Dietary Changes Over Time in Lebanese Urban Adults and Their Association With Anthropometric and Cardiometabolic Characteristics

Abstract

Title: Dietary Changes Over Time in Lebanese Urban Adults and their Association with Anthropometric and Cardiometabolic Characteristics

Background and objectives: The etiology of obesity is complex and multifactorial in nature, where both genetic and environmental factors come to play. While the majority of available studies have evaluated current behaviors in relation to body weight, longitudinal changes in lifestyle may in fact be more relevant in terms of their impact on weight gain and their translation into preventive strategies. It is in this context that we have conducted this study, with the aim of investigating longitudinal changes in food consumption patterns in a sample of Lebanese urban adults and examining their association with changes in anthropometric characteristics and cardiometabolic risk factors.

Methods: This is a longitudinal study of Lebanese adults aged ≥18 years residing in the Greater Beirut Area. The baseline survey was conducted in 2014 while the follow-up in 2019. The baseline sample n=501 was composed of 179 males (35.7%) and 322 females (64.3%) with a mean age of 45.4 ± 15.1, compared to the follow up sample which consisted of 186 subjects, with 59 males (31.6%) and 127 females (67.9%) and a mean age of 52.4 ± 13.0 SD. In both the original as well as the follow-up component, anthropometric measurements were obtained using standardized techniques and biochemical analyses were performed. Dietary intake was assessed using a culture-specific, semi-quantitative food frequency questionnaire. Intakes of energy and macronutrients were assessed using the Nutritionist Pro software, and food groups’ intakes were evaluated as g/day, % kcal and servings/day. The quality of the overall diet was assessed using the Healthy Eating Index (HEI).

Results: The 5 year follow up revealed a 2.6cm (0.52cm/year) increase in waist circumference and a 0.9% decrease in percent body fat, while the change in body weight was not significant (0.9kg during the study period; 0.18kg/year) Fasting blood glucose, SBP and DBP have significantly increased over time in the study population with a mean change (5th, 95th percentile) of 8.5 (-21, 59.4), 2.5 (-28.3, 41.7) and 2.4 (-15.5, 22.5) respectively. Macronutrient composition of the diet changed significantly, whereby total fat intake decreased by 2.4% EI, while carbohydrate intake increased by 2.3% EI. Other significant changes in dietary intakes were for fresh/dried fruits and whole grains, the consumption of which has increased by approximately one serving/day for each. On the other hand, a significant decrease in the consumption of fats and oils, sugar sweetened beverages, processed meat, and refined grains (-1.6, -0.2, -0.1 and -1.9 servings/day, respectively) was observed. Multivariate regression models showed an association between dairy products and changes in WC, whereby each increase in one serving of low fat dairy products decreased WC by 1.5 cm, while each increase in one serving of full-fat dairy products increased WC by 1.4-1.6 cm respectively. In addition, each increase in one serving of 100% fruit juices was associated with a 1.1% decrease in percent body fat. The results showed that HEI score increased significantly with a mean (5th, 95th percentile) of 2.4(-14, 19.6) over the study period. Each increment increase in HEI was significantly associated with a 0.3 decrease in SBP.

Conclusion: The present study is amongst the first in the Middle-East to assess changes in dietary intakes and quality over time, and investigate their association with anthropometry and cardiometabolic risk factors. It documented significant changes in macronutrient composition, food groups’ intake and overall diet quality, and showed an association between changes in diet and long-term changes in waist circumference, body fat and blood pressure, thus highlighting specific dietary changes that might be prioritized in obesity-prevention strategies. Further studies should be done to better understand the predictors of dietary changes in the Lebanese population, in order to formulate appropriate preventive strategies.