144/2077

# NUTRIENT-PROFILING ANALYSIS IN PACKAGED FOODS AND BEVERAGES WITH VOLUNTARY FORTIFICATION IN CENTRAL AMERICA AND DOMINICAN REPUBLIC, 2015-2016

(¹)Roman, Ana Victoria; (¹)Roman, Ana Victoria; (²)Roldan, Evelyn;

(³)Perez, Wilton; (⁴)Ramirez, Nicté; (⁵)Espinoza, Leopoldo.

(¹)PhD. Food Science and Technology. Nutrition and Micronutrient Department. Institute of Nutrition of Central America and Panama. Guatemala; (²)MSc. Nutritionist. Nutrition and Micronutrient Department. Institute of Nutrition of Central America and Panama. Guatemala; (³)PhD. Epidemiologist. Department of monitoring and evaluation. Institute of Nutrition of Central America and Panama. Guatemala; (⁴)MSc. Public Health. Nutrition and Micronutrient Department. Institute of Nutrition of Central America and Panama. Guatemala; (⁵)MSc. Public Health. Department of monitoring and evaluation. Institute of Nutrition of Central America and Panama. Guatemala.

**Background and objectives:** Voluntary fortification with micronutrients in packaged foods and beverages is growing as a marketing strategy used by food corporations. Consumption of these foods and beverages is increasing worldwide and potential links relate their intake with risk factors of non-communicable diseases. Critical nutrients added in excess may affect the human health. To our knowledge this is the first study performed combining data at regional level. This study aims to examine the nutrient profile of fortified packaged foods and beverages.

**Methods:** This study was carried-out in Central American countries and Dominican Republic. The nutritional content was obtained from the nutritional label and it was registered in an electronic platform. A convenience sampling technique was performed during 2015-2016. Foods groups were arranged based on the Central American food composition table. Macro and micronutrient information were determined and adequacy assessed for children less than two years old and for women of reproductive age. The WHO nutrient profile modelling was used to assess critical nutrient on each packaged food and beverage. The NutRINCAP 1.0 software was used to determine the nutrient content and Stata 14.0 for analysis. Descriptive and statistical inferences were determined. P-value < 0.05 is considered as significant.

**Results:** Based on INCAP's dietary recommendations from Central America, a considerable proportion of fortified foods and beverages showed adequacy levels of nutrient in children and women of reproductive age above the established recommendation. Some essential nutrients found in excess were vitamin A, zinc, folic acid, iron among other. Foods and beverages were highly energy dense reporting excess of more than one-third of the energy required in children and adults. Dehydrated soups reported the highest sodium energy density in our sample.

**Conclusions:** The packaged foods and beverages sample with voluntary fortification reported excess of nutrients added. Sodium was found in excess in several packaged foods and beverages. In contexts where nutritional deficiencies and nutritional excess coexist, our findings support the need for regulatory instruments

regarding the level of fortified nutrient added in packaged foods and beverages.

**Keywords:** packaged foods and beverages, fortification, micronutrient

**Further collaborators:**

Carolina Siu.MSc.Public Health.DesDirection.Institute of Nutrition of Central America and Panama.Guatemala

144/2089

# GETTING THE FOOD LIST "RIGHT": AN APPROACH FOR THE DEVELOPMENT OF A COMPREHENSIVE FOOD LIST FOR HOUSEHOLD FOOD CONSUMPTION SURVEYS

(¹)Bell, Winnie; (²)Coates, Jennifer; (³)Rogers, Beatrice; (⁴)Bermudez, Odilia.

(¹)MSc/MPH. PhD Candidate and Assistant Researcher. Tufts University Friedman School of Nutrition Science and Policy. Boston. USA; (²)PhD. Associate Professor. Tufts University Friedman School of Nutrition Science and Policy. Boston. USA;

(³)PhD. Professor. Tufts University Friedman School of Nutrition Science and Policy. Boston. USA; (⁴)PhD/MPH. Associate Professor. Tufts University School of Medicine. Boston. USA.

**Background and objectives:** Due to under-investment in individual dietary data in many LMICs, detailed knowledge about dietary patterns is currently lacking. In an effort to fill this gap, researchers have turned to household consumption and expenditure surveys (HCES). However many HCES consumption modules do not capture sufficient detail in their food list. The objective of this paper was to use methods from nutritional epidemiology to demonstrate how quantitative 24-hour recall data can be used to generate a food list for HCES that can capture a comprehensive picture of nutrient intake.

**Methods:** The study analyzed dietary data from a large-scale, representative survey of rural Bangladesh. Four sequential steps commonly used in nutritional epidemiology for development of food frequency questionnaires were followed. First, similar foods were grouped; second a contribution analysis was conducted; third, stepwise regression was carried out; and finally, based on the results from the previous steps, a comprehensive food list was created.

**Results:** A total of 296 individual foods were grouped into 76 similar food categories and ranked based on the percent contribution of each food to total intake of pre-selected nutritional components (energy, protein, fat, calcium, iron, zinc, vitamin A). Results: **Conclusions:** This study illustrated a relatively straightforward method for developing a country-specific food list that can be used for HCES. Replicating these steps in other contexts depends on the availability of existing 24-hour dietary recall data and a sufficiently detailed food composition table to allow for accurate food to nutrient matches.

**Keywords:** Food list development; household consumption and expenditure surveys (HCES); food consumption data; method for food frequency questionnaire development
MICRONUTRIENT STATUS OF STUDENTS EN-
ROLLED IN RURAL MOROCCO

(1)Ahmed, Badahi; (2)Rjimati, El Arbi; (2)El Kari, Khalid; (2)El Hamdouchi, Asmaa; (3)Rjimati, Manelle; (2)Barich, Fatima; (2)Taboz, Youness; (2)Benkirane, Hasnae; (4)Barkat, Amina; (2)Aguenaou, Hassan.

(1)MD. Joint Unit for Research in Nutrition and Food. CNESTEN. Ibn Tofail University. Kénitra Rabat. Morocco.; (2)PhD. Joint Unit for Research in Nutrition and Food. CNESTEN. Ibn Tofail University. Kénitra Rabat. Morocco.; (3)MD. Joint Unit for Research in Nutrition and Food. CNESTEN. Ibn Tofail University. Kénitra Rabat. Morocco.; (4)MD. PhD. National Reference Center for Neonatology and Nutrition. Children's Hospital. Research Team on Mother and Child Health and Nutrition. Faculty of Medicine and Pharmacy of Rabat. CHU Rabat. Mohamed V University. Morocco.

**Background and objectives:** Micronutrient deficiencies are a public health problem in Morocco. The aim of this study is to evaluate the mineral and vitamin status of children enrolled in a rural area in Kingdom of Morocco

**Methods:** The study involved a sample of 152 randomized school-aged children (7 to 9 years), from rural schools in the province of Azilal. The collected data were analyzed by the Nutrilog software integrating the Moroccan table of food composition and were subjected to a statistical analysis by the software SPSS version 2.1.

**Results:** The main results of this study showed that the Iron intakes are insufficient in more than 33% of children, Iodine and Zinc intakes are insufficient in more than 90% of children, Magnesium and Potassium intakes are insufficient in more than 50% of children whereas the excess of sodium is barely perceptible at 0.7%. The calcium, vitamin D and vitamin A intakes are are insufficient in more than 80% of children

**Conclusions:** The eating habits of the study population are highly unbalanced. The results of this study suggest strengthening school feeding program and nutrition awareness activities for children, teachers and parents.

**Keywords:** Vitamins. Minerals. School children. Intake.

COCHLEAR HOMOCYSTEINE METABOLISM AND
RELATED PATHWAYS IN THE BHMT -/- MOUSE

(1)Partearroyo, Teresa; (2)Vallecillo, Néstor; (3) Rodríguez de la Rosa, Lourdes; (4)Zeisel, Steven H.; (5)Pajares, María A.; (6)Varela-Nieto, Isabel; (7)Varela, Gregorio.

(1)PhD. Pharmacist. Department of Pharmaceutical & Health Sciences. Faculty of Pharmacy. CEU San Pablo University. Madrid. Spain.; (2)Biochemical. Instituto de Investigaciones Biomédicas Alberto Sols (CSIC-UAM). Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER). Instituto de Salud Carlos III. Madrid. Spain.; (3)PhD. Instituto de Investigaciones Biomédicas Alberto Sols (CSIC-UAM). Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER). Instituto de Salud Carlos III. Madrid. Spain.; (4)M.D. Ph.D. University of North Carolina at Chapel Hill. Nutrition Research Institute. Kannapolis. North Carolina. USA.; (5)PhD. Instituto de Investigaciones Biomédicas Alberto Sols (CSIC-UAM). Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER). Instituto de Salud Carlos III. Madrid. Spain.; (6)Prof. Chemistry. Instituto de Investigaciones Biomédicas Alberto Sols (CSIC-UAM). Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER). Instituto de Salud Carlos III. Madrid. Spain.; (7)Departamento de Ciencias Farmacéuticas y de la Salud. Facultad de Farmacia. Universidad CEU San Pablo. Madrid. Spain.

**Background and objectives:** Background: Age-related hearing loss (ARHL) is one of the most common causes of disability in older people, affecting 1/3 of the population over 65-yr. Epidemiological studies have shown correlations among the nutritional condition, increased plasma homocysteine (Hcy) and HL, suggesting that nutritional supplementation may be beneficial. Accordingly, rodent experimental models have provided the molecular basis to understand the observed effects.

**Objectives:** Analyze the relevance of BHMT in the cochlea using Bhmt-/- mice, whose dependence on the metabolism of folate for the remetilacion of Hcy is greater, in the development of hearing loss and study of the contribution to gene silencing to damage by noise, and the influence of this genetic background on the effects by noise.

**Methods:** Three-month-old Bhmt-/- mice were used to determine hearing loss after exposure to noise.

**Results:** We present results showing that: 1) 3 month-old mice with Bhmt gene deleted present higher threshold shift after noise exposure; 2) an increase of plasma Hcy in knockout mice respect to wild type and heterozygous mice, with significant increase in total Hcy levels to 28 days of exposure to noise; 3) Noise exposure induced a significant decrease in MTR levels and a significant increase in the expression of Bhmt2 and Mtr in Bhmt gene deleted as compared to Bhmt null without exposure noise cochleae. In contrast, Bhmt-/- mice showed CBS protein levels similar to those in Bhmt+/-.

**Conclusions:** Our results confirm that the lack of BHMT in the cochlea alters cochlear Hcy metabolism. Deletion of BHMT makes the cochlea more sensitive to noise and expression and protein levels suggest changes in the mRNA or protein half-lives at several levels and a need to remethylate Hcy, either because of Hcy accumulation or an increased need of methionine
(1)Badahi, Ahmed; (2)Rjimati, El Arbi; (2)El Kari, Khalid; (2)El Hamdouchi, Asmaa; (3)Rjimati, Manelle; (2)Barich, Fatima; (2)Taboz, Youness; (2)Benkirane, Hasnae; (4)Barkat, Amina; (2)Aguenaou, Hassan.

(1)MD. Joint Unit for Research in Nutrition and Food. CNESTEN. Ibn Tofail University. Kénitra Rabat. Morocco.; (2)PhD. Joint Unit for Research in Nutrition and Food. CNESTEN. Ibn Tofail University. Kénitra Rabat. Morocco.; (3)MD. Joint Unit for Research in Nutrition and Food. CNESTEN. Ibn Tofail University. Kénitra Rabat. Morocco.; (4)MD. PhD. National Reference Center for Neonatology and Nutrition. Children's Hospital. Research Team on Mother and Child Health and Nutrition. Faculty of Medicine and Pharmacy of Rabat. CHU Rabat. Mohamed V University. Morocco.

**Background and objectives:** In Morocco, protein-energy malnutrition has virtually disappeared in pre-school children. However, there are few studies in school-aged children. The aim of this study is to assess the nutritional status of school children in a rural area in Morocco.

**Methods:** The study involved a sample of 152 randomized school-aged children from 7 to 9 years, recruited in Azilal province in kingdom of Morocco. The data collected were processed by WHO Anthro and the Nutrilog software on the basis of the Moroccan food composition table and were subjected to statistical analysis by the SPSS software version 2.1.

**Results:** The main results of this study show that emaciation measured by the BMI / A (Body Mass index for age) indicator (≤-2SD standard deviation) according to WHO standards reaches 0.7%, the mean energy intake Daily per person is 1513 ± 35 Kcal with a prevalence of insufficient daily energy intake of 56% (below the recommended nutritional intake which is 1912Kcal). These daily caloric intakes come from 55% carbohydrates, 32% lipids and 13% protein

**Conclusions:** This study among school-aged children living in Moroccan rural area shows that the dietary intake are lower than those recommended for this category of the population. This situation requires a sound policy in nutrition education.

**Keywords:** School children.Carbohydrate.lipid.protein intake.

(1)Huybrechts, Inge; (2)Aglago, Elom Kouassivi; (3)Mullee, Amy;

(4)De Keyzer, Willem; (5)Leclercq, Catherine; (5)Allemand, Pauline;

(5)Balcerzak, Agnieszka; (6)Zotor, Francis.; (7)Gunter, Marc J.

(1)PhD. Nutritional epidemiologist. International Agency for Research on Cancer (IARC). France; (2)PhD. Nutritional epidemiologist. International Agency for Research on Cancer (IARC). Lyon. France; (3)PhD. Nutritionist. International Agency for Research on Cancer (IARC). Lyon. France; (4)PhD. Nutritionist. Faculty of Science and Technology. Department of Bio- and Food Sciences. University College Ghent-Campus Vesalius. Belgium; (5)PhD. Nutrition Assessment & Scientific Advice Group (ESNA). Nutrition and Food Systems Division (ESN). Food and Agricultural Organization of the United Nations. Italy; (6)PhD. School of Public Health. University of Health and Allied Sciences. Ghana; (7)PhD. Molecular epidemiologist. International Agency for Research on Cancer (IARC). Lyon. France.

**Background and objectives:** Individual food consumption surveys (IFCS) are performed in many countries and are intended to evaluate compliance with nutrient intake requirements or exposure to potential harmful dietary contaminants/components, or to develop food based dietary guidelines. Such data could potentially be used for investigating associations between dietary factors and disease outcomes. This review aims at inventoring methods and designs used in national IFCS and discusses the methodologies applied across countries and continents. We further evaluated the potential for embedding IFCS in national health surveys.

**Methods:** Literature searches were performed using fixed sets of search terms in different databases. The inventory was completed with all accessible information from retrieved publications. Surveys from individual countries, originating from different continents are listed in the inventory.

**Results:** We identified IFCS in 39 countries from six world continents. National IFCS systems are available in most of the high-income countries/continents, while such surveys are scarce in low- and middle-income countries. Few countries (n=9) have their national IFCS incorporated into national health and nutrition examination surveys, allowing the investigation of dietary-related disease outcomes. Most of these integrated surveys have the advantage of being continuous/regular in contrary to the other IFCS that are mostly erratic.

**Conclusions:** This review serves as the basis to define gaps and needs in IFCS worldwide and will help in defining priorities for resource allocation. In addition it can serve as an inspiration source for countries that do not have a IFCS system in place yet and advocates for national IFCS to be incorporated into national health and nutrition examination surveys in order to create (1) more research opportunities for investigating diet-disease relationships and (2) a frame to evaluate the effect of diet-related policies (e.g. promotion of local nutrient rich foods) and of nutrition recommendations such as food based dietary guidelines. The countries that integrat-
ed their IFCS within their National Health and Nutrition examination survey can serve as proof of principle for other countries.

**Keywords:** Dietary surveillance, Health surveys, Food consumption surveys

144/2252

COMPREHENSIVE PHENOTYPIC ANALYSIS OF
LIVER HEPATOCYTE-SPECIFIC PHGDH DEFICIENT MICE

(1)Hamano, Momoko; (2)Esaki, Kayoko; (3)Moriyasu, Kazuki; (3)Mori, Shinya; (4)Hirabayashi, Yoshio; (5)Furuya, Shigeki.

(1)PhD student. Faculty of Agriculture. Kyushu University. Japan;

(2)Research Scientist. RIKEN Brain Science Institute. Japan;

(3)MS student. Faculty of Agriculture. Kyushu University. Japan;

(4)Senior Team Leader. RIKEN Brain Science Institute. Japan;

(5)Professor. Faculty of Agriculture. Kyushu University. Japan.

**Background and objectives:** L-Serine (Ser), a non-essential amino acid, is synthesized from 3-phosphoglycerate via the phosphorylated pathway composed of phosphoglycerate dehydrogenase (Phgdh), phosphoserine aminotransferase 1 (Psat1) and phosphoserine phosphatase (Psph). Ser is an important metabolic component as a precursor of various biological components such as glycine, nucleotide, glutathione and sphingolipids. We have investigated the physiological role for de novo Ser synthesis using mice and fibroblasts deficient in Phgdh. Our in vivo study revealed that the targeted disruption of Phgdh resulted in embryonic lethality associated with overall growth retardation, indicating that de novo Ser synthesis via the phosphorylated pathway is indispensable for embryonic growth and survival.

**Methods:** In the present study, to clarify the physiological significance of de novo Ser synthesis in liver, we generated the liver hepatocyte-specific Phgdh KO (LKO) mice using albumin-Cre transgene.

**Results:** LKO mice were born normally and fertile. Although the expression levels of Phgdh mRNA and protein were reduced significantly in the liver, free Ser level was not decreased in the liver and serum compared to those of Floxed control mice. On the other hand, in the kidney and muscle, free Ser level were raised significantly in LKO, which was associated with increased expression of Phgdh.

These observations suggest that the loss of Phgdh in the hepatocytes was compensated by activating the synthesis of Ser in the kidney and muscle. In addition, the body weight of LKO mice were significantly increased compared to control after 23 weeks old. Further, the systemic glucose metabolism was impaired in LKO mice.

**Conclusions:** These findings suggested that the Phgdh-dependent de novo Ser synthesis in the liver contributes to the maintenance of systemic glucose and energy metabolism. The underlying molecular mechanism is currently under investigation.

