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Saafan, T., El Ansari, W., Al-Yahri, O., Eleter, A., Eljohary, H., Alfkey, R., . . . El Osta, A. (2019). Assessment of PULP score in predicting 30-day perforated duodenal ulcer morbidity, and comparison of its performance with Boey and ASA, a retrospective study. Annals of Medicine and Surgery, 42, 23-28
Open this publication in new window or tab >>Assessment of PULP score in predicting 30-day perforated duodenal ulcer morbidity, and comparison of its performance with Boey and ASA, a retrospective study
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2019 (English)In: Annals of Medicine and Surgery, ISSN 2049-0801, Vol. 42, p. 23-28Article in journal (Refereed) Published
Abstract [en]

Background: /aim: Scores commonly employed to risk stratify perforated peptic ulcer patients include ASA (American Society of Anesthesiologists), Boey and peptic ulcer perforation score (PULP). However, few studies assessed and compared the accuracy indices of these three scores in predicting post PPU repair 30-day morbidity. We assessed accuracy indices of PULP, and compared them to Boey and ASA in predicting post perforated duodenal (PDU) ulcer repair 30-day morbidity. Methods: Retrospective chart review of all PDU patients (perforated duodenal ulcers only) at the largest two hospitals in Qatar (N = 152). Data included demographic, clinical, laboratory, operative, and post repair 30-day morbidity. Area under the Curve (AUC), sensitivity and specificity were computed for each of the 3 scores. Multivariate logistic regression assessed the accuracy indices of each score. Results: All patients were males (M age 37.41 years). Post PDU repair 30-day morbidity was 10.5% (16 morbidities). Older age, higher ASA (≥3), Boey (≥1) or PULP (≥8) scores, shock on admission and preoperative comorbidities; and conversely, lower hemoglobin and albumin were all positively significantly associated with higher post PDU 30-day morbidity. PULP displayed the largest AUC (72%), and was the only score to significantly predict 30-day morbidity. The current study is the first to report the sensitivity and specificity of these three scores for post PDU repair 30-day morbidity; and first to assess accuracy indices for PULP in predicting post PDU repair 30-day morbidity. Conclusion: PULP score had the largest AUC and was the only score to significantly predict post PDU repair 30-day morbidity. © 2019 The Author(s)

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
ASA, Boey, Perforated duodenal ulcer, Perforated peptic ulcer, Perforated peptic ulcer score, PULP
National Category
Surgery
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-16939 (URN)10.1016/j.amsu.2019.05.001 (DOI)000468373600006 ()2-s2.0-85065728629 (Scopus ID)
Available from: 2019-06-03 Created: 2019-06-03 Last updated: 2019-06-11Bibliographically approved
El Ansari, W. & Berg-Beckhoff, G. (2019). Association of health status and health behaviors with weight satisfaction vs. Body image concern: Analysis of 5888 undergraduates in Egypt, Palestine, and Finland. Nutrients, 11(12), Article ID 2860.
Open this publication in new window or tab >>Association of health status and health behaviors with weight satisfaction vs. Body image concern: Analysis of 5888 undergraduates in Egypt, Palestine, and Finland
2019 (English)In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 11, no 12, article id 2860Article in journal (Refereed) Published
Abstract [en]

Little is known about the relationships between weight satisfaction, body image concern, healthy nutrition, health awareness, and physical activity among college students across culturally different countries. We assessed country and sex-specific associations between health status (self-rated health, depression, BMI), healthy behavior (healthy nutrition, physical activity, health awareness), weight satisfaction, and body image concern via a cross-sectional survey (5888 undergraduates) in Egypt, Palestine, and Finland. This health and wellbeing survey employed identical self-administered paper questionnaires administered at several Universities in two Eastern Mediterranean countries (Egypt, Palestine—Gaza Strip), and an online-survey comprising the same questions in Finland. Regression analyses were employed. Health status variables exhibited the strongest associations; high BMI and more depressive symptoms were more often among students satisfied with their weight (except in Palestine), but they were positively associated with body image concern irrespective of country or gender. Self-rated health was not associated with body image concern or weight satisfaction. Healthy behaviors were not associated with body image concern or weight satisfaction. Depressive symptoms and BMI were the most prominent predictors for body image concern. There were country-specific consistent results when using the body image concern score. Further research is necessary to compare body image across different cultures and countries. 

