Greater Beirut Area Research Articles

Determinants of human papillomavirus vaccine hesitancy among Lebanese parents

Introduction Human papillomavirus (HPV) is the most common sexually transmitted infection. HPV is responsible for cancer of cervix uteri. Despite its safety and immunogenicity, HPV vaccine hesitancy is one of the most challenging topics that pediatricians face. Methods We aimed to describe the impact of knowledge, attitude, and practice towards vaccines in general, on practice related to HPV vaccination in Lebanon. A questionnaire addressed to parents of students (3–18 years of age) was distributed in 2 public and 2 private schools randomly selected from the greater Beirut area during the school year 2017–2018. Questionnaires covered knowledge, attitude, and practices of vaccination in general and HPV vaccine in particular. Results Out of 400 distributed questionnaires, 306 (76.5%) were returned. Of the 185 parents aware of HPV vaccine, 60% hadn’t given or were not planning to give the HPV vaccine to their children. Of parents not in favor of HPV vaccine, 7.5 thought that vaccines aren’t necessary versus none among those in favor of HPV vaccine(p = 0.02). Thirteen percent of those not in favor of HPV vaccine thought that vaccines are not safe versus 2.7% in the group in favor (p = 0.02). An effect of gender on vaccine acceptance was noted: mothers vs fathers and daughters vs sons. Lack of recommendation by pediatricians and the thought that too little is known about the vaccine were the most selected reasons for parents not wanting to vaccinate their children against HPV, whereas cost and religious and cultural beliefs seemed to have no impact. Conclusion Most parents in our study did not vaccinate or weren’t willing to vaccinate their children against HPV even when they were in favor of vaccines in general. Physician recommendation was shown to be one of the most important predictors of vaccination. Effort should be put into educating parents about the importance of the vaccine and its well-established safety and efficacy regardless of gender. Lebanese physicians should also be educated and empowered to recommend HPV vaccine more strongly and consistently.

Selection of a Suitable Waste to Energy Technology for Greater Beirut Area Using the Analytic Hierarchy Process

Waste to Energy (WtE) is becoming an interesting option for many countries as an effective waste management solution. The goal of this study is the selection of a suitable WtE technology for the treatment of municipal solid waste in Greater Beirut Area (GBA). In adopting a potential WtE technology for solid waste treatment in GBA, the protection of the environment and citizens health is mandatory, but it is also evident the pressing need for economically feasible new electrical energy sources. For a well and an efficient functioning of a WtE plant, an appropriate supply chain system of municipal solid waste should be guaranteed. The selection of a suitable WtE technology is a complex decision and to achieve the stated objective the Analytic Hierarchy Process (AHP) method was employed and experts in the waste management sector were consulted to formulate the model. AHP analysis was performed using SpiceLogic software. Results indicate that Composting is the best choice with a global score of 0.33, followed by Anaerobic Digestion which acquired 0.21 and Incineration ranked as the third preferred technology obtaining 0.14. A sensitivity analysis was conducted to ensure the results consistency, assessing the reliability of the experts’ judgments.

Impact of selection process on employees’ performance: A case of Lebanese small and medium enterprises

The main objective of this paper is to explore if the selection process has an impact on employees’ performance inside Lebanese small and medium-sized enterprises (SMEs). The research was conducted in SMEs located in the Greater Beirut area in which the empirical study consists of a quantitative method. The results have shown that the selection process has a full impact on employees’ performance and retention inside Lebanese SMEs. This study contributes to mitigating selection errors among SMEs that forms the backbone of the Lebanese economy and hence reducing their turnover expenses, and increasing their longevity. This paper concludes that SMEs shall consider seriously the selection process in hiring.

Impact of land cover change on land surface temperature over Greater Beirut Area – Lebanon

Remote sensing (RS) technology has been used together with geographic information systems (GIS) to determine the LC types, retrieve LST, and analyze their relationships. The term Greater Beirut Area (GBA) is used to refer to the city of Beirut and its suburbs, which witnessed rapid urban growth after the end of the civil war in the last decade of the twentieth century, due to the increase in the number of its inhabitants, and the prosperity and development of sectors such as; industrial, trade, tourism, and construction. These factors led to a wide change in land cover (LC) types and increased land surface temperature (LST). The results showed an increase in built-up areas by 29.1% and agricultural lands by 6%, while bare land, forests, and seawater decreased by 28.5%, 4.9%, and 1.9%, respectively. These changes caused large differences in the LST between built-up areas and other LC types. The highest LST recorded was in built-up areas (33.03°C in 1985, and 34.01°C in 2020), followed by bare lands (32.61 °C in 1985 and 33.49°C in 2020), cropland (31.23°C in 1985 and 32.17°C in 2020), forest (30.08°C in 1985 and 30.47°C in 2020), and water (24.97°C in 1985 and 28.15°C in 2020). Consequently, converting different LC types into built-up areas led to increases in LST and a changed microclimate.