**Keywords:** Serine, Phgdh, L liver, metabolic regulation

144/2343

MATERNAL SUPPLEMENTATION OF AMINO ACIDS FOR BEST FETAL OUTCOMES

(1)Nair, Sirimavo; (2)Banerjee, Reshmi; (3)Rodrigues, Anusha.

(1)Associate Professor; (2)Gynaecologist. Kashiba-Govardhan Bhai Patel Trust hospital. Karelibaug. Vadodara. India; (3)Masters student. Dept. Of Foods and Nutrition. The M.S. University of Baroda. Vadodara. India.

**Background and objectives:** Background-India has the highest number of children with birth defects. Congenital anomalies affect approximately 2-3 per 100 children across the world. In India, 1 in 33 infants are born with birth defects resulting in approximately 3.2 million birth defect-related disabilities every year (Various data bases). Supplementing nutrients to observe the long term effects helps to look at fetal growth in progress during pregnancy and thereby role of Nutrigenomics.

Objective of the study was to observe the impact of supplementation of amino acids 8-10grams a day to meet 1/3rd RDA, to the deficient mothers and observe the changes occurring biochemically. Mass spectroscopy was carried out for assessments.

**Methods:** Mass Spectroscopy- Amino acid profiles, Acyl transporters, Carnitine transporters

**Results:** Results revealed 27% mothers had IUGR, 37% had Anemia and 17% were at risk of pre-term deliveries; on US scan 14% babies had low fetal heart rate. The various amino acids and transport systems, Acylcarnitines were quantified from the blood samples obtained from the mother by Mass spectroscopy showed a prevalence of both amino acid and acyl-carnitine deficiency in the mothers with 43.33% of the pregnant mothers were deficient with amino acid profiles, 40% of the mothers were deficient in the various markers of the acyl-carnitine panel; 16.66% of the mothers were deficient in both amino acids and acyl-carnitine panel

**Conclusions:** Conclusion-The affected pathways may cause physiological disturbances in the body of the mother and hence also will influence the fetal growth. Moreover the child is also at risk of inheriting the defect and it may be expressed in its phenotype. It was indicative of the prevalence of some defect in the enzyme or other transport proteins; hence supplementation of amino acids may lead to some rectification at the gene level which could help the child to lead a quality life free of disease.

**Keywords:** Key words- Maternal nutrition, inborn errors, Metabolomes, Nutrigenomics
## ASSOCIATION OF FTO AND APELIN GENE EXPRESSION WITH DIETARY GLYCEMIC INDEX AND GLYCEMIC LOAD AMONG MORBID OBESE AND NON-OBESE SUBJECTS

**Background and objectives:** To investigate the association between the apelin and FTO gene expression in adipose tissue and dietary glycemic index (GI) and glycemic load (GL) among non-diabetic morbid obese and non-obese subjects.

**Methods:** Visceral and subcutaneous adipose tissues were obtained from 32 morbidly obese and 32 age- and sex-matched non-obese subjects, who underwent open abdominal surgery. All of the subjects are free of diabetes and cancers and without using anti-lipid medication. Usual dietary intake during the previous year was measured using a validated semi-quantitative food frequency questionnaire. Dietary GI and GL were calculated using International Tables of Glycemic Index and Glycemic Load Values (2008). The gene expressions of apelin and FTO in visceral and subcutaneous adipose tissue were assessed by Real-Time PCR.

**Results:** The mean age was 39.6 years for both groups and body mass index for morbidly obese and non-obese subjects was 45.3 and 25.6 kg/m2, respectively. Apelin gene expression in visceral adipose tissue was correlated with dietary GI (r=0.455, P=0.009) and GL (r=0.445, P=0.011) among non-obese subjects and, with GL (r= 0.351, P=0.049) among morbid obese subjects. Apelin gene expression in subcutaneous adipose tissue was correlated with GI among morbid obese (r= 0.395, P=0.025) and non-obese (r= 0.571, P=0.001) subjects. Moreover, we found significant correlations between apelin concentration and dietary GI among morbid obese (r=0.388, P=0.028) and non-obese (r=0.566, P=0.001) subjects. In addition, a positive correlation was observed between dietary GL and apelin concentration among non-obese subjects (r= 0.420, P=0.026). There were no significant findings between FTO gene expression and dietary GI and GL.

**Conclusions:** It seems that the apelin concentration and mRNA expression have positive correlation with dietary GL and GI among morbid obese and non-obese subjects; suggesting an important role for insulin pathways in the regulation of apelin expression.

**Keywords:** apelin; FTO; gene expression; glycemic index; glycemic load

**Further collaborators:** The authors would like to thank Dr Mohammad-Reza Ebrahimi for surgical procedures.

## DISTINCTIVE EFFECTS OF ISOCALORIC DIETS WITH DIFFERENT CARBOHYDRATE TO FAT RATIOS ON PHENOTYPIC FLEXIBILITY: A RANDOMIZED, CROSSOVER STUDY

**Background and objectives:** Acute and long term consumption of either high fat or high carbohydrate diet has several consequences on general metabolic disturbances (Silva FM et al. 2015; Qian F et al. 2016). Well-orchestrated physiological machinery maintains organisms' homeostasis which able to adapt continuously changing environment in which food and lifestyle play a major role. However, this so called 'phenotypic flexibility' has limited capacity and will shift soon towards 'phenotypic inflexibility' as the chronic stress condition present (van Ommen B et al. 2014). In the present study we aimed to investigate distinctive effects of breakfast with distinct carbohydrate and fat proportion on phenotypic flexibility indicated by genes and pathways involved in acute intervention.

**Methods:** This study was a randomized, single-blind, placebo-controlled crossover study. Twelve subjects (5 males and 7 females) aged 26.5±1.06 years with BMI: 23.79±0.63 kg/m² years fall in inclusion criteria were admitted to the study. Blood samples for peripheral blood mononuclear cells (PBMC's) isolation were collected at 0 and 4h after breakfast challenge. Illumina HumanHT-12 v4 Expression BeadChip Kit microarray was used for gene expression and data were processed for downstream analysis using R Bioconductor. Pathways analysis was conducted using PathVisio.

**Results:** After annotation, normalization and data filtering, amount of 106 (P<0.001), 482 (P<0.01) and 1668 (P<0.05) genes in PBMC's were significantly regulated in medium fat challenge (4h vs 0h). On the other hand, high fat challenge (4h vs 0h) resulted in modulation of 73 (P<0.001), 340 (P<0.01) and 1272 (P<0.05) genes postprandially.

**Conclusions:** We concluded that an acute high fat or carbohydrate breakfast challenge affects 'phenotypic flexibility' as indicated by involvements of some pathways such as inflammatory and fat metabolism pathways.

**Keywords:** PBMC's. high and medium fat breakfast. phenotypic flexibility. pathways analysis.

**Further collaborators:**

**References:**

Qian F et al. 2016. Diabetes Care 39(8):1448-1457.

Silva FM et al. 2015. J Nutr 145(4):736-741.

van Ommen B et al. 2014. Genes Nutr 9(5):423.

<footnote>(1) Safarian, Mohammad; (2) Yuzbashian, Emad; (3) Zarkesh, Maryam;</footnote>

<footnote>(4) Asghari, Golaleh; (5) Mirmiran, Parvin; (6) Hedayati, Mehdi;</footnote>

<footnote>(2) Mahmoodi, Behnaz.</footnote>

<footnote>(1) Biochemistry of Nutrition Research Center. School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.; (2) MSc. Nutrition and Endocrine Research Center. Research Institute for Endocrine Sciences. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (3) PhD. Cellular and Molecular Endocrine Research Center. Research Institute for Endocrine Sciences. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (4) PhD. Nutrition and Endocrine Research Center. Research Institute for Endocrine Sciences. Shahid Beheshti University of Medical Sciences. Tehran. Iran.</footnote>

<footnote>(1) Zanzer, Yoghatama Cindya; (2) Kalafati, Mirella; (3) Batista, Ângela;</footnote>

<footnote>(3) Eijssen, Lars; (4) Steinbusch-Coort, Susan; (5) Evelo, Chris; (6) Östman, Elin.</footnote>

<footnote>(1) MSc. PhD candidate. Food for Health Science Centre. Lund University. Sweden.; (2) MSc. PhD candidate. Department of Bioinformatics. Maastricht University. The Netherlands.;</footnote>

<footnote>(3) PhD. MD. Assistant Professor. Department of Bioinformatics. Maastricht University. The Netherlands.; (4) PhD. Assistant Professor. Department of Bioinformatics. Maastricht University. The Netherlands.;</footnote>

<footnote>(5) PhD. Professor. Department of Bioinformatics. Maastricht University. The Netherlands.; (6) PhD. Associate Professor. Food for Health Science Centre. Lund University. Sweden.</footnote>
A RETROSPECTIVE OBSERVATIONAL STUDY OF
MAXIMAL ENTERAL NUTRITION RATES IN A BURN
PATIENT POPULATION

(1)Mitchell, Stephanie L.; (2)Shields, Beth; (3)Senne-Duff, Beth; (4)Sweet, Ralph; (5)Aden, James; (6)Chung, Kevin K.; (3)Bonilla, Joseph.

(1)MS. RD. LD. Adjunct Faculty. Nutrition. University of the Incarnate Word. United States; (2)MS. RD. LD. CNSC. Clinical Dietitian. United States Army Institute of Surgical Research. United States.; (3)PhD. RD. Faculty. Nutrition. University of the Incarnate Word. United States; (4)RN. Data Collection. United States Army Institute of Surgical Research. United States.; (5)PhD. Statistics. United States Army Institute of Surgical Research. United States.; (6)MD. Critical Care. United States Army Institute of Surgical Research. United States.

**Background and objectives:** The objective of this retrospective observational study was to establish if there was a maximum enteral feeding flow rate (MAX) that burn patients could tolerate in order to meet caloric needs during the time enteral nutrition (EN) is provided, working around frequent interruptions in EN. This study examined the hourly MAX rate received by each subject and evaluated outcomes and tolerance in an effort to determine if there is a threshold for the MAX rate. Demographics, treatment, and outcomes data were collected during the MAX rate that each subject received and were analyzed with descriptive and comparative statistics. The gastrointestinal (GI) intolerance data examined included emesis, residuals ≥500 mL, aspiration, ≥1L stool output in 24 hours, and necrotic bowel during or after MAX rate. IRB approval was obtained.

**Methods:** This study was conducted on an adult population admitted to a major burn center during a three year period who received EN and had ≥20% total body surface area (TBSA) burned requiring excision.

**Results:** Data were collected on 151 subjects with 48% ± 18% TBSA burn who were 33 ± 14 years old and met the inclusion criteria. The average MAX rate ordered and received was 154 ± 45 mL/ hr. The factors that predicted mortality in this study were burn size (p = <0.001), age (p = < .001), and the total number of GI intolerance symptoms per subject during the MAX rate (p = .011). The MAX rate had a weak correlation with mortality and with any individual type of GI intolerance (all R2 <.05). MAX rate also had a poor correlation with the total number of GI intolerance symptoms per subject during MAX rate (R2 = .01).

**Conclusions:** The total number of GI intolerance symptoms experienced per subject was a predictor of mortality, but the MAX rate was not associated with increased GI intolerance symptoms. The highest MAX rate without experiencing any GI intolerance symptoms was 255 mL/hr, however, there was no strong correlation between increase in MAX rate and incidence of negative outcomes, therefore a definitive MAX rate was not established.

**Keywords:** Enteral nutrition, burn, enteral intolerance, enteral rate

DIFFERENCE BETWEEN “VISCOSITY IN PHYS-
ICS” AND VISCOSITY USED IN FOOD PROPER-
TIES OF INTESTINAL CONTENTS

(1)Takahashi, Toru; (2)Udagawa, Koko; (3)Horiuchi, Rie; (4)Tokunaga, Miki.

(1)Ph.D.. Graduate School of Human Environment Science. Fukuoka Women's University. Japan; (2)Ph.D.. Faculty of Family and Consumer Sciences. Kamakura Women's University. Japan; (3)Ph.D.. Faculty of Human Environmental Sciences. Mukogawa Women's University. Japan; (4)M.Sc.. Faculty of Health & Social Work. Kanagawa University of Human Services. Japan.

**Background and objectives:** Properties of viscosity of intestinal contents in pigs, chicken and rats were similar to those of fresh concrete (Takahashi et al Nutrition 2004). Properties of viscosity of fresh concrete have been studied in physics for long time, and would be one of a good example for understanding “viscosity in physics”. Textbooks of physics said that main modulators of viscosity in fresh concrete are sand and stone. “Viscosity in physics” is defined as a fluid’s internal resistance to flow. Sand and stone increase resistance against flow and increase “viscosity in physics” of fresh concrete. However, sand and stone don’t increase viscosity used in food properties because of no sticky property. Thus, there should be differences between “viscosity in physics” and viscosity used in food properties. The present study shows differences of “viscosity in physics” and viscosity used in food properties using intestinal contents of animals. We also discussed applications of “viscosity in physics” in the intestine to understand physiology of intestine.

**Methods:** Viscosities of small intestinal and/or cecal contents with solid particles in rats, pig, and chicken were measured for “viscosity in physics”. Viscosity of supernatant of cecal contents was measured for viscosity used in food properties.

**Results:** Range of “viscosity in physics” of small intestinal and cecal contents in rats, pig, and chicken was between 1 and 200 pa·s at a shear rate of 1s-1. Viscosity used in food properties of pig cecal contents (0.0015 pa·s) was 800 times smaller than “viscosity in physics” of pig cecal contents at 1 s-1. Thus, “viscosity in physics” would differ from viscosity used in food properties. “Viscosity in physics” can simulate flow behavior in intestine when contractions occur, and show behavior of nutrients in the lumen of the intestine, because of existence of equations, laws and theorems in physics.

**Conclusions:** “Viscosity in physics” can explain some phenomena in physiology in the intestine. However, viscosity used in food properties cannot translate to term of physics. Thus, viscosity used in food properties would not explain phenomena in intestine using equations, laws and theorems in physics.

**Keywords:** “viscosity in physics”, digesta, intestine, animals
# THE BODY COMPOSITION AND FAT DISTRIBUTION EFFECT ON BODY MINERAL DENSITY AND BONE METABOLISM BIOMARKERS OF PERIMENOPAUSAL WOMEN. PILOT STUDY

(1)Czlapka-Matyasik, Magdalena; (2)Przeorska, Dorota; (3)Marszalek, Andrzej.

(1)Poznan University of Life Sciences; (2)Msc. Food Technologist. Department of Human Nutrition and Hygiene. Poznan University of Life Sciences. Poland; (3)Ph.D MD. Synevo Sp. z o.o. Poland.

**Background and objectives:** Introduction: Bone turnover markers (BTMs) are widely used for the management of osteoporosis, and the perimenopausal women are the group where bone and fat metabolism (FM) is changing. Information about mutual relationship between BTM and FM is limited.

**Objectives:** The aim of this study was to assess relation between body mineral density (BMD), BTMs, fat percentage (FM%) and fat distribution in the group of perimenopausal women.

**Methods:** Method/Design: The study involved 52 women aged 47-56 years, BMI 24,2 kg/m2. BMD, Serum 25(OH)D3, bone turnover markers sP1NP, BcrossLabs sCTX and body composition, fat distribution included VAT (visceral adipose tissue) were examined. Biochemical markers were tested using routine laboratory methods. Fat mass, and bone mineral density were evaluated with dual-energy X-ray absorptiometry.

**Results:** Healthy, normal weight (BMI 24,2kg/m2; FM%: 37,7%) perimenopausal women were characterized by low serum 25(OH)D3 (28.19 ng/ml ± 7,21), normal bone mineralization (1,14 g/cm3 ± 0,10). T-score: 0,60 (-1,44 to 2,87), Z-score: 0,83 (-1,13 to 2,38). 6% of women presented T-score < -1.

**Conclusions:** Conclusion: Regular monitoring of bone markers included body fat distribution seems to be necessary in these patients and the early introduction of preventive strategies should be evaluated. Diet related behaviours should be analyzed in further studies.

References:

1. Adami S, Bianchi G, Brandi ML, i in. Determinants of bone turnover markers in healthy premenopausal women. Calcif Tissue Int. 2008;82(5):341-347. doi:10.1007/s00223-008-9126-5.

2. Holecki M, Chudek J, Bober MT, Więcek A, Markiewicz BZ, Duława J. Changes in bone mineral density in obese perimenopausal women during 5 year follow up. :139-147.

**Keywords:** Bone turnover markers, body composition, visceral fat, T-score, perimenopausal women.

# THE “COST” OF COSTING NUTRITION INTERVENTIONS: A CASE STUDY IN RURAL UGANDA

(1)Richardson, Belinda; (2)Vosti, Stephen; (3)D'Agostino, Alexis;

(1)Namaste, Sorrel.

(1)John Snow Research and Training Institute. USA; (2)University of California, Davis. USA

**Background and objectives:** While the importance of costing nutrition interventions is recognized for budgetary and planning purposes at both programmatic and national levels, resources allocation poses a challenge to organizations wanting to allocate resources to cost their programs. This micronutrient powder (MNP) cost study in Uganda highlights two key challenges and presents modifications to the cost data collection where the research methodology was scaled back due to resource constraints. We use various programmatic elements of this costing study as a guide to construct both ideal and minimum data collection scenarios for some key cost components and give corresponding resource estimates for each.

**Methods:** Using the Activity-Based Costing methodology (ABC), we conducted a total cost and cost-effectiveness study comparing two distinct MNP distribution arms in Namutumba, Uganda. To collect direct cost data on the prices and quantities of all inputs into the MNP intervention, program staff filled in spreadsheets on program activity costs corresponding to the activities for which they were responsible. Indirect costs were captured through a series of time allocation surveys with various stakeholders involved in MNP distribution.

**Results:** The time-consuming collection of time allocation data proved a challenge to data quality. Ideal time-and-motion studies were scaled back to individual and group interviews by two part time enumerators, striking a balance between maintaining sample size and limiting measurement error. Program staff should collect program activity cost data as activities are being carried out, to avoid errors due to long recall periods and incomplete records. The tradeoff here is managing resources to infer some smaller costs and spend more resources accurately measuring big cost drivers.

