIVES

This study aimed to explore the nutritional content and quality of food parcels distributed in Lebanon and assess their adherence to dietary guidelines during the COVID-19 pandemic and an unprecedented economic crisis.

DESIGN

Cross-sectional study (June-July 2020); phone survey (thirty items).

SETTING

Lebanon.

PARTICIPANTS

Food parcel providers (FPP; n 72) involved in food parcel distribution (FPD), mainly to Lebanese households.

RESULTS

FPP included international non-governmental organizations (INGO) (n 3), local non-governmental organizations (n 45) and personal initiatives (n 24). Overall, low adherence to the World Food Programme (WFP) food parcel guidelines were observed among FPP for specific food items, including vegetables, fish, legumes and cereals, whereas salt content significantly surpassed the guidelines (all P-values <0·001). On average, a food parcel provided 608·4 ± 55 kcal/d/person. The greatest contributors to total energy intake (TE) in the food parcel were carbohydrates (46·4 %) and fats (46·8 %), while protein contributed to 7 %TE. In addition, %TE from fats and sugars significantly surpassed the dietary reference intakes (DRI) for a single person per d (134-234 % and 185 % of DRI, respectively, P-values <0·001). Only 10-15 % of daily needs for key micronutrients, including Fe, Zn, thiamin, riboflavin and dietary folate, were met through the food parcels. Adequate food safety and hygiene practices were reported among FPP, yet dramatic changes in food costs due to overlapping crises affected the quality and quantity of food in parcels.

CONCLUSIONS

Findings highlight the need to improve the nutritional content of food parcels and adherence to dietary guidelines to alleviate food and nutrition insecurity while preventing diet-related diseases among vulnerable beneficiaries in Lebanon.

Is food insecurity related to sustainable and healthy eating behaviors?

In this cross-sectional study, it was aimed to investigate the relationship between sustainable and healthy eating behaviors such as nutritional insecurity and a healthy and balanced diet, interest in regional and organic food products, consumption of seasonal food and avoidance of food waste, preference for locally produced foods, reduction of meat consumption, preference for eggs from free-range chickens, and sustainable fishery products, and consumption of low-fat food products in adults. The study included 410 adults who were reached through social media applications. Data were collected through an online questionnaire including the Descriptive Information Form, the Household Food Insecurity Access Scale (HFIAS), and the Sustainable Healthy Eating Behaviors Scale (SHEBS). The proportion of participants determined as mildly food insecure, moderately food insecure, and severely food insecure was 10.2%, 6.6%, and 7.6%, respectively. Linear regression analysis revealed that in Models 1, 2, and 3, there was a statistically significant negative association between food insecurity and the components of sustainable and healthy eating behaviors such as healthy and balanced diet (β - 0.226, p < 0.001), quality labels (β - 0.230, p < 0.001), seasonal foods, which are of avoidance of food waste (β - 0.261, p < 0.001), animal welfare (β - 0.174, p < 0.001), and fat intake (β - 0.181, p < 0.001). In conclusion, food insecurity negatively affects healthy and balanced diet behaviors, interest in regional and organic food products, seasonal food products consumption and avoidance of food waste, consumption of low-fat food products, and the choice of products such as free-range chicken eggs, and sustainable fisheries.

Food insecurity was negatively associated with adherence to the "fruits, vegetables, and foods rich in animal protein" dietary pattern among university students' households: the 2018 Mexican National Household Survey

BACKGROUND

University students are often affected by food insecurity (FI) and this situation has been associated with low consumption of fruit/vegetables and high intake of added sugars and sweet drinks. However, there needs to be more evidence on the association between FI and dietary patterns (DPs), assessing the overall diet and allowing analysis of commonly consumed food combinations. We aimed to analyze the association between FI and DPs in university students' households.

METHODS

We used data from 7659 university student households from the 2018 Mexican National Household Income and Expenditure Survey (ENIGH, for its acronym in Spanish). We obtained FI levels (mild, moderate, and severe) using the validated Mexican Food Security Scale (EMSA, Spanish acronym). Two DPs were identified by principal component analysis based on the weekly frequency of consumption of 12 food groups. Multivariate logistic regression adjusted by university student and household's characteristics was applied.

