BackgroundThe ongoing Hamas-Israel war has put the civilian population in Gaza at risk of severe food and nutrition insecurity. Our goal was to provide objective, verifiable data to ascertain amounts and nutritional content of food supplied to Gaza through Israeli border crossings from January to July 2024. We aimed to assess their compliance with Sphere international humanitarian standards for food security and nutrition maintenance in crisis affected populations.MethodsWe obtained the registry of all food supplied to Gaza via air drops and land crossings from Israel's Coordinator of Government Activities in the Territories (COGAT) from January to July 2024. This registry itemizes daily food shipments, their items and estimated weights. Food items in shipments were categorized, quantified, assessed and summed for energy (kcal), protein (g), fat (g), iron (mg) content, based on food labels and composition tables. We then calculated supply per capita per day supplied to the the Gaza Strip, according to the most recent population census of Gaza. Finally, we compared it to the Sphere standards for population food security.ResultsAdjusting for projected food losses, a net total of 478,229 metric tons of food was supplied to Gaza over the seven consecutively studied months. The average amount of energy available per person per day was 3,004 kcal, with 98 g of protein (13% of energy), 61 g of fat (18% of energy), and 23 mg of iron. Except for February, when entries dropped from January, there was a steady increase in the tonnage, energy, macronutrients and iron content of donated foods supplied to Gaza registered by COGAT. The amounts of energy, protein, and fat, but not dietary iron, in food crossing the border into Gaza consistently exceeded Sphere standards after making conservative adjustment for high food loss and the age distribution of the Gazan population.ConclusionsThis study assessed food deliveries by type, amount and nutrient composition, supplied to Gaza from January to July 2024. We found that, except in February, food crossing the borders into Gaza exceeded per capita minimal requirements for humanitarian aid. While reliable data do not exist for critical dimensions of food access and consumption across Gaza, these estimates suggest that adequate amounts of nutritious food were being transported into the Gaza Strip during most of the 1st half of 2024. We propose that with increased cooperation of all partners and shared efforts to overcome barriers, communication and data sharing, the UN Food Security Cluster, COGAT and humanitarian assistance agencies can develop a comprehensive, continually updated database to gauge food availability, access, nutritional value, and gaps to address, especially in the areas most disrupted by conflict in Gaza. This will also help ensure that food donations supplied to Gaza reach populations in greatest need.

Dietary guidelines for families with children are designed to meet the Dietary Recommended Intake. However, the cost of a healthy diet and the extent to which families can afford it in Israel is unclear. The age distribution and the number of children per household by income quintile and geographic area in Israel in 2018 were obtained from the Central Bureau of Statistics. Food cost information was purchased from the commercial company Stornext. The cost of the recommended food items in the healthy diet for adults and children (by age group) was calculated using standard food portions and meal frequency and expressed as a percentage of the households net income. The proportion of households for which food expenditures exceeded 15

There are differences in the rates of short stature (WHO height-z score < -2SD) between the various sectors in Israeli children aged 6-7 years, with higher rates in the ultraorthodox Jewish population. We aimed to: (a) Compare the anthropometric data at 0-2 years of age and the obstetric and demographic data of children with short stature at 6-7 years of age with those of children with normal height. (b) Assess risk factors for short stature at the age of 6-7 years. (c) Evaluate the impact of clinical and socioeconomic factors on linear growth from birth to the age of 6-7 years. This was a retrospective cohort study. Anonymized anthropometric data measured at the first grade of school during 2015-2019 were collected from the Ministry of Health records. The participants were stratified into sectors according to the affiliation of their school. Retrospective growth and sociodemographic data were extracted for each child from the national birth registry and Maternal Child Health Clinics files. The cohort included 368,088 children, with a median age of 6.7 years (IQR 6.3,7.0). Short stature was more prevalent in ultraorthodox Jewish boys (3.8%) and girls (3.2%), and least prevalent in Arab boys (0.8%) and girls (0.7%) compared with all other sectors (P < 0.001). The rate of stunting in Bedouin children was similar to that in the general population (1.6%). In a logistic regression model, the variables that predicted short stature at the age of 6-7 years were female sex, longer gestation, lower height z-score at 2 months of age, birth weight < 90th percentile, being in the ultraorthodox Jewish sector, and a smaller change in height z-score until 2 years of age. Growth gaps between different sectors of school-aged Israeli children emerge during the first 2 years of life. The most vulnerable population for stunting is the ultraorthodox population. Public health services, including Maternal Child Health clinics and primary caregivers, should prioritize this group and closely monitor for growth faltering during the first and second years of life.