Place, publisher, year, edition, pages
MDPI AG, 2019
Keywords
body image, college students, depressive symptoms, health awareness, health behaviors, healthy nutrition, physical activity, weight satisfaction, adolescent, adult, article, awareness, Beck Depression Inventory, body mass, body weight management, body weight satisfaction, cross-sectional study, depression, female, health behavior, health status, human, income, Likert scale, major clinical study, male, nutrition, obesity, physical well-being, practice guideline, questionnaire, self rated general health, social stratification, university student
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17991 (URN)10.3390/nu11122860 (DOI)31766557 (PubMedID)2-s2.0-85075404215 (Scopus ID)
Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2019-12-11
Saafan, T., El Ansari, W. & Bashah, M. (2019). Compared to What? Is BMI Associated with Histopathological Changes in Laparoscopic Sleeve Gastrectomy Specimens?. Obesity Surgery, 29(7), 2166-2173
Open this publication in new window or tab >>Compared to What? Is BMI Associated with Histopathological Changes in Laparoscopic Sleeve Gastrectomy Specimens?
2019 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 29, no 7, p. 2166-2173Article in journal (Refereed) Published
Abstract [en]

Background Obesity is a risk for many different cancers. Laparoscopic sleeve gastrectomy (LSG) is common, and benign or pre-malignant histopathology types are reported in the removed gastric specimens. We assessed whether higher BMI was associated with certain benign or pre-malignant histopathological changes. Method Retrospective chart review of all primary LSG patients (N = 1555). Demographic, clinical, and LSG histopathology data were retrieved. BMI of patients with specific benign or pre-malignant conditions in their gastric specimens was compared with the BMI of the rest of the patients with abnormal histopathology specimens and also compared with the BMI of patients with normal control specimens. Results Females comprised 70% of the patients. Mean BMI were 46.3 (females) and 48 (males). Normal LSG specimens comprised 52%. Most common abnormal histopathologies were chronic inactive gastritis (33%), chronic active gastritis (6.8%), follicular gastritis (2.7%), lymphoid aggregates (2.2%), intestinal metaplasia (1.4%) and GIST (0.7%). After controlling for confounders (age, gender, H. pylori, diabetes mellitus type 2, hypertension), no significant association was observed between the BMI of patients with specific benign or pre-malignant histopathology compared with the BMI of the rest of the patients with abnormal histopathologies and compared to the BMI of patients with normal histopathologies. Conclusion When confounders were taken into account, there appeared no significant associations between the BMI of patients with specific benign or pre-malignant histopathology compared with the BMI of the rest of the patients with abnormal histopathologies and compared to the BMI of patients with normal histopathologies of their gastric specimens. There was a very weak correlation between BMI and other covariates.

Place, publisher, year, edition, pages
USA: Springer, 2019
Keywords
Laparoscopic sleeve gastrectomy, LSG, Histopathologies, BMI, Pre-malignant histopathology, Benign histopathology
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17222 (URN)10.1007/s11695-019-03801-y (DOI)000469767700021 ()30989568 (PubMedID)2-s2.0-85064708438 (Scopus ID)
Available from: 2019-06-20 Created: 2019-06-20 Last updated: 2019-08-06Bibliographically approved
Toffaha, A., El Ansari, W., Elaiwy, O., Obaid, M., Al-Yahri, O. & Abdelazim, S. (2019). First sliding Amyand hernia harbouring appendicular schistosomiasis: Case report. International journal of surgery case reports, 63, 143-146
Open this publication in new window or tab >>First sliding Amyand hernia harbouring appendicular schistosomiasis: Case report
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2019 (English)In: International journal of surgery case reports, ISSN 2210-2612, E-ISSN 2210-2612, Vol. 63, p. 143-146Article in journal (Refereed) Published
Abstract [en]

