Assessment of the Composition of Breastmilk Substitutes, Commercial Complementary Foods, and Commercial Snack Products Commonly Fed to Infant and Young Children in Lebanon: A Call to Action.

(1) Background: Nutrition for optimum growth and physical development is acquired by adequate infant feeding practices. (2) Methods: One hundred seventeen different brands of infant formulas (n = 41) and baby food products (n = 76) were selected from the Lebanese market and were analyzed for their nutritional content. (3) Results: Saturated fatty acid content was detected to be the highest in follow-up formulas (79.85 g/100 g) and milky cereals (75.38 g/100 g). Among all saturated fatty acids, palmitic acid (C16:0) accounted for the greatest proportion. Moreover, glucose and sucrose were the predominant added sugars in infant formulas, while sucrose was the main added sugar in baby food products. Our data showed that the majority of the products were non-compliant to the regulations and the manufacturers' nutrition facts labels. Our results stated also that the contribution to the daily value for the saturated fatty acids, added sugars, and protein exceeded the daily recommended intake for most infant formulas and baby food products. (4) Conclusions: This requires careful evaluation from policymakers in order to improve the infant and young children feeding practices.

Breastfeeding Practices, Infant Formula Use, Complementary Feeding and Childhood Malnutrition: An Updated Overview of the Eastern Mediterranean Landscape.

BACKGROUND: With increasing global rates of overweight, obesity and non-communicable diseases (NCDs) along with undernutrition and micronutrient deficiencies, the Eastern Mediterranean Region (EMR) is no exception. This review focuses on specific nutrition parameters among under five years children, namely ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods and malnutrition. METHODOLOGY: PubMed, Google Scholar, United Nations International Children's Emergency Fund (UNICEF) databases, World Health Organization (WHO) databases, the World Bank databases and the Global Nutrition Report databases were explored between 10 January and 6 June 2022, to review the nutrition situation among under five years children in the EMR. RESULTS: The regional average prevalence of ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods was estimated at 84.3%, 30.9%, 42.9%, 41.5%, 32.1% and 69.3%, respectively. Iran, Iraq, Libya and Palestine have seen a decline over time in the prevalence of exclusive breastfeeding. Lebanon, Egypt, Kuwait and Saudi Arabia reported early introduction of infant formula. Moreover, Lebanon, Pakistan, Saudi Arabia and United Arab Emirates were seen to introduce food early to the child, at between 4-6 months of age. The estimated weighted regional averages for stunting, wasting and underweight were 20.3%, 8.9% and 13.1%, respectively. Of concern is the increasing prevalence of stunting in Libya. As for overweight and obesity, the average prevalence was reported to be 8.9% and 3%, respectively. Lebanon, Libya, Kuwait and Palestine showed an increased trend throughout this time. CONCLUSIONS: In this review, the suboptimal infant and young child feeding patterns and the twofold incidence of malnutrition in the EMR are highlighted and we urge the prioritizing of measures to improve children's nutrition.

Prevalence of Essential Nutrient Supplement Use and Assessment of the Knowledge and Attitudes of Lebanese Mothers towards Dietary Supplement Practices in Maternal, Infancy and Preschool Ages: Findings of a National Representative Cross-Sectional Study.

Mothers are understandably concerned about protecting the well-being of their offspring in every way possible, including providing oral dietary supplements (DSs). Up to now, there has been limited data on maternal knowledge and attitudes toward concomitant maternal-child DSs practices in Lebanon. This study evaluated the maternal knowledge and attitudes toward DSs and documented the DS-related practices in mothers and their under-5 children with their correlates. This cross-sectional study involved a representative stratified cluster random sample of 511 mother-child dyads (mothers: mean age ± SD = 30.25 ± 4.98 years; children: mean age ± SD = 18.7 ± 15.5 months, girls: 55.0%). A self-administered questionnaire was used to meet study aims. Most mothers lack awareness and hold unfavorable attitudes regarding DS use. Among all mothers, 47% were DS users, with the majority using vitamin D (82%). Almost 64% of mothers provide DSs for their children, with a predominant use of multivitamin drops (61.0%). "To keep the child healthy" was the reported reason by 60.0% of mothers to provide DSs for their children. Physicians were the primary information source about DSs for most mothers (64.0%). The usage of DSs among mothers was influenced by their pregnancy status, child's age, number of children per household, and their awareness and attitudes towards DSs. DS usage among children was correlated with maternal DS use and their mothers' attitudes towards DSs. DS usage among Lebanese mother-child dyads is common. Mothers should be the focus of education sessions regarding DS use.

Pediatric Health Risk Assessment for Exposure to Aluminum from Infant Formulas and Children under the Age of Five's Food Products among Arab Infants: Experience from Lebanon.