RESULTS

Compared to food security, households with mild-FI (OR:0.34; 95%CI:0.30, 0.40), moderate-FI (OR:0.20; 95%CI:0.16, 0.24) or severe-FI (OR:0.14; 95%CI:0.11, 0.19) were less likely to adhere to the dietary pattern "Fruits, vegetables and foods rich in animal protein" (fruits, vegetables, meat, fish or seafood, dairy products, and starchy vegetables). In addition, people with severe-FI (OR:0.51; 95% CI:0.34, 0.76) were also less likely to adhere to the dietary pattern "Traditional-Westernized" (pulses, oils or fats, sugar, sweets, industrialized drinks, foods made from corn/maize, wheat, rice, oats or bran, coffee, tea and eggs).

CONCLUSIONS

In these households FI impairs the ability to consume a healthy dietary pattern (fruits/vegetables and foods rich in animal protein). In addition, the intake of foods typical of the Mexican food culture reflecting the local Western dietary pattern is compromised in households with severe-FI.

Assessing the relationship between food insecurity and lifestyle behaviors among university students: a comparative study between Lebanon and Germany

BACKGROUND

Food insecurity is a common public health problem in both developed and developing countries. This study aimed to profile food insecurity among university students in a developed country with stable economic circumstances (Germany) and a developing Mediterranean country undergoing a severe economic and financial crisis (Lebanon) and examine the associations between food insecurity and lifestyle behaviors (i.e., physical activity, sleep, and adherence to a healthy eating pattern, such as the Mediterranean diet), stress, and financial well-being.

METHOD

This online cross-sectional study was conducted between September 2021 and March 2022. Subjects were recruited through social media platforms (Facebook, WhatsApp, Instagram, and personal email) and in-class announcements by several university professors of various majors and from different universities in Lebanon and Germany. The final sample included 547 participants (197 from Lebanon and 350 from Germany).

RESULTS

Our findings showed a higher food insecurity rate in Lebanon compared with Germany (59% versus 33%). In the bivariate analysis, food insecurity was associated with insomnia (r = 0.230; p < 0.001) and stress (r = 0.225; p = 0.001); German university students had higher physical activity (p < 0.001), better diet quality (p < 0.001), and lower adherence to the Mediterranean diet (p < 0001) than Lebanese students. In the multivariable analyses, more stress was related to insomnia (B = 0.178; p < 0.001), while financial well-being was not associated with any of the lifestyle behaviors. Physical activity, insomnia, and Mediterranean diet adherence were not associated with the country or food insecurity (p > 0.05); however, living in Germany was associated with better diet quality (B = -7.85; p < 0.001).

CONCLUSION

The high prevalence of food insecurity reported in this study is alarming, particularly among Lebanese students; German students had better diet quality and higher physical activity but worse adherence to the Mediterranean diet. Moreover, food insecurity was also associated with worse sleep and stress. Further studies are necessary to assess the role of food insecurity as a mediating factor between sociodemographic characteristics and lifestyle behaviors.

Relationship between food insecurity and geriatric syndromes in older adults: A multicenter study in Turkey

AIMS

In this study, the aim was to determine the prevalence of geriatric syndromes such as frailty, sarcopenia risk and malnutrition in older adults and to investigate the relationship between food insecurity, and frailty, risk of sarcopenia and malnutrition.

METHODS

The study was cross-sectional. It was conducted between February 2022 and June 2022 with 707 older adults. The data were collected through the face-to-face interview method with a questionnaire including the Descriptive Information Form, Household Food Insecurity Access Scale (HFIAS), Frail Scale, Sarcopenia Risk Screening Scale (SARC-F) and Mini Nutritional Assessment-Short Form (MNA-SF). Numbers, percentages, mean, standard deviation, Pearson chi-square test and binary logistic regression analysis were used in data analysis.

RESULTS

In the present sample, 30% of the participants experienced some degree of food insecurity. The prevalence of frailty, sarcopenia risk, and malnutrition in the participants was 15.3%, 19.5%, and 1.3%, respectively. We determined that food insecurity was not associated with pre-frailty/frailty and sarcopenia risk. After adjusment for potential counfounders moderate and severe food insecurity was associated with higher odds of malnutrition risk and malnutrition (AOR: 2.06, 95% CI: 1.21-3.51, p:0.007).

