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

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Abstract

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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References

  1. Demory-Luce D, Motil KJ, (2018) Adolescent eating habits. https://www.uptodate.com/contents/adolescent-eating-habits. Accessed 27 Mar 2019

  2. Das JK, Salam RA, Thornburg KL, Prentice AM, Campisi S, Lassi ZS, Koletzko B, Bhutta ZA (2017) Nutrition in adolescents: physiology, metabolism, and nutritional needs. Ann N Y Acad Sci 1393(1):21–33. https://doi.org/10.1111/nyas.13330

    Article  PubMed  Google Scholar 

  3. Neumark-Sztainer D, Story M, Perry C, Casey MA (1999) Factors influencing food choices of adolescents: findings from focus-group discussions with adolescents. J Am Diet Assoc 99(8):929–937. https://doi.org/10.1016/S0002-8223(99)00222-9

    Article  CAS  PubMed  Google Scholar 

  4. Baird J, Jacob C, Barker M, Fall C, Hanson M, Harvey N, Inskip H, Kumaran K, Cooper C (2017) Developmental origins of health and disease: a lifecourse approach to the prevention of non-communicable diseases. Healthcare 5(1):14. https://doi.org/10.3390/healthcare5010014

    Article  PubMed Central  Google Scholar 

  5. Rodrigues PRM, Luiz RR, Monteiro LS, Ferreira MG, Gonçalves-Silva RMV, Pereira RA (2017) Adolescents’ unhealthy eating habits are associated with meal skipping. Nutr J 42:114–120. https://doi.org/10.1016/j.nut.2017.03.011

    Article  Google Scholar 

  6. Badr HE, Lakha SF, Pennefather P (2017) Differences in physical activity, eating habits and risk of obesity among Kuwaiti adolescent boys and girls: a population-based study. Int J Adolesc Med Health. https://doi.org/10.1515/ijamh-2016-0138

    Article  PubMed  Google Scholar 

  7. Kumar S, Ray S, Roy D, Ganguly K, Dutta S, Mahapatra T, Mahapatra S, Gupta K, Chakraborty K, Das MK (2017) Exercise and eating habits among urban adolescents: a cross-sectional study in Kolkata, India. BMC Public Health 17(1):468. https://doi.org/10.1186/s12889-017-4390-9

    Article  PubMed  PubMed Central  Google Scholar 

  8. Neumark-Sztainer D, Story M, Resnick M, Blum R (1998) Adolescent nutrition: lessons learned from the minnesota adolescent health survey. J Am Diet Assoc 98:1449–1456. https://doi.org/10.1016/S0002-8223(98)00329-0

    Article  CAS  PubMed  Google Scholar 

  9. Bull NL (1992) Dietary habits, food consumption, and nutrient intake during adolescence. J Adolesc Health 13(5):384–388. https://doi.org/10.1016/1054-139X(92)90034-9

    Article  CAS  PubMed  Google Scholar 

  10. Lachance L, Sean Martin M, Kaduri P, Godoy-Paiz P, Ginieniewicz J, Tarasuk V, McKenzie K (2014) Food insecurity, diet quality, and mental health in culturally diverse adolescents. Ethn Inequal Health Soc Care 7(1):14–22

    Article  Google Scholar 

  11. Scaglioni S, De Cosmi V, Ciappolino V, Parazzini F, Brambilla P, Agostoni C (2018) Factors influencing children’s eating behaviours. Nutrients 10(6):706. https://doi.org/10.3390/nu10060706

    Article  PubMed Central  Google Scholar 

  12. FAO (2010) The state of food insecurity in the world. http://www.fao.org/3/a-i1683e.pdf. Accessed 21 Mar 2019

  13. Belachew T, Lindstrom D, Gebremariam A, Hogan D, Lachat C, Huybregts L, Kolsteren P (2013) Food insecurity, food based coping strategies and suboptimal dietary practices of adolescents in Jimma zone Southwest Ethiopia. PLoS ONE 8(3):e57643. https://doi.org/10.1371/journal.pone.0057643

