using medications that can alter sodium excretion; (b) assess how sodium intake is related to blo... more using medications that can alter sodium excretion; (b) assess how sodium intake is related to blood pressure, hypertension, obesity and caloric intake. Methods Sample and population. The survey was carried out by the Nutrition Division and the Health Promotion Department of the Public Health Services of the Ministry of Health and the Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center. A representative sample of Israeli adults of two age groups, 25-44 and 45-64 years, Jews and Arabs, comprised the basis of this report. The sample size was determined so that in a repeat survey it would be possible to identify a reduction in daily salt consumption from 9.6 g to approximately 6 g at the program conclusion, assuming that other interviewees would then be included. To obtain a power of at least 80% and to test the hypotheses at a significance level of 5%, a minimum of 140 people in each of the four groups (2 age groups, 2 sex groups) were sampled. The required sample size was 560, and the sample size was set to 630 people in anticipation of about 10% incomplete urine collections. The sample population comprised subjects insured in three major Health Maintenance Organizations (HMOs): Clalit Health Services, Maccabi Health Services and Leumit Health Services, which collectively insured 86.1% of the population 15. Interviewees were sampled from six out of the seven state districts in five localities per district, each with at least 20,000 residents. All randomly sampled subjects in the predetermined age range and survey locations were included. Exclusion criteria were the use of diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or steroids; a known diagnosis of kidney failure, heart failure, stroke or liver disease; pregnant women, or those with urinary incontinence. The survey had approval of the Helsinki's (human subject) committee of the Tel Aviv-Sourasky Medical Center (approval number 0020-12-TLV), Ethics committee of the Clalit Health Services (approval number 0010-12-COM), Maccabi Health Services (approval number 2013025) and Leumit Health Care Services (approval no. 001-13). Written informed consent was obtained from all subjects participating in the survey. All methods were carried out in accordance with STROBE guidelines for crosssectional studies 16. All methods were performed in accordance with the relevant guidelines and regulations by the Declaration of Helsinki. Survey protocol. The lists of the sampled persons received from the HMOs were combined and letters sent with a brief explanation, shortly after which, interviewees were called, received an explanation regarding the 24-h urine collection and a monetary compensation ($100) for the collection. The first interview was set at the interviewee's home after a verbal consent to participate was given, during which participants signed the Informed Consent Form and were introduced to and provided with the required equipment for the 24-h urine collection along with a detailed explanation of the urine collection protocol (Supplemental Methods 1). The second meeting was on the day of completion of the 24-h urine collection. An hour-long interview included a general detail personal and health questionnaire, two dietary questionnaires and anthropometric measurements.
Background: Polypharmacy increases with age and is associated with serious health and economic co... more Background: Polypharmacy increases with age and is associated with serious health and economic costs. This study reports changes over a decade in medication-use patterns and polypharmacy, in Israeli community-dwelling older adults aged ≥ 65 years. Methods: Demographic and health data from two representative national health cross-sectional surveys-MABAT ZAHAV 1 (MZ1) in 2005-2006, and MZ2 in 2014-2015 were analyzed. Polypharmacy was defined as use of ≥ 5 medications. Risk factors for polypharmacy were estimated by multivariable logistic regression with adjusted odds ratios (aOR) and their 95% confidence intervals (CI). Results: Self-reported data on medications taken were available for 1647 participants (91.5%) in MZ1, and for 833 participants (80.2%) in MZ2, 55% women, and about 20% aged ≥ 80, in both surveys. The prevalence of polypharmacy was significantly lower in MZ2 than in MZ1: 64.2% versus 56.3%, p = .0001; with an aOR (95%CI) of 0.64 (0.52, 0.80). The most commonly taken drugs were for hypertension (27.0%, 25.3%), dyslipidemia (9.7%, 12.4%) and anticoagulation (9.2%, 9.8%). For approximately 10% of drugs, indications were either unknown or incorrect. Polypharmacy was significantly associated with poor self-health assessment 2.47 (1.99, 3.06), ≥ 4 versus 1-3 chronic illnesses 6.36 (3.85, 10.50), and age ≥ 80 versus younger 1.72 (1.32, 2.24). Similar associations were observed with major polypharmacy of ≥ 8 medications. Conclusion: Polypharmacy, although reduced in the last decade, requires constant attention, especially concerning lack of knowledge of indications which leads to poor adherence and adverse side effects. Health-care teams should carry out regular medicine reconciliation in at-risk elderly patients.