Road traffic air pollution in the Greater Beirut Area (GBA), Lebanon – impact on public health: urgent need for public transport development, especially rail

Road traffic air pollution in the Greater Beirut Area (GBA), Lebanon – impact on public health: urgent need for public transport development, especially rail

Predictors of psychosocial adjustment in Syrian refugee children attending Lebanese public schools

To recognize the role schools play in the acclimatization of refugee children to their new life in the host country, we sought to investigate the psychosocial adjustment of Syrian refugee students enrolled in Lebanese public schools. Psychosocial adjustment involves both the emotional and behavioral wellbeing of children and is measured using the Strength and Difficulties Questionnaire (SDQ). Psychosocial adjustment is also consistently linked to school belonging which, in turn, can be assessed using the Psychological Sense of School Membership (PSSM) scale. The aim of this study is to identify associations between psychosocial adjustment, determined by the SDQ and PSSM scale, and both (1) sociodemographics (age, gender, parental level of education and length of stay in the host country) and (2) classroom environment in Lebanese public schools in the greater Beirut area. A total of 410 Syrian refugee students (222 females) with a mean age of 11.4 years, who arrived in Lebanon between the years 2011 and 2017, were included in the study. The results showed a very weak correlation between older age and psychosocial maladjustment measured using the SDQ (r = .10, p = .04). Additionally, girls had a better psychosocial adjustment than boys (mean PSSM-scale score: 70.7 ± 10.1 Vs. 67.4 ± 11.8, p = .0014). On multivariate linear regression, there was a strong positive correlation between the classroom environment and psychosocial adjustment (p < .001). Policies addressing the emotional needs of Syrian refugee children in Lebanese public schools and promoting their psychosocial adjustment are needed.

Assessing the intra-urban variability of nitrogen oxides and ozone across a highly heterogeneous urban area.

High-resolution air quality maps are critical towards assessing and understanding exposures to elevated air pollution in dense urban areas. However, these surfaces are rarely available in low- and middle-income countries that suffer from some of the highest air pollution levels worldwide. In this study, we make use of land use regressions (LURs) to generate annual and seasonal, high-resolution nitrogen dioxide (NO2), nitrogen oxides (NOx), and ozone (O3) exposure surfaces for the Greater Beirut Area (GBA) in Lebanon. NO2, NOx and O3 concentrations were monitored using passive samplers that were deployed at 55 pre-defined monitoring locations. The average annual concentrations of NO2, NOx, and O3 across the GBA were 36.0, 89.7, and 26.9ppb, respectively. Overall, the performance of the generated models was appropriate, with low biases, high model robustness, and acceptable R2 values that ranged between 0.66 and 0.73 for NO2, 0.56 and 0.60 for NOx, and 0.54 and 0.65 for O3. Traffic-related emissions as well as the operation of a fossil-fuel power plant were found to be the main contributors to the measured NO2 and NOx levels in the GBA, whereas they acted as sinks for O3 concentrations. No seasonally significant differences were found for the NO2 and NOx pollution surfaces; as their seasonal and annual models were largely similar (Pearson's r > 0.85 for both pollutants). On the other hand, seasonal O3 pollution surfaces were significantly different. The model results showed that around 99% of the population of the GBA were exposed to NO2 levels that exceeded the World Health Organization defined annual standard.