Chronic dietary aluminum (Al) exposure can have various negative effects on health. The aim of our study is to (1) assess the contamination level of Al in infant formulas (n = 41) and baby food products (n = 76) available in the Lebanese market, and to (2) evaluate the margin of exposure of Al through the consumption of these foods among children under the age of five in Lebanon. Flame atomic absorption spectrometry (FAAS) was used to evaluate all of the samples. Al levels in all tested children's food items were below the limit of detection. The highest Al level was detected in cornflakes (0.361 ± 0.049 mg/kg) and pureed foods (0.362 ± 0.079 mg/kg). Among infants aged 0−23 months, the average Al exposure due to the daily intake of infant formulas and baby foods was 0.01 and 0.0104 mg/kg BW/day for males and females, respectively. Babies aged 8−10 and 3−5 months had the highest and lowest levels of Al exposure, respectively. Additionally, the toxicological contribution of Al exposure determined for several age groups to a provisional tolerated weekly intake (PTWI) set by JECFA was <6% and <7% for males and females, respectively. The total Al exposure through the consumption of infant formulas and complementary foods among all ages in both males and females was below the values of weekly tolerable intakes (2 mg/kg/BW/W) set by JECFA. However, the values of hazard quotient (HQ) exceeded 1 in both male and female Lebanese infants. As a result, the risk of infants being exposed to Al in baby foods needs to be continuously considered.

Correlates of Sub-Optimal Feeding Practices among under-5 Children amid Escalating Crises in Lebanon: A National Representative Cross-Sectional Study.

Sub-optimal feeding practices among under-5 children are the major drivers of malnutrition. This study aims to assess the prevalence of malnutrition and the factors affecting exclusive breastfeeding, bottle feeding, and complementary feeding practices among under 5 children amid the COVID-19 pandemic as well as the economic and the political crises in Lebanon. A nationally representative stratified random sample of mother-child dyads (n = 511) was collected from households using a stratified cluster sampling design. The survey inquired about infant's feeding and complementary feeding practices using a valid questionnaire. Anthropometric measurements of the mother and child were collected. Multivariate logistic regression was conducted to explore the determinants associated with under-5 children's practices. The prevalence of underweight, stunting, wasting, overweight and obese children was 0.5%, 8.4%, 6.7%, 16.8% and 8.9%, respectively. In total, among under-5 children, the prevalence of ever breastfeeding, exclusive breastfeeding, and bottle feeding at birth was 95.1%, 59.1% and 25.8%, respectively. Half the children in this study started solid foods between 4 and 6 months. Regression analysis showed that supporting breastfeeding at hospital (aOR = 8.20, 95% CI (3.03-22.17)) and husband's support (aOR = 3.07, 95% CI (1.9-4.92)) were associated with increased breastfeeding odds. However, mother's occupation (aOR = 0.18, 95% CI (0.55-0.58)) was inversely associated with breastfeeding practices. Male children (aOR = 2.119, 95% CI (1.37-3.27), mothers diagnosed with COVID-19 (aOR = 0.58, 95% CI (0.35-0.95)), and bottle feeding at hospital (aOR = 0.5, 95% CI (0.32-0.77)) were more likely to induce early initiation of solid foods at 4 months of age. This study demonstrated non-negligible rates of malnutrition, low prevalence of exclusive breastfeeding, and high rates of early introduction of formula feeding and solid foods among Lebanese under-5-children amid escalating crises.

COVID-19 home isolation and food consumption patterns: Investigating the correlates of poor dietary diversity in Lebanon: a cross-sectional study.

Background: The unfurling COVID-19 pandemic has uncovered the defenselessness of the Lebanese food system leading to serious implication in maintaining a healthy sustainable lifestyle. Aim: The main purpose of this study is to examine the impact of the COVID-19 pandemic on food consumption patterns and dietary diversity of the Lebanese people. Methods: The online survey, completed between April and June 2020, consisted of a cross-sectional study on 2282 Lebanese participants (mean age: 29.36±12.221, 80.9% women) that was part of a survey across 38 different countries conducted by De Backer, C. et al. A food frequency questionnaire was used to investigate the consumption patterns along with the calculation of the Food Consumption Score (FCS), a proxy indicator of dietary diversity. Data collected on cooking attitudes, shopping, and food stock identify the community mitigation measures. Results: Home isolation due to COVID-19 induced an increase in the consumption of legumes and pulses (3.2%, p-value=0.001) and whole wheat groups (2.8%, p-value=0.03). In contrast, a decrease of 5.4%, 6.9%, 5.8%, 5.1%, 3.1%, 3.4% and 2.8% was observed in the consumption of fruits (p-value=0), vegetables (p-value=0), processed meats, poultry, and fish (p-value=0), other dairy products (p-value=0), sweet snacks (p-value=0.001), sugared beverages (p-value=0), fats and oils (p-value=0.001), respectively. The FCS decreased by 4.6%. As food-related behaviors, most cooking attitudes, and practices (10 out of 13) showed an amelioration during the lockdown and the proportions of food stocked have been changing since the start of the pandemic seeing higher amounts of pasta, rice or other grains, flour, and legumes/pulses stocked. Conclusion: To conclude, the hostile home isolation strategy followed to prevent the COVID-19 spread in Lebanon, came at a high nutritional cost, driving poor dietary diversity.

