**3. Results**

#### *3.1. Study Sample*

For the purpose of this study, subjects for whom dietary data were missing or incomplete were excluded (out of 939 subjects, 71 were excluded). Accordingly, the final study sample consisted of 868 subjects (439 boys and 429 girls), with a mean age of 13.06 years (±3.91) and a median age of 12.85 years. Of the study participants, 42.6% were 6–11 years old and 57.4% were 12–19 years old. The male to female ratio was of 1.02 with 50.6% boys and 49.4% females.

The proportion of parents who had attained high school level education and above was of 38.6% for fathers and 46.3% for mothers with no significant differences between age groups (Table 1). A significantly higher proportion of working mothers was reported amongst 12–19-year-old adolescents (29.6%) compared to children (19.4%). Parental obesity (mother or father) was reported amongst 31% of the study population with no significant differences between age groups. The majority of subjects (81.7%) had a crowding index SHUVRQVURRP7DEOH

The proportions of subjects reporting a daily consumption of breakfast was significantly higher amongst children compared to adolescents (86.4% *vs.* 69.5% in adolescents) while a significantly higher proportion of adolescents reported eating outside home more than once per week (58.4% in adolescents compared to 44.4% in children) (Table 1). Similarly, sedentary time was significantly higher amongst 12–19-year-old adolescents compared to children (10.09 ± 2.94 *vs.* 8.72 ± 2.77 h/day) while the proportion of subjects reporting high physical activity was significantly higher in children compared to adolescents (63.9% *vs.* 33.5%).

Mean weight (35.01 ± 12.55 in children *vs.* 60.77 ± 15.61 kg in adolescents), mean height (135.63 ± 12.26 *vs.*164.17 ± 10.07 cm), mean BMI (18.53 ± 3.99 *vs.* 22.32 ± 4.37 kg/m<sup>2</sup> ) and mean WC (63.77 ± 10.75 *vs.* 74.93 ± 10.97 cm) were all significantly higher in 12–19-year-old adolescents compared to children aged 6–11 years (Table 1).


**Table 1.** Socio-demographic, lifestyle and anthropometric characteristics of the study sample by age group, Lebanon (*n* = 868).


**Table 1.** *Cont.*

(1) Lack of corresponding sum of frequencies with total sample size is due to missing data; (2) Differences between age groups were examined using *t*-test and chi-square test for continuous and categorical variables, respectively; (3) Total number of parents with anthropometric data was equal to 564; (4) The three categories of physical activity (Low, Moderate, High) refer to the frequency of physical activity outside the school setting (Never; 1–2 times/week; >2 times/week, respectively).

Taking both genders, 40.2% of 6–11-year-olds and 30.8% of 12–19-year-olds were found to be overweight (BMI *z* score >+1), while 17.1% and 10.3% were found to be obese (BMI *z* score >+2), respectively (Table 2). Gender-based differences were noted amongst 12–19-year-olds, with the prevalence of overweight (37.9% in boys *vs.* 23.7% in girls) and obesity (16.1% in boys *vs.* 4.4% in girls) being significantly higher in boys compared to girls. Similar gender-based differentials were noted in the total sample of 6–19-year-old subjects.

Based on WC as an indicator of central fatness, abdominal obesity was observed in 13.8% of 6–11-year-olds and 14.1% of 12–19-year-olds, with no significant differences between genders (Table 2). Elevated WHtR was observed in 22% and 20.9% of children and adolescents, respectively, with gender-based differences being observed amongst 12–19-year-old subjects (26.2% in boys *vs.* 15.6% in girls; *p* < 0.05). Similar gender-based differentials were noted in the prevalence of elevated WHtR in the total sample of 6–19-year-old subjects (Table 2).

As shown in Figure 1, the prevalence of overweight, obesity, elevated WHtR and elevated WC amongst boys reached the highest rates at the age of 10–13 years (47%, 23%, 32% and 18%, respectively), while declining afterwards (Figure 1). Amongst girls, the prevalence of overweight and obesity was the highest at 6–9 years (38% and 14%, respectively) and followed a consistent declining trajectory with age. The prevalence of elevated WC reached its highest in girls aged between 14 and 17 years (16%) and declined afterwards (Figure 1).


**Table 2.** Prevalence of overweight, obesity and abdominal adiposity amongst Lebanese children and adolescents (*n* = 868) by gender and by age group.

WC: Waist Circumference; WHtR: Waist to Height ratio; (1) Overweight and obesity defined based on sex and age specific +1 and +2 BMI *z*-scores, respectively [22]; (2) For subjects aged 6–15 years, abdominal obesity: WC > 90th percentile [26] or adult cut-off value if lower [25]; For subjects aged 16–19 years, abdominal obesity: WC > 94 cm for males and >80 cm for females [25]; (3) Elevated WHtR defined as WHtR > 0.5 [13]; a,b,c Within each age group, values with the same superscripts are significantly different by gender at *p* < 0.05 (Using Chi-square test).

#### *3.3. Dietary Intake*

As shown in Table 3, average energy intake (2255.85 *vs.* 1736.48 kcal/day) and percent contribution of fast food (17.27% *vs.* 11.35%) and legumes and nuts (3.28% *vs.* 2.05%) to daily energy intake were significantly higher among 12–19-year-old adolescents compared to 6–11-year-old children. On the other hand, the percent contribution of milk and dairies (8.90% *vs.* 6.47%) and breads and cereals (36.92% *vs.* 32.67%) were significantly higher in 6–11-year-old children compared to adolescents. No significant differences in macronutrient intake were observed between age groups.


**Table 3.** Energy, macronutrient and food group intake amongst Lebanese children and adolescents according to age group (*n* = 868).

a,b,c,d,e Values with the same superscripts are significantly different by age group at *p* < 0.05 (Using *t*-test).