Vitamin D Deficiency in Lebanese Adults: Prevalence and Predictors from a Cross-Sectional Community-Based Study

Methods A random sample of Lebanese adults residing in the Greater Beirut area was selected based on area probability and multistage cluster sampling. Data from 446 participants (68% females) with mean age 45.3 ± 15 years were used for the analyses. Participants were recruited between March and May. Serum 25-hydroxyvitamin D levels were measured using electrochemiluminescent immunoassay. Results Vitamin D deficiency was highly prevalent whether using the cutoff of 50 nmol/L or using the more conservative cutoff of 30 nmol/L; more specifically, 71.9% and 39.1% of the study population were deficient using the above cutoffs, respectively In the bivariate analyses, gender, BMI and body fat mass, socioeconomic factors (income and education level), alcohol consumption, dietary intake of fat and of vitamin D, serum LDL-cholesterol, and serum creatinine were all associated with vitamin D status. After adjustment for multiple covariates, age, income, alcohol consumption, and serum creatinine were independent predictors of vitamin D deficiency. Conclusion Vitamin D deficiency is highly prevalent in Lebanon. Preventive measures should target the modifiable risk factors.

Impact of land cover change on land surface temperature over Greater Beirut Area – Lebanon

Remote sensing (RS) technology has been used together with geographic information systems (GIS) to determine the LC types, retrieve LST, and analyze their relationships. The term Greater Beirut Area (GBA) is used to refer to the city of Beirut and its suburbs which witnessed rapid urban growth, after the end of the civil war, in the last decade of the twentieth century, due to the increase in the number of its inhabitants, and the prosperity and development of sectors such as; industrial, trade, tourism, and construction. These factors led to a wide change in the land cover (LC) types and increased land surface temperature LST. The results showed an increase in built-up areas by 29.1%, and agricultural lands by 6%, while bare land, forests, and seawater decreased by 28.5%, 4.9%, and 1.9%, respectively. These changes caused large differences in the LST between built-up areas and other LC types. The highest LST recorded was in built-up areas (33.03°C in 1985, and 34.01°C in 2020), followed by bare lands (32.61 °C in 1985 and 33.49°C in 2020), cropland (31.23°C in 1985 and 32.17°C in 2020), forest (30.08°C in 1985 and 30.47°C in 2020), and water (24.97°C in 1985 and 28.15°C in 2020). Consequently, converting different LC types into built-up areas led to increases in LST and changed microclimate.

Consumer preferences for hybrid and electric vehicles and deployment of the charging infrastructure: A case study of Lebanon

This case study investigates consumer preferences and stakeholders’ interests regarding hybrid electric vehicles (HEVs) and electric vehicles (EVs) in the Greater Beirut Area (GBA) in Lebanon where the market for these vehicle types is still nascent. A mixed logit model incorporating financial and technical attributes of common mid-size Internal Combustion Engines (ICE), HEVs, and EVs is estimated then used to compute Willingness to Pay (WTP) measures and evaluate the effectiveness of different monetary incentives in promoting these vehicle types. The study also uses qualitative research methods to capture the perspectives of different stakeholders regarding electric mobility in Lebanon. Data collected in 2018 through a stated preference survey reveals a WTP for a 100-km increase in driving range equal to 705 $ and for a 1 $ reduction in driving costs per 100 km equal to 305 $, values that are generally lower than several values found in the literature. A policy testing exercise suggests that doubling fuel taxes could increase the potential market shares of HEVs and EVs from 9.25% to 9.59% and from 4.98% to 5.84%, respectively. The provision of charging incentives to consumers could raise the market share of EVs up to 6.96%. A combination of both policies could further increase the proportion of EVs to 7.22%. In parallel, a stakeholder analysis draws attention to a multitude of challenges regarding the HEVs and EVs uptake as well as the public charging infrastructure rollout, namely excessive delays in establishing the enabling institutional and regulatory environment and shortcomings in the electricity supply. This research shows that it is more likely for HEVs than EVs to take off in the short term and that a solid transition to electric mobility in Lebanon necessitates further planning, especially in terms of instituting a clear and effective incentives scheme.

Patients' knowledge and awareness about patient support programs: a cross-sectional study on Lebanese adults with chronic diseases.

Patient Support Programs (PSPs) have become a trend among pharmaceutical companies and a standard service offering to patients. The objective of the present study is to describe the status of PSPs in Lebanon and to assess the extent of knowledge and awareness among Lebanese patients about the PSPs. A cross-sectional study was conducted between April and July 2017. A convenient sample of patients was randomly selected from outpatient clinics at four hospitals within the Greater Beirut Area. A questionnaire was used to address the study objective. Bivariate analysis was performed using the Chi-square test. Data were analyzed by using SPSS version 23. Out of 385 patients who participated in the study, 45.45 percent were aged between 46 and 66 years. None of them indicated that they were enrolled in a PSP, and only 13 percent of the respondents were aware of the existence of such a program. In terms of adherence habits, 55.6 percent of the patients self-reported that they do not skip any dose of their medication and consume their medication as prescribed by their healthcare providers. The main reason for nonadherence reported by the majority of nonadherent participants 144 (84.2%) was simple forgetfulness. There is a severe lack of awareness of PSPs in Lebanon. Given the important role that PSPs play in creating value for patients-in terms of healthcare follow-up practices, improved adherence habits, and cost savings-there should be a more substantial effort by pharmaceutical companies to expand and promote their PSPs in the Lebanese market.