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Laraia BA (2013) Food insecurity and chronic disease. Adv Nutr 4(2):203–212. https://doi.org/10.3945/an.112.003277

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hanson KL, Connor LM (2014) Food insecurity and dietary quality in US adults and children: a systematic review. Am J Clin Nutr 100(2):684–692. https://doi.org/10.3945/ajcn.114.084525

    Article  CAS  PubMed  Google Scholar 

  16. Kim HJ, Oh K (2015) Household food insecurity and dietary intake in Korea: results from the 2012 Korea National Health and Nutrition Examination Survey. Public Health Nutr 18(18):3317–3325. https://doi.org/10.3390/nu8120819

    Article  PubMed  Google Scholar 

  17. Kirkpatrick SI, Tarasuk V (2008) Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents. J Nutr 138(3):604–612. https://doi.org/10.3390/ijerph15071424

    Article  CAS  PubMed  Google Scholar 

  18. Poole-Di Salvo E, Silver EJ, Stein RE (2016) Household food insecurity and mental health problems among adolescents: what do parents report? Acad Pediatr 16(1):90–96

    Article  Google Scholar 

  19. Eicher-Miller HA, Zhao Y (2018) Evidence for the age-specific relationship of food insecurity and key dietary outcomes among US children and adolescents. Nutr Res Rev 31(1):98–113. https://doi.org/10.1017/S0954422417000245

    Article  PubMed  Google Scholar 

  20. Rani D, Singh J, Acharya D, Paudel R, Lee K, Singh S (2018) Household food insecurity and mental health among teenage girls living in urban slums in Varanasi, India: a cross-sectional study. Int J Environ Res Public Health 15(8):1585. https://doi.org/10.3390/ijerph15081585

    Article  PubMed Central  Google Scholar 

  21. Smith C, Richards R (2008) Dietary intake, overweight status, and perceptions of food insecurity among homeless Minnesotan youth. Am J Hum Biol 20(5):550–563. https://doi.org/10.1002/ajhb.20780

    Article  PubMed  Google Scholar 

  22. Shanafelt A, Hearst MO, Wang Q, Nanney MS (2016) Food insecurity and rural adolescent personal health, home, and academic environments. J Sch Health 86(6):472–480. https://doi.org/10.1111/josh.12397

    Article  PubMed  PubMed Central  Google Scholar 

  23. Rodríguez LA, Mundo-Rosas V, Méndez-Gómez-Humarán I, Pérez-Escamilla R, Shamah-Levy T (2017) Dietary quality and household food insecurity among Mexican children and adolescents. Matern Child Nutr 13(4):e12372. https://doi.org/10.1111/mcn.12372

    Article  Google Scholar 

  24. Nakitto M, Asano K, Choi I, Yoon J (2017) Dietary intakes of adolescents from food insecure households: analysis of data from the 6th (2013–2015) Korea National Health and Nutrition Examination Survey. Nutr Res Pract 11(6):507–516. https://doi.org/10.4162/nrp.2017.11.6.507

    Article  PubMed  PubMed Central  Google Scholar 

  25. Science Direct (2018) Dietary pattern—an overview. https://www.sciencedirect.com/topics/medicine-and-dentistry/dietary-pattern Accessed 15 Mar 2019

  26. Slattery ML (2008) Defining dietary consumption: is the sum greater than its parts? J Clin Nutr 88(1):14–15. https://doi.org/10.1093/ajcn/88.1.14

    Article  CAS  Google Scholar 

  27. Pinho Ld, Silveira MF, Botelho ACdC, Caldeira AP (2014) Identification of dietary patterns of adolescents attending public schools. J Pediatr (Rio J) 90(3):267–272. https://doi.org/10.1016/j.jped.2013.04.006

    Article  Google Scholar 

  28. Hojhabrimanesh A, Akhlaghi M, Rahmani E, Amanat S, Atefi M, Najafi M, Hashemzadeh M, Salehi S, Faghih S (2017) A Western dietary pattern is associated with higher blood pressure in Iranian adolescents. Eur J Nutr 56(1):399–408. https://doi.org/10.1007/s00394-015-1090-z

