Noncommunicable Disease Risk and Nutrient Adequacy Among University Staff in Lebanon: A Study Using The Global Diet Quality Score and The Healthy Eating Index

Abstract

Background: Since October 2019, Lebanon has been grappling with a multifaceted crisis characterized by political and economic instability, leading to a surge in poverty due to rising inflation and a shift towards lower-quality diets. This crisis has exacerbated poor dietary habits and the prevalence of non-communicable diseases (NCDs), emphasizing the importance of identifying dietary deficiencies. Utilizing tools like the Global Diet Quality Score (GDQS) and Healthy Eating Index (HEI) becomes crucial for the development of evidence-based strategies aimed at enhancing diet quality and alleviating the burden of NCDs on the population and the healthcare system in Lebanon. Objectives: This study aimed to evaluate the dietary quality of non-academic staff aged 24 to 49 at the American University of Beirut (AUB) in Lebanon using the GDQS and HEI. Additionally, the study sought to pinpoint the specific food groups responsible f or driving consumption patterns associated with NCD risk, leading to lower GDQS and HEI scores, while also exploring potential gender differences in these patterns. Methods: To examine the role of diet as a risk factor for NCDs in university staff in Lebanon, we recruited a convenient sample of 200 AUB non-academic staff (comprising 100 males and 100 females) aged between 24 and 49 years. This sample represented more than 20% of the staff population. Diet quality assessment was conducted using two metrics: the GDQS, which considers both nutrient adequacy and NCD risk factors, and the HEI, which evaluates nutrient quality and how well dietary choices align with recommended nutritional guidelines. A total GDQS score ≥ 23 is an indicator of low risk of both suboptimal diet and NCDs development. A score <15 is an indicator of high risk, and a score of ≥15 and 23 is an indicator of moderate risk. Whereas HEI scores of (0-50), (51-80) & (81-100) indicated respectively low, moderate and high adherence to nutritional guidelines. Data on dietary intake were collected using a specialized application developed by INTAKE to provide a standardized, efficient, user-friendly, and cost-effective method for gathering information on food consumption. Face-to-face interviews collected a multi-component questionnaire, including sociodemographic information, lifestyle factors, consumption drivers, self- reported anthropometric measurements, and 24-hour dietary recalls. Dietary intake data were analyzed using the Nutritionist Pro software, with data processing conducted using the Statistical Package for the Social Sciences (SPSS; version 25). For all statistical analyses, P-values less than 0.05 indicated statistical significance. 3 Results: The mean total GDQS score for AUB non-academic staff was 18.46 ± 4.39. Only 15% of participants achieved a high GDQS score, indicating a low risk of adverse health outcomes, while 59.5% scored at a moderate level, suggesting a moderate risk, and 25.5% achieved a low GDQS score, indicating a high risk for NCDs. Inadequate consumption of fruits, dark green leafy vegetables, deep orange vegetables, legumes, nuts and seeds, whole grains, liquid oils, and fish and shellfish emerged as key contributors to low GDQS scores. The three most frequently reported barriers to consuming healthy foods were adherence to past eating habits, high cost, and a dislike of taste and texture. The overall HEI score for AUB non-academic staff was 51.6 ± 12.54, with only 1% achieving a high HEI score, 53.5% attaining a moderate score, and 45.5% scoring low. Insufficient consumption of whole fruits, green beans, whole grains, dairy, total protein foods, and seafood and plant proteins were identified as determinants of low HEI scores. Conclusion: The study revealed that a small proportion of AUB non-academic staff had high GDQS. No significant gender differences were observed in GDQS scores or categories, and sociodemographic, lifestyle, and BMI characteristics did not appear to impact GDQS scores significantly. The primary barriers to consuming healthy foods were rooted in past eating habits, high costs, and taste preferences. Conversely, enjoying the taste and texture of unhealthy foods emerged as the primary facilitator of their consumption, followed by past eating habits and a tendency to overlook their adverse health effects. A noteworthy portion of AUB non-academic staff also achieved moderate HEI scores, with no significant gender disparities. These findings underscore the need for strategies aimed at promoting healthier eating habits and reducing NCD risk factors to mitigate adverse health consequences and the burden of NCDs.