Israel Journal of Health Policy Research, Jun 10, 2020
Background: Disordered eating (DE), defined as unhealthy eating attitudes and behaviors, is consi... more Background: Disordered eating (DE), defined as unhealthy eating attitudes and behaviors, is considered a major public health problem among adolescents. Nevertheless, rates of DE among Arab and Jewish adolescents in Israel are still unknown. Furthermore, while previous studies have highlighted the role of frequent family meals as a protective factor against DE, studies examining home family dinners relative to other common dinner options (e.g., eating at home alone, eating out of the home, not eating dinner at all) are largely unavailable. We sought to use representative data of middle and high-school children in Israel in order to identify rates of DE among Arabs and Jews, while examining the relations of home family dinners (vs. other dinner options) with DE. Methods: A nationally representative school-based survey of 4926 middle and high-school children (11-19 years old) was conducted during 2015-2016. Participants indicated where and with whom they had eaten dinner the day before. The 5-item SCOFF questionnaire was used (> 2 affirmative items were considered a likely case of DE). Height and weight were measured by personnel. Results: DE was more prevalent among girls (29.7%) relative to boys (12.2%), Arabs (25.1%) relative to Jews (19.5%), and older (25.3%) relative to younger (17.6%) adolescents. Arabs were more likely to eat dinner at home with parents/family (chi 2 = 10.75, p = .001), or not to eat dinner at all (chi 2 = 63.27, p < .001), while Jews were more likely to eat dinner alone (chi 2 = 5.37, p = .021) or to eat dinner out of the home (chi 2 = 67.65, p < .001). Logistic regressions (stratified by ethnicity and adjusted for gender, age, weight) revealed that family dinners acted as a protective factor against DE, relative to eating out of the home or relative to not eating dinner at all among both ethnic groups, and relative to eating dinner alone among Arabs. Conclusion: There are differences between Arab and Jewish adolescents in terms of rates of yesterday's family dinners and DE. Given that eating dinner with the family was linked with lower rates of DE, possible interventions to reduce DE may include educating parents of both Arab and Jewish adolescents regarding the importance of family meals.
ABSTRACT Background Handgrip strength (HGS) is used to assess muscle strength, which is an import... more ABSTRACT Background Handgrip strength (HGS) is used to assess muscle strength, which is an important indicator of health status in older adults. Objective We evaluated associations of demographic, anthropometric, clinical, and nutritional factors with muscle strength in community-dwelling elderly adults. Methods This population-based cross-sectional study employed the 2014–2015 Israeli Health and Nutrition Survey in the Elderly (n = 1039, age ≥65 y, 46.7% males, 9.9% Arabs). Trained personnel performed face-to-face interviews that focused on health and nutrition status, as well as anthropometric measurements and examinations. HGS was measured in the dominant hand 3 times using a digital grip strength dynamometer; the highest result was reported. Dietary intake data were collected using single-day 24-h recall. Multivariable logistic regressions were used to explore factors associated with low HGS (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;27 kg for men and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;16 kg for women). Results HGS measurements were completed by 704 participants. Following adjustment for several factors, higher prevalence of low HGS was significantly associated with age (OR: 1.14; 95% CI: 1.11, 1.18), whereas decreased prevalence was associated with higher levels of education (OR: 0.55; 95% CI: 0.32, 0.94) and meeting physical activity recommendations (OR: 0.53; 95% CI: 0.31, 0.88); P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 for all. Incremental