Drivers of seasonal and annual air pollution exposure in a complex urban environment with multiple source contributions

Outdoor air pollution is a global health concern, but detailed exposure information is still limited for many parts of the world. In this study, high-resolution exposure surfaces were generated for annual and seasonal fine particulate matter (PM2.5), coarse particulate matter (PM10), and carbon monoxide (CO) for the Greater Beirut Area (GBA), Lebanon, an urban zone with a complex topography and multiple source contributions. Land use regression models (LUR) were calibrated and validated with monthly data collected from 58 locations between March 2017 and March 2018. The annual mean (±1 SD) concentrations of PM2.5, PM10, and CO across the monitoring locations were 68.1 (±15.7) μg/m3, 83.5 (±19.5) μg/m3, and 2.48 (±1.12) ppm, respectively. The coefficients of determination for LUR models ranged from 56 to 67% for PM2.5, 44 to 63% for the PM10 models, and 50 to 60% for the CO. LUR model structures varied significantly by season for both PM2.5 and PM10 but not for CO. Traffic emissions were consistently the main source of CO emissions throughout the year. The relative importance of industrial emissions and power generation sources towards predicted PM levels increased during the hot season while the contribution of the international airport diminished. Moreover, the complex topography of the study area along with the seasonal changes in the predominant wind directions affected the spatial predicted concentrations of all three pollutants. Overall, the predicted exposure surfaces were able to conserve the inter-pollution correlations determined from the field monitoring campaign, with the exception of the cold season. Our pollution surfaces suggest that the entire population of Beirut is regularly exposed to concentrations exceeding the World Health Organization (WHO) air quality standards for both PM2.5 and PM10.

Earnings and gender wage gap in Lebanon: the role of the human and social capital

ABSTRACT This paper investigates the earning function and the gender wage gap in Lebanon using human and social capital covariates. The study uses a randomly collected sample from the Lebanese working population in the greater Beirut area applying the counterfactual decomposition and the generalized quantile regressions. Most of the results support previous research which concludes that the human and social capital indicators have a significant impact on earnings and that the wage gap is mainly due to structural effect. Moreover, the results show evidence of quicksand and glass ceiling effects that limit female income.

Metabolically Healthy Overweight and Obesity Is Associated with a Healthy Lifestyle Pattern in Lebanese Adults Hwalla N, Naja F, Itani L, Nasrallah M, Tamim H, Nasreddine L (P04-177-19)

ObjectivesThe study aims to identify lifestyle patterns in a sample of Lebanese adults and examine the association of these patterns with Metabolically Healthy Overweight and Obesity (MHOv/O). MethodsThis study is based on a cross-sectional survey of Lebanese adults living in Greater Beirut area (n = 305), and which was conducted in 2014. Dietary intake assessment was performed using an 80-item semi-quantitative food frequency questionnaire. The identification of MHOv/O was based on the ATP-III criteria. Principal Component Factor Analysis was implemented to derive lifestyle patterns, including variables related to dietary intake, eating at home, alcohol consumption, drinking water, sleeping difficulties, smoking and physical activity. ResultsTwo lifestyle patterns were identified in the study population: the “Unhealthy” pattern which was characterized by cigarette smoking, fast food, soft drinks and alcohol consumption. Eating at home loaded negatively on this pattern. The “Healthy” lifestyle pattern was characterized by positive loadings of food groups such as milk and dairy products, fruits and vegetables. Sleeping difficulties loaded negatively on this pattern, while physical activity had a positive loading. Multiple logistic regression analyses was performed. The results showed that subjects belonging to the 4th quartile of the “Healthy” pattern scores had higher odds of MHOv/O as compared to those in the 1st quartile (OR: 4.04, CI:1.26–13.01). ConclusionsThe findings of this study provided evidence on the combined effect of lifestyle factors in relation to cardiometabolic abnormalities that are complex and multifactorial in nature. The results highlighted the importance of focusing on ‘holistic’ lifestyle patterns modifications in designing and implementing culturally sensitive interventions in overweight and obese subjects. Funding SourcesLebanese National Council for Scientific Research; University Research Board at the American University of Beirut); Medical Practice Plan at the American University of Beirut.