Background The continuing Gaza-Israel war puts the civilian population in Gaza at risk of food and nutrition insecurity. We aimed to assess the nutritional content of the humanitarian food aid supplied to Gaza. We assembled and analyzed data on the quantity of food aid delivered to the Gaza Strip, and analyzed its compliance with population needs, as established by Sphere international humanitarian guidelines. Methods We obtained the registry of all food aid delivered to Gaza via air drops and land crossings between January - April 2024 from Israel’s Coordinator of Government Activities in the Territories (COGAT). For every truck or airdrop of food, we categorized, quantified, and assessed the nutrient composition of individual food items. We then summed the energy, protein, fat, and iron content of all shipments, and calculated supply per capita per day, according to the size of Gaza’s population. Finally, we compared the findings to the Sphere standards for food security and nutrition in conflict-affected populations. Results Between January and April 2024, 14,916 trucks conveying 227,854 tons, and 95 airdrops weighing 3,694 tons of food entered Gaza. On average, 3,729 food trucks per month entered Gaza, with a continuous increase of 431 trucks per month since January. Between January and April, the overall weight of food shipments increased by 57%. Food group diversity increased. The crude mean per capita per day energy supplied was 3,374 kcal, protein was 101 gr (12.1% of energy), fat was 80.6 gr (21.5% of energy), and iron was 25.2 mg. Energy, protein, and fat amounts exceed Sphere recommendations. Although the amount of iron supplied improved over time, it remained lower than the Sphere standard. Conclusions Of the four pillars of food security - availability, access, utilization, and stability - this study focuses on the availability pillar. The quantity and quality of food aid delivered to Gaza have steadily improved since January 2024 and supply sufficient energy, protein, and fat for the population’s needs. In addition to monitoring the quality and quantity of food available to Gaza, reliable data on food distribution and population access will be necessary for securing the civilian population’s nutrition.

Abstract Background The COVID-19 pandemic caused massive disruptions globally, with food insecurity a primary concern amongst vulnerable communities. As one of the most marginalized and vulnerable groups in Israeli society asylum seekers and undocumented populations were amongst the first to be affected by the pandemic and the economic crisis that followed. The objective of the study was to evaluate the severity and causes of food insecurity among asylum seekers and other undocumented communities because of COVID-19. Methods A multi method approach was used. The quantitative component included an online questionnaire regarding access to food, aid and choices, and the 6 item Household Food Security Survey Module (HFSSM) The qualitative component included 4 focus groups and thematic analysis. The study was conducted in November 2020, by the Ministry of Health's Nutrition Division and the Tel Aviv Municipality's foreign community assistance and information center (Mesila). The convenience sample was drawn from the low-income neighborhood population of South Tel Aviv. Logistic regression, multivariate analysis and content analysis, were performed. Results Four hundred eighty-five people completed the quantitative survey, with average age 33.2 ± 5.4 years and 349 (72.0%) experienced food insecurity. In the multivariate analysis, being older (p = 0.04, Odds Ratio OR 1.1, Confidence Interval CI 1.05–1.15) and being single (unmarried) (p = 0.03, OR 2.1, CI 1.2, 3.5) predicted food insecurity. Qualitative findings identified three main themes: children preferring Israeli/ Western foods to traditional foods; financial stresses were compounded; a preference for receiving assistance with purchasing food (vouchers), rather than food handouts. Conclusion In conclusion, vulnerable populations (asylum seekers and other undocumented communities) were severely affected and are in danger of food insecurity. Culturally relevant and contextualized solutions are needed to address the acute hunger within the community. These include establishment of a cross-ministerial forum, a social grocery store, increased liaison with food rescue bodies, complete nutritional support for children in educational settings and increased guidance regarding food choices and budgeting.