increases of 100 kcal/d in energy intake and of 1 cm in midarm circumference were associated with decreased prevalence of low HGS (OR: 0.95; 95% CI: 0.91, 0.99 and OR: 0.91; 95% CI: 0.85, 0.97, respectively; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01 for both). Associations were not found of low HGS with ethnicity, comorbidity, BMI, smoking, or alcohol consumption or with protein, carbohydrate, or fat intakes. Conclusion Energy intake, physical activity, midarm circumference, and education are associated with HGS in elderly Israeli adults. Further cohort studies are necessary to assess possible causal relations between these factors and HGS. Modifiable factors should be targeted in planning public health strategies for promoting a healthy aging population.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Efforts to shape the food environment are aimed at reducing diet-related co-morbidities. Front-of... more Efforts to shape the food environment are aimed at reducing diet-related co-morbidities. Front-of-package labeling (FOPL) may support the consumers to make an informed decision at the point of purchase and encourage industry to reformulate food products. The Israeli Ministry of Health (MOH) implemented a unique FOPL system, using two colors: A mandatory warning (red) label alongside a voluntary positive (green) label. An independent Scientific Committee, from academia, the healthcare system, and MOH was appointed to determine the core principles for the positive FOPL. The criteria were based on the Mediterranean diet principles, with adjustments to the Israeli dietary habits, focusing on the health advantages of the food and considering its processing level. The food products eligible for positive FOPL are foods in their natural form or with added spices or herbs, or those that underwent minimal processing, with no food additives. Based on population consumption data, 19.8% of food ...
Background & aims: There is a substantial body of evidence supporting the health benefits of the ... more Background & aims: There is a substantial body of evidence supporting the health benefits of the Mediterranean diet, which has differing variations across the Mediterranean region. Abbreviated dietary screeners can be adapted and used to assess adherence to the local Mediterranean diet variant. We aimed to describe the process of adapting the Spanish Mediterranean Diet Adherence Screener (MEDAS) for use in Israel, and to test the predictive utility of the adapted score for mortality. Methods: A professional committee of nutritional policy makers, dieticians and researchers adapted MEDAS to create an Israeli Mediterranean diet screener (I-MEDAS) that reflected the local Mediterranean diet and national dietary recommendations. The Hadera District Study (HDS) was a population-based, prospective cohort study of adults in Israel. Food frequency questionnaire (FFQ) data from the HDS was used to calculate Mediterranean diet adherence according to the I-MEDAS score criteria and evaluate the score's predictive utility. Mortality status was obtained from the national population registry. Cox proportional hazards regression models were used to test the predictive utility of the I-MEDAS score for all-cause mortality. Results: The 14-item MEDAS was adapted to create a 17-item I-MEDAS. According to FFQ data from the HDS cohort (n ¼ 1092 adults; median [IQR] follow-up time ¼ 14 [12e15] years, 179 deaths), the median (IQR) I-MEDAS score was 8 (7e9). In multivariable analysis, every 1-point increase in the I-MEDAS score reduced the hazard of death by 12% (adjusted HR: 0.88; 95% CI: 0.80e0.97). The original MEDAS score was less strongly associated with mortality, and lost significance after adjustment for potential confounders. Conclusions: I-MEDAS reflects the local Mediterranean diet and national dietary recommendations in Israel. The I-MEDAS score, calculated from FFQ data, demonstrated predictive utility for mortality in a population-based cohort of adults.
