Malek  Batal,  PhD  Nutrition  Program  University  of  Ottawa    

  Low  consumption  of  fruits  and  vegetables  (Hwalla,  2004)  

  High  consumption  of  bread  and  refined  grains  (~350g/d)  (WHO,  1998).    

  Low  consumption  of  fish  (Hwalla,  2004)      Low  dietary  diversity  in  school  

children  (Shaker,  unpublished)      Decreased  consumption  of  

traditional  foods  due  to  urbanization  (Mouawad,  2004)  

  Indicators  of  food  insecurity  (Batal  et  al.,  2007;  IFPRI,  2003)    

  Obesity  rates  reaching  figures  in  developed  countries  (Batal  et  al.,  2007;  Sibai,  2003)  

  Hypertension  (23%  in  men  and  women  in  Beirut)  (Tohme,  2005)  

Distribution of respondents by BMI categories and gender

0.2%

38.8%

43.9%

13.7%

3.4%

0.0%0.5%

8.5%

2.1%

29.9%

35.7%

23.3%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

<18.5 18.5- 24.9 25.0- 29.9 30.0- 34.9 35.00- 39.9 >=40

BM

I (K

g/ m

2)

Male

Female

  The  Ecohealth  Approach  to  Human  Health  relies  on  the  premise  that  human  health  is:     Closely  linked  to  the  health  of  the  ecosystem      A  holistic  approach  is  needed  to  understand  the  social,  economic  and  

environmental  factors  that  influence  human  health,  thus  requiring  a  wide  network  of  disciplines  working  together.    

  It  is  considered  a  cost-­‐effective  and  creative  approach  to  improving  human  health.    

 

Briceno-Leon, R., & Nugent, R. (2003). PI External Reviews: Summary of Report - Ecosystem Approaches to Human Health (Ecohealth). Venezuela: IDRC. Gopalan, H. (n.d.). Ecohealth: The Ecosystem Approach to Human Well-Being. Retrieved December 9, 2010, from http://www.unep.org/ourplanet/imgversn/images/Gopalan_ecohealthv3.pdf Briceno-Leon, R., & Nugent, R. (2003). PI External Reviews: Summary of Report - Ecosystem Approaches to Human Health (Ecohealth). Venezuela: IDRC. Gopalan, H. (n.d.). Ecohealth: The Ecosystem Approach to Human Well-Being. Retrieved December 9, 2010, from http://www.unep.org/ourplanet/imgversn/images/Gopalan_ecohealthv3.pdf

Briceno-­‐Leon,  R.,  &  Nugent,  R.  (2003).  PI  External  Reviews:  Summary  of  Report  -­‐  Ecosystem  Approaches  to  Human  Health  (Ecohealth).  Venezuela:  IDRC.      Gopalan,  H.  (n.d.).  Ecohealth:  The  Ecosystem  Approach  to  Human  Well-­‐Being.  Retrieved  December  9,  2010,  from  http://www.unep.org/ourplanet/imgversn/images/Gopalan_ecohealthv3.pdf    

   ‘  

  Phase  II:  2009-­‐2013    University  of  Ottawa/American  University  of  Beirut  

  Multi-­‐disciplinary  with  researchers  from:    Nutrition,  Horticulture,  Landscape  Design,  Ethnography,  Physiology,  Economics,  Food  Toxicology,  Epidemiology,  Food  Science  

  Strong  NGO  and  CBO  linkages    Local  policy  connections  

  Goal      To  reduce  the  vulnerability  of  poor  rural  

communities  to  human  health  problems  caused  by  ecosystem  and  global  food  market  changes  by  promoting  ecosystem  approaches  to  human  health.  

   

  General  Objective      To  develop  practical  interventions  and  provide  

policy  options  for  improved  dietary  diversity,  food  security  and  health  in  poor  and  vulnerable  communities  in  Lebanon    

Food  Heritage  Preservation  •  There  is  tremendous  pride  associated  with  land  based  food  

practices  •  People  identified  cultural,  nutritional/health  and  economic  

benefits  associated  with  growing,  preparing  and  consuming  local  foods  

•  Despite  this,  there  are  serious  deterrents  to  local  food  production  which  hinder  their  continuance  in  the  future  

•  Any  support  must  be  in  line  with  new  economic  realities  of  life  in  the  communities  

  Linear  programming  to  establish  food  based  dietary  guidelines  based  on  24-­‐hour  recall  data  from  phase  1  

  Nutrient  analysis  of  local  mixed  dishes  (500  composite  dishes  and  production  of  Food  Composition  Tables)  

  School  feeding  program  using  locally  produced  traditional  food  

  Metabolic  study  comparing  between  rural  and  urban  diets  and  impact  on  glucose  tolerance  and  insulin  sensitivity  

 

  A  mathematical  technique  used  to  develop  inexpensive  and  nutritious  diets.  

