The Drivers of Consumption of Foods Associated With Noncommunicable Disease Risk Among Lebanese Adults Using the Global Diet Quality Score

Abstract

Background: In Lebanon, the burden of non-communicable diseases (NCDs) remains the largest contributer to morbidity and mortality in the country. Diet has been reported as one of the most influential modifiable risk factors contributing to its prevalence. Unhealthy diets constitute major drivers of NCDs around the world. The Global Diet Quality Score (GDQS) was developed as a food based metric for diet quality and incorporates in its design and scoring method specific foods’consumption as associated with NCDs.

Objectives: This study aims at assessing the diet quality of Lebanese male students at the American University of Beirut (AUB) using the GDQS, determine the divers of consumption of foods associated with NCD risk, assess changes in diet quality (GDQS) and food groups consumption over time and between genders and compare the conformity of GDQS with the Healthy Eating Index (HEI) score.

Methods: This study assessed the diet as a risk factor of NCDs in male students at AUB. A convenient sample of 385 male students aged between 18-24 years were recruited. The sample size was determined using the World Health Organization (WHO) sample size calculator. Diet quality was assessed using the GDQS which is a food-based metric that incorporates both nutrient adequacy and the risk factors associated with non-communicable diseases (NCDs) in its design and scoring method. This d Dietary intake data was collected using an app which was developed by INTAKE to provide a standard, easy-to- use, low-cost, and time-relevant method for collecting and recording food consumption data. GDQS scores of ≥ 23, ≥15 & <23, and <15, in study sample, indicated high, moderate and low risk of NCDs respectively. Comparisons with HEI was also conducted. A multi-component questionnaire which includes sociodemographic, lifestyle factors and drivers of consumption as well as self- reported anthropometric measurements was also collected from participants using face-to-face interviews. Changes in GDQS scores between genders, over time and between different diet scoring methods were conducted using secondary analysis of dietary intake data of female AUB students, and dietary intake data reported in a national nutrition survey carried out in Lebanon between 2008 and 2009,). The Statistical Package for the Social Sciences (SPSS; version 25) was used for all computations.

Results: In 2023, the mean total GDQS, score of Lebanese AUB male students was 14.5±4.5. With only 3.1% of the participants having a high GDQS score suggesting low risk of disease outcomes, and 41.6% had a moderate GDQS score suggesting moderate risk and 55.3% had a low GDQS score suggesting high risk for NCDs. Participants living at their own home and pursuing a health-related major were associated with higher GDQS scores compared to those living at student residence and parental home and being of non-health related major. Low consumption of fruits, vegetables, (legumes, deep orange tubers, nuts and seeds, whole grains, liquid oils, fish and shellfish, low fat dairy and eggs were shown as determinants of low GDQS score. Compared to females, males a had a significantly higher percentage of low total GDQS score and a significantly lower percentage of high total GDQS scores. Compared to 2008/09, males in 2023 had similar GDQS scores but lower HEI scores. The mostly reported factor influencing consumption of food groups was taste, followed by past eating habits and availability.

Conclusion: The study showed that in 2023, the majority of young Lebanese male AUB students have a low GDQS score, suggesting high risk of NCDs, and identified food groups associated with the low score. It also identified taste as most significant driver of food consumption followed by availability and past eating habits. The GDQS of young Lebanese females was better than that of males. While there was no significant alteration observed in GDQS scores between the years 2008/09 and 2023, a significant change was seen in the HEI scores between both years. Interventions strategies to address such targeted poor dietary habits are needed to promote adherence of university students to healthy diets for mitigating the increase in NCDs in the country.