**Conclusions:** Cost studies, while expensive to conduct, are vital contributions to the process of translating research into evidence-based policy. The tradeoffs provided in this case study provide some pitfalls to avoid when costing nutritional interventions while remaining compatible with the larger initiative to standardize costing across programs and sectors. For programs that undertake cost studies for nutritional interventions with limited resources, identification of the big program cost drivers and the big cost study costs, will help in adjusting the scope and level of detail of a costing study.

**Keywords:** Micronutrient powder, Cost Study, Cost-Effectiveness Study
SLEEP, ANXIETY AND MOOD PROFILE BEFORE A
MILITARY PHYSICAL APTITUDE TEST

(1)Juzwiak, Claudia; (2)Daniel, Natalia; (3)Zimberg, Ioná; (3)Padovani, Ricardo; (3)Estadella, Debora.

(1)PhD. Departamento de Ciências do Movimento Humano.
Universidade Federal de Sao Paulo. Brazil.; (2)MS. Universidade
Federal de Sao Paulo. Brazil; (3)PhD. Universidade Federal de Sao
Paulo. Brazil.

**Background and objectives:** Reduced sleep duration or impaired sleep quality are common conditions before important sport events and precompetitive anxiety is one of the main factors which affect sleep. The aim of this study was to assess sleep, anxiety and mood profile of military personnel before a Physical Aptitude Test (PAT), which evaluates whether physical performance is reached and/or maintained for purposes of fitness sufficiency assessment, and the score is considered for the military career.

**Methods:** Ten males, 31.4(8.3) years old, physically active, serving the Brazilian Army completed a sleep diary for six pre-PAT nights (N1 to N6), where N1-N5 were called "pre-PAT week"-PPW, and N6 "pre-PAT night"-PPN. The Sleep Quality Index of Pittsburgh-PSQI assessed their usual sleep quality on PPW. To analyze anxiety and mood, subjects answered the Brunel Mood Scale, and the short versions of the Competitive State Anxiety Inventory-CSAI-2R, and of the State-Trait Anxiety Inventory on PPN. To assess sleepiness, they answered the Epworth Sleepiness Scale on PAT morning.

**Results:** On the PPN participants presented state-anxiety of 11.8(2.7) and trait-anxiety of 14.9(2.7). The CSAI-2R mean scores were: self-confidence: 2.5(0.7), cognitive anxiety: 1.6(0.6), and somatic anxiety: 2.0(0.9). As for mood, vigor was the higher score factor [8.2(3.7)], but individuals presented heterogeneous results. Sleep quality was low (mean PSQI 6.5). On PAT morning, subjects showed low levels of anxiety and did not present daytime sleepiness [7.4(3.8)]. Mean PPW sleep duration was significantly different from PPN: 6.6(0.7)h and 5.4(1.2)h, respectively (p=0.01) with no significant difference in subjective sleep quality [PPW: 6.3(1.4); PPN: 5.5(2.1), p=0.09] or number of awakenings [PPW: 0.8(1.6); PPN: 0.8(1.2), p=0.9]. Most subjects slept later on PPN or woke up earlier on PAT morning.

**Conclusions:** Both during PPW and PPN volunteers slept less than recommended (7-9h) for individuals with the same age range. Although PPN sleep duration was lower than PPW, the low score suggests that anxiety was not the cause. The levels of anxiety and mood indicated good self-control. Sleep duration was affected by PAT, but not subjective sleep quality or number of awakenings.

**Keywords:** sleep, anxiety, military

**Conflict of Interest Disclosure:** The present study was fund-
ed by FAPESP (#2014/14276-0) and CAPES.

DETERMINATION OF FACTORS RELATED TO
MALNUTRITION IN PRE-SURGICAL ONCOLOGI-
CAL PATIENTS

(1)Markmann, Carlos Alberto; (2)Croxatto, Maria Eugenia; (3)Dufau, Lucrecia; (3)Lavigna, Elisa.

(1)PhD. Doctor. Hospital Marie Curie. Argentina.; (2)MD. Hospital Marie Curie. Argentina.; (3)Nutritionist. Hospital Marie Curie. Argentina.

**Background and objectives:** During 2012 there were 14.1 million new cases of cancer, 8.2 million cancer deaths and 32.6 million people living with this type of disease. Malnutrition is the most common secondary diagnosis in cancer patients, with an incidence between 15-40% at the time of diagnosis and 80% in advanced disease; being one of the main causes of morbi-mortality.

To determine the alteration of malnutrition related factors in
pre-surgical cancer patients.

**Methods:** Descriptive, transversal. By direct questionnaire and pre-surgical Nutrition Assessment sheets of patients who consulted from January 2015 to August 2016, where data on age, sex, cancer location, weight, percentage of weight loss were evaluated. Biochemical determinations were analyzed, being these Albumin (g / dl), Lymphocytes/mm3, Total cholesterol (mg / dl) and Hemoglobin (g / dl). The Malnutrition´s Degree Assessment by CONUT method was used to diagnose malnutrition.

**Results:** The total sample was 589 patients, of which 291 presented alteration related to malnutrition (49.4%), being 86.3% (n = 251) of the female sex, and 13.7% (n = 40) male; ages ranging from 18 to 90 years (mean 52.07 years). Cancer location, endometrial or cervical 45.7% (n = 133), 27.1% breast (n = 79), head and neck 8.9% (n = 26), 5.5% ovary (n = 16), 4.8% gastrointestinal tract (n = 14), remaining 7.9% (n = 29) to other cancers. According to the Malnutrition´s Degree Assessment by CONUT method, 68.4% (n = 403) showed no malnutrition, 30.2% had mild malnutrition (n = 178) and 1.3% (n = 8) moderate malnutrition. No patient presented severe malnutrition. Regarding weight loss in the last 6 months, values ranged from 1.5% to 27%, with an average value of 8.74%.

**Conclusions:** Malnutrition was observed in more than 30% of the patients in the pre-surgical evaluation, predisposing to an increased risk of complications and being the major cause of morbidity and mortality in advanced cancer. An assessment of nutritional status will play a fundamental role in the pathogenesis of malnutrition risk in order to establish nutritional support strategies.

**Keywords:** Malnutrition - Cancer - CONUT

**Further collaborators:** Micaela Scuri.
# THE EFFECT OF PUNICIC ACID (POMEGRANATE SEED OIL) ON METALLOPROTEINASE GENES (MMP-1, 3) IN THP-1 CELLS STIMULATED WITH LPS COMPARED WITH STEROIDAL AND NON-STEROIDAL DRUGS

(1) Vazirijavid, Roya; (2) Vazirijavid, Roya; (3) magsodi, hossein.

(1) Royavazirijavid. Iran; (2) Payam Nor University In Biotecnology Department In Teran. Iran; (3) Department Of Biotechnology In Payam Nor University Tehran. Iran.

**Background and objectives:** Osteoarthritis is a common joint disease for which there are currently no disease-modifying drugs available. Osteoarthritis (OA) affects most of the elderly population, the main features of which are cartilage damage. Degradation of the cartilage extracellular matrix is a central feature of the disease and is widely thought to be mediated by proteinases that degrade structural components of the matrix, The matrix metalloproteinases (MMPs) are a family of 23 human zinc endopeptidases that play significant roles in inflammatory diseases such as osteoarthritis.

**Methods:** In this experiential laboratory study, punicic acid of pomegranate seed oil was purchased from Clarodan Kerman Co, representative of LCG Co. in Iran. K562 cells (Pasteur Institute of Iran) were cultured and were administered with densities of 8 to 100 µg/ml (in 24h, 48h, and 72h). Cellular toxicity of punicic acid against K562 leukemic cells was estimated using the MTT Method, and to measure the inhibitory effects of PA on Matrix metalloproteinase proteinase activity, ELISA and Western blot, migration and invasion was performed. Data were analyzed with using T.student and ANOVA.

**Results:** Western blotting and ELISA were showed inhibitory effect on the expression of MMP-1 but not in MMP-3. Punicic acid of pomegranate seed oil shows the most cellular toxicity effect at $lc50=50$ micrograms per milliliters and 72 hours after treatment.

**Conclusions:** According to effect of Punicic Acid on MMP-1 expression, this material can be used as a potential candidate for further studies on the other MMPS and its replacing the chemical drugs.

**Keywords:** Punicic Acid, MMP-1, 3, K562, Osteoarthritis

**Conflict of Interest Disclosure:** Cellular nutrition

**Further collaborators:** Pharmacology and nutrition

# THE EFFECT OF INGESTION OF THE AMAZON DIET ON ELDERLY NEUROPSYCHIATRIC PATIENTS

(1) de Souza Praia, Raquel; (2) Ribeiro, Euler Esteves; (3) Ribeiro, Euler Esteves; (4) Cruz, Ivana Beatrice Mânica da; (5) Bondim, Helena Figueiredo Felisbino Barbosa; (6) Oneti, Ciro Félix; (7) Mortágua, Andréa Rebouças; (8) Costa, Michelle Silva; (9) Furtado, Mônica Costeira Mendonça.

(1) Doutoranda em Saúde Pública. Universidade de Ciencias Empresariales y Sociales (UCES). Enfermeira. Universidade Aberta da Terceira Idade (UNATI/UEA/AM). Brasil.; (2) Médico. Doutorado em Medicina e Ciências da Saúde. Diretor da Universidade Aberta da Terceira Idade (UNATI/UEA). Manaus. Brasil.; (3) Médica. Doutorado em Ciências da Atividade Física e Desporte. Universidade Aberta da Terceira Idade (UNATI/UEA/AM). Brasil.; (4) Mestre e doutora em Genética e Biologia Molecular. Pós-doutorado na University of California, Davis-USA. Coordenadora do Programa em Gerontologia (UFSM). Universidade Aberta da Terceira Idade (UNATI/UEA/AM). Brasil.; (5) Enfermeira. Unidade de Reabilitação do Hospital Escola São Francisco de Assis- UFRJ. Brasil.; (6) Enfermeiro. Universidade Aberta da Terceira Idade (UNATI/UEA/AM). Brasil.; (7) Fisioterapeuta. Universidade Aberta da Terceira Idade (UNATI/UEA/AM). Brasil.; (8) Assistente Social. Especialista em Política Pública de Atenção a Família. Universidade Aberta da Terceira Idade (UNATI/UEA/AM). Brasil.; (9) Advogada. Assistente social. Diretora da 1ª Vara da Família do Tribunal de Justiça do Amazonas (TJAM). Brasil.

**Background and objectives:** Changes in the nutritional condition of the elderly may be related to the aging process and / or pathological processes. With regard to the psychological aspect of this elderly person, the manifestation of neuropsychiatric disorders may also impair good nutrition. The fact that some also present underlying diseases reinforces the need for supply and nutrient balance, which can be found in foods of native cooking. Objective: to investigate the action of the Amazon diet during the period of home care for the elderly using psychotropic drugs.

**Methods:** It is an observational study in loco, to determine the effect of the food intake of the Amazonian diet on the improvement of signs and symptoms of adverse reactions to the use of psychotropics, by the elderly, with moderate and high risk for fragility.

**Results:** Some of the foods in the Amazon diet have natural compounds that may have activity in the fight against cardiometabolic diseases, chronic non-transmissible diseases, due to its antioxidant, anti-inflammatory, cholesterol-lowering, polyphenol-rich properties. The elderly, accompanied by the Pilot Health at Home Project and who presented neuropsychiatric disorders, were cared for by a multiprofessional team and oriented to the Amazonian diet, according to the categorization of Ribeiro and Cruz (2012) in fruits, flours and fish, and Its effects on health, quality of life, optimal amount of nutrient intake. It was verified that the elderly who started to insert in their daily food the native cuisine, have reported improvement of the symptoms related to the adverse effects of the administered psychotropics. The nutritional evaluation by
the health professionals of the team also showed improvement of nutritional standards, lipid profile, glucose, blood pressure, and self-esteem improvement.

**Conclusions:** Nutrition for the elderly population needs to be carefully discussed by the health team, especially when these elderly people use psychotropic drugs that are almost always associated with other medications. In view of the diversity and peculiarity of food in the Amazon region, the study also reveals the importance of the health team in the region to be bringing this information to the population and carrying out actions aimed at native nutritional education.

**Keywords:** Amazon diet; psychotropic drugs; elderly

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DAIRY PRODUCTS CONSUMPTION AND RISK OF COLORECTAL CANCER INCIDENCE IN AN ELDERLY MEDITERRANEAN POPULATION AT HIGH CARDIOVASCULAR RISK

(1)Babio Sánchez, Nancy Elvira; (2)Barrubés, Laura; (2)Mena-Sánchez, Guillermo; (3)Toledo, Estefania; (4)Corella, Dolores; (5)Estruch, Ramón;

(6)Ros, Emilio; (7)Fitó, Montse; (8)Arós, Fernando; (9)Salas-Salvadó, Jordi.

(1)PhD. BSc. Nutritionist. Human Nutrition Unit. Faculty of Medicine and Health Sciences. Biochemistry and Biotechnology Department. Rovira i Virgili University. Sant Joan Hospital de Reus. IISPV. Reus. CIBEROBN. ISCIII. Madrid. Spain; (2)RD. Human Nutrition Unit. Faculty of Medicine and Health Sciences. Biochemistry & Biotechnology Department. Rovira i Virgili University and Sant Joan de Reus Hospital. IISPV. Reus. Spain;

(3)MD. PhD. Department of Preventive Medicine and Public Health. University of Navarra-Navarra Institute for Health Research. Pamplona. CIBEROBN. ISCIII. Madrid. Spain.; (4)D.Pharm. PhD. Department of Preventive Medicine. University of Valencia. Valencia. CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN). Instituto de Salud Carlos III (ISCIII). Madrid. Spain.;

(5)MD. PhD. Department of Internal Medicine. Hospital Clínic. University of Barcelona. Barcelona. August Pi i Sunyer Biomedical Research Institute (IDIBAPS). Barcelona. Spain. CIBEROBN. ISCIII. Madrid. Spain; (6)MD. PhD. Department of Lipids. Hospital Clínic. University of Barcelona. Barcelona. Spain. August Pi i Sunyer Biomedical Research Institute (IDIBAPS). Barcelona. CIBEROBN. ISCIII. Madrid. Spain; (7)MD. PhD. Cardiovascular Risk and Nutrition Research (REGICOR Group). Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Barcelona. CIBEROBN. ISCIII. Madrid. Spain; (8)MD. PhD. Department of Cardiology. University Hospital Araba. Vitoria. Spain. CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN). Instituto de Salud Carlos III (ISCIII). Madrid. Spain.; (9)MD. PhD. Human Nutrition Unit. Faculty of Medicine and Health Sciences. Biochemistry & Biotechnology Department. Rovira i Virgili University and Sant Joan de Reus Hospital. IISPV. Reus. Spain. CIBEROBN. ISCIII.

**Background and objectives:** The inverse association between total dairy and milk consumption and the risk of develop-

ing colorectal cancer (CRC) has been previously reported in several prospective studies. Nonetheless, evidences regarding to dairy subtypes are scarce and inconsistent.

The objective was to assess the associations between total dairy and different dairy subtype consumption and the risk of developing CRC in a Mediterranean population at high cardiovascular risk.

**Methods:** We prospectively analyzed data from 7216 men and women (aged 55-80 y) without CRC at baseline from the PREVención con DIeta MEDITerránea (PREDIMED) study. Individuals were recruited between October 2003 and June 2009, and the intervention lasted until December 2010. However, the present analysis was based on an expanded follow-up until 2012. At baseline and yearly thereafter, total and specific dairy subtypes were repeatedly measured by using a 137-item validated food-frequency questionnaire. Time-dependent Cox proportional hazards models were conducted.

**Results:** During a median [inter-quartile range] follow-up of 6.4 [5.0-7.7] years, we documented and confirmed 101 incident cases of CRC. In the multivariable-adjusted model, HRs (95% CI) of CRC for the comparison of extreme tertiles of dairy product consumption were 0.50 (0.29-0.89) for total dairy consumption, 0.53 (0.31-0.89) for low-fat dairy, 0.52 (0.31-0.89) for total milk and 0.47 (0.27-0.83) for low-fat milk. No significant associations were found with other dairy subtype consumption.

**Conclusions:** The higher consumption of total dairy, low-fat dairy, total milk and low-fat milk was significantly associated with a reduced risk to develop CRC in Mediterranean individuals at high cardiovascular risk. The trial was registered at controlled-trials.com as ISRCTN35739639

**Keywords:** Colorectal cancer, Mediterranean diet, dairy, milk, PREDIMED study

**Conflict of Interest Disclosure:** Dr Nancy Babio declares that she received payments from Danone S.A. for the purposes of scientific and technical consulting, but not for the preparation of this study.

Professor Jordi Salas-Salvadó declares that he is a member of Danone S.A.'s Advisory Board, a member of the Danone Institute, and that he received payments from Danone S.A. for the purposes of scientific and technical consulting, but not for the preparation of this study.

The other authors declare that they have no conflicts of interest.

**Further collaborators:**

Miquel Fiol. MD. PhD. José Lapetra. MD. PhD. Lluís Serra-Majem. MD. PhD. Xavier Pintó. MD. PhD. Miguel Ángel Martínez-González. MD. PhD. José Vicente Sorlí. MD. PhD. Josep Basora. MD. PhD.
## FERMENTED DAIRY, DIET QUALITY DIET AND CARDIO-METABOLIC PROFILE IN A MEDITERRANEAN COHORT AT HIGH CARDIOVASCULAR RISK (CVR)

(1)Mena-Sánchez, Guillermo; (1)Mena-Sánchez, Guillermo; (2)Babio Sánchez, Nancy Elvira.

(1)PhD. Nutritionist. Human Nutrition Unit. Department of Biochemistry & Biotechnology. School of Medicine. Rovira i Virgili University. Reus, Spain.; (2)Doctor. Nutritionist. Human Nutrition Unit. Department of Biochemistry & Biotechnology. School of Medicine. Rovira i Virgili University. Reus, Spain.

**Background and objectives:** Fermented dairy products, such as yoghurt and cheese are usually consumed in Mediterranean diet. Their consumption has been associated with a better diet quality and a healthier metabolic profile in healthy adults. However, the relative contributions of fermented dairy products concerning diet quality and the prevalence of metabolic syndrome (MetS) components have not been yet fully studied in a Mediterranean population at high CVR.