 MS  Excel  2010  using  data  from  24-­‐hour  recalls.  

  Including:  food  prices  nutritional  composition    

  Goal:  Achieve  a  diet  that  follows  dietary  recommendations  while  minimizing  cost  and  energy  intake  

Nutritional constraints used for Lebanese women and men, 19-50 years old

(Derived from Institute of Medicine, 2005; Institute of Medicine, 2011; U.S. Department of Agriculture, 2010)

Females Males Minimum Maximum Minimum Maximum

Energy (Kcal)* 2000 2000 2600 2600 Macronutrients

Carbohydrate (% of E) 45% 65% 45% 65% Protein (% of E) 10% 35% 10% 35% Fat (% of E) 20% 35% 20% 35%

Saturated fat (g) - 20 - 20 Fiber (g) 25 38 Sugar (g) - 50 - 65

Vitamins Vitamin D (ug) 15 100 15 100

Minerals Sodium (mg) 1500 2300 1500 2300 Potassium (mg) 4.7 - 4.7 - Calcium (mg) 1000 2500 1000 2500 Iron (mg) 18 45 8 45

*For 19-30 years of age, Energy needs are of 2000-2200 Kcal and 2600-2800 Kcal for females and males respectively. *For 31-50 years of age, Energy needs are of 2000 Kcal and 2400-2600 Kcal for females and males respectively.

Food list and total diet cost for females, minimizing energy intake, and including nutritional constraints

Food item Quantity (grams)

Bread, French 80 Milk, cow's, fluid, whole 187 Pear, Prickly (Cactus Figs) 84 Cucumber 1711 Onions, Scallion or Spring Green 315 Shorbit kishk b' toum (Kishk soup with garlic) 356 Rice with vermicelli 229 Samkeh harra (Broiled fish with spicy sauce) 197

Energy intake (Kcal) 1553 Total diet cost (LBP) 7701

One week food basket for females,with all constraints

Food item Quantity (grams)

Bread, Pita, White 1272

Yoghurt from goat's milk, low fat, plain 379

Milk, cow's, fluid, whole 500

Cheese, Gruyere 200

Watermelon 200

Cantaloupe 1780

Apple 200

Banana 200

Pear, Prickly (Cactus Figs) 200

Cucumber 3853

Oil, Olive 86

Chips, Potato, Salted 65

Fattoush (Crisp bread salad) 70

Tabbouli (Parsley, mint, and bulgur salad) 300

Cucumber and tomato salad 100

Warak areesh b' zayt (Vine leaves stuffed-meatless) 58

Fassoulia bayda b' zayt (White beans-meatless) 561

Dajaj bil saniyeh (Roasted chicken with potato) 1383

Silik b' lahm (Swiss chard leaves stuffed with rice and meat) 500

Rice with vermicelli 500

Hrisse (Wheat and meat porridge) 500

Samkeh harra (Broiled fish with spicy sauce) 300

Energy intake (Kcal) 14000

Total diet cost (LBP) 36344

   Semi-­‐arid   rural   community  

e xpe r i enc i ng   a   nut r i t i on  t rans i t ion ,   env i ronmenta l  degradation   and   abandonment  of  agriculture.  

   ‘Food  and  health  in  rural  Lebanon:  Options  to  

Important  in  lower  income  countries  for  most  vulnerable  households,  of  low  socio-­‐economic  status  with  food  insecurity.    

Improvements  in:    School  attendance    School  performance    Nutritional  status  

(particularly  height)    Improvement  in  mental,  

physical  and  psychosocial  health.  

 Kristjansson  et  al.(2007)  School  feeding  for  improving  the  physical  and  psychosocial  health  of  disadvantaged  students  (Review).  Cochrane  Database  Syst  Rev.  

   

 To  investigate  the  feasibility  and  impact  of  a  community  based  school   feeding   and   a   nutrition   education   program   on  nutritional  status,  breakfast  consumption  and  attitude  towards  traditional  diets.    

  At  baseline  and  endpoint:  breakfast  recall,  socio-­‐demographic  data,  weight,  height,  and  hemoglobin(Hemocue)  

  Meal  provision  at  the  Intervention  school:    Optimized  traditional  recipes    Prepared  safely  by  local  women  involved  with  the  healthy  kitchen    A  snack  to  meet  25%  of  daily  energy,  protein  and  micronutrient  needs  

  Interactive  education  sessions  for  students,  parents  and  teachers  at  two  schools.  