CONCLUSION

While food insecurity is not associated with pre-frailty/frailty and sarcopenia risk, moderate and severe food insecurity is a modifiable risk factor for malnutrition risk and malnutrition. Thus, economic and social policies to eliminate food insecurity should be implemented, and efforts to prevent food insecurity should be planned through inter-sectoral cooperation.

Moderators of Food Insecurity and Diet Quality in Pairs of Mothers and Their Children

Research has suggested that maternal diet and characteristics may influence the diet of offspring during childhood. The present cross-sectional study aimed to assess the influence of distinct maternal characteristics and the diet quality of mothers on the prevalence of household food insecurity (FI) and the diet quality of children. A total of 179 mother–child pairs were recruited from two primary schools in the metropolitan area of Thessaloniki. The children were aged between 10 and 12 years old. Diet quality was assessed as the level of adherence to the Mediterranean diet (MD), with the use of the KIDMED for the children and the MedDietScore for the mothers. The household FI and the social and demographic characteristics of the mothers were also recorded, and anthropometric measures of both the mothers and their children were collected. Approximately ¼ (26.3%) of the pairs reported some degree of FI, with a greater prevalence (64.7%) within single-mother families. Moreover, FI affected the level of maternal MD adherence (p = 0.011). On the other hand, FI was decreased in households with a greater maternal educational level (OR: 0.25; 95% CI: 0.10–0.63) and conjugal family status (OR: 0.15; 95% CI: 0.87–0.52). Maternal adherence to the MD was inversely related to the respective adherence of their offspring (OR: 0.93; 95% CI: 0.86–0.997), suggesting that during periods of financial constraints, maternal diet quality is compromised at the expense of affording a better diet for the minors in the family.

Adherence to the Mediterranean diet among adults in Mediterranean countries: a systematic literature review

BACKGROUND AND AIM

While the Mediterranean diet (MD) is promoted in non-Mediterranean countries, inhabitants of Mediterranean countries seem to be shifting away from this healthy diet. The aim of this study is to provide an overview of MD adherence in the general adult population of Mediterranean countries.

METHODS

A systematic review was conducted following the PRISMA 2020 (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines and registered in the Prospero database (CRD42020189337). Literature was searched in PubMed, Web of Science and PsycINFO databases for studies published from 2010 up to and including 2021. The following inclusion criteria were used: age 18 years and older, sample size > 1000 participants, and using a validated MD adherence score. Studies that only included participants with nutrition-related or other severe chronic disorders, as well as studies that only included specific subpopulations (e.g., pregnant women), were excluded in order to focus on the general adult population. A quality analysis of the included studies was done using the NCCMT scale.

RESULTS

A total of 50 studies were included. The number of participants in the included studies ranged between 1013 and 94,113. Most of the included studies pertained to the European Mediterranean countries, with fewer studies from the Middle Eastern and North African Mediterranean countries. The vast majority of the included studies reported low or moderate MD adherence, both based on the mean adherence as well as the low or moderate adherence category often being the most prevalent. There were no clear differences noted between sex and age groups. The quality assessment generally showed weak or moderate scores.

CONCLUSIONS

Mediterranean populations have been showing moderate adherence to MD in the past 10 years, indicating room for improving adherence to the MD in countries of its origin.

Dietary Patterns and Their Associations With the FTO and FGF21 Gene Variants Among Emirati Adults

Purpose: To examine the dietary patterns and their associations with the FTO and FGF21 gene variants among Emirati adults. Methods: Using a cross-sectional design, healthy adult male and female Emiratis (n = 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 FTOrs9939609(A>T), FTOrs9930506(A>G), FGF21 rs838133 (A > G), and FGF21 rs838145 (A > G). Dietary patterns were derived using the principal component analysis. Logistic regression analyses were used to examine the association of dietary patterns with genetic variants. Results: 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 FTO rs9939609 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 FTO rs9930506 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 FGF21 rs838133 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). Conclusions: The findings of this study suggested associations among specific FTO and FGF21 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.