High salt intake is a well-known risk factor for cardiovascular disease (CVD). Some recent prospective studies have challenged the salt-CVD link. We conducted a narrative review based on a systematic search and provided a national policy update. We reviewed 14 observational prospective studies in healthy adults, reporting the association between sodium intake and excretion or reduction and CVD incidence. Validated by cohort studies, recommended sodium consumption levels (< 1.5–2 gram per day) are still relevant for the prevention of CVD in adults. We discussed the findings and policy initiatives implemented in Israel. Such initiatives included voluntary and mandatory food labeling, and culturally tailored educational programs. The Ministry of Health in Israel initiated a salt reduction policy in recent years—aimed for the future of the industry as well as the population.

Background: The anthroposophical philosophy is a holistic educational and lifestyle approach. Limited information exists on the health-promoting behavioral norms and obesity rates among children living anthroposophical vs. conventional lifestyles. Aims: This study aims to compare the prevalence of childhood obesity, and parents’ perceptions of their children’s food environment, between anthroposophical and conventional education systems. Methods: We performed a cross-sectional analysis of the National Anthropometric Measurement Survey for first grade students in Israel, comparing anthroposophical schools with matched conventional schools. Additionally, an online survey was distributed among parents of children in both school systems, assessing children’s eating norms and dietary intake. Results: Overweight and obesity rates were higher among students in conventional schools (n = 205,500) compared to anthroposophical schools (n = 2247) (11.2% vs. 9.6%, and 7.8% vs. 4.8%, respectively; Pv < 0.001). Anthroposophical schools were perceived by more parents to have health-promoting curricula, health promoting teacher behavior, and health promoting social dietary norms, while their children’s dietary intake was perceived as healthier both in school and in the after-school, social, and familial environment (Pv < 0.001). Conclusions: Children in anthroposophical education exhibited lower overweight and obesity rates, and engaged in more health-promoting behaviors. Further research is needed to explore the relationship between the anthroposophical lifestyle and childhood obesity, and to identify effective anthroposophical strategies for health promotion among children.

AbstractObjectives:To assess the attitudes and perceived knowledge of health professionals regarding the food product judgemental-labelling reform that began in January 2020 in Israel.Design:Cross-sectional survey.Settings:An online survey among health professionals working in the Israeli health system.Participants:456 participants (118 physicians, 207 nurses, 131 nutritionists).Results:Most respondents (89·9 %) were women, 36 % had over 20 years of professional experience. All nutritionists, 96·6 % of physicians and 94·7 % of nurses reported hearing about the reform, and most (88·9 % of nurses, 76·3 % of physicians and 75·6 % of nutritionists) claimed supporting the reform to a great or very great extent. Most respondents believe they should discuss issues related to healthy eating with their patients (91·8 % of nurses, 94·9 % of physicians and all nutritionists), but only about half (47·5 % of physicians and 57·0 % of nurses) reported that they have sufficient knowledge in this field, particularly about food labelling. Almost two-thirds of nutritionists (60·3 %) reported instructing patients to change their food intake according to labelling v. 40·1 % and 34·7 % of nurses and physicians, respectively. Only some respondents felt that they could influence their patients’ nutrition habits. Most participants believe that additional regulatory measures should also be used to promote healthy nutrition.Conclusions:There is a gap between the desire of physicians and nurses to provide nutritional guidance to the public and their actual knowledge about the labels’ meaning as well as their competencies in providing nutrition counselling. When formulating a reform, policymakers should provide clear guidelines about the expectations of implementing it in therapeutic practice.