Background Polypharmacy increases with age and is associated with serious health and economic cos... more Background Polypharmacy increases with age and is associated with serious health and economic costs. This study reports changes over a decade in medication-use patterns and polypharmacy, in Israeli community-dwelling older adults aged ≥ 65 years. Methods Demographic and health data from two representative national health cross-sectional surveys – MABAT ZAHAV 1 (MZ1) in 2005–2006, and MZ2 in 2014–2015 were analyzed. Polypharmacy was defined as use of ≥ 5 medications. Risk factors for polypharmacy were estimated by multivariable logistic regression with adjusted odds ratios (aOR) and their 95% confidence intervals (CI). Results Self-reported data on medications taken were available for 1647 participants (91.5%) in MZ1, and for 833 participants (80.2%) in MZ2, 55% women, and about 20% aged ≥ 80, in both surveys. The prevalence of polypharmacy was significantly lower in MZ2 than in MZ1: 64.2% versus 56.3%, p = .0001; with an aOR (95%CI) of 0.64 (0.52, 0.80). The most commonly taken drug...
Background Disordered eating (DE), defined as unhealthy eating attitudes and behaviors, is consid... more Background Disordered eating (DE), defined as unhealthy eating attitudes and behaviors, is considered a major public health problem among adolescents. Nevertheless, rates of DE among Arab and Jewish adolescents in Israel are still unknown. Furthermore, while previous studies have highlighted the role of frequent family meals as a protective factor against DE, studies examining home family dinners relative to other common dinner options (e.g., eating at home alone, eating out of the home, not eating dinner at all) are largely unavailable. We sought to use representative data of middle and high-school children in Israel in order to identify rates of DE among Arabs and Jews, while examining the relations of home family dinners (vs. other dinner options) with DE. Methods A nationally representative school-based survey of 4926 middle and high-school children (11–19 years old) was conducted during 2015–2016. Participants indicated where and with whom they had eaten dinner the day before. ...
Since current recommendations call for a substantial reduction in overall sodium consumption, we ... more Since current recommendations call for a substantial reduction in overall sodium consumption, we tested whether or not these recommendations are implemented in common large subpopulations such as those with abnormal weight or hypertension in the current high sodium, high-calorie nutritional environment. In a national representative cross-sectional survey of the community-dwelling subjects aged 25–65 years conducted in Israel between 2015 and 2017, 582 randomly selected subjects completed health and dietary questionnaires, underwent blood pressure and anthropometric measurements and collected 24-h urine specimens, to assess dietary sodium intake. Overall mean 24-h sodium excretion was 3834 mg, more than double the recommended upper intake for adults
Background Handgrip strength (HGS) is used to assess muscle strength, which is an important indic... more Background Handgrip strength (HGS) is used to assess muscle strength, which is an important indicator of health status in older adults. Objective We evaluated associations of demographic, anthropometric, clinical, and nutritional factors with muscle strength in community-dwelling elderly adults. Methods This population-based cross-sectional study employed the 2014–2015 Israeli Health and Nutrition Survey in the Elderly (n = 1039, age ≥65 y, 46.7% males, 9.9% Arabs). Trained personnel performed face-to-face interviews that focused on health and nutrition status, as well as anthropometric measurements and examinations. HGS was measured in the dominant hand 3 times using a digital grip strength dynamometer; the highest result was reported. Dietary intake data were collected using single-day 24-h recall. Multivariable logistic regressions were used to explore factors associated with low HGS (<27 kg for men and <16 kg for women). Results HGS measurements were completed by 704 parti...
A balanced diet and weight loss are the first lines of treatment for the prevention of metabolic ... more A balanced diet and weight loss are the first lines of treatment for the prevention of metabolic syndrome (MS). Dietary strategies may include changing the composition of macronutrients, adopting a particular dietary pattern as a Mediterranean diet. However, the role of micronutrients, particularly potassium, in the propensity for or treatment of the syndrome is unclear. The study aimed to examine the relationship between the presence of the MS and its risk factors and the 24-h potassium excretion as the most valid proxy for dietary intake. The analyses were performed as part of the national survey estimating sodium and other electrolytes excretion conducted between 2014–2016 in Israel. The survey included urine collection, anthropometric and blood pressure measurements, and a comprehensive medical questionnaire that included details on the intake of medications that may affect electrolyte secretion. A model was constructed to evaluate the probability for the MS. MS score and its pr...