    Article  CAS  PubMed  Google Scholar 

  29. Zhen S, Ma Y, Zhao Z, Yang X, Wen D (2018) Dietary pattern is associated with obesity in Chinese children and adolescents: data from China Health and Nutrition Survey (CHNS). Nutr J 17(1):68. https://doi.org/10.1186/s12937-018-0372-8

    Article  PubMed  PubMed Central  Google Scholar 

  30. Cunha C, Costa P, De Oliveira L, Queiroz V, Pitangueira J, Oliveira A (2018) Dietary patterns and cardiometabolic risk factors among adolescents: systematic review and meta-analysis. Br J Nutr 119(8):859–879. https://doi.org/10.1017/S0007114518000533

    Article  CAS  PubMed  Google Scholar 

  31. Nasreddine L, Naja F, Akl C, Chamieh MC, Karam S, Sibai AM, Hwalla N (2014) Dietary, lifestyle and socio-economic correlates of overweight, obesity and central adiposity in Lebanese children and adolescents. Nutrients 6(3):1038–1062. https://doi.org/10.3390/nu6031038

    Article  PubMed  PubMed Central  Google Scholar 

  32. WHO (2010) Technical Paper. Regional strategy on nutrition 2010–2019. https://applications.emro.who.int/docs/EM_RC57_54_en.pdf. Accessed 21 Mar 2019

  33. Naja F, Hwalla N, Itani L, Karam S, Mehio Sibai A, Nasreddine L (2015) A Western dietary pattern is associated with overweight and obesity in a national sample of Lebanese adolescents (13–19 years): a cross-sectional study. Br J Nutr 114(11):1909–1919. https://doi.org/10.1017/S0007114515003657

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Naja F, Nasreddine L, Itani L, Chamieh MC, Adra N, Sibai AM, Hwalla N (2011) Dietary patterns and their association with obesity and sociodemographic factors in a national sample of Lebanese adults. Public Health Nutr 14(9):1570–1578. https://doi.org/10.1017/S136898001100070X

    Article  PubMed  Google Scholar 

  35. Nasreddine L, Naja F, Chamieh MC, Adra N, Sibai A-M, Hwalla N (2012) Trends in overweight and obesity in Lebanon: evidence from two national cross-sectional surveys (1997 and 2009). BMC Public Health 12(1):798. https://doi.org/10.1186/1471-2458-12-798

    Article  PubMed  PubMed Central  Google Scholar 

  36. Jomaa L, Naja F, Kharroubi S, Hwalla N (2019) Prevalence and correlates of food insecurity among Lebanese households with children aged 4–18 years: findings from a national cross-sectional study. Public Health Nutr 22(2):202–211. https://doi.org/10.1017/S1368980018003245

    Article  PubMed  Google Scholar 

  37. Cummings SR, Hulley SB (1988) Designing clinical research: an epidemiologic approach. Williams & Wilkins, Philadelhia

    Google Scholar 

  38. Central Administration for Statistics (2006) Living conditions of households: the national survey of household living condition 2004. https://www.databank.com.lb/docs/Living%20conditions%202004%20-%20CAS.pdf.

  39. Melki I, Beydoun H, Khogali M, Tamim H, Yunis K (2004) Household crowding index: a correlate of socioeconomic status and inter-pregnancy spacing in an urban setting. J Epidemiol Community Health 58(6):476–480. https://doi.org/10.1136/jech.2003.012690

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Corder K, van Sluijs EM, Wright A, Whincup P, Wareham NJ, Ekelund U (2009) Is it possible to assess free-living physical activity and energy expenditure in young people by self-report? Am J Clin Nutr 89(3):862–870. https://doi.org/10.3945/ajcn.2008.26739

    Article  CAS  PubMed  Google Scholar 

  41. WHO (2010) Global recommendations on physical activity for health. https://scholar.google.com/scholar_lookup?title=Global+recommendations+on+physical+activity+for+health&publication_year=2010. Accessed 1 Aug 2019