Introduction: Amyand's hernia (AH) is rare, schistosomiasis of the appendix is very uncommon, and both conditions coexisting together is an extremely rare event. Pre-operative diagnosis of each of the two conditions is usually difficult. To the best of our knowledge, the current paper is first to report both these two conditions in coexistence. Presentation of case: A 31-year old man who had no comorbidities was admitted electively as a day case of non-complicated right indirect inguinal hernia. Further history and physical examination were unremarkable. Intraoperatively the patient was found to have right sliding AH with appendicular schistosomiasis (AS). The patient underwent Lichtenstein repair of the hernia with appendectomy. On follow up he was referred to infectious disease clinic, and the post-operative course was uneventful. Conclusions: Intraoperative identification of non-typical hernia sac before its opening should alert the surgeon to the possibility of sliding hernia and the presence of an organ as a part of the sac. Rare causes of appendicular masses like schistosomiasis granuloma should be considered in endemic areas or immigrants from these areas, despite the difficulty of preoperative diagnosis. Management should follow general guidelines of appendectomy, hernia repair and dealing with the associated pathology if present. 

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Case report, Inguinal hernia, Intestinal schistosomiasis, Tropical disease
National Category
Surgery Health Care Service and Management, Health Policy and Services and Health Economy Gastroenterology and Hepatology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17781 (URN)10.1016/j.ijscr.2019.09.014 (DOI)31585325 (PubMedID)2-s2.0-85072758444 (Scopus ID)
Available from: 2019-10-10 Created: 2019-10-10 Last updated: 2019-10-21Bibliographically approved
Sulieman, I., Elmoghazy, W., El Ansari, W., Elaffandi, A. & Khalaf, H. (2019). Gallbladder cancer: 7-Year experience from Qatar. Annals of Medicine and Surgery, 44, 33-38
Open this publication in new window or tab >>Gallbladder cancer: 7-Year experience from Qatar
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2019 (English)In: Annals of Medicine and Surgery, ISSN 2049-0801, Vol. 44, p. 33-38Article in journal (Refereed) Published
Abstract [en]

Background: Gallbladder cancer (GC) is a relatively rare disease. To date, there are no studies describing the epidemiology of this disease in Qatar. Objective: To study the epidemiology of Gallbladder Cancer in Qatar. Methods: A retrospective analysis of the cases of GC in Hamad General Hospital in Qatar from 2009 to 2016. Results: Thirty-five patients presented with GC during the study period, 10 females (28.6%) and 25 males (71.4%). Fourteen patients (40%) were diagnosed incidentally after laparoscopic cholecystectomy, 16 (48.6%) were diagnosed pathologically, and 4 (11.4%) were diagnosed radiologically. The median age at diagnosis was 54 years (31–78). 74.3% of the disease occurred in patients less than 60 years old. Metastatic disease was discovered in 25 patients (71.4%) versus no metastasis in 10 patients (28.6%). The most common sites for metastasis were the liver (42.9%), peritoneum (25.7%), and lymph nodes (25.7%). Curative central hepatic resection was done in 8 patients (22.9%). Pathology showed adenocarcinoma in 27 patients (77.1%), neuroendocrine tumor in 3 patients (8.6%) and high-grade dysplasia in 1 patient (2.9%). No histopathology was available for 4 patients (11.4%). Twenty-eight patients (80.0%) had regular follow up, with 22 (62.9%) still alive. Six patients (17.1%) died during follow up with survival after diagnosis ranging from 42 days to 6.8 years. Conclusions: In Qatar, due to the unique demographics, GC is more common in males and younger age groups. Most of the patients present late with metastasis, but curative resection is associated with long-term survival.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Epidemiology, Gallbladder cancer, Qatar, Risk factors, Survival
National Category
Clinical Medicine
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17418 (URN)10.1016/j.amsu.2019.06.001 (DOI)000477739600007 ()2-s2.0-85067824950 (Scopus ID)
Available from: 2019-07-09 Created: 2019-07-09 Last updated: 2019-11-11Bibliographically approved
Elmoghazy, W., Ahmed, K., Vijay, A., Kamel, Y., Elaffandi, A., El Ansari, W., . . . Khalaf, H. (2019). Hepatocellular carcinoma in a rapidly growing community: Epidemiology, clinico-pathology and predictors of extrahepatic metastasis. Arab Journal of Gastroenterology, 20(1), 38-43
Open this publication in new window or tab >>Hepatocellular carcinoma in a rapidly growing community: Epidemiology, clinico-pathology and predictors of extrahepatic metastasis
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2019 (English)In: Arab Journal of Gastroenterology, ISSN 1687-1979, Vol. 20, no 1, p. 38-43Article in journal (Refereed) Published
Abstract [en]