Assessment of Industrially Produced Trans Fatty Acids in Traditional Dishes, Arabic Sweets, and Market Food Products and Its Risks on Non-communicable Diseases in Lebanon.

Industrially produced trans fatty acids (IP-TFAs) are a major dietary contributor to non-communicable diseases worldwide. To address the industrially produced trans fatty acids food sources in Lebanon, a mapping exercise was enrolled between January 2019 and April 2021 to establish a national database. The 2019 survey was a pooled data from five separate sources and had relatively 30 types of traditional dishes. In contrast, the subsequent surveys in 2020 had a sample of 35 types of Arabic sweets and 80 types of market food products. The 2021 survey covered all types of butter and margarine available in the Lebanese markets. Our findings show that about 93% of the products tested in Lebanon, between 2019 and 2021, met the World Health Organization recommendations, while about 7% exceeded the limit. The mean level of the IP-TFAs elaidic and linolelaidic acids in most traditional dishes (0.9%), Arabic sweets (0.6%), butter, and margarine (1.6%), and market foods (0.52%) were relatively low compared with other countries. Although trans fatty acids have a small impact on heart disease mortality in Lebanon, they are unquestionably significant. The persistence of food products with high quantities of trans fatty acids poses a health risk to Lebanese citizens. Fortunately, proper laws in Lebanon can easily remedy this situation.

Non-Conjugated-Industrially-Produced-Trans Fatty in Lebanese Foods: The Case of Elaidic and Linolelaidic Acids.

To determine Industrially-Produced Trans fatty acids (IP-TFAs) distribution of Lebanese traditional foods, especially regarding Elaidic acid (EA; 9t18:1) and Linolelaidic acid (LEA; 9t12t18:2), a mapping exercise was enrolled between January 2019 and April 2021 in which 145 food samples of three categories (traditional dishes, Arabic sweets, and market food products) were analyzed using Gas chromatography methods. Results showed that about 93% of the products tested in Lebanon, between 2019 and 2021, met the World Health Organization recommendations, while about 7% exceeded the limit. The mean level of the IP-TFAs Elaidic and Linolelaidic acid in most Traditional dishes (0.9%), Arabic sweets (0.6%), butter and margarine (1.6%), and market foods (0.52%) were relatively low compared with other countries. Despite that, the relative impact of IP-TFAs on heart diseases mortality in Lebanon is limited but unambiguously still substantial. The persistence of food products with high IP-TFAs levels threatens the health of Lebanese people. Fortunately, this problem is fairly easy to solve in Lebanon via proper legislation.

Evaluation of Eating Habits and Quality of Life in Postbariatric Surgery Patients and Their Family Members: A Case-Control Study.

BACKGROUND: Obesity is a major health problem worldwide. Today, bariatric surgery is considered as the last option and most effective treatment for severe obesity (BMI ≥40 kg/m2 or BMI ≥35 kg/m2 with metabolic conditions). AIMS: We aimed to evaluate the medium-term effect (>36 months) of bariatric surgery and assess postbariatric nutritional and lifestyle management among Lebanese patients who underwent bariatric surgeries in Jbeil and Keserwan hospitals. METHODS: This study is a quantitative case-control study. The case group includes a couple of patients who have undergone sleeve or bypass surgery 6 months ago and above, along with the main family caregivers. The control group constitutes a couple of obese patients with BMI ≥30 kg/m2 who did not proceed to any surgical intervention with their main caregivers. The final samples consisted of 53 cases and caregivers and 50 controls and caregivers. The assessment was made by an online questionnaire. RESULTS: Compared to obese patients, bariatric patients were less likely to have high energy intake (54% versus 34%, P value 0.012). Moreover, 35.8% of the caregivers of bariatric patients had a low physical activity level compared to those of the control group who had a lower level (70%). In addition, cases' main caregivers (75.5%) had much higher quality of life compared to the cases (56.6%), and also, higher quality of life was seen among the case's main caregivers (75%) compared to the controls (72%). CONCLUSION: In Jbeil and Keserwan regions of Lebanon, there is a lack of postbariatric nutritional and lifestyle management leading to less desirable outcomes in the medium to long term. A set of recommendations are developed based on this study.