  42. Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M (2008) Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 40(1):181–188

    Article  Google Scholar 

  43. Naja F, Hwalla N, Fossian T, Zebian D, Nasreddine L (2015) Validity and reliability of the Arabic version of the household food insecurity access scale in rural Lebanon. Public Health Nutr 18(2):251–258. https://doi.org/10.1017/S1368980014000317

    Article  PubMed  Google Scholar 

  44. Coates J, Swindale A, Bilinsky P (2007) Household food insecurity access scale (HFIAS) for measurement of food access: indicator guide. https://www.fao.org/fileadmin/user_upload/eufao-fsi4dm/doc-training/hfias.pdf. Accessed 20 Apr 2019

  45. Moghames P, Hammami N, Hwalla N, Yazbeck N, Shoaib H, Nasreddine L, Naja F (2016) Validity and reliability of a food frequency questionnaire to estimate dietary intake among Lebanese children. Nutr J 15:4. https://doi.org/10.1186/s12937-015-0121-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. McCann SE, Marshall JR, Brasure JR et al (2001) Analysis of patterns of food intake in nutritional epidemiology: food classification in principal components analysis and the subsequent impact on estimates for endometrial cancer. Public Health Nutr 4:989–997. https://doi.org/10.1079/PHN2001168

    Article  CAS  PubMed  Google Scholar 

  47. Kafeshani O, Sarrafzadegan N, Nouri F, Mohammadifard N (2015) Major dietary patterns in Iranian adolescents: Isfahan Healthy Heart Program Iran. ARYA Atheroscler 11(Suppl 1):61

    PubMed  PubMed Central  Google Scholar 

  48. Naja F, Hwalla N, Itani L, Karam S, Sibai AM, Nasreddine L (2015) A Western dietary pattern is associated with overweight and obesity in a national sample of Lebanese adolescents (13–19 years): a cross-sectional study. Br J Nutr 114(11):1909–1919

    Article  CAS  Google Scholar 

  49. Abizari A-R, Ali Z (2019) Dietary patterns and associated factors of schooling Ghanaian adolescents. J Health Popul Nutr 38(1):5. https://doi.org/10.1186/s41043-019-0162-8

    Article  PubMed  PubMed Central  Google Scholar 

  50. Rezazadeh A, Omidvar N, Eini-Zinab H, Ghazi-Tabatabaie M, Majdzadeh R, Ghavamzadeh S, Nouri-Saeidlou S (2016) Major dietary patterns in relation to demographic and socio-economic status and food insecurity in two Iranian ethnic groups living in Urmia Iran. Public Health Nutr 19(18):3337–3348. https://doi.org/10.1017/S1368980016001634

    Article  PubMed  Google Scholar 

  51. Rocha NP, Milagres LC, Longo GZ, Ribeiro AQ, de Novaes JF (2017) Association between dietary pattern and cardiometabolic risk in children and adolescents: a systematic review. J Pediatr (Rio J) 93(3):214–222. https://doi.org/10.1016/j.jped.2017.01.002

    Article  Google Scholar 

  52. Okubo H, Sasaki S, Murakami K, Kim M, Takahashi Y, Hosoi Y, Itabashi M (2008) Three major dietary patterns are all independently related to the risk of obesity among 3760 Japanese women aged 18–20 years. Int J Obes (Lond) 32(3):541. https://doi.org/10.1038/sj.ijo.0803737

    Article  CAS  Google Scholar 

  53. Denova-Gutiérrez E, Castañón S, Talavera JO, Flores M, Macías N, Rodríguez-Ramírez S, Flores YN, Salmerón J (2011) Dietary patterns are associated with different indexes of adiposity and obesity in an urban Mexican population. J Nutr 141(5):921–927. https://doi.org/10.3945/jn.110.132332

