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Head of Institute: Prof. Ido Braslavsky

Administrative manager: Rakefet Kalev

Office Address:
Institute of Biochemistry, Food Science and Nutrition,
Robert H. Smith Faculty of Agriculture, Food and Environment,
The Hebrew University of Jerusalem, 
Herzl 229, Rehovot 7610001, ISRAEL

Tel: +972 - (0)8-9489385
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Email Address: rakefetk@savion.huji.ac.il

Publications

2021
Dor, C. ; Stark, A. H. ; Dichtiar, R. ; Keinan-Boker, L. ; Shimony, T. ; Sinai, T. Milk and dairy consumption is positively associated with height in adolescents: results from the Israeli National Youth Health and Nutrition Survey. EUROPEAN JOURNAL OF NUTRITION 2021.Abstract
Purpose Milk consumption is associated with increased height primarily in early childhood. However, in adolescents, data are scarce with inconsistent results. Since height is a proxy for overall health and well-being, this study evaluated the association of dairy intake with height in adolescents. Methods Students in 7th-12th grades, participating in the 2015-2016 Israeli Health and Nutrition Youth Survey, a school-based cross-sectional study, completed self-administered questionnaires, including a semi-quantitative food frequency questionnaire (n = 3529, 48% males, 15.2 +/- 1.6 years). Anthropometric measurements were also performed. Dairy servings were calculated as the calcium equivalent of 1 cup of milk, and consumption was divided into four categories from very low (< 1 serving/day) to high (3 + servings/day). BMI- and Height-for-age z scores (HAZs) were calculated according to WHO growth standard; relatively short stature (RSS) was defined as HAZ < - 0.7 SD (< 25th percentile). Multivariable linear and logistic regression analyses were performed to evaluate the association of dairy intake with HAZ and prevalence of RSS, respectively. Results Median consumption of dairy products was 2 servings/day, 1.4 from unsweetened products (milk, cheese and yogurt). Controlling for age, sex, BMI-z-score and socioeconomic status, each increment of unsweetened dairy intake was associated with on average 0.04 higher HAZ (equivalent to 0.3-0.4 cm, p < 0.05), and with reduced risk for RSS: OR 0.90, 95%CI: 0.84, 0.97, p < 0.01. No such associations were found with sweetened dairy products. Conclusion Consumption of unsweetened dairy products (3-4 servings/day) appears to contribute to achieving growth potential in adolescents. Intervention studies are necessary to determine the causal relationship between dairy intake and linear growth.
2020
Sinai, T. ; Bromberg, M. ; Axelrod, R. ; Shimony, T. ; Stark, A. H. ; Keinan-Boker, L. Menarche at an Earlier Age: Results from Two National Surveys of Israeli Youth, 2003 and 2016. JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY 2020, 33, 459-465.Abstract
Study Objective: To assess emergent changes in the age at menarche and investigate associated factors in Israeli adolescents in 2003 and 2016. Design: Cross-sectional study. Setting: Two national representative school-based surveys (first and second ``Mabat Youth''). Participants: Both surveys included female students in 7th-12th grades (ages 11-19 years). The first (N = 3328) was conducted between the years 2003 and 2004, and the second (N = 2535) from 2015 to 2016. Interventions: The survey questionnaire was self-administered and anthropometric measurements were performed by trained personnel. Main Outcome Measures: The current age at menarche in Israeli girls was determined and independent factors (demographic, clinical, and lifestyle) examined. Changes that occurred since the past national survey more than a decade ago were documented. Results: The estimated median age at menarche declined from 13.0 (interquartile range, 12.0-14.0) years in 2003-2004 to 12.5 (interquartile range, 12.0-13.0) years in 2015-2016 (P < .0001). Jewish girls reached menarche earlier than Arab girls, but both populations experienced a similar downward trend in the past approximately 14 years. Greater body mass index, higher socioeconomic status, and immigrant status were associated with younger menarche onset (P < .001). Age at menarche remained lower in 2015-2016 vs 2003-2004, even after adjustment for these potential confounders, with a high hazard ratio (HR), which decreased as a function of survival time (t): HRt = 15.417 x 0.813(t). Conclusion: This study confirms the decline in age at menarche in Israel. Findings were associated with body mass index and population group but also indicated that other factors are likely involved.