using medications that can alter sodium excretion; (b) assess how sodium intake is related to blo... more using medications that can alter sodium excretion; (b) assess how sodium intake is related to blood pressure, hypertension, obesity and caloric intake. Methods Sample and population. The survey was carried out by the Nutrition Division and the Health Promotion Department of the Public Health Services of the Ministry of Health and the Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center. A representative sample of Israeli adults of two age groups, 25-44 and 45-64 years, Jews and Arabs, comprised the basis of this report. The sample size was determined so that in a repeat survey it would be possible to identify a reduction in daily salt consumption from 9.6 g to approximately 6 g at the program conclusion, assuming that other interviewees would then be included. To obtain a power of at least 80% and to test the hypotheses at a significance level of 5%, a minimum of 140 people in each of the four groups (2 age groups, 2 sex groups) were sampled. The required sample size was 560, and the sample size was set to 630 people in anticipation of about 10% incomplete urine collections. The sample population comprised subjects insured in three major Health Maintenance Organizations (HMOs): Clalit Health Services, Maccabi Health Services and Leumit Health Services, which collectively insured 86.1% of the population 15. Interviewees were sampled from six out of the seven state districts in five localities per district, each with at least 20,000 residents. All randomly sampled subjects in the predetermined age range and survey locations were included. Exclusion criteria were the use of diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or steroids; a known diagnosis of kidney failure, heart failure, stroke or liver disease; pregnant women, or those with urinary incontinence. The survey had approval of the Helsinki's (human subject) committee of the Tel Aviv-Sourasky Medical Center (approval number 0020-12-TLV), Ethics committee of the Clalit Health Services (approval number 0010-12-COM), Maccabi Health Services (approval number 2013025) and Leumit Health Care Services (approval no. 001-13). Written informed consent was obtained from all subjects participating in the survey. All methods were carried out in accordance with STROBE guidelines for crosssectional studies 16. All methods were performed in accordance with the relevant guidelines and regulations by the Declaration of Helsinki. Survey protocol. The lists of the sampled persons received from the HMOs were combined and letters sent with a brief explanation, shortly after which, interviewees were called, received an explanation regarding the 24-h urine collection and a monetary compensation ($100) for the collection. The first interview was set at the interviewee's home after a verbal consent to participate was given, during which participants signed the Informed Consent Form and were introduced to and provided with the required equipment for the 24-h urine collection along with a detailed explanation of the urine collection protocol (Supplemental Methods 1). The second meeting was on the day of completion of the 24-h urine collection. An hour-long interview included a general detail personal and health questionnaire, two dietary questionnaires and anthropometric measurements.
Background: Polypharmacy increases with age and is associated with serious health and economic co... more Background: Polypharmacy increases with age and is associated with serious health and economic costs. This study reports changes over a decade in medication-use patterns and polypharmacy, in Israeli community-dwelling older adults aged ≥ 65 years. Methods: Demographic and health data from two representative national health cross-sectional surveys-MABAT ZAHAV 1 (MZ1) in 2005-2006, and MZ2 in 2014-2015 were analyzed. Polypharmacy was defined as use of ≥ 5 medications. Risk factors for polypharmacy were estimated by multivariable logistic regression with adjusted odds ratios (aOR) and their 95% confidence intervals (CI). Results: Self-reported data on medications taken were available for 1647 participants (91.5%) in MZ1, and for 833 participants (80.2%) in MZ2, 55% women, and about 20% aged ≥ 80, in both surveys. The prevalence of polypharmacy was significantly lower in MZ2 than in MZ1: 64.2% versus 56.3%, p = .0001; with an aOR (95%CI) of 0.64 (0.52, 0.80). The most commonly taken drugs were for hypertension (27.0%, 25.3%), dyslipidemia (9.7%, 12.4%) and anticoagulation (9.2%, 9.8%). For approximately 10% of drugs, indications were either unknown or incorrect. Polypharmacy was significantly associated with poor self-health assessment 2.47 (1.99, 3.06), ≥ 4 versus 1-3 chronic illnesses 6.36 (3.85, 10.50), and age ≥ 80 versus younger 1.72 (1.32, 2.24). Similar associations were observed with major polypharmacy of ≥ 8 medications. Conclusion: Polypharmacy, although reduced in the last decade, requires constant attention, especially concerning lack of knowledge of indications which leads to poor adherence and adverse side effects. Health-care teams should carry out regular medicine reconciliation in at-risk elderly patients.