    Article  CAS  PubMed  Google Scholar 

  54. Wadolowska L, Hamulka J, Kowalkowska J, Kostecka M, Wadolowska K, Biezanowska-Kopec R, Czarniecka-Skubina E, Kozirok W, Piotrowska A (2018) Prudent-active and fast-food-sedentary dietary-lifestyle patterns: the association with adiposity, nutrition knowledge and sociodemographic factors in polish teenagers—the ABC of healthy eating project. Nutrients 10(12):1988. https://doi.org/10.3390/nu10121988

    Article  PubMed Central  Google Scholar 

  55. Mais LA, Warkentin S, Vega JB, De Oliveira MDRD, Carnell S, Taddei JAdAC (2018) Sociodemographic, anthropometric and behavioural risk factors for ultra-processed food consumption in a sample of 2–9-year-olds in Brazil. Public Health Nutr 21(1):77–86. https://doi.org/10.1017/S1368980017002452

    Article  PubMed  Google Scholar 

  56. del Mar BM, Martínez E, Llull R, Pons A, Tur JA (2012) Western and Mediterranean dietary patterns among Balearic Islands’ adolescents: socio-economic and lifestyle determinants. Public Health Nutr 15(4):683–692. https://doi.org/10.1017/S1368980011002199

    Article  Google Scholar 

  57. Abdullah N-F, Teo P, Foo L (2016) Ethnic differences in the food intake patterns and its associated factors of adolescents in Kelantan Malaysia. Nutrients 8(9):551. https://doi.org/10.1111/nyas.13330

    Article  PubMed Central  Google Scholar 

  58. Auma CI, Pradeilles R, Blake MK, Holdsworth M (2019) What can dietary patterns tell us about the nutrition transition and environmental sustainability of diets in Uganda? Nutrients 11(2):342. https://doi.org/10.3390/nu11020342

    Article  PubMed Central  Google Scholar 

  59. Schulze MB, Hoffmann K, Kroke A, Boeing H (2001) Dietary patterns and their association with food and nutrient intake in the European Prospective Investigation into Cancer and Nutrition (EPIC)—Potsdam study. Br J Nutr 85(3):363–373. https://doi.org/10.1079/BJN2000254

    Article  CAS  PubMed  Google Scholar 

  60. Beck K, Jones B, Ullah I, McNaughton S, Haslett S, Stonehouse W (2018) Associations between dietary patterns, socio-demographic factors and anthropometric measurements in adult New Zealanders: an analysis of data from the 2008/09 New Zealand Adult Nutrition Survey. Eur J Nutr 57(4):1421–1433. https://doi.org/10.1007/s00394-017-1421-3

    Article  CAS  PubMed  Google Scholar 

  61. Torres-Aguilar P, Teran-Garcia M, Wiley A, Raffaelli M, Morales M (2016) Factors correlated to protective and risk dietary patterns in immigrant Latino mothers in non-metropolitan rural communities. J Immigr Minor Health 18(3):652–659. https://doi.org/10.1007/s10903-015-0212-2

    Article  PubMed  Google Scholar 

  62. Sharkey JR, Nalty C, Johnson CM, Dean WR (2012) Children’s very low food security is associated with increased dietary intakes in energy, fat, and added sugar among Mexican-origin children (6–11 years) in Texas border Colonias. BMC Pediatr 12(1):16. https://doi.org/10.1186/1471-2431-12-16

    Article  PubMed  PubMed Central  Google Scholar 

  63. Theodoridis X, Grammatikopoulou M, Gkiouras K, Papadopoulou S, Agorastou T, Gkika I, Maraki M, Dardavessis T, Chourdakis M (2018) Food insecurity and Mediterranean diet adherence among Greek university students. Nutr Metab Cardiovasc Dis 28(5):477–485. https://doi.org/10.1016/j.numecd.2018.02.007

    Article  CAS  PubMed  Google Scholar 

  64. Fram MS, Ritchie LD, Rosen N, Frongillo EA (2015) Child experience of food insecurity is associated with child diet and physical activity. J Nutr 145(3):499–504. https://doi.org/10.3945/jn.114.194365