Background and study aims: Hepatocellular carcinoma (HCC) with extrahepatic metastasis has been studied, however, data from the Middle East remain scarce. In this study, we assess epidemiology of HCC in Qatar, and identify predictors of the metastatic behaviour. Patients and methods: All newly-diagnosed HCC patients on top of liver cirrhosis between 2011 and 2015 were included in the study. Results: A total of 180 patients met our inclusion criteria. The mean age was 58.8 ± 10.5 years with a mean follow-up of 1.0 ± 1.1 years. There were 150 male patients and HCV was the most common cause of liver cirrhosis 108 (60%), and 22 (12.2%) patients were classified as Child-Pugh class C. The overall survival of 51.1%, and 47 (26%) had at least one extrahepatic metastasis at the time of diagnosis. Single site metastasis was diagnosed in 10 patients, whereas 37 patients had multiple sites metastases. We compared patients who had metastases with patients who did not have metastasis at the time of diagnosis of HCC regarding several variables, and analysis revealed that tumour diameter larger than 5 cm (OR = 6.10, 95% CI = 1.85–20.12) (p = 0.003), and bilobar liver involvement (OR = 5.49, 95% CI = 1.10–27.30) (p = 0.037) were independent predictors of metastatic behaviour of HCC. Conclusion: The incidence of HCC is rising in our population, extrahepatic metastasis is no longer rare and tumours larger than 5 cm and bilobar involvement are determinants of the extrahepatic metastasis. © 2019 Pan-Arab Association of Gastroenterology

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Hepatocellular carcinoma, Incidence, Maximal tumour diameter, Metastasis, Prognosis, Risk factors, Total tumour volume
National Category
Gastroenterology and Hepatology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-16705 (URN)10.1016/j.ajg.2019.01.006 (DOI)000463364700008 ()30853257 (PubMedID)2-s2.0-85062444660 (Scopus ID)
Available from: 2019-03-18 Created: 2019-03-18 Last updated: 2019-04-30Bibliographically approved
Elhag, W., El Ansari, W., Razaq, S., Elsherif, M. & Mustafa, I. (2019). Lorcaserin vs. Phentermine among non-surgical and surgical obese patients: Anthropometric, glycemic, lipid, safety and cost outcomes. Annals of Medicine and Surgery, 45, 75-81
Open this publication in new window or tab >>Lorcaserin vs. Phentermine among non-surgical and surgical obese patients: Anthropometric, glycemic, lipid, safety and cost outcomes
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2019 (English)In: Annals of Medicine and Surgery, ISSN 2049-0801, Vol. 45, p. 75-81Article in journal (Refereed) Published
Abstract [en]

Background: To evaluate effectiveness, safety, and costs of Lorcaserin vs. phentermine among obese non–surgical and surgical patients (post bariatric surgery). Methods: This retrospective study retrieved charts of all patients (January 2013–June 2016) who received Lorcaserin or phentermine for 3 months. The study assessed anthropometric, glycemic, and lipid changes, as well as side effects and cost of medications among overweight and obese non-surgical (n = 83) and surgical patients (n = 46). These two patient groups were compared using Chi-square (χ2) and unpaired‘t’ test for qualitative and quantitative variables respectively. Results: At 3 months, among the non-surgical group, Phentermine patients had greater percentage of total weight loss (TWL%) (7.65 ± 8.26 vs. 2.99 ± 3.72%, P = 0.003), and greater BMI reduction (−3.16 ± 3.63 vs. −1.15 ± 1.53 kg/m2, P = 0.003) than Lorcaserin. Within the surgical group, Lorcaserin patients had significantly smaller TWL% (1.86 ± 5.06 vs. 7.62 ± 9.80%, P = 0.012), and smaller BMI reduction (−0.74 ± 1.80 vs. −3.06 ± 4.08 kg/m2, P = 0.012) than Phentermine. Lorcaserin exhibited significant total cholesterol and LDL improvements only among surgical patients with significant weight reduction (≥5% TW). Both medications were not associated with glycemic improvements among non-surgical and surgical groups. Phentermine had slightly more side effects but was less expensive. Conclusions: Among both patient groups, phentermine was more effective in achieving weight loss. Lorcaserin showed dyslipidemia improvements only among surgical patients who achieved significant weight reduction. Anti-obesity medications as part of weight management programs can result in weight loss among non-surgical and surgical patients, or halt weight regain among surgical patients. This is the first study to evaluate the effectiveness and safety of two anti-obesity medications (lorcaserin vs. phentermine) among two distinct obese patient groups, non-surgical and surgical patients. 