Adetola, O. Y. ; Onabanjo, O. O. ; Stark, A. H. The search for sustainable solutions: Producing a sweet potato based complementary food rich in vitamin A, zinc and iron for infants in developing countries. SCIENTIFIC AFRICAN 2020, 8.Abstract
Deficiencies of vitamin A, zinc and iron are prevalent among infants and young children in developing countries. This is often due to consumption of unfortified cereal-based foods. Two nutritionally balanced sweet potato-based complementary foods containing locally available products were developed to help combat micronutrient deficiencies. Composite flours from orange-fleshed sweet potato (OFSP), soybean and carrots were produced by drying, milling and blending in the ratio of 64.6:34.8:0.7 and 61.3:37.7:1.0, respectively. The formulations were evaluated for nutrient composition and compared with a commercially cereal-based product (Control) and the Codex Alimentarius Commission Guidelines for complementary foods for infants and young children. The newly formulated OFSP-based complementary foods (OFSP-CFs) had higher levels of protein and fat compared to the Control. However, the latter was higher in carbohydrates and energy. The OFSP-CFs met the stipulated values for energy (>= 400 kcal/100 g), protein (>= 15%) and fat (10 - 25%) as specified in the Codex standards. Vitamin A (2057 - 2064 mu g RAE/100 g) and zinc (8.82 - 10.38 mg/100 g) were significantly higher (p < 0.05) than levels in the Control (370 mu g RAE/100 g and 2.5 mg/100 g, respectively). OFSP-CF2 was highest in iron content (9.95 mg/100 g). The newly formulated complementary foods exceeded the minimum recommended standards (at least 50% of daily recommendation in an estimated ration of 50 g) for zinc (>100%) and iron (>70%). Furthermore, the blends contained more than 200% of the requirement for daily vitamin A intake as stipulated in the Codex unlike the Control which only met about 46%. OFSP-CFs could improve the vitamin A, zinc and iron intake of infants and young children better than the Control. They may also serve as a sustainable food-based strategy for reducing vitamin A, iron and zinc deficiency as well as protein-energy malnutrition among infants and young children in Nigeria and other developing countries. (C) 2020 The Authors. Published by Elsevier B.V. on behalf of African Institute of Mathematical Sciences / Next Einstein Initiative.
Ben-Yacov, L. ; Ainembabazi, P. ; Stark, A. H. ; Kizito, S. ; Bahendeka, S. Prevalence and sex-specific patterns of metabolic syndrome in rural Uganda. BMJ Nutrition, Prevention & Health 2020. Publisher's VersionAbstract
{Background and aims In sub-Saharan Africa, infectious diseases are still the leading causes of mortality; however, this may soon be surpassed by non-communicable illnesses, namely hypertension, diabetes and cardiovascular disease. This study determined the prevalence and patterns of metabolic syndrome and cardio-risk factors in men and women in rural Uganda.Methods A household-based, cross-sectional survey was carried out following the WHO STEP-wise approach to surveillance. It included demographic and lifestyle questionnaires, anthropometric measurements and biochemical analyses. Of the 200 randomly recruited participants, 183 successfully completed two steps of the study and 161 provided blood samples.Results Data were collected from 183 adults, aged 18–69 years; 62% were female. Based on the National Cholesterol Education Program-Adult Treatment Panel-III criteria, the prevalence of metabolic syndrome was 19.1% (95% CI 14.0 to 22.5). Elevated fasting plasma glucose was observed in 14.2% (95% CI 9.1 to 19.3) of participants, hypertriglyceridaemia in 16.9% (95% CI 12.1 to 23.1); hypertension in 36.1% (95% CI 29.0 to 43.0) and 52.5% (95% CI 45.2 to 59.6) had low HDL (high-density lipoprotein) cholesterol. Abdominal obesity was found in 24.6% (95% CI 18.8 to 31.4) of participants. Sex disparities were significant for several risk factors. Females had significantly higher prevalence of abdominal obesity (38.6% vs 1.5% in males
2019
Berkovich, B. - E. ; Stark, A. H. ; Eliakim, A. ; Nemet, D. ; Sinai, T. Rapid Weight Loss in Competitive Judo and Taekwondo Athletes: Attitudes and Practices of Coaches and Trainers. International Journal of Sport Nutrition and Exercise Metabolism 2019, 1 - 7. Publisher's VersionAbstract
Fasting, skipping meals, and dehydration are common methods of rapid weight loss used prior to competition in weight category sports. This study examines coaches? attitudes, perceptions, and practices regarding rapid weight loss among judo and taekwondo athletes. A convenience sample of experienced coaches and trainers (n?=?68) completed structured questionnaires. Participants in this study were 33.8?±?9.3 years old; 57 were males and 11 were females; and 59% were certified coaches, with 71% reporting over 20 years of involvement in sports and 68% having more than 10 years of teaching experience. The majority (90%) reported that they usually supervised athletes through the weight loss process. Interventions for weight loss began at 12.7?±?1.9 years of age, with a recommended precompetition weight loss duration of 16.2?±?8.2 days and an average reduction of 1.5?