Analysis and interpret road traffic congestion costs in Lebanon

The cost of environmental degradation in Lebanon was estimated to be close to $485 million per year, or 2.9 percent of the Gross Domestic Product (GDP). The large negative impacts of this degradation are the pollution occurring in urban area and is mainly caused by air pollution and with an average estimate of $145 million per year and around 0.87 percent of the GDP. This high air pollution is mostly linked to the transportation sector in Lebanon. Lebanon suffers from a daily increase in road network usage, which has resulted in gridlocks, especially in the greater Beirut area. By all means, the continued lack of policies and a political will to encourage the adoption of an efficient and reliable public transportation and to discourage the ownership of private vehicles have resulted in traffic growth that is faster than the road capacity. By all means, congestion is not a passing problem; it will continue to grow in the absence of measures to reduce traffic by adopting other modes of transportation, such as buses, trains, Trams, bicycles and others etc. This study describes the various factors that affect the costs associated with congestion, and provides well-defined methods for evaluating the corresponding costs.

Prevalence, Awareness, and Control of Hypertension in Greater Beirut Area, Lebanon.

Background Hypertension (HTN) has been identified as the leading risk factor for mortality and the third cause of disability worldwide. Lebanon has witnessed a threefold increase in the prevalence of HTN in the past decade. The timely exploration and detection of the factors contributing to a higher prevalence of the disease among the Lebanese population is fundamental. The objectives of this study were to assess the prevalence, awareness, and control rates of HTN in Greater Beirut Area in Lebanon and to identify their respective predictors. Methods A representative sample of 501 participants aged 18-79 years residing in Greater Beirut Area was examined. Data collection form was filled up, through interviews, physical exams, and lab tests. The analysis was done for three defined outcomes: blood pressure status (normotensive, prehypertension, and hypertension), unaware HTN, and uncontrolled HTN. These were compared for the various associated predictors. Results The sample consisted of 64.3% women and mean age 45.4 ± 15 years and the subjects were predominantly from low educational income levels. The results showed that 36.4% of the study participants were hypertensive, 25.3% were prehypertensive, and 38.2% had optimal blood pressure, while the awareness rate was 65.4% and control rate was 61%. The independent predictors of HTN were age, gender, marital status, T2D, body fat, triglyceride (positive correlates), and income level (negative correlate). Moreover, unawareness of HTN was common among older age, men, single participants, and the obese. We could not identify any factor related to uncontrolled HTN. Conclusion The trend in the prevalence of HTN in Greater Beirut Area is found to be consistent and relatively high, yet there was an observed improvement in the awareness and control of the disease. Public health measures on a national level are urgently needed to curb the increasing prevalence of HTN, achieve primary prevention, and better control the disease.

Worsening of the Cardiovascular Profile in a Developing Country: The Greater Beirut Area Cardiovascular Cohort.

Lebanon has no established governmental noncommunicable diseases surveillance and monitoring system to permit reporting on noncommunicable diseases rates. The last World Health Organization-supported surveillance report showed worrying trends in cardiovascular disease (CVD) risk factors. A cardiovascular cohort was established to permit CVD outcomes studies in an urban sample in the Lebanese capital and the study in hand presents the baseline CVD risk factors of this cohort. A cross-sectional study was carried out including 501 Lebanese adults (64.3% women) from the Greater Beirut area using random multistage probability sampling. Interviews, physical exams, and blood withdrawal were conducted to collect information on demographic and lifestyle factors, body mass index, blood pressure, fasting blood glucose, blood lipids, as well as history of coronary artery diseases, hypertension, diabetes mellitus type 2, dyslipidemia, and stroke. Means with SD for continuous variables and frequencies and percentages for categorical variables are reported. The prevalence CVD risk factors including obesity, smoking, diabetes mellitus type 2, hypertension, and dyslipidemia prevalence in the Greater Beirut area was higher than that reported for the general population. Important sex and age differences were also observed, whereby older participants and women had higher rates of obesity, diabetes mellitus type 2, and dyslipidemia and younger participants and men were engaged more in cigarette smoking and alcohol consumption. Interestingly, water pipe smoking was similarly prevalent among genders. The overall prevalence of CVD risk factors in this urban population is higher than reported in the 2010 World Health Organization Stepwise Approach to Surveillance report on the Lebanese population, indicating that the urban population in the capital carries a higher burden of CVD risk. In addition, sex and age difference rates of CVD risk factors highlight the need for tailored public health measures to tackle the sex- and age-based CVD risk factors.