Israel Journal of Health Policy Research, Jun 10, 2020
Background: Disordered eating (DE), defined as unhealthy eating attitudes and behaviors, is consi... more Background: Disordered eating (DE), defined as unhealthy eating attitudes and behaviors, is considered a major public health problem among adolescents. Nevertheless, rates of DE among Arab and Jewish adolescents in Israel are still unknown. Furthermore, while previous studies have highlighted the role of frequent family meals as a protective factor against DE, studies examining home family dinners relative to other common dinner options (e.g., eating at home alone, eating out of the home, not eating dinner at all) are largely unavailable. We sought to use representative data of middle and high-school children in Israel in order to identify rates of DE among Arabs and Jews, while examining the relations of home family dinners (vs. other dinner options) with DE. Methods: A nationally representative school-based survey of 4926 middle and high-school children (11-19 years old) was conducted during 2015-2016. Participants indicated where and with whom they had eaten dinner the day before. The 5-item SCOFF questionnaire was used (> 2 affirmative items were considered a likely case of DE). Height and weight were measured by personnel. Results: DE was more prevalent among girls (29.7%) relative to boys (12.2%), Arabs (25.1%) relative to Jews (19.5%), and older (25.3%) relative to younger (17.6%) adolescents. Arabs were more likely to eat dinner at home with parents/family (chi 2 = 10.75, p = .001), or not to eat dinner at all (chi 2 = 63.27, p < .001), while Jews were more likely to eat dinner alone (chi 2 = 5.37, p = .021) or to eat dinner out of the home (chi 2 = 67.65, p < .001). Logistic regressions (stratified by ethnicity and adjusted for gender, age, weight) revealed that family dinners acted as a protective factor against DE, relative to eating out of the home or relative to not eating dinner at all among both ethnic groups, and relative to eating dinner alone among Arabs. Conclusion: There are differences between Arab and Jewish adolescents in terms of rates of yesterday's family dinners and DE. Given that eating dinner with the family was linked with lower rates of DE, possible interventions to reduce DE may include educating parents of both Arab and Jewish adolescents regarding the importance of family meals.
ABSTRACT Background Handgrip strength (HGS) is used to assess muscle strength, which is an import... more ABSTRACT Background Handgrip strength (HGS) is used to assess muscle strength, which is an important indicator of health status in older adults. Objective We evaluated associations of demographic, anthropometric, clinical, and nutritional factors with muscle strength in community-dwelling elderly adults. Methods This population-based cross-sectional study employed the 2014–2015 Israeli Health and Nutrition Survey in the Elderly (n = 1039, age ≥65 y, 46.7% males, 9.9% Arabs). Trained personnel performed face-to-face interviews that focused on health and nutrition status, as well as anthropometric measurements and examinations. HGS was measured in the dominant hand 3 times using a digital grip strength dynamometer; the highest result was reported. Dietary intake data were collected using single-day 24-h recall. Multivariable logistic regressions were used to explore factors associated with low HGS (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;27 kg for men and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;16 kg for women). Results HGS measurements were completed by 704 participants. Following adjustment for several factors, higher prevalence of low HGS was significantly associated with age (OR: 1.14; 95% CI: 1.11, 1.18), whereas decreased prevalence was associated with higher levels of education (OR: 0.55; 95% CI: 0.32, 0.94) and meeting physical activity recommendations (OR: 0.53; 95% CI: 0.31, 0.88); P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 for all. Incremental