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Obesity, Lorcaserin, Phentermine, Weight regain, Bariatric surgery, Lipid profile, Glycemic, parameters
National Category
Surgery
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17505 (URN)10.1016/j.amsu.2019.07.024 (DOI)000482224200016 ()31388419 (PubMedID)2-s2.0-85069915724 (Scopus ID)
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-11-18Bibliographically approved
Hammad, Y. A., El Ansari, W., Shallik, N. A., Bali, S. & Feki, A. M. (2019). Quality, safety and efficiency in practice: Risk assessment and standardisation of anesthesia equipment and supplies in operating theaters of high-volume tertiary-care academic medical center. Middle East Journal of Anesthesiology, 26(1), 3-9
Open this publication in new window or tab >>Quality, safety and efficiency in practice: Risk assessment and standardisation of anesthesia equipment and supplies in operating theaters of high-volume tertiary-care academic medical center
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2019 (English)In: Middle East Journal of Anesthesiology, ISSN 0544-0440, Vol. 26, no 1, p. 3-9Article in journal (Refereed) Published
Abstract [en]

Background: Operating theatres (OTs) are valuable and costly resources that need to be appropriately designed and stocked for efficient, quality and safe patient care. We assessed the logistic inefficiency including the availability and location layout of necessary supplies across OTs of a high-volume tertiary-care academic medical center. Methods: A blinded observer (anesthesia technologist) was allocated to 10 OTs. For each OT, the availability, quantity and time spent to locate and obtain a set of required items were recorded (baseline values). We then developed an OT mapping plan to determine the specific item/s to be stocked in specific locations, and one OT was standardized to this configuration map. A blinded observer was then allocated to this standardized OT and time spent to obtain the same set of items was again recorded. Six of our regular OTs were then standardized to the same configuration, and the time to obtain the items by a blinded observer were again recorded for each OT. T tests compared the time required to locate items in the standardized OT vs. regular OTs; paired t tests compared the time required in each OT vs. itself before and after standardization. Results: The observer required significantly more time in each of the 10 regular OTs compared to the standardized OT. The time spent by the observer to obtain the required items significantly and considerably decreased in each of 6 OTs after their standardization, compared to the time required before their standardization. Conclusion: This quality improvement project successfully reduced the time required to identify and locate different supplies, which impacts on the efficiency and quality of patient care. For anesthesia staff moving from one anesthetizing location to another within the institution, consistencies in location and number of anesthesia equipment and supplies create higher levels of safety and professionalism.

Place, publisher, year, edition, pages
American University of Beirut, 2019
Keywords
Anesthesia equipment and supplies, Quality, Risk assessment, Safety
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17994 (URN)2-s2.0-85075549884 (Scopus ID)
Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2019-12-11
Toffaha, A., El Ansari, W., Ramzee, A. F., Afana, M. & Aljohary, H. (2019). Rare presentation of primary varicella zoster as fatal fulminant hepatitis in adult on low-dose, short-term steroid: Case report. Annals of Medicine and Surgery, 48, 115-117
Open this publication in new window or tab >>Rare presentation of primary varicella zoster as fatal fulminant hepatitis in adult on low-dose, short-term steroid: Case report
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2019 (English)In: Annals of Medicine and Surgery, ISSN 2049-0801, Vol. 48, p. 115-117Article in journal (Refereed) Published
Abstract [en]