Association of Autism with Maternal Infections, Perinatal and Other Risk Factors: A Case-Control Study.

This case-control study explores the association between pregnancy/birth complications and other factors with Autism Spectrum Disorder (ASD) in Lebanese subjects aged 2-18years. Researchers interviewed 136 ASD cases from the American University of Beirut Medical Center Special Kids Clinic, and 178 controls selected by systematic digit dialing in the Greater-Beirut area. Male gender (Adjusted Odds Ratio [95% CI]: 3.9 [2.2-7.0]); postpartum feeding difficulties (2.5 [1.2-5.4]); maternal infections/complications during pregnancy (2.9 [1.5-5.5], 2.1 [1.1-3.9]); consanguinity (2.5 [1.0-6.0]); family history of psychiatric disorders (2.2 [1.1-4.4]) were risk factors for ASD. Being born first/second (0.52 [0.28-0.95]) and maternal psychological support during pregnancy (0.49 [0.27-0.89]) were negatively associated with ASD. Identifying ASD correlates is crucial for instigating timely screening and subsequent early intervention.

Composite Sustainable Indicators Framework for Cost Assessment of Land Transport Mode in Lebanon Cities

The aim of the work performed in this paper is to present a composite indicators framework to guide sustainable transportation planning in Lebanon by assessing the sustainability marginal cost of Land Transport modes used mostly based on ICE (internal combustion engine) auto dependence. The framework covers 6 indicators of the triple bottom line of sustainability (economy, society, and environment): operating cost, energy consumption, noise exposure, congestion delay, emissions, and safety. The framework process follows an evaluation toolkit that monitors the cost implied from listed individual indicators of transport mode. Moreover, this evaluation methodology can be used to estimate to an acceptable degree the cost variation resulting from transport mode modifications within same geographical zone. This cost variance is the main interest of investors and decision makers seeking profits and successful results of their transportation planning process. A case study is executed in Lebanon GBA (Greater Beirut Area), where the annual cost of an alternative consisting of light rail transit (LRT) to passenger cars (PC) system is assessed; applying the stated methodology. Results show clearly an environmental amelioration with a reduction of 4,651,817,100 MJ of energy and 181,936 ton of CO2 emissions in addition to a saving of 255,643,035$ annually.

A minimally processed dietary pattern is associated with lower odds of metabolic syndrome among Lebanese adults.

To (i) estimate the consumption of minimally processed, processed and ultra-processed foods in a sample of Lebanese adults; (ii) explore patterns of intakes of these food groups; and (iii) investigate the association of the derived patterns with cardiometabolic risk. Cross-sectional survey. Data collection included dietary assessment using an FFQ and biochemical, anthropometric and blood pressure measurements. Food items were categorized into twenty-five groups based on the NOVA food classification. The contribution of each food group to total energy intake (TEI) was estimated. Patterns of intakes of these food groups were examined using exploratory factor analysis. Multivariate logistic regression analysis was used to evaluate the associations of derived patterns with cardiometabolic risk factors. Greater Beirut area, Lebanon. Adults ≥18 years (n 302) with no prior history of chronic diseases. Of TEI, 36·53 and 27·10 % were contributed by ultra-processed and minimally processed foods, respectively. Two dietary patterns were identified: the 'ultra-processed' and the 'minimally processed/processed'. The 'ultra-processed' consisted mainly of fast foods, snacks, meat, nuts, sweets and liquor, while the 'minimally processed/processed' consisted mostly of fruits, vegetables, legumes, breads, cheeses, sugar and fats. Participants in the highest quartile of the 'minimally processed/processed' pattern had significantly lower odds for metabolic syndrome (OR=0·18, 95 % CI 0·04, 0·77), hyperglycaemia (OR=0·25, 95 % CI 0·07, 0·98) and low HDL cholesterol (OR=0·17, 95 % CI 0·05, 0·60). The study findings may be used for the development of evidence-based interventions aimed at encouraging the consumption of minimally processed foods.