**Objective:** To determine the association between fermented dairy product intake, quality diet profile and the prevalence of MetS components in a Mediterranean population at high CVR.

**Methods:** Cross-sectional analyses were performed on baseline data from 4,230 Spanish adults (aged 55-75y in men; 60-75y in women) with overweight/obesity and MetS, from October 2013 to October 2016, in the PREDIMED-PLUS trial. Multivariable-adjusted Cox regressions with robust variance and constant time (given the cross-sectional design) were fitted. The highest vs. the lowest quartiles (as reference category) of total fermented dairy products consumption, yogurt and cheese were compared.

**Results:** Comparing the highest and the lowest of fermented dairy products showed a better quality of diet. The highest consumers scored higher in the 17-point Mediterranean Diet Adherence Questionnaire and also they reported more consumption of fruit, vegetables, fish, nuts but less alcohol, cereals, cookies. Highest vs. lowest consumers of fermented dairy products showed higher HDL-cholesterol, lower plasma triglycerides concentrations and lower systolic and diastolic blood pressure.

Comparing the highest vs. reference quartile, the total fermented dairy, total yogurt and low-fat yogurt consumption were associated with 8% [0.92(95%CI: 0.88-0.97); P-trend <0.001], 7% [0.93(95%CI: 0.87-0.98); P-trend= 0.001] and 8% [0.92(95%CI: 0.87-0.96); P-trend = 0.002] lower risk of high blood pressure, respectively. Total fermented dairy and cheese were associated with 13% [0.87(95% CI 0.76-0.98); P-trend = 0.009] and 8% [0.82(95% CI 0.73-0.92); P-trend <0.001] lower risk of hypertriglyceridemia. Individuals allocated of the highest quartile of cheese consumption were associated with 13% lower risk of low HDL-cholesterol prevalence [0.87 (95% CI 0.78-0.97); P-trend = 0.017].

**Conclusions:** In the context of a Mediterranean diet, fermented dairy products were inversely associated with some of the MetS components and a better quality diet in individuals at CVR.

**Keywords:** Fermented dairy, yogurt, cheese, metabolic syndrome, quality diet.

**Conflict of Interest Disclosure:** Dra. Nancy Babio Sánchez declares that she received payments from Danone S.A. for the purposes of scientific and technical consulting, but not for the preparation of this document.

Professor Jordi Salas-Salvadó declares that he is a member of Danone S.A.'s Advisory Board, a member of the Danone Institute, and that he received payments from Danone S.A. for the purposes of scientific and technical consulting, but not for the preparation of this document.

Sr. Guillermo Mena Sánchez declares that he has no conflict of interest.

**Further collaborators:** Jordi Salas-Salvadó

## NAIP EXPRESSION INCREASES IN RAT'S LIVER RE-GENERATION

(1)Plaza-Díaz, Julio; (2)Toribio Castello, Sofia; (2)Moron Calvente, Virginia; (3)Saez-Lara, Maria Jose; (4)Robles Sanchez, Candido;

(5)Fontana, Luis; (6)Abadia Molina, Francisco.

(1)Ph D in Biochemistry and Molecular Biology/ Dept. Biochemistry & Molecular Biology II. School of Pharmacy and Institute of Nutrition and Food Technology "José Mataix". Biomedical Research Center. University of Granada. Spain; (2)MSc. Department of Cell Biology. School of Sciences. University of Granada. Spain.; (3)PhD. Department of Biochemistry and Molecular Biology I. School of Sciences. University of Granada. Spain.; (4)MSc. Institute of Nutrition and Food Technology "José Mataix". Biomedical Research Centre. University of Granada. Spain; (5)PhD. Department of Biochemistry and Molecular Biology II. School of Pharmacy. University of Granada. Spain.; (6)PhD. Department of Cell Biology. School of Sciences. University of Granada. Spain.

**Background and objectives:** NAIP (NLR family apoptosis inhibitory protein) belongs to the IAP (Inhibitor of Apoptosis Protein) and NLR (NOD-Like Receptor protein) families. As a receptor of pathogen/damaged associated molecular patterns (PAMPs/DAMPs), NAIP is involved in the innate immune response, and is also a fundamental component of the NLRC4 inflammasome. As such, NAIP participates in caspase-1 activation leading to inflammatory cytokine secretion. Recently, our research group has reported the implication of NAIP in cell proliferation. The aim of this study was to analyze NAIP expression in the hepatic regenerative process.

**Methods:** Eight female Wistar rats weighing 260 g were used. The major liver lobe of the rats was removed. Hepatectomized rats were sacrificed 3 days (n=4) and 7 days (n=4) after surgery, and pieces from both regenerated and healthy liver were taken. Total RNA and proteins were extracted and analyzed by qRT-PCR and western blotting, respectively.

**Results:** NAIP mRNA showed a 3-fold increase at day 3 after hepatectomy, and a 2-fold increase at day 7 after hepatectomy. NAIP protein levels exhibited a 2-fold higher expression in the re-
activity. Children living at high altitude in San Antonio de los Co-
bres (SAC), Argentina, were shown to have lower HDL-cholesterol
(HDL-C) levels than children from Buenos Aires (BA) who live at
sea level. However, no prior study has analyzed PON 1 status in
children exposed to high altitude.

Objective: To compare PON-1 activities in SAC versus BA chil-
dren.

**Methods:** A cross-sectional study compared 158 SAC versus 97 BA children (6-16 years). Anthropometric parameters, lipoprotein profile, and PON1 activities were evaluated. PON1 was measured employing paraoxon (PON activity) and phenylacetate (ARE activity) as substrates, given that PON activity better reflects the intrinsic antioxidant activity and ARE activity better correlates with the enzymatic concentration.

**Results:** The prevalence of overweight/obesity was signifi-
cantly lower in SAC than in BA children (18.3 vs. 30.9%; p<0.01).
Triglycerides (1.34 vs. 0.90 mmol/L; p<0.01), apo B (0.84 vs.0.72
g/L; p<0.01) and apo A-I (1.33 vs. 1.27 g/L; p<0.01) levels were
significantly higher, while HDL-C (1.16 vs. 1.32 mmol/L; p<0.01)
concentration was significantly lower in SAC than in BA children.
PON activity was significantly lower (170 vs. 203 nmol.ml-1.
min-1; p<0.05), ARE activity higher (100 vs. 90 µmol.ml-1min-1;
p<0.01) and PON/ARE ratio lower (1.7 vs. 2.2; p<0.05) in SAC
compared with BA. Separate multiple linear regression analyses
showed that all the above mentioned differences persisted even af-
ter adjusting for age, gender, and BMI.

**Conclusions:** SAC children showed an unfavorable lipoprotein profile, except for higher apo A-I levels compared with BA children. Furthermore, they presented lower PON and higher ARE activities. The presence of higher ARE activity and apo A-I concentration in combination with lower PON activity and HDL-C levels would be indicative of unaltered HDL particle number but deficient antioxidant function and capacity to promote cell cholesterol efflux.

**Keywords:** Paraoxonase 1, HDL, High altitude, Apolipoprotein A-I

ent effect of protein intake on skeletal muscle hypertrophy and the
role of circadian rhythm for its effect.

**Methods:** Six-week-old male ICR and Clock mutant mice were kept under 12h light/dark cycle (Light was turned on at ZT0 and off at ZT12). Mice were fed the 2g meal twice a day at ZT12 (the beginning of active phase) and ZT20 (the end of active phase), which were defined as breakfast and supper, respectively. The overloading of plantaris muscle was induced by unilateral surgical removal of the distal tendon of soleus and gastrocnemius muscles, while contralateral leg was sham-treated on day 7 after twice meals per day schedule. The plantaris muscles were collected on day 14. Study1: Breakfast protein group (Breakfast-P) was fed 20% casein diet at breakfast and 3% casein diet at supper. Even protein group (Even-P) was fed 11.5% casein diet at each meal. Supper protein group (Supper-P) was fed 3% casein diet at breakfast and 20% casein diet at supper. Study2: Breakfast BCAA (Breakfast-B) and supper BCAA (Supper-B) groups were fed the BCAA-containing 3% casein diet (equivalent to BCAA of 20% casein diet) at breakfast and supper, respectively. Study3: Clock mutant mice were kept under the same feeding condition as the study1 and 2.

**Results:** Study1: The muscle growth rate (Overloading muscle / sham-treated muscle weight) in Breakfast-P was higher than that in Even-P (P=0.09) and Supper-P (P<0.05). Study2: Breakfast-B produced higher growth rate than Supper-B. The greater effect of Breakfast-B was not observed in the intake of other amino acids. Study3: The increases of muscle growth rate in mice fed protein and BCAA at breakfast were not also observed in the clock mutant mice.

**Conclusions:** These results suggested that protein intake for
breakfast accelerated muscle hypertrophy, and BCAA and circadi-
an rhythm were involved in such effects.

**Keywords:** chrono-nutrition, skeletal muscle, protein, BCAA, circadian rhythm

**Further collaborators:** This work was partially supported by the council for Science, Technology and Innovation, SIP, "Technologies for creating next-generation agriculture, forestry and fisheries" (funding agency: Bio-oriented Technology Research Advancement Institution, NARO).

144/2626

EFFECTS OF TIME-RESTRICTED PROTEIN FEEDING ON SKELETAL MUSCLE HYPERTROPHY IN MICE

(1)Aoyama, Shinya; (2)Tanaka, Mizuho; (3)Shimoda, Takeru; (3)Kojima, Shuichi; (3)Sasaki, Keisuke; (4)Shibata, Shigenobu.

(1)PhD. Dietitian. Organization for university research initiative. Waseda university. Japan; (2)MSc. School of advanced science and engineering. Waseda university. Japan; (3)BSc. School of advanced science and engineering. Waseda university. Japan;
(4)PhD. School of advanced science and engineering. Waseda university. Japan.

**Background and objectives:** Dietary protein enhances
muscle protein synthesis. It has not been fully elucidated about
the effects of timing or distribution of protein intake on skeletal
muscle mass, although the amount of protein intake for breakfast
is known to be small in a day. We investigated the time-depend-

144/2628

RECENT ADVANCES IN FORTIFICATION OF RICE – A
REVIEW

(1)Hackl, Laura; (2)Zimmermann, Michael Bruce; (3)Moretti, Diego.

(1)Mag. pharm. Pharmacist/ PhD candidate. Laboratory for Human Nutrition. Institute of Food. Nutrition and Health. ETH Zürich. Zurich. Switzerland.; (2)2 Dr. med. Professor. Laboratory for Human Nutrition. Institute of Food. Nutrition and Health. ETH Zürich. Zurich. Switzerland.; (3)Dr. Senior Scientist. Laboratory for Human Nutrition, Institute of Food. Nutrition and Health. ETH Zürich. Zurich. Switzerland.

**Background and objectives:** Rice is a staple food for more
than half the world's population, however, it is a poor source of
micronutrients in its milled form. Iron deficiency (ID) and other
micronutrient deficiencies are prevalent in many rice consuming
countries. Rice fortification is one of the remaining frontiers in food fortification and is particularly technically challenging as rice is consumed as intact grains and due to its white color. Iron fortification of rice can be an approach to combat ID in rice-consuming populations. Commonly used techniques for rice fortification are extrusion or coating with iron phosphates as iron source resulting in sensory acceptable fortified rice grains. However, iron bioavailability from those compounds is low. It is thus crucial to identify micronutrient formulations that increase human iron bioavailability while maintaining acceptable sensory properties.

Our objective is to present a narrative overview of the field of rice fortification including recent advances, identify knowledge gaps and research priorities to ensure optimal nutrient composition for rice fortification formulations.

**Methods:** A systematic review of the literature was conducted by searching public databases such as Pubmed, Web of Science and Scopus for relevant terms. We appraise currently used iron compounds and formulations to increase iron absorption, compare recent findings on iron bioavailability from fortified rice, evaluate fortification techniques regarding the acceptability of the fortified product and their applicability in different settings and suggest directions for further research.

**Results:** Fortified rice is a suitable vehicle to deliver bioavailable iron, zinc, vitamins B12 and A. Recent studies suggest optimized rice formulations containing iron chelators to substantially increase iron bioavailability, thus owning the potential to counteract ID in rice consuming populations.

**Conclusions:** The chosen fortification technique can affect nutrient bioavailability likely due to transformations in the starch microstructure. More data are required to further optimize the fortification technology regarding nutrient delivery and bioavailability in humans.

**Keywords:** Iron deficiency. Rice. Fortification. Iron. Micronutrient deficiencies.

144/2651

EFFECT OF THE YACON (SMALLANTHUS SONCHIFOLIUS) IN GLYCEMIC PROFILE OF THE WISTAR RATS

**Background and objectives:** Yacon is considered a functional food, which has among its properties a hypoglycemic capacity. The aim of this study was to evaluate the modulatory effect of yacon in the glycemic profile of Wistar rats.

**Methods:** The experiment lasted 60 days with 32 animals. It was used the dehydrated food matrix (yacon powder / YP) added to the diet of the groups that received intervention in the dose of 7.5% of inulin type fructan (ITF). The analyzed variables were: centesimal composition and content of inulin type frutans, weight gain, relative weight of cecum (RWC), food consumption, coefficient of food efficiency and glycemia. All analyzes followed the AOAC protocols. In the statistical analysis, the following tests were used: ANOVA or Kruskal Wallis followed by comparison tests of means, t test and paired t test. The level of statistical significance was p <0.05 for all analyzes. This study was approved by the Ethics Committee on the Use of Animals of the Federal University of Alfenas, protocol no. 698/2015.

**Results:** The results showed that the control group receiving YP had a significant reduction in glycemic values. In all groups receiving YP there was a significant increase of cecum, as expected. The development of diabetes was not observed due to the use of streptozotocin with 35% sucrose.

**Conclusions:** Therefore, the evaluation of the effect of yacon on hypoglycaemia has been impaired. This suggests that studies in this line are encouraged for further elucidations.

**Keywords:** Glycemia, Rats, FOS and Inulin.

144/2655

COMMUNITY PERCEPTIONS ON THE NEW ROLE OF TRADITIONAL BIRTH ATTENDANTS AS BIRTH COMPANIONS AND NUTRITION ADVOCATES IN KAKAMEGA COUNTY, KENYA: A QUALITATIVE STUDY

**Background and objectives:** There is consensus that delivery at health facility assisted by skilled birth attendant is priority for reducing maternal mortality in areas with poor access to health facilities. Traditional Birth Attendants (TBAs) are known to conduct deliveries in such set-ups. One key intervention is the re-orientation of TBAs as birth companions for women to deliver at health facilities. The objective of this study was to explore community perceptions on the new role of TBAs as birth companions and nutrition advocates and their influence on health facility delivery.

**Methods:** This was qualitative component of an evaluation part of an intervention study whose aim was to reduce maternal mortality through increased health facility delivery. The study was

<footnote>(1) Vasconcelos, Debora; (2) Goulart de Souza e Silva, Thaiay; (3) Henrique Costa, Lellis; (4) Aparecida Almeida Paula, Hudsara.</footnote>

<footnote>(1) PhD. Student in Biosciences Applied to Health. Nutritionist. Federal University of Alfenas. Brazil.; (2) BSc. Student in Nutrition. College of Nutrition. Federal University of Alfenas. Brazil.; (3) MSc in Pharmaceutical Sciences. Pharmaceutical. Federal University of Alfenas. Brazil.; (4) PhD in Food Science and Technology. Nutritionist. Professor of the College of Nutrition. Federal University of Alfenas. Brazil.</footnote>

<footnote>(1) Anono, Esther; (2) Ochola, Sophie; (3) Wawire, Salome; (4) Ogada, Irene; (5) Ndedda, Crispin; (6) Kung'u, Jacqueline.</footnote>

<footnote>(1) BSc. Researcher. Department of Food Nutrition and Dietetics. Kenyatta university. Kenya.; (2) PhD. Senior Lecturer and Chairman. Department of Food, Nutrition and Dietetics. Kenyatta University. Kenya.; (3) PhD. Independent Researcher Medical Anthropology and Demography. Kenya.; (4) PhD. Lecturer. Department of Food, Nutrition and Dietetics. Kenyatta University. Kenya.; (5) MSc. Senior Programme Officer Maternal and New Born. Micronutrient Initiative. Kenya.; (6) PhD. Regional Advisor Research and Evaluation Africa. Micronutrient Initiative. Kenya.</footnote>
composed of intervention and control groups. Data was collected in both study groups through Key Informant Interviews with health workers and Focus Group Discussions with lactating and pregnant women, fathers, community leaders, Community Health Volunteers and TBAs. Data was analyzed through content analysis and was organized into sub-themes and conclusions made from each sub-theme using the Atlas ti software.

**Results:** In the intervention group, the re-oriented TBAs adopted their new role with ease as the majority offered companionship to mothers to deliver at health facilities. This led to increased health facility deliveries as reported by nurses and community members. The mothers and the community members were happy with the new role of the TBAs. They reported that the TBAs accompanied the women to deliver at the health facilities and offered them companionship after delivery. In contrast, TBAs did not adopt the nutrition advocacy role sufficiently. In comparison group majority of the TBAs continued with their traditional roles of delivering women at home. However, few of them were reported to advise mothers to seek skilled help after community sensitization by the health workers.

**Conclusions:** It is feasible and acceptable to mothers, community and the TBAs to be utilized as birth companions to increase health facility delivery. Nutrition advocacy by the TBAs should be strengthened to maximize on the opportunity provided by the close association between TBAs and mothers and the community.

**Keywords:** Birth Companion. Nutrition Advocate. Skilled Birth Attendant. Traditional Birth Attendant.

**Background and objectives:** Vitamin K (VK) plays as a coenzyme for γ-glutamylcarboxylase and regulates blood coagulation system and bone formation via γ-glutamylcarboxylation of VK dependent proteins. VK1 is found in vegetables, and VK2 significantly in fermented-food products and animal meats. Ingested VK is known to be converted to menaquinone-4 (MK-4, a kind of VK2) in several tissues including pancreas and liver. Although this conversion is effectively occurred and the large amount of MK-4 is accumulated in pancreas, the role of MK-4 has not been well elucidated. Epidemiological researches suggested that VK intake correlated with plasma glucose and insulin levels. Here we examined the effect of VK deficient diet on glucose metabolism in genetically diabetic mice.