±?0.7 kg. The majority of the responders (92%) recommended that their athletes practice gradual weight loss methods using a combination of dehydration or increased physical activity (80.3%), sweat suits (50.8%), restricted fluid intake (39.3%), training in heated rooms (27%), and sauna (26.2%). Recommendations of spitting (27.8%) or using laxatives, diuretics, diet pills, or vomiting (21.3%) were also reported. Coaches and trainers often encouraged athletes to cut weight before competition. The methods recommended are potentially harmful with severe health risks, including compromised nutritional status and diminished athletic performance. This is of particular concern in young athletes who are still growing and developing physically. Enhancing knowledge and awareness for coaches, athletes, and parents regarding potential dangers, along with improved nutrition education, is critical for reducing the magnitude and misuse of rapid weight loss methods.Fasting, skipping meals, and dehydration are common methods of rapid weight loss used prior to competition in weight category sports. This study examines coaches? attitudes, perceptions, and practices regarding rapid weight loss among judo and taekwondo athletes. A convenience sample of experienced coaches and trainers (n?=?68) completed structured questionnaires. Participants in this study were 33.8?±?9.3 years old; 57 were males and 11 were females; and 59% were certified coaches, with 71% reporting over 20 years of involvement in sports and 68% having more than 10 years of teaching experience. The majority (90%) reported that they usually supervised athletes through the weight loss process. Interventions for weight loss began at 12.7?±?1.9 years of age, with a recommended precompetition weight loss duration of 16.2?±?8.2 days and an average reduction of 1.5?±?0.7 kg. The majority of the responders (92%) recommended that their athletes practice gradual weight loss methods using a combination of dehydration or increased physical activity (80.3%), sweat suits (50.8%), restricted fluid intake (39.3%), training in heated rooms (27%), and sauna (26.2%). Recommendations of spitting (27.8%) or using laxatives, diuretics, diet pills, or vomiting (21.3%) were also reported. Coaches and trainers often encouraged athletes to cut weight before competition. The methods recommended are potentially harmful with severe health risks, including compromised nutritional status and diminished athletic performance. This is of particular concern in young athletes who are still growing and developing physically. Enhancing knowledge and awareness for coaches, athletes, and parents regarding potential dangers, along with improved nutrition education, is critical for reducing the magnitude and misuse of rapid weight loss methods.
2018
Iron-Segev, S. ; Lusweti, J. N. ; Kamau-Mbuthia, E. ; Stark, A. H. Impact of Community-Based Nutrition Education on Geophagic Behavior and Dietary Knowledge and Practices among Rural Women in Nakuru Town, Kenya: A Pilot Study. Journal of Nutrition Education and Behavior 2018, 50, 408 - 414.e1. Publisher's VersionAbstract
ObjectiveGeophagia, the deliberate consumption of rocks, soil, or clay, is prevalent in developing countries, particularly sub-Saharan Africa. Health risks associated with this behavior include parasitosis, heavy metal poisoning, nutrient deficiencies, and poor birth outcomes. This pilot study was designed to reduce geophagic practices and improve nutrition among rural Kenyan women. Methods The researchers used snowball sampling to recruit participants (n = 135; aged 15–49 years) from low socioeconomic areas who consumed geophagic materials. Interviews were carried out before and after a nutrition intervention implemented by trained community health volunteers. Results Nutrition education focusing on geophagia significantly (P < .001) decreased the practice in 77% of participants. Postintervention interviews also demonstrated substantial improvement in understanding the concept of making half the plate vegetables using the healthy plate model. Conclusions and Implications Nutrition education can be useful for reducing geophagia (a largely ignored, unsafe dietary behavior) and enhancing nutritional knowledge in African women.
Hasson, R. ; Stark, A. H. ; Constantini, N. ; Polak, R. ; Verbov, G. ; Edelstein, N. ; Lachmi, M. ; Cohen, R. ; Maoz, S. ; Daoud, N. ; et al. “Practice What You Teach” Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe): Program Evaluation. The Journal of Ambulatory Care Management 2018, 41. Publisher's VersionAbstract
Healthy lifestyle programs are essential for meeting the challenge of noncommunicable diseases. The Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe) program engaged nurses from family health clinics in Jerusalem District and included physical activity, healthy nutrition, and motivational skills. Questionnaires were completed at baseline, postintervention, and at 18 months. Results showed a marked effect on health practices. The proportion of nurses consuming a balanced diet and the use of food labels significantly increased and were maintained over time. Short-term improvements in physical activity were also observed. Nurses who practiced a healthy lifestyle were significantly more likely to provide guidance and counseling to families on healthy behaviors.