    Article  CAS  PubMed  Google Scholar 

  65. Bamia C, Martimianaki G, Kritikou M, Trichopoulou A (2017) Indexes for assessing adherence to a Mediterranean diet from data measured through brief questionnaires: issues raised from the analysis of a Greek population study. Curr Dev Nutr 1(3):e000075. https://doi.org/10.3945/cdn.116.000075

    Article  PubMed  PubMed Central  Google Scholar 

  66. Idelson PI, Scalfi L, Valerio G (2017) Adherence to the Mediterranean diet in children and adolescents: a systematic review. Nutr Metab Cardiovasc Dis 27(4):283–299. https://doi.org/10.1016/j.numecd.2017.01.002

    Article  Google Scholar 

  67. Bonaccio M, Bes-Rastrollo M, de Gaetano G, Iacoviello L (2016) Challenges to the Mediterranean diet at a time of economic crisis. Nutr Metab Cardiovasc Dis 26(12):1057–1063. https://doi.org/10.1016/j.numecd.2016.07.005

    Article  CAS  PubMed  Google Scholar 

  68. Bonaccio M, Castelnuovo A, Bonanni A, Costanzo S, Lucia F, Persichillo M, Zito F, Donati M, Gaetano G, Iacoviello L (2014) Decline of the Mediterranean diet at a time of economic crisis. Results from the Moli-sani study. Nutr Metab Cardiovasc Dis 24(8):853–860. https://doi.org/10.1016/j.numecd.2014.02.014

    Article  CAS  PubMed  Google Scholar 

  69. The World Bank (2019) Poverty rates Lebanon. https://data.worldbank.org/indicator/SI.POV.NAHC?locations=LB. Accessed 10 May 2019

  70. Archero F, Ricotti R, Solito A, Carrera D, Civello F, Di Bella R, Bellone S, Prodam F (2018) Adherence to the Mediterranean diet among school children and adolescents living in northern Italy and unhealthy food behaviors associated to overweight. Nutrients 10(9):1322

    Article  Google Scholar 

  71. Shim J-S, Oh K, Kim HC (2014) Dietary assessment methods in epidemiologic studies. Epidemiol Health 36:e2014009

    Article  Google Scholar 

  72. Cade JE, Burley V, Warm D, Thompson R, Margetts B (2004) Food-frequency questionnaires: a review of their design, validation and utilisation. Nutr Res Rev 17(1):5–22

    Article  CAS  Google Scholar 

  73. Hu FB, Rimm E, Smith-Warner SA, Feskanich D, Stampfer MJ, Ascherio A, Sampson L, Willett WC (1999) Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am J Clin Nutr 69(2):243–249

    Article  CAS  Google Scholar 

  74. Naja F, Nasreddine L, Itani L, Adra N, Sibai A, Hwalla N (2013) Association between dietary patterns and the risk of metabolic syndrome among Lebanese adults. Eur J Nutr 52(1):97–105. https://doi.org/10.1007/s00394-011-0291-3

    Article  CAS  PubMed  Google Scholar 

  75. Martínez ME, Marshall JR, Sechrest L (1998) Invited commentary: factor analysis and the search for objectivity. Am J Epidemiol 148(1):17–19

    Article  Google Scholar 

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Acknowledgements

The authors express their sincere gratitude to all study participants and acknowledge the efforts of field workers who were involved in data collection as part of the original national study.

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Authors and Affiliations

  1. 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

    Farah Naja, Samer Kharroubi, Marwa Diab El Harake, Nahla Hwalla & Lamis Jomaa

  2. Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, PO Box 11-5020, Riad El Solh, Beirut, 1107-2809, Lebanon

    Leila Itani

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  1. Farah Naja
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The present study was approved by the appropriate ethics committee, and all procedures performed were in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.

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Naja, F., Itani, L., Kharroubi, S. et al. Food insecurity is associated with lower adherence to the Mediterranean dietary pattern among Lebanese adolescents: a cross-sectional national study. Eur J Nutr 59, 3281–3292 (2020). https://doi.org/10.1007/s00394-019-02166-3

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