**Methods:** Male KK-Ay mice (4 weeks old) were divided into two groups and fed AIN-93G based standard diet (Cont group) or VK free diet (K free group) for 60 days. During the experimental period, their body weight, food intake, and plasma glucose level were measured. We performed oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) on 33rd and 41st day of feeding, respectively. Mice were sacrificed after the experimental period, and their serum and organs were obtained. The VK contents in organs were measured by fluorescent-HPLC and mRNA levels of gene involved glucose metabolism in liver and pancreas were also analyzed by quantitative RT-PCR.

**Results:** During the experimental period, plasma glucose level was higher in K free group compared to Cont group. Severer glucose intolerance and insufficient insulin secretion were observed in K free group in OGTT. Pancreatic VK level was significantly lower in K free group.

**Conclusions:** Our results suggested that feeding of VK deficient diet reduces MK-4 content in pancreas and leads to the lowering of glucose-induced insulin secretion in diabetic mice.

**Keywords:** Vitamin K. menaquinone-4. glucose metabolism. diabetes.

**Background and objectives:** Interaction between foods and drugs may inadvertently reduce or increase the effect of drug. Adverse effects of clinically relevant food-drug interactions are caused by food-induced changes in the bioavailability of the drug. The bioavailability of drug is tightly regulated by xenobiotic/drug metabolism system. The expression of genes involved in xenobiotic/drug metabolism is transcriptionally regulated by pregnane X receptor (PXR). PXR is a ligand-dependent nuclear receptor that functions as a xenobiotic sensor. PXR is activated by a diverse array of pharmaceutical agents and also nutrients. Therefore, our present study focused on vitamin K2 that is known as a PXR ligand, and investigated vitamin K2-drug interaction in cultured human colon cancer cells.

**Methods:** Human colon adenocarcinoma LS180 cells were treated with menaquinone-4 (MK-4), one of vitamin K2, and rifampicin (Rif), a typical ligand of PXR, and then expression levels of drug-metabolizing genes were measured by qRT-PCR and western blot analysis. The ligand-induced PXR activation was also analyzed with reporter gene assay.

<footnote>(1)Shirakawa, Hitoshi; (2)Hirahara, Keisuke; (2)S, Masayori; (3)Giriwono, Puspo E.; (2)Katsurai, Tomoko; (3)Goto, Tomoko; (3)Komai, Michio.</footnote>

<footnote>(1)PhD. Associate Professor. Laboratory of Nutrition. Graduate School of Agricultural Science. Tohoku University. Japan.; (2)MSc. Laboratory of Nutrition. Graduate School of Agricultural Science. Tohoku University. Japan.; (3)PhD. Laboratory of Nutrition. Graduate School of Agricultural Science. Tohoku University. Japan.</footnote>

<footnote>(1)Shirakawa, Hitoshi; (2)Sultana, Halima; (2)Kato, Ayaka; (3)Goto, Tomoko; (3)Komai, Michio.</footnote>

<footnote>(1)PhD. Associate Professor. Laboratory of Nutrition. Graduate School of Agricultural Science. Tohoku University. Japan.; (2)MSc. Laboratory of Nutrition. Graduate School of Agricultural Science. Tohoku University. Japan.; (3)PhD. Laboratory of Nutrition. Graduate School of Agricultural Science. Tohoku University. Japan.</footnote>
**Results:** MK-4 significantly upregulated mRNA levels of CYP3A4 and MDR1 in dose- and time-dependent manner. Reporter activity from luciferase construct that has PXR binding element in its promoter was also increased by MK-4 treatment. These enhancements were abolished by PXR-targeted siRNA. These results indicated that MK-4 stimulates mRNA expression of CYP3A4 and MDR1 through PXR. In western blot analysis, MK-4 increased MDR1 protein levels whereas decreased CYP3A4 levels. Cotreatment with MK-4 and Rif showed synergistically enhanced mRNA expression of both genes.

**Conclusions:** These results suggested that MK-4 modulate drug-metabolizing genes and may cause inadvertent effects of prescribed medicines.

**Keywords:** Vitamin K. PXR. drug-metabolism

144/2829

A MACRO AND MICRONUTRIENT FORTIFIED
COMPLEMENTARY FOOD SUPPLEMENT EN-
HANCES PLASMA BRANCHED-CHAIN AMINO
ACID LEVELS IN GHANAIAN INFANTS

**Background and objectives:** A significant association was reported between stunting and low circulating levels of essential amino acids (AA). The study objectives were to examine the effect of providing a macro-micronutrient fortified complementary food supplement (energy, fat, protein, the essential amino acid lysine and micronutrients) called KOKO Plus on plasma AA in Ghanaian infants under two years of age.

**Methods:** This is a secondary analysis from a single blind cluster randomized controlled trial conducted in rural Ghana to examine the effect of KOKO Plus on linear growth. Thirty-eight communities (903 infants) were randomly assigned to KOKO Plus with nutrition education (KKP) or a multiple micronutrient powder with nutrition education (MN) or nutrition education only groups (NE) (n=301/group). KKP and MN supplements were delivered weekly with one sachet used daily. Infants were enrolled at 6 months of age and graduated at 18 months of age with blood sampling at 6 (baseline), 12 (midline) and 18 (endline) months. Plasma samples were separated, deproteinized and AA was measured using the ninhydrin method. Mixed models with adjusted for baseline concentration AA and clustering as random effects examined the effect of intervention.

**Results:** Adjusting for baseline AA, plasma levels of total branched-chain AA (BCAA) were significantly higher at midline

and endline in the KKP and NE but not the MN group. Difference in difference between groups were; KKP-MN = 30.3 µM (95% confidence interval (CI) 12.3 to 48.2), p<0.001, NE-MN = 17.9 µM (95% CI -0.1 to 36.0), p=0.052 at midline and KKP-MN = 23.6 µM (95% CI 5.7 to 41.4), p=0.005, NE-MN = 22.4 µM (95% CI 4.5 to 40.4), p=0.009 at endline. Modeling by number of supplements consumed showed increases in plasma BCAA with increase in KKP supplement but not MN.

**Conclusions:** Infants in the KKP group had enhanced plasma BCAA level in Ghanaian infants compared to the MN group alone. A dose response is observed with higher the consumption in the KKP group leading to a higher BCAA level. BCAA have been linked to impaired growth and neurodevelopment in neonates. Further analysis is needed to understand the nature of the relationship with linear growth in these infants.

**Keywords:** protein, lysine, amino acids, linear growth, stunting

**Conflict of Interest Disclosure:** Wataru Sato, Chie Furuta, Hitoshi Murakami are employees of Ajinomoto Co. Inc.

144/2939

GENETIC TESTING FOR WEIGHT LOSS COUN-
SELING

**Background and objectives:** Most known dietary strategies or weight loss are aimed to reduce calories and increase physical activity. Standard treatments of dietary modification with various amounts of protein, carbohydrates and fat work for most but not all overweight patients. Obese patients are especially quick to stop treatment if they don't see an immediate response. Responses by individuals are highly variable. In addition to behavior modification, genetic evaluation based on metabolic genotypes has been found helpful in understanding which dietary and activity recommendations are a best fit for long term weight management. Individual variations in genes can affect nutrient transport and metabolism. This study

will investigate whether the inclusion of genetic information to personalize patients' diet can improve weight management after a 4 month intervention.

**Methods:** Twenty obese patients who have had difficulty losing weight will be offered a genotype test

screening for over 40 variants in genes that affect macro- and micro-nutrient utilization, and influence physiological response to exercise. Patients will volunteer and be selected based on a weight loss in past four months of 5 pounds or less. Gene assays will be collected by oral swab. Fasting blood sugar, lipid profile and A1c

<footnote>(1)Sato, Wataru; (2)Furuta, Chie; (3)Murakami, Hitoshi; (4)Suri, Devika;</footnote>

<footnote>(5)Otoo, Gloria; (5)Tano-Debrah, Kwaku; (6)Ghosh, Shibani.</footnote>

<footnote>(1)MSc. Institute for Innovation. Ajinomoto Co., Inc. Japan.;</footnote>

<footnote>(2)DVM. PhD. Institute for Innovation. Ajinomoto Co., Inc. Japan.;</footnote>

<footnote>(3)PhD. Institute for Innovation. Ajinomoto Co., Inc. Japan.; (4)MSc. MPH. Friedman School of Nutrition Science and Policy. Tufts University. USA.; (5)PhD. Department of Nutrition and Food Science. University of Ghana. Ghana.; (6)PhD. Nevin Scrimshaw International Nutrition Foundation. USA.</footnote>

<footnote>(1)James, Kathy; (2)Matsangas, Panagiotis; (3)Connelly, Cynthia.</footnote>

<footnote>(1)DNSc. Nurse Practitioner. Associate Professor of Nursing. University of San Diego.Hahn School of Nursing and Health Sciences. California. USA; (2)PhD. National Research Council Postdoctoral Associate. Operations Research Department. Naval Postgraduate School. Monterey. California. USA; (3)PhD. Professor of Nursing. University of San Diego Hahn School of Nursing and Health Science. San Diego. California. USA.</footnote>
will be obtained for all participants along with blood pressure, waist measure and body fat composition and demographic information. Surveys on stress, self efficacy for nutrition and physical activity and binge eating will be completed. Patients will follow the diet recommended for their gene specificity. Weight loss and measures will be compared at four months with prior measurements. Outcome measures will be BMI, weight, waist measure, changes in

lipid profile, A1C, fasting blood sugar.

**Results:** In progress.

**Conclusions:** Findings will help provide support for use of genetic nutrient testing in patient assessments.

**Keywords:** genetic-testing, obese, nutrition, activity

solutions. Future studies on the subject should consider their performance in athletes since their physical condition allows exercise for longer periods of time and therefore the generation of greater metabolic changes that lead to significant variations of sweetness preferences.

**Keywords:** Excersise, intensity, nutrition, glucose test

144/3042

THE EFFECT OF TWO INTENSITIES OF ACUTE PHYSICAL EXERCISE ON THE PREFERENCE FOR SWEET TASTE OVER REST

(1)Espinosa, Alejandra; (2)Miranda, Camila; (3)Aravena, Javiera.

(1)MSc. Nutricionista. Universidad Católica de Chile. Chile;

(2)Estudiante de Nutricion. Universidad Católica de Chile. Chile;

(3)Estudiante de Nutrición. Universidad Católica de Chile. Chile.

**Background and objectives:** At a higher intensity of physical exercise, the preference for glucose solutions will be greater with respect to rest.

- Determine the taste preference according to the intensity of the exercise

**Methods:** Twelve healthy subjects with the following characteristics were evaluated: 18-23 years of age, sedentary, with normal nutritional status, without drug consumption and nonsmokers; pregnant and breastfeeding mothers were excluded. Subjects were cited on three occasions. In the first session, anthropometric, residual heart rate and maximum aerobic capacity measurements were performed according to the Bruce Protocol, in addition to the application of the 24-hour Reminder ingestion survey.

In the second and third sessions, subjects underwent static exercise on two different intensities at 50% VO2max and 85% VO2max. For 20 and 10 minutes respectively, in addition to determining the preference for sweet taste before and after physical exercise. Preference for sweet taste: it was determined by the Mohnell Test, which consists in giving the subject pairs of glasses with alternating glucose solutions in increasing and decreasing order, this should indicates the preference for each pair of glasses. The latter had 10 cc of solution, prepared with distilled water and glucose up to 3%, 6%, 12%, 24% and 36%.

**Results:** The preference for sweet taste (PSD) after exercise decreased significantly in high intensity physical exercise (p 0.02). When evaluating the relationship between sweet taste preference, time (before and after exercise) and intensity of exercise (50% VO2max and 85% VO2max), no significant differences were found (p 0.93).

**Conclusions:** It was not possible to verify that to a greater intensity of physical exercise, there is a greater preference for sweet
## Track 2: Nutrition Through Life Course

144/220

### CARBOHYDRATES CONTENT AND GLYCAEMIC INDEX OF THREE TRADITIONAL CAMEROONIANS MEALS

(1)EtoundiOmgba, Cunégonde Blanche; (2)Mbock, Emilie Danielle;

(3)Moussambe Abanga, Agate; (4)Ngom Ngom, Justice Trésor.

(1)Phd. Nutritionist. Department of Biochemistry. University of Douala. Cameroon.; (2)MSc. Nutritionist. Department of Biochemistry. University of Douala. Cameroon.; (3)MSc. Engineer in biology. Department of clinic biology. University of Douala. Cameroon.; (4)MSc. Molecular biologist. Department of Biochemistry. University of Douala. Cameroon.

**Background and objectives:** Glycaemic index (GI), is an adequate tool not only for diet schedule, but also for the management of metabolic pathologies. This study aimed to determine the carbohydrates content (Cc) and GI of three Cameroonians meals commonly consumed. The studied sauces were mainly constituted of Aframomum aulacocarpos/citratum species (A.sp), Manihot esculenta leaves (LM) with Arachis hypogaea seeds, Telfairia occidentalis leaves (LT) with Citrullus colocynthis seeds. They were all associated with Manihot esculenta tuber (TM).

**Methods:** We included 27 healthy male volunteers aged 19-29 years old, who gave their informed consent. They were separated into groups of eight (8) for each meal. After a 10-14 hours overnight fasting, 50 g/70Kg of glucose was administered day one of the experiment to the participants, and the tested food three other days spaced from two weeks each. Their capillary finger-prick blood samples were collected at 0, 15, 30, 60, 90, and 120 minutes after consumption. The GI values were computed from the area under the glycemic-response curve of each food with glucose as reference. The Cc of each sauce and TM alone was determined.

**Results:** The mean GI was respectively 96.85 ± 2.04; 91.22 ± 5.20; 88.68 ± 3.47 for A.sp, LM, LT (all combined with TM). The Cc values of TM was high (p<0.05) with 62.234 ± 2.235, compared to A.sp 28.610 ± 3.214, LM 18.141 ± 4.394, and LT 19.377 ± 8.441 g/100g.

**Conclusion:** All the GIs of the meals were high. The sauces presented a poor carbohydrates content, so they can be proposed to people with carbohydrates metabolism disorders. However, they should be associated with less carbohydrates accompaniment to prevent a high and/or a chronic postprandial glycaemia.

**Keywords:** Glycaemic index, traditional meals, carbohydrates content.

144/237

### DIETARY CHOLINE INTAKES DO NOT REFLECT RECOMMENDED CONSUMPTION AMONG LACTATING WOMEN IN GUATEMALA

(1)Diaz-Jereda, Liza; (2)Vossenaar, Marieke; (3)Solomons, Noel W.

(1)BSc. Nutritionist. Center for Studies of Sensory Impairment Aging and Metabolism. Guatemala City. Guatemala.;

(2)PhD. Center for Studies of Sensory Impairment. Aging and Metabolism (CeSSIAM).; (3)Center for Studies of Sensory Impairment. Aging and Metabolism (CeSSIAM). Guatemala City. Guatemala.

**Background and objectives:** No information is currently available on habitual intakes of choline, in the Guatemalan population. Guatemala has the highest national prevalence of under-5 stunting in the Americas, with a frequency of 46.5% in 2015; with that for the indigenous population is 61.2%. Choline is linked to short-stature through biochemical pathways for ossification of the growth plate for the elongation of long-bones of the human extremities. We sought to assess the dietary choline intake among lactating mothers in the Western Highlands of Guatemala.

**Methods:** The previous-day intakes of 118 low-income women, 55 recruited at a public health clinic in the city of Quetzaltenango and 63 interviewed across 8 Mam-speaking villages in the same province served as the data-base. These were coupled with the food choline content values from the USDA food composition software to produce intake estimates in mg/day. Estimated median choline intakes were compared to the 550 mg/day Adequate Intake (AI) for lactating women, established by the US Institute of Medicine, and expressed as percentages. The critical nutrient density for choline of 183 mg/1000 kcal was calculated for lactation. The principal food sources of choline were established by geographic setting.

**Results:** Reported daily choline intake ranged from 0-1115 mg, with median choline intake of 256 mg: 306 mg in urban and 199 mg in rural women (p<0.05). Respective median densities were 89% and 64% of the choline critical nutrient density. Eggs, chicken and maize tamalitos were the first 3 main sources in urban, whereas maize tamalitos, eggs and chicken occupied these places in rural-areas.

**Conclusions:** With median maternal choline intakes ranging from 56% to 36% of the AI recommendation during lactation in Guatemala, plausibility for its contribution to poor infant/toddler growth is established. Evaluation of human milk content and breast-feeding delivery of choline are warranted.

**Keywords:** choline, stunting, lactation, Guatemala
BRAZILIAN IMMIGRANT MOTHERS' BELIEFS AND PRACTICES RELATED TO INFANT FEEDING: A QUALITATIVE STUDY

(1)Lindsay, Ana Cristina; (2)Lindsay, Ana Cristina; (3)Greaney, Mary;

(4)Wallington, Sherrie; (5)Hasselmann, Maria Helena; (6)Tavares Machado, Marcia Maria.

(1)University of Massachusetts Boston/Harvard. T. H. Chan School of Public Health. USA.; (2)University of Massachusetts Boston, USA.; (3)Kingston.Rhode Island. USA.; (4)Georgetown University. Washington DC. USA; (5)Rio de Janeiro State University. Brazi;

(6)Federal University of Ceara. Brazil.

**Background and objectives:** Background: Exclusive breastfeeding for the first six months of life and the timely introduction of appropriate solid foods are important determinants of weight status in infancy and later life stages. Disparities in obesity rates among young children suggest that maternal feeding practices during the first two years of life may contribute to these disparities. Brazilians are a growing immigrant group in the U.S., yet little research has focused on parental beliefs and behaviors affecting health of Brazilian immigrant children living in the U.S.

**Objective:** Explore beliefs and infant feeding practices of Brazilian immigrant mothers in the U.S.

**Methods:** Focus group discussions were conducted with Brazilian immigrant mothers. Transcripts were analyzed using thematic analysis. Themes were categorized using the socioecological model.