Background: Varicella zoster virus presents clinically as primary (chickenpox) or secondary (herpes zoster) infection. Cutaneous and extracutaneous dissemination may occur, usually in immunocompromised patients. VZV hepatitis that progresses to fulminant hepatic failure is very rare and fatal. To the best of our knowledge, 9 cases have been reported to date, of which 7 were in immunocompromised adults, and only one patient was on short duration steroid therapy. Presentation of case: We present a 26-year old man who was admitted initially with acute abdomen as query persistent biliary colic. Later, he showed clinical and laboratory findings of VZV hepatitis that progressed rapidly despite maximal medical ICU support and he expired on day 3 of admission. Conclusions: Acute VZV infection may present as fulminant hepatitis. The presentation may initially be challenging for the diagnosis and should be considered if the patient has been in contact with a sick case. Low dose corticosteroid could carry a risk for fatal VZV fulminant hepatitis and should be used very cautiously especially with VZV patients’ contacts. Further causative relationships remain to be established. 

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Biliary colic, Case report, Fulminant acute hepatic failure, Hepatitis, Liver failure
National Category
Gastroenterology and Hepatology Infectious Medicine
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17904 (URN)10.1016/j.amsu.2019.10.034 (DOI)31763037 (PubMedID)2-s2.0-85074811478 (Scopus ID)
Available from: 2019-11-21 Created: 2019-11-21 Last updated: 2019-12-05Bibliographically approved
El Ansari, W. & Samara, A. (2018). Adherence to Recommended Dietary Guidelines and the Relationships with the Importance of Eating Healthy in Egyptian University Students. International Journal of Preventive Medicine, 9(1), Article ID 73.
Open this publication in new window or tab >>Adherence to Recommended Dietary Guidelines and the Relationships with the Importance of Eating Healthy in Egyptian University Students
2018 (English)In: International Journal of Preventive Medicine, ISSN 2008-7802, E-ISSN 2008-8213, Vol. 9, no 1, article id 73Article in journal (Refereed) Published
Abstract [en]

Background: Little is known on the food consumption habits and adherence to dietary guidelines among young adults. We examined students' adherence to recommended guidelines, and the associations between importance of eating healthy and guidelines adherence. Methods: A total of 3271 undergraduates at 11 faculties, Assiut University, Egypt (2009-2010), completed a questionnaire reporting their consumption of 12 food groups; number of servings of fruits/vegetables/day; and how important it is for them to eat healthy. We employed the WHO guidelines for the Eastern Mediterranean region (WHO 2012) to compute students' adherence to dietary guidelines for the different food groups. Chi-square tested the differences for adherence to guidelines by gender, and the associations between the importance of healthy eating and guidelines adherence for the whole sample and by gender. Results: Except for cereal products, no food group had an adherence level >45%. Gender differences were observed (men had better adherence for sweets, cake/cookies, snacks, and raw vegetables but not for fast food/canned food or cooked vegetables, P < 0.001 for each). There was a significant positive trend between the increase of subjective importance of eating healthy and adherence to guidelines (P = 0.012-<0.001). However, this association was only for some food groups and gender dependent. Conclusions: Across the majority of food groups we examined, this sample exhibited low adherence levels to International Nutrition Guidelines. Healthier eating educational/intervention efforts should target foods exhibiting low adherence (most food groups, particularly salad/raw vegetables, fresh fruits, dairy/dairy products, meat/sausage products); consider gender differences (females reported lower adherence across most food groups); and note the relation between adherence and subjective importance of eating healthy by food groups and gender.

Place, publisher, year, edition, pages
Wolters Kluwer, 2018
Keywords
Adherence, eating healthy, feeding behavior, gender, Mediterranean region, students, vegetables and fruits
National Category
Health Sciences
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-16380 (URN)10.4103/ijpvm.IJPVM_619_14 (DOI)000444405100007 ()30167103 (PubMedID)2-s2.0-85059897154 (Scopus ID)
Available from: 2018-11-09 Created: 2018-11-09 Last updated: 2019-09-30Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-0961-1302

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