The main obstacle facing cancer preventive strategies worldwide is a lack of well conducted epidemiological studies to guide local and international efforts for disease control. In Lebanon, long due political strain has added yet another obstacle to the development of methodologies aiming to collect data on cancer epidemiology. However, through several efforts dated from the 1960s the picture is becoming clearer. We herein review the outcome of all such efforts and their interpretation as a guide for future preventive strategies.

Lebanon is a country located in the Middle East. This country, despite its small size, is of great geopolitical significance. The political and social structure of Lebanon compared to other Arab countries in the Middle East is very different. Lebanon's social structure has unique features that distinguish it from other societies. Its democratic system is considered a defining feature which makes it different from other Arab countries. It is a consociational democracy which is applicable to the societies with deep ethnic and religious divisions. In these kinds of societies, majority democracy is not considered a feasible system. The main question posed by this article is that why and how consociational democracy could provide peace and stability in this country? The answer to this question is advanced in the framework of the hypothesis that consociational democracy based on the distribution of power in Lebanon, and supported by a foreign power, paves the way for involved groups to look for their interests in compromise and cooperation and not in conflict.

Background: Globally, there is a trend towards consumption of energy-dense, nutrient-poor foods leading to dietary imbalances in toddlers. Nutrient deficiencies are associated with the risk of obesity and other health risks. NutricheQ is an 18-item questionnaire that can quickly identify these risks based on dietary patterns in healthy toddlers. Objectives: This study aimed to validate the NutricheQ tool, describe the dietary intake of toddlers and classify them into risk groups. Methods: This was a national, multi-center, observational, validation study conducted at 21 medical centers in Lebanon. Data was collected from NutricheQ administered to the parents of toddlers during a single outpatient visit, and food diary filled by parents during a 4-day follow-up. The validation process of NutricheQ was done using Pearson’ s and Spearman’ s correlation, ANOVA and ANCOVA. The accuracy of NutricheQ in the Identifying categories of nutritional risk was evaluated using the receiver operating characteristic (ROC) curves. All analyses were performed using IBM-SPSS version 24 and P value of  0. 05 was considered to be statistically significant. Results: Of the 487 toddlers enrolled, 467 had full data on NutricheQ and food diary data was available for 247 only. Majority of toddlers in Lebanon (80%-88%) were categorized in the moderate or low-risk groups of dietary intake indicating good eating habits. There was a significant positive association between the total NutricheQ score and both, age (r = 0. 11, P = 0. 021) and BMI Z-score (r = 0. 11, P = 0. 021). ROC fitting showed a very low discriminatory ability of the scores to correctly classify toddlers into the high-risk group basedontheir BMI Z-score. Significant positive correlation was obtained between the NutricheQ total score and exchangeable fat and meat with high fat, in the food diaries (R = 0. 170, P = 0. 045), indicating risk. Also, there was a negative association between the total NutricheQ score and soluble and insoluble fiber (Rs = 0. 181, P = 0. 004). Conclusions: Results from this study showed that NutricheQ has reasonable validity in the Lebanese context to assess the dietary quality of toddlers in Lebanon and in identifying those at increased nutritional risk.