**Results:** Twenty-nine immigrant Brazilian mothers participated in the study. Analyses revealed all participants breastfed their infants. The majority initiated breastfeeding soon after childbirth. However, most mothers stated that they did not exclusively breastfeed. They used breast and formula feeding concomitantly. Family and culture influenced mothers' infant feeding beliefs and practices early introduction of solid foods.

**Conclusions:** As the number of children in the U.S. growing up in families of immigrant parents increases, understanding influences on Brazilian immigrant mothers' infant feeding practices will be important to development of effective interventions to promote healthy infant feeding and weight status among Brazilian children. Interventions designed for Brazilian immigrant families should incorporate an understanding of social context, family and cultural factors to develop health promotion messages tailored to the needs of this ethnic group.

**Keywords:** Brazil, immigrant, mothers, infants, breastfeeding, complementary feeding.

AVERAGE DAILY CONSUMPTION, NUTRIENT DENSITY AND PRINCIPAL SOURCES OF CHO- LINE AMONG SEMI-RURAL SCHOOLCHILDREN IN WESTERN GUATEMALA

(1)Escobar, Marta Lucía; (2)Solomons, Noel W.; (3)Vossenaar, Marieke.

(1)BSc. Nutritionist. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.; (2)Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala City. Guatemala.; (3)PhD. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM).

**Background and objectives:** Choline is an essential nutrient found in varying amounts in foods of both plant and animal origin. Adequate Intakes (AI), established by the US Institute of Medicine, recommended 250 mg daily for ages 4-8 years and 375 mg for ages 9-13 years. Sub-adequate choline intakes are being documented in adult Guatemalan women across the life-span, i.e., pregnant, lactating and neither. Our objective was to determine average intake and relative adequacy as well as principal sources of choline in semi-rural school children using a pictorial registry of dietary consumption.

**Methods:** Predominantly Mayan-indigenous, semi-rural, public school children (n=115) from Quetzaltenango were enrolled: 57 boys and 58 girls. 40 (35%) were 8 years old and 75 (65%) were 9-11 years old. Critical nutrient-density values for choline, based AI and energy requirements on specific for age were defined as 142 and 196 mg/1000 kcal, respectively. One-day choline intake was estimated from self-drawn depictions of each meal and snack consumed over a 24-h period. Choline intake was then derived using the USDA food composition table software values. A hierarchy of food contributions to total choline intake was tabulated.

**Results:** The total daily choline intakes ranged from 7.5-545mg, median=231 mg and mean=233±101 mg, without significant sex differences (p=0.92). The median for 8 y/o was 224 mg, and for 9-11 y/o, 234 mg. 83.5% consumed less than their age-specific AI value, whereas in 79.1%, nutrient density was below the reference critical-nutrient-density level. The five leading sources (eggs, maize tamalito, chicken, beef and milk) cumulatively constituted 70.6% of choline intake.

**Conclusions:** In semi-urban schoolchildren of the Guatemalan Western Highlands, choline intake is suboptimal according to AI, strategies are required to promote its consumption due to its critical role in the children health and development.

**Keywords:** Choline, schoolchildren, diet, growth, Guatemala
## GUATEMALAN WOMEN CONSUME ABOUT HALF OF THE ADEQUATE INTAKE LEVEL FOR DIETARY CHOLINE, WITHOUT SIGNIFICANT CLASS OR REGIONAL VARIANCE

**Background and objectives:** Choline has heretofore been an ignored essential nutrient for the Guatemalan dietary context. Dailly Adequate Intakes (AI) for non-pregnant and pregnant women has been set by the US Institute of Medicine at 425 and 450 mg, respectively, increasing to 550 mg in lactation. Western Highlands (WH) rural and urban women had respective median choline intakes of 199 and 304 mg (Díaz-Jereda, elsewhere at ICN, 2017). Here, our objective was to compare choline intakes of numerically-equivalent convenience samples of non-pregnant/non-lactating (NPNL) women across six groupings of socioeconomic class and regional setting in Guatemala.

**Methods:** Previous-day intakes were recorded among 240 adult NPNL Guatemalan women, 40 participants each across six subgroups: G1, WH rural peasantry; G2, WH urban low-income; G3, WH urban middle-income; G4, Pacific-coastal-plain middle-income; G5, Central-Highlands, peri-urban low-income; and G6, Central-Highlands, urban middle-income. Choline contents of foods from the USDA food composition table software were applied to 1-day intake records to generate choline intakes, expressed in mg.

**Results:** The global choline intake for the 240 participants had (in mg) a median of 204 and mean 227±131, ranging 18-790; this was 48% of the 425 mg AI reference value. By subgroups, respective median and limits-interval data were (in mg): G1, 199 (73-609); G2, 214 (30-515); G3, 211 (23-504); G4, 148 (18-570); G5, 225 (30-790); and G6, 215 (39-567). Subgroup differences were non-significant (p=0.579). Overall, choline from eggs (37%), beef (9.5%) and black beans (8.8%) comprised over half the intake, but hierarchies of main choline sources varied greatly across subgroups.

**Conclusions:** NPNL women in the G2 region had 30% lower choline intakes (214 mg) than corresponding lactating peers (304 mg), whereas inter-stage intakes were identical at 199 mg in the G1 region. Current dietary patterns for a diverse cross-section of NPNL Guatemalan women do not support the habitual consumption of adequate amounts of choline.

**Keywords:** Choline, dietary intake, women, Guatemala

## ASSOCIATION OF RELATIVE BODY WEIGHT (BODY MASS INDEX) AND FATNESS (PERCENT BODY-WEIGHT AS FAT) IN A CONVENIENCE SAMPLE OF ADULT WOMEN IN THE SOLOLÁ PROVINCE OF GUATEMALA

**Background and objectives:** Quetelet's body-mass index (BMI) is a measure of relative weight in kg/m2. States of underweight, normal-weight, overweight and obesity have been classified by specific BMI intervals. However, "excess" in body mass is a function of increased fat (fatness as % body-weight as fat, %BF). Therefore, these two indicators should have a complementary association. As part of a protocol to classify women as "normal" or "obese" by dual criteria among Mayan-indigenous women, we sought to explore the association of BMI with %BF.

**Methods:** Height and clothing-adjusted body weight were measured in women aged 30-45 years, and their BMI calculated. As per the classification protocol, only women with BMI in the ranges of 18.5 to <25 kg/m2 ("normal") or >30 kg/m2 ("obese") advanced to stage 2 for %BF assessment with bioimpedance analysis (BIA). With tetrapolar placement of skin electrodes of the mBCA 525 BIA instrument (SECA, Hamburg, Germany), the gamut of 25 output variables were measured, with specific attention to the %BF value.

**Results:** We successfully measured all variables in 38 women (median: 34y): n=24 "normal" (median BMI: 22 kg/m2) and n=14 "obese" (median BMI: 32 kg/m2). Respective median %BF were 32% and 43%. The overall Pearson r value for BMI vs %BF (n=38) was 0.87, with partial r values of 0.74 (n=24, normal) and 0.74 (n=14, obese). BIA-measured %BF were, on average, 2.7 percentage-points higher than the theoretical association from the Deurenberg equation (1991).

**Conclusions:** %BF was higher than the reference criteria for non-excessive and obesity-associated fat in relation to selected confines for both "normal" and "obese" BMI status. Genetic and/or environmental factors may modify associations from the textbook standards for the upper- and lower-limits of body fatness that, along with BMI, would co-define "leanness" and "obesity".

**Keywords:** body-composition, women, body-fat, BMI, Guatemala

<footnote>(1)Campos, Raquel; (2)Vossenaar, Marieke; (1)Díaz-Jereda, Liza;</footnote>

<footnote>(3)Solomons, Noel W.</footnote>

<footnote>(1)BSc. Nutritionist. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala City. Guatemala;</footnote>

<footnote>(2)PhD. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.; (3)Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala City. Guatemala.</footnote>

<footnote>(1)Zamora, Alejandra; (2)Arriaga, Claudia Lorena; (3)Orozco, Monica;</footnote>

<footnote>(4)Solomons, Noel W.; (5)Schümann, Klaus.</footnote>

<footnote>(1)BSc. Nutritionist. Center for Studies of Sensory Impairment, Aging and Metabolism. Guatemala.; (2)BSc. Chemistry. Center for Studies of Sensory Impairment, Aging and Metabolism. CeSSIAM. Guatemala.; (3)PhD. Nutritionist. Center for Studies of Sensory Impairment, Aging and Metabolism. CeSSIAM. Guatemala.; (4)MD. Scientific Director. Center for Studies of Sensory Impairment, Aging and Metabolism. CeSSIAM. Guatemala.; (5)MD. President. Hildegard Grunow Foundation. Germany.</footnote>
## HEAD CIRCUMFERENCE IS AMONG THE LEAST AFFECTED ANTHROPOMETRIC MEASURES IN INFANCY AND AT FOLLOW-UP IN A COHORT OF RURAL, MAM-MAYAN CHILDREN IN THE 3RD AND 4TH YEARS OF LIFE

(1)MALDONADO SOCH, CLAUDIA ALEJANDRA; (2)Escobar, Marta Lucía; (3)Garcia Meza, Rosario; (4)Chomat, Anne Marie; (5)Solomons, Noel W.

(1)Bs. Nutritionist. Center for Studies of Sensory Impairment, Aging and Metabolism. Guatemala; (2)BSc. Nutritionist. Center for Studies of Sensory Impairment, Aging and Metabolism. Guatemala.; (3)MDs. Nutritionist. Center for Studies of Sensory Impairment, Aging and Metabolism. Guatemala.; (4)MD. MPH. PhD. McGill Department of Family Medicine. McGill University. Montreal. Canada.; (5)Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala City. Guatemala.

**Background and objectives:** Environmentally-related short-stature or stunting is often termed “chronic undernutrition,” projecting a connotation of a generalized under-nourishing process due to improper diet. This was called into question in the 1980s from observations on Negev Bedouin infants by Dagan et al. (AJCN 1983;38:747-753) examining the standard anthropometric measures of length, weight, head-circumference and skin-folds. More recently, Miller et al. (Pediatr Int Child Health 2016;36:91-101) found head-circumference z-scores (HCZ) to decline by 30% from birth to 4 years in Nepalese children. We sought to document for anthropometric measures of indigenous Guatemalans, the relative degrees of conservation versus deterioration from infancy to an average of ~4 years following initial assessment.

**Methods:** The same anthropometrists twice measured a cohort of 105 Mam-Mayan children: 85 enrolled before the 2nd month of life and 20 at ~5±1 months, with follow-up measurements between the 41st and 56th month (median:48.3mo). Weight, length/height and head circumference were measured, generating z-scores for HAZ, WAZ and HCZ (WHO-Anthro), with the paired t test used for statistical assessment.

**Results:** At baseline and at 4-y endline, respective median z-scores were (in order, n=105): HAZ, -1.15/-2.68; WAZ, +0.07/-1.51; and HCZ, -0.74/-1.06. Specifically, instances of HCZ <-2SD (microcephaly) were 19 (18.1%) in first-semester baseline and 15 (14.2%) at 4-y endline. Median z-scores differences from 1st-2nd measurements, respecting the vector sign, were: HAZ (-1.53, p<0.001); WAZ (-1.58, p<0.001), and HCZ (-0.32, p=0.135), respectively.

**Conclusions:** Although WAZ was best conserved among the z-scores in early infancy followed by HCZ, the latter was by far the index showing least longitudinal deterioration 4 years later, and its value was superior to the other indicators. The time-dependent status-dynamics for HCZ here differ from those reported for Nepalese children from birth through 4 years of life.

**Keywords:** Stunting, wasting, underweight, microcephaly, Guatemala

## TWO-YEAR FOLLOW-UP OF A WEIGHT LOSS INTERVENTION AMONG POSTPARTUM WOMEN: RESULTS FROM A RANDOMIZED CONTROLLED TRIAL IN PRIMARY HEALTH CARE

(1)Huseinovic, Ena; (1)Bertz, Fredrik; (1)Brekke, Hilde Kristin; (2)Winkvist, Anna.

(1)PhD. Dietitian. Department of Internal Medicine and Clinical Nutrition. University of Gothenburg. Sweden.; (2)PhD. Nutritionist. Department of Internal Medicine and Clinical Nutrition. University of Gothenburg. Sweden.

**Background and objectives:** Weight regain is a critical problem in obesity treatment. We recently reported that a 12-wk diet intervention among postpartum women produced a weight loss of 12% after 1 y, compared to 5% in controls. Here, we present 2-y results after 1 y of unsupervised follow-up.

**Methods:** A total of 110 women with a self-reported BMI of ≥27 kg/m2 at 6-15 wk postpartum were randomized to diet group (D-group) or control group (C-group). D-group (n=54) received a 12-wk diet intervention by a dietitian followed by monthly e-mails up to the 1-y follow-up. C-group (n=56) received a brochure on healthy eating at the baseline visit. No contact was provided from 1-2 y to either group. Changes in anthropometric outcome measures from 0-2 y and 1-2 y are reported.

**Results:** Eighty-nine women (81%) completed the 2-y follow-up. Median (1st; 3rd quartile) weight change from 0-2 y was -6.9 (-11.0; -2.2) kg in D-group and -4.3 (-8.7; -0.2) kg in C-group. There was no group by time interaction at 2 y (p=0.082); however, when women with a new pregnancy between 1-2 y were excluded the interaction became significant (-8.2 kg vs -4.6 kg, p=0.038). From 1-2 y, women in D- and C-group gained 2.5±5.0 kg and 1.1±4.4 kg, respectively (p=0.186). Women who gained weight from 1-2 y reported a decrease in self-weighing frequency compared to women who maintained or lost weight (p=0.008). Finally, percent weight change at 12 wk was positively related to percent weight change at 2 y (p<0.001).

**Conclusions:** Both groups achieved clinically relevant 2-y weight loss but the significant between-group-difference observed at 1 y was not maintained at 2 y in the main analysis. However, when women with a new pregnancy between 1-2 y were excluded, a significant weight loss effect was observed also at 2 y.

**Keywords:** Weight loss, weight loss maintenance, postpartum, RCT, overweight/obesity
HEALTH AND NUTRITION RELATED CHALLENGES ASSOCIATED WITH PEOPLE LIVING WITH DISABILITIES IN NAKURU COUNTY, KENYA

(1)Chege, Peter; (2)Gachuiri, Grace.

(1)Department of Food, Nutrition and Dieteics. Kenyatta University. Kenya.; (2)Nursing Department. Kenyatta University. Kenya.

**Background and objectives:** People living with disability (PLD) are among the most vulnerable groups to health and nutrition problems mainly due to limited access to essential services. Minimal information exists on health and nutrition related challenges among PLD as they are normally excluded from many researches due to challenges in conducting assessments. This study aimed to document the health and nutrition related challenges.

**Methods:** The study adopted a cross-sectional analytical research design, in Nakuru municipality on a randomly selected sample of 396 adults living with various forms of disability. Data was collected using semi-structured questionnaires, focus group discussions guides and key informants interviews. Quantitative data was analyzed using SPPSS while qualitative data using Nvivo software.

**Results:** Physical disability (67.2%) was the main disability problem, followed by mental disability (15.2%), deafness/dumbness (10.9%), and visual impairment (5.1%). Over 68% were dependent on other people for movement and accessibility to essential services. Most of the PLD (62.1%) earned an income of <2USD daily leading to about 40% being food insecure. A majority (78.9%) of the PLD had low nutrition knowledge with (68.8%) not meeting their daily dietary requirements while 85.2% engaged in low physical activity. Prevalence of hypertension, diabetes and CVDs was 25.8%, 5.5%, and 6.3% respectively. In addition, illness like malaria, pneumonia and diarrhea were prevalent. The prevalence of overweight, obesity and underweight was 21.5%, 10.2% and 23.4%, respectively, a clear indication of dual burden of malnutrition. Over a half (53.9%) were noted to be living with stigma towards disability.

**Conclusions:** Due to stigma, food insecurity and low nutrition knowledge, PLD practice poor dietary practices and live with lifestyle diseases. The disability condition led to engagement in low physical activity which contributed to overweight and obesity. There exists a dual burden of malnutrition. There is thus need to train PLD on good nutrition, dietary management of lifestyle diseases and on entrepreneurship for income generation.

**Keywords:** People living with disability, health, nutrition, challenges, adults

FACTORS AFFECTING NUTRITIONAL STATUS OF ELDERLY PEOPLE OF RURAL NEPAL: A COMMUNITY BASED CROSS SECTIONAL STUDY

(1)Tamang, Man Kumar; (2)Yadav, Uday Narayan.

(1)MSc. Teaching Assistant. Department of nutrition and dietetics. Central Campus of Technology. Tribbuvan University. Nepal.; (2)MPH. Program officer. Forum for Health Research and Development. Dharan. Nepal.

**Background and objectives:** Every country in the world is facing a demographic challenge due to drastic growth of population over 60 years. Adequate diet and nutritional status are important determinants of health in elderly populations. This study aimed to assess the nutritional status among the elderly population and factors associated with malnutrition at the community setting in rural Nepal

**Methods:** This is a community based cross-sectional study among elderly of age 60 years or above in the three randomly selected VDCs of Morang district in eastern Nepal, between August and November, 2016. A multi stage cluster sampling was adopted with sample size of 345 of which 339 participated in the study. Nutritional status was assessed by MNA tool and associated socio-economic, demographic, psychological and nutritional factors were checked by binary logistic regression analysis

**Results:** Among 339 participants, 24.8% were found to be within normal nutritional status, 49.6% were at risk of malnutrition and 24.8% were malnourished. Independent factors associated with malnutrition status among the elderly people after controlling the cofounders in the bivariate analysis were: elderly who were malnourished were those who belonged to backward caste according to traditional Hindu caste system [OR=2.69, 95% CI: 1.17-6.21], being unemployed (OR=3.23, 95% CI: 1.63-6.41),who experienced any mistreatment from caregivers (OR=4.05, 95% CI: 1.90-8.60), being not involved in physical activity (OR=4.67, 95% CI: 1.87-11.66) and those taking medication for any co-morbidities.

**Conclusions:** Many socio-economic, psychological and physiological factors affect nutritional status in our sample population and these issues need to be addressed for bringing improvement in elderly nutrition and health status.