increases of 100 kcal/d in energy intake and of 1 cm in midarm circumference were associated with decreased prevalence of low HGS (OR: 0.95; 95% CI: 0.91, 0.99 and OR: 0.91; 95% CI: 0.85, 0.97, respectively; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01 for both). Associations were not found of low HGS with ethnicity, comorbidity, BMI, smoking, or alcohol consumption or with protein, carbohydrate, or fat intakes. Conclusion Energy intake, physical activity, midarm circumference, and education are associated with HGS in elderly Israeli adults. Further cohort studies are necessary to assess possible causal relations between these factors and HGS. Modifiable factors should be targeted in planning public health strategies for promoting a healthy aging population.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Efforts to shape the food environment are aimed at reducing diet-related co-morbidities. Front-of... more Efforts to shape the food environment are aimed at reducing diet-related co-morbidities. Front-of-package labeling (FOPL) may support the consumers to make an informed decision at the point of purchase and encourage industry to reformulate food products. The Israeli Ministry of Health (MOH) implemented a unique FOPL system, using two colors: A mandatory warning (red) label alongside a voluntary positive (green) label. An independent Scientific Committee, from academia, the healthcare system, and MOH was appointed to determine the core principles for the positive FOPL. The criteria were based on the Mediterranean diet principles, with adjustments to the Israeli dietary habits, focusing on the health advantages of the food and considering its processing level. The food products eligible for positive FOPL are foods in their natural form or with added spices or herbs, or those that underwent minimal processing, with no food additives. Based on population consumption data, 19.8% of food ...
Background & aims: There is a substantial body of evidence supporting the health benefits of the ... more Background & aims: There is a substantial body of evidence supporting the health benefits of the Mediterranean diet, which has differing variations across the Mediterranean region. Abbreviated dietary screeners can be adapted and used to assess adherence to the local Mediterranean diet variant. We aimed to describe the process of adapting the Spanish Mediterranean Diet Adherence Screener (MEDAS) for use in Israel, and to test the predictive utility of the adapted score for mortality. Methods: A professional committee of nutritional policy makers, dieticians and researchers adapted MEDAS to create an Israeli Mediterranean diet screener (I-MEDAS) that reflected the local Mediterranean diet and national dietary recommendations. The Hadera District Study (HDS) was a population-based, prospective cohort study of adults in Israel. Food frequency questionnaire (FFQ) data from the HDS was used to calculate Mediterranean diet adherence according to the I-MEDAS score criteria and evaluate the score's predictive utility. Mortality status was obtained from the national population registry. Cox proportional hazards regression models were used to test the predictive utility of the I-MEDAS score for all-cause mortality. Results: The 14-item MEDAS was adapted to create a 17-item I-MEDAS. According to FFQ data from the HDS cohort (n ¼ 1092 adults; median [IQR] follow-up time ¼ 14 [12e15] years, 179 deaths), the median (IQR) I-MEDAS score was 8 (7e9). In multivariable analysis, every 1-point increase in the I-MEDAS score reduced the hazard of death by 12% (adjusted HR: 0.88; 95% CI: 0.80e0.97). The original MEDAS score was less strongly associated with mortality, and lost significance after adjustment for potential confounders. Conclusions: I-MEDAS reflects the local Mediterranean diet and national dietary recommendations in Israel. The I-MEDAS score, calculated from FFQ data, demonstrated predictive utility for mortality in a population-based cohort of adults.