  S i g n i fi c a n t   c h a ng e s   i n   b r e a k f a s t  consumption:  

-­‐  Increase  in  breakfast  consumption  -­‐  Increase   in   breakfast   containing   at   least   2  food  groups  

-­‐  Increase   in   breakfast   containing   at   least   1  fruit  and/or  vegetable  

Outcome School  1  (Edu)  

n=156

School  2  (SFP)  

n=143

Total    

n=299

Change  from  baselinea  

Mean  height-­‐for-­‐age  Z  scoreb  ±  

SEM

-­‐0.11  ±0.07 -­‐0.28  ±0.08 -­‐0.19  ±0.05

Mean  BMI-­‐for-­‐age  Z  score  ±  SEM -­‐0.01  ±0.07 0.21  ±0.07 0.99  ±0.05

Mean  hemoglobin  (mg/dl)  ±  SEM -­‐0.70  ±0.13        0.07  ±0.11e -­‐0.32  ±0.09 a When comparing across schools, age and gender were corrected for. b Comparison of height-for-age corrected for father’s education. C P<0.05, d P<0.01, e P<0.001

Changes from baseline nutritional status indicators during the 5-mo intervention in schoolchildren receiving a school meal plus education or education alone.

“The  Aarsal  Healthy  kitchen  practiced  safer  methods  that  we  saw  throughout  all  our  rotations”  -­‐  Nutrition  intern  student    

  Successful  preparation  &  delivery  of  the  school  meal  (mid-­‐morning  snack)  4  days  a  week.    

  High  acceptability  of  school  meal,  plate  waste  decreased  from  beginning  to  end  of  program  (not  shown).  

  An  improvement  in  breakfast  consumption  and  food  choices.    Marginal  improvements  in  Hb  status    Cost:  0.40USD  per  student  per  day    

  The  set  up  of  4  pilot  plants  under  the  “Healthy  Kitchen”  network  

  Healthy  Kitchen  is  a  catering  unit  providing  local  food  choices  using  nutritious  organic  whole  ingredients  

  All  kitchens  make  enough  financial  profit  to  cover  their  expenses  and  employees’  salaries  (around  20  women  per  kitchen).  Occasionally,  additional  financial  profit  is  generated  to  make  small  purchases  of  necessary  kitchen  supplies.    

Implement  an  enhanced  food  safety  program  that  is  critical  to  assure  the  safety  of  locally  produced,  ecosystem  based  foodstuffs  for  self-­‐consumption  and  build  consumer  confidence,    increasing  marketability  of  the  traditionally  produced  food  items  

A  modified  HACCP  program  has  been  developed  and  applied  in  the  communities.  The  model  was  tested  nationally  by  the  Lebanese  Association  for  Food  Safety  which  now  provides  certification  to  restaurants  

“The  important  goal  of  empowering  women  has  been  fulfilled  to  some  extent  through  establishing  the  kitchens.”  Halimeh  Hojeiry  

 “  Women,  who  have  been  confined  to  their  own  homes  within  the  borders  of  

their  villages,  are  now  traveling  throughout  Lebanon,  meeting  new  people  from  different  backgrounds,  entering  new  markets  and  taking  responsibilities  for  major  business  transactions  within  the  sales  context.”  Iqbal  Bousaleh  

 “The  kitchens  have  also  allowed  local  suppliers  from  the  agriculture  and  

animal  farming  sectors  to  sell  their  own  products  and  increase  their  profits.”  Khadijeh  Chahine    

   Edible  Wall  Boxes     Containing:  cherry  tomatoes,  beans,  basil,  rosemary,  sweet  pepper,  marjoram

AARSAL,  North  East  Lebanon  

Landscape  Design  and  Eco-­‐System  Management  FINAL  YEAR  PROJECT  –  2011  

Karel  Matar  

Setting  up    of  nurseries  for  native  species  

  malek   batal,   salma   talhouk,   omar   obeid,   zeina   kassaify,  jad  chaaban,  ammar  olabi,  jala  makhzoumi,  hala  ghattas,  najat   saliba,   michael   robidoux,   mounir   mabsout,   salah  sadek,   rabih   shibli,  elke  berger,   roland   riachi,   carla  haibi,  mélanie   mattar,   bassam   hamzeh,   reem   hamzeh,   rheam  abou   ezze   ,   lina   abou   farraj,   qassem   al   assad,   olga   safa  majzoub,   rawad   massoud,   carol   itani,   francine   francis,  hayat   hatab   hala   khudari   ,   karel   matar,   nassim   basma,  mahmoud   el   jazzar,   dana   hamra   fatima   jebara   ,   ziad  kachmar,   hussein  mheidli,   chaza   houjeiri,   racha   zarzour,  rodolphe  ghossoub,  dima  ousta.  

Aarsal  Festival  –  Closing  Ceremony