**Keywords:** elderly, nutritional status, rural Nepal
ASSESSMENT OF NUTRITIONAL STATUS IN
OBESE CHILDREN DURING A 10 YEARS FOL-
LOW-UP AND CARDIO-METABOLIC RISK

(1)Andreoli, Angela; (2)Pitaro, Eugenio; (3)Neri, Anna; (4)Rizza, Stefano;

(5)Sorge, Roberto; (6)Petrilli, Arianna; (6)Manca Bitti, Maria Luisa.

(1)MD. PhD. Nutritionisti. Physiologist. Human Physiology and Nutrition. Department Medicine of System. University of Rome Tor Vergata. Rome. Italy.; (2)MD. Pediatric Diabetology Unit, Policlinico di Tor Vergata. University of Rome Tor Vergata. Rome. Italy.; (3)Department of Biopathology and Imaging Diagnostics. University of Rome Tor Vergata. Rome. Italy.; (4)MD. Department Medicine of System. University of Rome Tor Vergata. Rome. Italy.; (5)PhD. Statistics Unit. University of Rome "Tor Vergata". Italy.; (6)MD. Pediatrician. Pediatric Diabetology Unit. Policlinico di Tor Vergata. University "Tor Vergata". Italy.

**Background and objectives:** Incidence of childhood obesity and its complications (cardiovascular disease, diabetes, etc.) is increasing. Aim of the study was to evaluated nutritional status of a cohort of obese children with ten years follow-up and to assessed the relationship between body composition, liver and cardiovascular function.

**Methods:** The cohort was 56 subjects (27 females and 29 males). The dropout was 10 subjects, 23 males and 23 females, aged respectively 10,6+/-1,8 and 9,8 +/-1,51 at time0 and 20,3+/-1.9 and 21,0+/-21.5 at 10 years follow-up.

Anamnesis and FFQ, blood pressure (DBP, SBP), blood analy-
ses, weight, height was measured and Body Mass Index (BMI) was
calculated; waist circumference (WC) and body composition (Fat,
FFM, TBW, ECW, ICW, BCM) by Bioelectrical impedance analysis
(BIA), epiaortic and hepatic ultrasounds was assessed.

**Results:** BMI, DBP, glycaemia, insulinemia, triglycerides, choles-
terol, LDL, HDL, HOMA-IR and Tg/HDL was no statistical differ-
ences between males and females at the baseline and after ten years.

BMI in males was 32,55+/-6,20 and in female was 30,77+/-6,04; Fat Mass (FM) was 28,16+/-13,06 and 30,32+/-12,99 respectively; Free Fat Mass (FFM) was 68,57+/-11,19 and 49,19+/-8,36 respectively ; Total body water (TBW) was 50,20 +/-8,17 and 36,05+/- 8 respectively; Body cell Mass (BCM) was 40,76+/-5,38 and 30,16+/-8,19 respectively

54 % of the subjects are still obese 26% overweight 20% normal weight at follow-up.

72% of patients were affected by liver steatosis (80% of obese,
83% overweight and 30% normal weight). FM (p=0,019), FFM
(p=0,04), TBW (p=0,03), was significant difference between in
subjects affected by steatosis and not.

A significant increment in males for SBP (p=0,001) and uric acid levels (UAL) (p=0,007), was observed. There was a significant correlation between WC and cIMT (P=0,003; R=0,441) which shows that cIMT is growing proportionally. There was a correlation between WC and UAL (p<0,001; R=0,58). 38% of these subjects have a high-moderate cardiovascular risk.

**Conclusions:** Results show that is necessary over the course of early life a complete evaluation of obese children and epiaortic

and hepatic ultrasounds must be performed in each to established hepatic damage that can persist also after weight loss.

**Keywords:** Fat Mass, children, cardio-metabolic-risk, follow-up.

IMPACT OF CHILD NUTRITION POLICY IN ME-
DELLÍN, COLOMBIA

(1)Alvarez Castaño, Luz Stella; (2)Quintero Morales, Maria Teresa;

(2)Goez Rueda, Juan Diego; (2)Gallego Osorio, Gloria Yaneth; (3)Cuesta Caicedo, Eimy Yaritza.

(1)PhD. Msc. Nutritionist. Escuela de Nutricion y Dietetica.
Universidad de Antioquia. Colombia.; (2)MSC. Nutritionist. Escuela
de Nutricion y Dietetica. Universidad de Antioquia. Colombia.;

(3)Student. Escuela de Nutricion y Dietetica. Universidad de Antioquia. Colombia.

**Background and objectives:** Children´s Nutrition Programs are being considered a social protection strategy to guarantee the right to food. This study aimed to evaluate the “Buen Comienzo” Program of Medellin which is part of the Infant policy of the city, to establish the principles of this policy, how it is being implement-ed and what have been its results according to the perspective of the different actors involved.

**Methods:** An evaluation was carried out to the "Buen Comienzo" Program (BCP) which is targeted to children from two to six years of age; the Program seeks the integral development through pedagogical strategies and the supply of food to the children who remain eight hours daily, from Monday to Friday. The evaluation was carried out by using a methodology of multidimensional evaluation by triangulation of methods created by the School of Nutrition and Dietetics of the Universidad de Antioquia. 12 centers located in different zone of the city were evaluated. Anthropometric measures of height, weight and age were registered and semi-structured interviews to parents, educators and high level administrative officers of the Program were conducted.

**Results:** It was founded that children attending to the BCP have a better nutritional status as comparing with data from Colombia children as a whole and with Medellin children measured by the indicator low height to Age. (6.7% (BCP), 13% (Colombia) and 13.5% Medellin respectively. Parents and educators find positive changes in the eating habits of children, who are transformers of family habits. Related to right to food this principle supports all the infant policy guidelines and most of educators and Program Officers know it. However they state that it is implemented just because the adequate amount and quality of foods. Other aspects as universal coverage, no exclusion criteria, budget allocation are not considered in the analysis.

**Conclusions:** The “Buen Comienzo” Programe is a strategy to guarantee the right to food although other elements than quality and quantity of food must be added to its structure.

**Keywords:** Child,Preschool. Policy. Evaluation. Food. Educa-
tion.
CONSUMPTION OF SUGAR-SWEETENED BEVERSAGES IS NEGATIVELY ASSOCIATED WITH ACADEMIC OUTCOMES IN THE TRANSITION FROM SECONDARY TO HIGHER EDUCATION IN YOUTHS FROM AN INFANCY CHILEAN COHORT

(1)Loeff Wetzstein, Tamara; (2)Correa-Burrows, Paulina; (1)Rodriguez, Yanina; (1)Curi Quinto, Katherine; (3)Blanco, Estela; (4)Gahagan, Sheila; (5)Burrows, Raquel.

(1)MSc. Nutritionist. Institute of Nutrition and Food Technology. University of Chile. Chile.; (2)PhD. Social Science. Institute of Nutrition and Food Technology. University of Chile. Chile.;
(3)MPH. Division of Child Development and Community Health. University of California San Diego. USA.; (4)MPH. MD. Division of Child Development and Community Health. University of California San Diego. USA.; (5)MD. Institute of Nutrition and Food Technology. University of Chile. Chile.

**Background and objectives:** A high consumption of sug-
ar-sweetened beverages (SSB), made with high-fructose corn syrup
(HFCS), is associated with excessive weight gain and cardiometabolic
risk. Moreover, consumption of SSB also relates with impairment in
hippocampal learning and memory processes, regardless of weight
status. Impairment in memory consolidation and performance is a
risk factor for learning difficulties, including, poor academic progress.
In Latin-America, the Global School-based Healthy Survey shows
that two thirds of adolescents in Argentina, Chile and Uruguay report
daily intake of SSB. We aimed to study the association between daily
consumption of SSB with academic results (school-grades and high
school completion) in adolescent students from Santiago, Chile.

**Methods:** Observational study in n=678 youths participants in a follow-up beginning in infancy. Consumption of SSB at 16y was assessed using a validated food frequency questionnaire. Academic outcomes were approached as the odds of high school (HS) completion and HS grade-point average (GPA). Multivariate logistic regressions were performed to determine independent associations of snacking with having completed HS, after controlling sex, nutritional status and parental education. ANCOVA was used to estimate differences in high school GPA by consumption of SSB after controlling other influences. The effect size (ES) for difference was estimated using Cohen's d coefficients.

**Results:** In the sample, 43% of participants had daily con-
sumption of SSB. After controlling other influences, the odds of
high school completion were significantly lower among partic-
ipants consuming SSB once (aOR: 0.60; 95% CI: 0.38-0.95) and
twice (aOR: 0.36; 95% CI: 0.19-0.66) a day compared to partic-
pant with no SSB consumption. Adolescents consuming SSB once
(mean difference: -25 points, p=0.003, d=0.19) and twice (mean
difference: -36 points, p=0.011, d=0.28) a day had significantly
lower GPA compared to adolescents with no SSB consumption.

**Conclusions:** In our sample, the consumption of SSB was neg-
atively associated with academic performance in the transition
from secondary to higher education. Consumption of SSB was as-
sociated with lower GPA and reduced odds of HS completion. Our
findings are consistent with previous evidence of a relationship be-

tween Western dietary patterns and academic achievement. Fund-
ing: NIH (NHBLI-R01HL088530), CONICYT (PAI-79140003,
FONDECYT-1160240).

**Keywords:** Sugar-sweetened beverages, adolescents, academic performance, Western dietary patterns.

BREASTFEEDING SELF-EFFICACY AND BREASTFEEDING PRACTICES AMONG LACTATING MOTHERS ATTENDING A MATERNITY TEACHING HOSPITAL. IBADAN. NIGERIA

(1)Ogundairo, Yetunde; (2)Samuel, Folake.

(1)MSc. Nutritionist. Department of Human Nutrition. University of Ibadan. Nigeria.; (2)PhD. Nutritionist. Department of Human Nutrition. University of Ibadan. Nigeria.

**Background and objectives:** Background: Breastfeeding self-efficacy is the confidence a mother has in her ability to breastfeed her infant. Mothers with low breastfeeding self-efficacy have been observed not to start early initiation of breastfeeding and not to continue exclusive breastfeeding for six months. Few studies have examined the relationship between breastfeeding self-efficacy and breastfeeding practice among lactating mothers in Nigeria. Therefore, this study assessed the relationship between breastfeeding self-efficacy and breastfeeding practices among lactating mothers in Ibadan.

**Methods:** The study was descriptive cross sectional in design. A total of four hundred and nineteen lactating mothers with infants aged 0-6 months were randomly selected from Adeoyo Maternity Teaching Hospital in Ibadan. A semi-structured interviewer administered questionnaire was used to obtain information on socio-demographic characteristics, breastfeeding knowledge, breastfeeding attitude, breastfeeding self-efficacy and breastfeeding practices (measured using the breastfeeding performance index). Data were analyzed using descriptive statistics such as frequencies, percentages, Mean ±SD and inferential analysis such as chi square, correlation at P < 0.05.

**Results:** The mean age of the mothers and infants was 28.8 ±5.3 years and 2.1 ±1.5 months respectively. Majority (76.4%) of the mothers had high breastfeeding self-efficacy. Almost all (98.8%) of the mothers had breastfed during the previous 24 hours, but despite this, 78.3% of infants were still bottle fed. The proportion of mothers who scored high breastfeeding performance index was 93.3%. There was good breastfeeding knowledge (82.8%) and positive breastfeeding attitude (23.2%) among the mothers. A significant positive correlation was observed between breastfeeding self-efficacy and breastfeeding practices; and also between breastfeeding self-efficacy and breastfeeding knowledge.

**Conclusions:** Breastfeeding self-efficacy was observed to posi-
tively influence breastfeeding knowledge, which was also positive-
ly associated with optimal breastfeeding practices. Mothers should
be properly informed on the importance of breastfeeding to boost
their confidence to breastfeed.

**Keywords:** Breastfeeding, Self-efficacy, Lactating mothers.
ASSOCIATION OF HELICOBACTER PYLORI INFECTION WITH ANTHROPOMETRIC INDICES AND BLOOD PRESSURE AMONG UNDERGRADUATE STUDENTS IN SOUTHEAST OF IRAN

(1)Shahraki, Mansour; (2)Eslami, Omid.

(1)Associated professor. Department of Nutrition. Medical Faculty. Zahedan University of Medical Sciences. Zahedan. Iran.; (2)Department of Nutrition. Faculty of Public Health. Iran University of Medical Sciences. Tehran. Iran.

**Background and objectives:** There are inconclusive evidence on the association of Helicobacter pylori (H.pylori) with cardiometabolic disorders such as obesity and hypertension. The aim of current study was to assess the association of H.pylori seropositivity with anthropometric indices and blood pressure among a group of young population in southeast of Iran, Zahedan.

**Methods:** A total of 363 undergraduate students at Zahedan University of Medical Sciences were participated in this cross-sectional study, in 2014. H.pylori positivity was examined by measuring serum anti-H.pylori IgG antibodies. Anthropometric indices including body mass index(BMI),waist circumference(WC),waist to hip ratio (WHpR),and waist to height ratio (WHtR),as well as systolic blood pressure(SBP) and diastolic blood pressure (DBP) were measured using standard protocols.

**Results:** H.pylori seropositivity In our study was 45.7%(166/363).H.pylori positive subjects had significantly lower mean values of BMI compared to H.pylori negative subjects.While WC,WHpR,WHtR,SBP,and DBP were not significantly different between the two groups. Also multiple regression analysis didn't show any significant association between H.pylori seropositivity and other study variables.

**Conclusions:** H.pylori seropositivity was significantly associated with BMI ,but not with central obesity indices and blood pressure among a group of young undergraduate students in southeast of Iran.

**Keywords:** Helicobacter pylori; Anthropometric indices; Blood pressure; Undergraduate students;Iran

ASSOCIATION BETWEEN NUTRITIONAL STATUS AND FOOD HABITS IN SCHOOL CHILDREN FROM SANTIAGO

(1)Leiva Rodriguez, Carla Andrea; (2)Reyes, Maria; (3)Ossa, Francisca;

(4)Toledo Astudillo, Juan.

(1)Msc. Nutricionista. Carrera de nutrición y dietética. Pontificia Universidad Católica de Chile. Chile.; (2)Alumna Quinto año. Nutrición y Dietética. Pontificia Universidad Católica de Chile. Chile.; (3)Alumna Quinto año. Nutrición y Dietética. Pontificia Universidad Católica de Chile. Chile.; (4)Medico Cirujano. Servicio de Salud Metropolitano Norte. Chile.

**Background and objectives:** Environmental and social changes can alter eating behavior, which flavors the development of overweight and obesity. The National Food Consumption Survey reveals the high rates of overweight in scholar children, and the lack of accomplishment from alimentary recommendations. Investigations must be done to discover possible behaviors that favours the increase of malnutrition by excess. This study seeks to associate alimentary habits with nutritional status in children from first to fourth grade.

**Hypothesis:** Children from first to fourth grade with malnutrition by excess have a higher prevalence of bad alimentary habits compared with their normal-weight peers.

**Methods:** Application of a pre-elaborated survey that measured alimentary habits to 82 students from first to fourth grade. It was measured weight, height, waist girth, skinfold thickness and muscular strength, and nutritional status was established by BMI/ Age. Associations between nutritional status, muscular strength and waist girth with alimentary habits were made.

**Results:** The distribution according to nutritional status shows 54.8% (n = 45) of eutrophic schoolchildren and 45% (n = 37) with excess malnutrition; Within this category, 19.5% of the subjects are overweight, 19.5% are obese and 6% are severely obese. The association between alimentary habits and nutritional status shows that 29,3% of children presents poor nutritional habits and are eutrophic, and 20,7% have poor alimentary habits and have malnutrition by excess. A 25,6% have good alimentary habits and are eutrophic, and 24,4% have good alimentary habits and malnutrition by excess. There are no differences between alimentary habits and nutritional status.

**Conclusions:** It is recommend to depthly analyse the alimentary habits survey applied in this study, because the results revealed inconsistencies between children's diet and their nutritional status.

**Keywords:** Food habits
Obesity
# FACTORS THAT MOTIVATE YOUNG WHITE MOTHERS FROM LOW SOCIO-ECONOMIC OR DEPRIVED BACKGROUNDS TO SUCCESSFULLY BREASTFEED - A QUALITATIVE EXPLORATORY STUDY IN BIRKENHEAD, UNITED KINGDOM

Tetteh, Jedidah.

PhD. Public Health Nutritionist. National Centre for Sport and Exercise Medicine. Loughborough University. United Kingdom.

**Background and objectives:** Breastmilk is the gold standard for all infants in terms of infant nutrition. In view of this, WHO has recommended that breastfeeding must be initiated during the first hour of life and continued until two years or over. Breastfeeding initiation rates continue to be very low in the United Kingdom (UK) (74%) with even lower rates in the Wirral (57%). In the UK, studies have proven that white adolescent mothers from deprived backgrounds are the least likely to breastfeed and therefore require additional support to their unique developmental position. The study investigated the factors that motivate the few mothers who breastfeed at Birkenhead to successfully breastfeed for at least six weeks.

**Methods:** The study was an explorative and inductive qualitative study involving four mothers aged between 18 and 30 years. Data were collected using semi-structured questionnaires. Interviews were audio-recorded and analysed using thematic analysis approach.

**Results:** The study identified some factors that motivate young white British mothers to successfully breastfeed. The study found that one-to-one support from midwives, and family and friends could positively influence them to adopt breastfeeding practices. Further, a positive societal attitude towards breastfeeding in the public could influence breastfeeding positively. Also, knowledge about breastfeeding, a beautiful baby growth and no sickness encouraged mothers to continue breastfeeding. The study also revealed that mothers were willing to sacrifice for their babies so far as they knew of the benefits for the baby.

**Conclusions:** The findings of this study suggest that young British white mothers require support to motivate them to breastfeed and sustain breastfeeding practices. However, because this study was a small scale qualitative study the findings are not generalisable. A further large scale study, adopting a mixed method approach, could be useful to investigate whether this is a general need or views of the white British young women.

**Keywords:** Breastmilk, motivate, breastfeed, young British white mothers.

**Further collaborators**

This dissertation was supervised by Dr Clare Soulsby. Department of Clinical Sciences. University of Chester.