Nutrition Literacy among Adolescents and Its Association with Eating Habits and BMI in Tripoli, Lebanon

(1) Background: Adolescence is a period of increased autonomy and independent decision making; it determines health behaviors that can persist into the future. Individual factors like food choices and unhealthy lifestyle have an essential role in the development and prevention of obesity among adolescents and are associated with the nutrition literacy of parents and other adults. While the association of parents' nutrition literacy with adolescent BMI has been addressed, there is still a scarcity of studies that examine the effect of adolescents' nutrition literacy on their eating habits and body mass index (BMI) status. (2) Methods: A cross-sectional study was conducted that included 189 adolescents (68 with overweight and obesity and 121 with normal weight) aged between 14-19 years from four private schools in Tripoli, Lebanon. A self-administered questionnaire that included the Nutrition Literacy Assessment Instrument (NLAI) and the Adolescent Food Habits Checklist (AFHC) was used. Anthropometrics were measured using standardized procedures. The association between nutrition literacy, food habits and BMI was assessed using a chi squared test for independence and Poisson regression analysis where suitable. (3) Results: Results indicated no association between all five components of nutrition literacy and body mass index categories. Furthermore, there was no association between the Adolescent Food Habits Checklist and overweight or obese BMI status (RR = 0.947, 95%CI: 0.629-1.426) (p = 0.796). No association was observed between nutrition literacy and food habits, except for an inverse association with macronutrients literacy. (4) Conclusions: In conclusion, the study indicated that there was no association between the components of nutrition literacy with body mass index or with food habits, except for macronutrient literacy.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

How Healthy Are Health-Related Behaviors in University Students: The HOLISTic Study

The aim of this cross-sectional study was to assess the health-related behaviors among university students, with emphasis on health sciences students from Croatia, Italy, Lebanon, Poland, Romania, Spain and Turkey. We included 6222 students in Medicine, Dentistry, Nursing, Pharmacy, Nutrition and Dietetics, Sports Sciences, Veterinary, and Economics enrolled between April 2018 and March 2020. We assessed dietary patterns, sleeping habits, physical activity and perceived stress among students by means of validated questionnaires. The median age ranged between 19 and 24 years, smoking prevalence between 12.0% and 35.4%, and body mass index (BMI) ranged between 21.1 and 23.2 kg/m². Breakfast was less often and more often consumed daily in Turkey (36.7%), and Italy (75.7%), respectively. The highest Mediterranean diet score was recorded in Spain and Italy, and the lowest in Turkey, followed by students from Croatia, Lebanon, Poland and Romania. Sleep duration, physical activity and stress perception also differed between countries. Multivariable regression analysis revealed a small, but positive association between BMI and several characteristics, including age, female gender, smoking, physical activity, mobile phone use, and perceived stress. A negative association was found between BMI and sleep duration on non-working days. Self-rated health perception was positively associated with female gender, breakfast, physical activity, and time spent studying, and negatively with BMI, smoking and stress. Our results demonstrated diverse habits in students from different countries, some of which were less healthy than anticipated, given their educational background. Greater emphasis needs to be placed on improving the lifestyle of these adolescents and young adults, who will be tomorrow’s healthcare workers.

Trends of Alcohol Use, Dietary Behaviour, Interpersonal Violence, Mental Health, Oral and Hand Hygiene Behaviour among Adolescents in Lebanon: Cross-Sectional National School Surveys from 2005, 2011 and 2017

Health risk behaviours during adolescence can have long-term negative consequences. Little is known, however, about the recent health risk behaviour trends in adolescents in Lebanon. This investigation aimed to report the trends in the prevalence of various health risk behaviours, such as alcohol use, dietary behaviour, interpersonal violence, mental health, oral and hand hygiene, among adolescents in Lebanon. Cross-sectional nationally representative data were analysed from 13,109 adolescents (14 years median age) that participated in three waves (2005, 2011 and 2017) of the “Lebanon Global School-Based Student Health Survey (GSHS)”. Results indicate that significant improvements were found among both boys and girls in the decline in interpersonal violence (bulling victimization, being physically attack and involvement in physical fighting), poor washing of hands after using the toilet, and suicide planning, and among girls only loneliness, worry-induced sleep disturbance and suicidal ideation. Significant increases were found among both boys and girls in the prevalence of inadequate fruit consumption, and among boys only unintentional injury and not always washing hands before eating. In conclusion, several decreases but also increases in health risk behaviours were found over three assessment points during a period of 12 years calling for continued health enhancing activities in this adolescent population.