2017
Rachman-Elbaum, S. ; Stark, A. H. ; Kachal, J. ; Johnson, T. W. ; Porat-Katz, B. S. A New System of Documentation to Improve Dietitian-Physician Crosstalk. Isr Med Assoc J 2017, 19, 360-364.Abstract
BACKGROUND: Standardization of the dietetic care process allows for early identification of malnutrition and metabolic disorders, interdisciplinary collaboration among the medical team, and improved quality of patient care. Globally, dietitians are adopting a nutrition care model that integrates national regulations with professional scope of practice. Currently, Israel lacks a standardized dietetic care process and documentation terminology. OBJECTIVES: To assess the utilization of a novel sectoral documentation system for nutrition care in Israel. METHODS: Seventy dietitians working in 63 geriatric facilities completed an online training program presenting the proposed patient-sectoral-model. Training was followed by submission of sample case studies from clinical practice or completion of a case simulation. Application of the proposed model was assessed by measuring the frequency participants implemented different sections of the model and responses to an approval questionnaire. RESULTS: Fifty-four participants (77%) provided completed cases. Over 80% of participants reported each step of the proposed dietary care process with 100% reporting the "nutrition diagnosis". Fifty-one dietitians (72.8%) completed the approval survey with the section on nutrition diagnosis receiving a highly favorable response (95%), indicating that the new documentation system was beneficial. Over 80% of participants rated the model useful in clinical practice. CONCLUSIONS: A sectoral approach for documenting dietetic care may be the ideal model for dietitians working in specific patient populations with the potential for improving interdisciplinary collaboration in patient care.
Rachman-Elbaum, S. ; Stark, A. H. ; Kachal, J. ; Johnson, T. ; Porat-Katz, B. S. Online training introduces a novel approach to the Dietetic Care Process documentation. Nutr Diet 2017, 74, 365-371.Abstract
AIM: Nutrition professionals in Israel are developing a system to document the Dietetic Care Process (DCP) tailored for specific patient sectors and compliant with national health guidelines. The ultimate goal is to achieve uniform documentation and improve nutrition care. Israeli dietetic practitioners work in specific patient sectors; therefore, a patient population-specific reporting system is proposed instead of the typical singular format applied across all patient populations. The purpose of this project was to evaluate learning outcomes and attitudes among registered dietitians (RDs) after online training of a novel DCP documentation system. METHODS: A total of 80 Israeli RDs working in geriatric practice completed an eight-week online educational program learning documentation that is compatible for use with electronic health records and compliant with Israeli standards of practice. A paired sample t-test and McNemar test were used to analyse pre- to post-test performance, while Pearson's r, point-biserial, Spearman's and ANOVA were used to assess relationships among variables. RESULTS: Post-test knowledge scores increased significantly, t  = -9.007, P = 0.000; 95% CI (-26.713, -17.019). Age, education, geographic location and previous experience with online courses were not correlated with academic performance, suggesting that demographic characteristics did not impact training. Overall, RDs (>80%) responded positively to the training model and were highly interested in future proficiency online learning opportunities (98%). CONCLUSIONS: A sectoral DCP online training program significantly improved knowledge and was rated favourably by Israeli RDs. DCP training for clinical practitioners may be optimised when standardised nutrition care and reporting systems are adapted to specific patient populations.
Ben-Yacov, L. ; Ainembabazi, P. ; Stark, A. H. Is it time to update body mass index standards in the elderly or embrace measurements of body composition?. European Journal of Clinical Nutrition 2017, 71, 1029 -. Publisher's Version
2016
Berkovich, B. - E. ; Eliakim, A. ; Nemet, D. ; Stark, A. H. ; Sinai, T. Rapid Weight Loss Among Adolescents Participating In Competitive Judo. 2016, 26, 276 - 284. Publisher's Version
Rachman-Elbaum, S. ; Porat-Katz, B. S. ; Kachal, J. ; Stark, A. H. Documentation of the dietetic care process: developing a sectoral, tailored system. 2016, 70, 753 - 755. Publisher's VersionAbstract
Use of electronic health records necessitates a systematic approach for documentation of the Dietetic Care Process (DCP). However, no standardized system exists in Israel. The authors propose a novel documentation system developed by an expert advisory committee and tailored to a specific patient population. In this pilot study, 12 experienced Israeli Registered Dietitians (RDs) (median years of practice=23.0; s.d.=8.8; practice in geriatric populations median=13.0; s.d.=8.5) were recruited to evaluate the new tool for DCP documentation. Participants completed an explanatory short course online and evaluated the utility of the tool. There was full agreement that the proposed tool is necessary and an effective method for documenting the DCP within geriatric populations in clinical practice. In conclusion, a novel, tailored and sectoral tool designed for standardized documentation of dietetic care was recommended for implementation by an experienced group of RDs with substantive clinical experience in geriatric populations.
Stark, A. H. ; Reifen, R. ; Crawford, M. A. Past and Present Insights on Alpha-linolenic Acid and the Omega-3 Fatty Acid Family. Critical Reviews in Food Science and NutritionCritical Reviews in Food Science and Nutrition 2016, 56, 2261 - 2267. Publisher's Version