Background Polypharmacy increases with age and is associated with serious health and economic cos... more Background Polypharmacy increases with age and is associated with serious health and economic costs. This study reports changes over a decade in medication-use patterns and polypharmacy, in Israeli community-dwelling older adults aged ≥ 65 years. Methods Demographic and health data from two representative national health cross-sectional surveys – MABAT ZAHAV 1 (MZ1) in 2005–2006, and MZ2 in 2014–2015 were analyzed. Polypharmacy was defined as use of ≥ 5 medications. Risk factors for polypharmacy were estimated by multivariable logistic regression with adjusted odds ratios (aOR) and their 95% confidence intervals (CI). Results Self-reported data on medications taken were available for 1647 participants (91.5%) in MZ1, and for 833 participants (80.2%) in MZ2, 55% women, and about 20% aged ≥ 80, in both surveys. The prevalence of polypharmacy was significantly lower in MZ2 than in MZ1: 64.2% versus 56.3%, p = .0001; with an aOR (95%CI) of 0.64 (0.52, 0.80). The most commonly taken drug...
Background Disordered eating (DE), defined as unhealthy eating attitudes and behaviors, is consid... more Background Disordered eating (DE), defined as unhealthy eating attitudes and behaviors, is considered a major public health problem among adolescents. Nevertheless, rates of DE among Arab and Jewish adolescents in Israel are still unknown. Furthermore, while previous studies have highlighted the role of frequent family meals as a protective factor against DE, studies examining home family dinners relative to other common dinner options (e.g., eating at home alone, eating out of the home, not eating dinner at all) are largely unavailable. We sought to use representative data of middle and high-school children in Israel in order to identify rates of DE among Arabs and Jews, while examining the relations of home family dinners (vs. other dinner options) with DE. Methods A nationally representative school-based survey of 4926 middle and high-school children (11–19 years old) was conducted during 2015–2016. Participants indicated where and with whom they had eaten dinner the day before. ...
Since current recommendations call for a substantial reduction in overall sodium consumption, we ... more Since current recommendations call for a substantial reduction in overall sodium consumption, we tested whether or not these recommendations are implemented in common large subpopulations such as those with abnormal weight or hypertension in the current high sodium, high-calorie nutritional environment. In a national representative cross-sectional survey of the community-dwelling subjects aged 25–65 years conducted in Israel between 2015 and 2017, 582 randomly selected subjects completed health and dietary questionnaires, underwent blood pressure and anthropometric measurements and collected 24-h urine specimens, to assess dietary sodium intake. Overall mean 24-h sodium excretion was 3834 mg, more than double the recommended upper intake for adults
Background Handgrip strength (HGS) is used to assess muscle strength, which is an important indic... more Background Handgrip strength (HGS) is used to assess muscle strength, which is an important indicator of health status in older adults. Objective We evaluated associations of demographic, anthropometric, clinical, and nutritional factors with muscle strength in community-dwelling elderly adults. Methods This population-based cross-sectional study employed the 2014–2015 Israeli Health and Nutrition Survey in the Elderly (n = 1039, age ≥65 y, 46.7% males, 9.9% Arabs). Trained personnel performed face-to-face interviews that focused on health and nutrition status, as well as anthropometric measurements and examinations. HGS was measured in the dominant hand 3 times using a digital grip strength dynamometer; the highest result was reported. Dietary intake data were collected using single-day 24-h recall. Multivariable logistic regressions were used to explore factors associated with low HGS (<27 kg for men and <16 kg for women). Results HGS measurements were completed by 704 parti...
A balanced diet and weight loss are the first lines of treatment for the prevention of metabolic ... more A balanced diet and weight loss are the first lines of treatment for the prevention of metabolic syndrome (MS). Dietary strategies may include changing the composition of macronutrients, adopting a particular dietary pattern as a Mediterranean diet. However, the role of micronutrients, particularly potassium, in the propensity for or treatment of the syndrome is unclear. The study aimed to examine the relationship between the presence of the MS and its risk factors and the 24-h potassium excretion as the most valid proxy for dietary intake. The analyses were performed as part of the national survey estimating sodium and other electrolytes excretion conducted between 2014–2016 in Israel. The survey included urine collection, anthropometric and blood pressure measurements, and a comprehensive medical questionnaire that included details on the intake of medications that may affect electrolyte secretion. A model was constructed to evaluate the probability for the MS. MS score and its pr...
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Papers by Lesley Nitsan