Background Adequate iodine intake is essential for human health, for normal thyroid function, and for attainment of full intellectual potential in children. In light of Israel's lack of a mandatory salt fortification policy, heavy reliance on desalination and low iodine intake from dairy products and seafood, there is concern in Israel that the population is iodine deficient. Indeed, the first Israeli National Iodine Survey in 2016 found a median urinary iodine concentration (UIC) of 83 µg/L among school age children, falling below the WHO’s adequacy range of 100–299 µg/L for children. Methods In the framework of the National Human Biomonitoring Program in Israel, spot urine samples and questionnaire data were collected from 166 healthy children aged 4–12 years in 2020–2021. Urinary iodine concentrations were measured at the Ministry of Health National Biomonitoring Laboratory, using mass spectrometry. An international comparison of median urinary iodine concentrations (UIC) was performed taking into consideration the levels of desalinated water per capita, and fortification policies. Results The overall median (interquartile range [IQR]) UIC was 80.1 µg/L (44.7–130.8 µg/L) indicating that the population’s iodine status has not improved in the five years that have passed since inadequacy was first identified. When comparing 13 countries with population size above 150,000, whose desalinated water per capita was at least 1 m 3 , Israel and Lebanon were the only countries with median UIC below the WHO adequacy range. Conclusions There is an urgent need for mandatory salt fortification in Israel. Based on our international comparison, we conclude that the potential impact of desalination on iodine intake can be compensated for using the implementation of salt fortification policy. This study highlights the critical need for public health surveillance of nutritional and environmental exposures using human biomonitoring, with emphasis on vulnerable populations such as pregnant women and children.

Background Since March 2020, the world has been coping with the COVID-19 pandemic. One group particularly affected were mothers of newborns. The Israeli government imposed three lockdowns, with the first from 14 March to 11 May 2020. It had the strictest rules, with effects among mothers including panic and stress. These mothers coped with new challenges as they were often without help from the extended family, could not meet lactation counsellors in person, and stayed longer on maternity leave. Methods A cross-sectional, observational study collected data via an online anonymous survey in Israel. From 27 April 2020 to 11 May 2020, the survey was distributed through Facebook groups for breastfeeding mothers. It contained 32 multiple choice and 10 open questions. Multivariate logistic regression analysis, with adjustment for potential factors, was performed to determine the pandemic-related factors influencing breastfeeding, including the decision to breastfeed longer than planned. Results Five hundred eighty women participated in the survey. Most mothers were over 30, (mean age 32.55), married with an academic degree (81.5%). 127 (22%) women reported changes in their lactation plans. 85 (15%) responded that due to the COVID -19 pandemic they extended their breastfeeding period and 42 (7%) reported shortening it. A significant relationship was found between this extension and returning to work later than expected adjusted OR = 2.38 95% CI 1.46,3.87). When asked to rank steps national health authorities should take to encourage breastfeeding, the highest agreement (96%) was with maternity leave extension. More than 90% believed that receiving breastfeeding counselling at home and/or in hospital will encourage breastfeeding. Conclusions This study demonstrated that most women did not change their breastfeeding patterns because of the lockdown though some did experience difficulties. Some lengthened their breastfeeding period, as, due to the pandemic, they stayed home longer than expected. This finding should be considered for future emergency situations.

Efforts to shape the food environment are aimed at reducing diet-related co-morbidities. Front-of-package labeling (FOPL) may support the consumers to make an informed decision at the point of purchase and encourage industry to reformulate food products. The Israeli Ministry of Health (MOH) implemented a unique FOPL system, using two colors: A mandatory warning (red) label alongside a voluntary positive (green) label. An independent Scientific Committee, from academia, the healthcare system, and MOH was appointed to determine the core principles for the positive FOPL. The criteria were based on the Mediterranean diet principles, with adjustments to the Israeli dietary habits, focusing on the health advantages of the food and considering its processing level. The food products eligible for positive FOPL are foods in their natural form or with added spices or herbs, or those that underwent minimal processing, with no food additives. Based on population consumption data, 19.8% of food products were eligible for positive FOPL; of them, 54% were fruits and vegetables, 20% dairy, and 14% grains. An evaluation plan is needed to assess the degree of acceptance of the positive FOPL by the industry, retailers, and the public, and its impact on food consumption and on public health.