# THE CORRELATION OF OBESITY INDICES WITH BLOOD GLUCOSE AMONG A GROUP OF MEDICAL UNIVERSITY EMPLOYEES IN ZAHEDAN, SOUTH-EASTERN OF IRAN

**Background and objectives:** Employees are considered as an at-risk group for obesity and its adverse outcomes particularly cardiovascular (CV) disease. The present study was conducted to assess the correlation of obesity indices with blood glucose among a group of medical university employees in Zahedan, south-eastern of Iran.

**Methods:** This cross-sectional study recruited 211 healthy medical employees of Zahedan University of Medical Sciences during October 2015. Obesity indices including body mass index (BMI), waist circumference (WC), waist to hip ratio (WHpR) and waist to height ratio (WHtR) were measured in accordance to standard criteria. Blood glucose was measured after a full night fasting. Data analysis was done by SPSS using descriptive statistics, bivariate analysis and Pearson correlations.

**Results:** Women had significantly higher values of weight, WC, WHpR and fasting blood sugar than men (p < 0.05). Bivariate analysis showed that those with BMI, WC or WHtR above the cut-off-points levels had significantly higher serum levels of blood glucose compared to normal subjects. BMI and WC had significant positive correlation with blood glucose and these correlations were slightly stronger for WC compared to BMI.

**Conclusions:** BMI and WC had an almost moderate correlation with blood glucose among a sample of medical university employees in south-eastern of Iran. Therefore, using WC along with BMI is suggested as the preferred method for assessment of blood glucose among this at risk group.

**Keywords:** Anthropocentric indices, Blood glucose, Medical employee

<footnote>(1)Shahraki, Mansour; (2)Eslami, Omid.</footnote>

<footnote>(1)Associated professor. Department of Nutrition. Medical Faculty. Zahedan University of Medical Sciences. Zahedan. Iran.; (2)Department of Nutrition. Faculty of Public Health. Iran University of Medical Sciences. Tehran. Iran.</footnote>
LOW BIRTH WEIGHT AND FEEDING PRACTICES ARE ASSOCIATED WITH CHILD WASTING AND THE CO-OCCURRENCE OF WASTING AND STUNTING IN SOUTH ASIA

(1)Harding, Kassandra; (1)Webb, Patrick; (2)Aguayo, Victor.

(1)PhD. Friedman School of Nutrition Science and Policy. Tufts University. United States; (2)PhD. United Nations Children's Fund Programme Division. United States.

**Background and objectives:** Undernutrition remains a major public health and development problem in South Asia, where 15% of children <5 years of age are wasted and roughly 38% are stunted. Low birth weight (LBW) and poor infant and young child feeding (IYCF) practices are also prevalent across the region, likely contributing to undesirable child outcomes.

**Methods:** We examined associations between LBW and seven measures of IYCF with three anthropometric outcomes in children aged 0 to 59 months old (mo): being wasted (WHZ<-2), being severely wasted (WHZ<-3), and the co-occurrence of both wasting and stunting (HAZ<-2). Recent cross-sectional national surveys from South Asia were pooled and logistic regression accounting for the surveys' clustered designs and adjusted for a number of factors were used to examine the relationships of interest.

**Results:** Approximately 62,509 children from 6 countries were included in the analysis, of which 16% were wasted, 5% severely wasted and 6% were both wasted and stunted. Children with reported LBW had a higher odds of being wasted (AOR (95% CI): 1.60 (1.45, 1.76)) as well as severely wasted (1.57 (1.34, 1.83)), compared to children without reported LBW. Children 0 to 23 mo who were reportedly breastfed within the first hour postpartum, those not provided prelacteal feeds in the first three days of life, and 0 to 5 mo who were exclusively breastfed were significantly less likely to be wasted later in life (p<0.05 for all three predictors). Not meeting the minimum diet diversity was associated with the likelihood of wasting and the co-occurrence of wasting and stunting in India and not meeting the minimum acceptable diet was associated with the co-occurrence of wasting and stunting in India.

**Conclusions:** LBW and poor IYCF are associated with wasting, severe wasting and the co-occurrence of wasting and stunting among South Asian children. Programs to prevent LBW and promote improved IYCF need to be urgently scaled up to reduce the risk of wasting across the region.

**Keywords:** Wasting, low birth weight, infant and young child feeding, South Asia

IS MID UPPER ARM CIRCUMFERENCE (MUAC) CUT-OFFS BY WHO ALONE A SUFFICIENT CRITERION FOR DETECTING ACUTE MALNOURISHED PAKISTANI CHILDREN, AGED 6-59 MONTHS?

(1)Safdar, Nilofer Fatimi; (2)Kumar, Ratan; (3)Amir, Mehreen; (4)Zaheer, Sidra.

(1)MSc.MS.PhD. Nutritionist. School of Public Health. Dow University of Health Sciences. Karachi. Pakistan.; (2)MBBS. Graduate Student.School of Public Health. Dow University of Health Sciences. Karachi. Pakistan.; (3)MSc.Nutritionist.School of Public Health. Dow University of Health Sciences. Karachi. Pakistan; (4)MSc. Statistician.School of Public Health. Dow University of Health Sciences. Karachi. Pakistan.

**Background and objectives:** Weight for height Z score (WHZ) is a gold standard for identifying malnutrition in children <5 years of age. Whereas, mid upper arm circumference (MUAC) is a proxy for WHZ and is mostly used in Pakistan to identify malnutrition in children. Current WHO guide lines for community screening for malnutrition recommend MUAC < 11.5 cm for severe acute malnutrition (SAM), however it is abstruse how MUAC relates to WHZ to define acute malnutrition. Our aim was to estimate the cut-off values of MUAC and its sensitivity and appropriateness with WHZ scale for screening SAM in children from Sindh, Pakistan.

**Methods:** A cross-sectional study of 491 children < 5 years old from rural area of Adilpur village, Sind Pakistan was undertaken. Demographic information was taken from the parent/caretaker and anthropometric data was assessed according to WHO protocol. Receiver operator characteristics (ROC) curves and Youden index was constructed to present the relationship between MUAC and WHZ score for different cut-off values of MUAC for moderate acute malnutrition (MAM) and SAM. Sensitivity and specificity of MUAC < 11.5 cm was calculated in comparison with WHZ-score <-3 standard deviation (SD).

**Results:** The sensitivity and specificity of MUAC <11.5 cm was 25.5% and 98.6% respectively. Using the current WHO cut-off <11.5 cm for MUAC to screen SAM, more than 74% of children with WHZ-score < -3 were missed. The best and optimal cut-off for screening SAM was obtained at MUAC <12.8 cm with sensitivity 63.8% and specificity 88.1%.

**Conclusions:** Using the current WHO cut-off of MUAC can only capture a smaller proportion of children < 5 years of age with SAM. There is an urgent need to revise cutoff value of MUAC from <11.5 cm to 12.8 cm in the community for treatment of malnutrition in children < 5 years old or we need to apply both tools MUAC <11.5 cm and WHZ-score < -3 SD simultaneously to detect all SAM children in the community.

**Keywords:** Severe acute malnutrition (SAM), mid upper arm circumference (MUAC), WHZ-score, Pakistan
DIETARY DIVERSITY AND ADEQUACY OF NUTRIENTS CONSUMED BY SCHOOL CHILDREN IN NAIROBI CITY COUNTY, KENYA

(1)Ndungu, Zipporah; (2)Mbithe, Dorcus; (3)Mutie, Catherine.

(1)Lecturer. Department of food science and technology Jomo Kenyatta. University of agriculture and technology. Kenya;

(2)PhD. Lecturer. Department of Food, Nutrition and Dietetics. Kenyatta University. Kenya; (3)PhD. Nutritionist. Global Alliance for Improved Nutrition. Kenya.

**Background and objectives:** School children experience changes in biological, psychological and social dimensions. Nutrition adequacy or inadequacy at this stage affects nutrition and health outcomes throughout the life cycle. The objective of the study was to analyze dietary diversity and adequacy of nutrient intake among school children in comparison with the global recommendations.

**Methods:** A cross sectional study design was used to collect data on a randomly selected sample of 202 children from urban day primary schools in Nairobi City County. Dietary diversity and 24-hour recall questionnaires were used to assess diversity and adequacy of the nutrients intake. Data from 24-hour recall was analyzed using Nutri-survey computer software to establish the amount of nutrients consumed in a day and compared with the reference values (FAO/WHO, 2001). The dietary diversity score (DDS) was calculated from 14 food groups. A score of ≤3 was considered as low, 4-6 was considered as moderate while a score of >6 was considered as high dietary diversity (FAO, 2008). Spearman's correlation was used to assess association between DDS and nutrients intake.

**Results:** The mean DDS for the children was 3.8(SD1.4) The diet was predominantly cereals, legumes and green leafy vegetables. There was inadequate consumption of vitamin A rich fruits and vegetables, organ meat, eggs, fish and flesh meat. Protein consumed was mainly from plant origin. Approximately a third of the children had inadequate consumption of crucial micronutrients such as iron (31.2%), vitamin A (28.7%), zinc (30.7%) and calcium (33.2%). Significant correlations were found between DDS and micronutrient intake and no association with energy intake. Energy intake was adequate for most (94.6%) children. Mean values for diet composition indicated that carbohydrate constituted 57.5% of the total energy, fat provided 33.1% and protein provided 9.4%.

**Conclusions:** The DDS of school children in Nairobi is low. Though the consumption of energy was generally adequate, the diet was devoid of protein and crucial micronutrients. This study recommends promotion of efforts to improve consumption of diversified, adequate diets by school children.

**Keywords:** Dietary diversity, nutrient adequacy, school children

MOTHER'S KNOWLEDGE, ATTITUDE AND PRACTICE OF INFANT NUTRITION AND HEALTH CARE STRATEGIES IN DELTA STATE, NIGERIA

(1)Ofili, Oghenefego; (2)Fadupin, Grace T.

(1)PhD Student. Department of Human Nutrition. University of Ibadan. Nigeria.; (2)PhD, Nutritionist. Senior Lecturer. Department of Human Nutrition. University of Ibadan. Nigeria.

**Background and objectives:** Knowledge of infant nutrition and health care strategies has been found to be high in numerous studies, but the lacunae have always been in the actual practice of the knowledge received. The nutrition education strategy currently used in disseminating information to pregnant and lactating mothers at Primary Health Care Centres during antenatal clinics does not seem to have yielded significant impact in improving the nutritional health of infants in Delta State. This could be linked to the assumption that programs are not designed to achieve behavior change; only to provide information. This study seeks to gather evidence for policy advocacy on nutrition behavior change communication as a key strategy to improving infant health and nutrition in Nigeria.

**Methods:** A cross sectional assessment as part of formative research was conducted to review the situation and gaps in knowledge, skill or other issues related to infant nutrition and health of mothers in Delta State. A semi-structured questionnaire was used to gather information on demographic characteristics, nutritional status of mother-child pair and KAP of infant nutrition and health care strategies in 6 communities in Delta State. Knowledge, attitude and practice scores were determined by the number of correctly answered questions.

**Results:** A total of 260 mother-child pairs participated in this study. Only 8.8% of mother had adequate knowledge of infant nutrition and health care strategies. 61.9% did not know what exclusive breastfeeding meant. 41.2% had negative attitudes towards infant nutrition and health care strategies. **Results: Conclusions:** It is evident from this study that there needs to be an improvement in the methods used in disseminating information on infant nutrition and health care at the community levels. It is possible to bridge the difference in educational gaps through the use of behavior change communication strategies for nutrition education.

**Keywords:** Infant, Nutrition, Knowledge, Attitude, Practice
NUTRITIONAL STATUS AND TREATMENT OUT-
COME OF OUTPATIENTS WITH EATING DISOR-
DERS IN AN INTERDISCIPLINARY THERAPEUTIC
CENTER IN BUENOS AIRES

(1)Grippo, Beatriz; (2)Ricciardi, Olga; (3)Moretti, Mariana; (4)Rodriguez, Pedro; (5)Villar, Julieta.

(1)Nutritionist. Center specializing in eating disorders. Buenos Aires. Argentina.; (2)Licensed in psychology. Director. Center specializing in eating disorders. Professor. Faculty of psychology. Buenos Aires University. Buenos Aires. Argentina.; (3)Md. Nutritionist. Medical Director. Center specializing in eating disorders. Buenos Aires. Argentina.; (4)Licensed in Computer Science. Faculty of exact and natural sciences. Buenos Aires University. Buenos Aires. Argentina.; (5)Institutional relations manager. Center specializing in eating disorders. Buenos Aires. Argentina.

**Background and objectives:** Eating disorders (ED) are a psy-
chiatric problem that affect mainly young women. The multidisci-
plinary team approach to patients with ED is widely recognized as
the best practice. The Specialized Center for Eating Disorders pro-
vides individualized treatment to children, adolescent and adults
with ED. The aim of this study is to describe demographic charac-
teristics, nutritional status and treatment drop-out and success rates.

**Methods:** The database used contains data on diagnosed pa-
tients (DSM-IV) in 2010-2016. For nutritional status WHO body
mass index categories are used, and data statistical analysis with
software R Version 3.3.1.

**Results:** 991 patients (84% F, 16% M). Women /man rate was 9 in anorexia nervosa (AN) and bulimia nervosa (BN), and 4 in eating disorders not otherwise specified (EDNOS). Mean age was 38.5± 16.6y, for AN 21.6 ± 10.9y, for BN 35± 14.9y and for EDNOS 43.5 ± 15.7y. The age variable was found to be significant (p< 0.001) in a logistic regression model to predict among ED. The distribution of the admitted patients was 59.0% EDNOS, 29.2% BN, 11.5% AN, and 0.3% feeding disorder of infancy. Prevalence of excess weight was 75.4% (overweight 22.6%, obesity 44.4% and morbid obesity 8.0%); 20.2% had normal weight and 4.5% underweight; 8.7% had psychiatrics comorbidities. 932 patients started treatment; 2% were derived; 60% dropped-out (9% returned to treatment); 13% finished treatment and 25% were still in treatment at the end of the study period. Drop-out was 49% in AN, 57% BN and 66% EDNOS. Pa-tients with EDNOS showed a tendency for higher dropout (p=0.01). Patients who dropped out on the first 3 months (40%), were 38% for personal reasons, 20% for administratively discharged, 8% for time schedule, 4% went inpatient and 30% for unknown reasons. The average length of treatment was 443± 220 days.

**Conclusions:** EDNOS showed the highest prevalence of ED. More than half of the patients had 31-60 y old. The rate of obesi- ty of the patients studied is in line with comparable studies. The multidisciplinary treatment approach and drop-out rates results were similar to reported from other countries.

**Keywords:** eating disorders, nutritional status, dropout

**Conflict of Interest Disclosure:** Olga Ricciardi is CEDA's (Center Specializing in Eating Disorders) Managing Director.

Mariana Moretti is Medical Director in CEDA. Beatriz Grippo
works as outside consultant in CEDA and Julieta Villar is Institu-
tional relations manager in CEDA.

NUTRITION STATUS AND ACADEMIC PERFOR-
MANCE OF PRIMARY SCHOOL CHILDREN IN
UGANDA. A CASE OF MPIGI DISTRICT, CENTRAL
UGANDA

Ssenyondo, Muzafaru; Ainomugisha, Prudence; Ahumuza, Gracious.

BSc. Department of Food Technology & Nutrition. Makerere University. Uganda.

**Background and objectives:** Background: The Education for All (EFA) Global Monitoring Report (UNESCO, 2011) states that more than a quarter of children below fifteen years of age in sub-Saharan Africa are underweight due to poor diet and malnutrition, making them more vulnerable to disease and less able to concentrate at school. Although studies relating schoolchildren's health and nutritional status and their learning have been conducted elsewhere, relatively little is known about the nutrition and health conditions of school aged children in Uganda and how these factors affect their learning.

Objective: To investigate the relationship between health, nu-
tritional status and academic performance of primary school chil-
dren in Mpigi district, a rural district in Central Uganda

**Methods:** The study was a cross-sectional comprising of total of 300 primary school children in class 4, between the ages of 7-14 years. All children sampled were from day schools. Sampling of schools was done using a modification of WHO 30x30 cluster sampling technique (using only grade one schools). The children were sampled randomly from a list of all children in the target class. Anthropometric measurements were done using standard methods. The educational performance of children was assessed using results scored for both English and Mathematics tests.

**Results:** The prevalence of stunting and wasting in the study group was 15.3% and 3%, respectively. Being wasted seemed to favor academic performance, as the likelihood of children scoring above cut-off increased with when the child was wasted (OR= 3.171). Stunting as expected had a negative effect on academic performance (OR=0.969). Factors that significantly affected academic performance included; feeding at school, suffering from disease, mother's education and main source of water (p<0.05)

**Conclusions:** Under nutrition and poor health in the primary school children in rural areas is likely to negatively affect educational performance, which could affect their quality of life in the long-term.

**Keywords:** Educational performance, nutritional status,
school children, under nutrition.
DIETARY INTAKES ON GROWTH DEVELOPMENT
IN THE FIRST DECADE FROM A BIRTH COHORT
IN TAIWAN

(1)Lyu, Li-Ching; (2)Hsueh, Yu-Hui; (3)Lu, Yu-Ping; (3)Li, Shih-An; (4)Liu, Chih-Yi; (4)Chen, Yun-Lin.

(1)Professor. Program of Nutrition Science and Education. Department of Human Development and Family Studies. National Taiwan Normal University. Taiwan; (2)RD. MSc. Nutritionist. John Tung Foundation. Taipei. Taiwan.; (3)Msc. Graduate student. Program of Nutrition Science and Education. Department of Human Development and Family Studies. National Taiwan Normal University. Taiwan.; (4)Bsc. Graduate student. Porgram of Nutrition Science and Education. Department of Human Development and Family Studies. National Taiwan Normal University. Taiwan.

**Background and objectives:** The purpose of this study is to examine the dietary intakes and growth development including adiposity rebound from birth to 10 years old with different birth weights.

**Methods:** We follow and analyze the dietary and anthropometric parameters from 1 to 10 years old children with relative high (n=87 at 1, 43 at 10), normal (n=69 at 1, 12 at 10) and low (n=73 at 1, 39 at 10) birth weights from singlet pregnancies.

**Results:** The average energy intakes are from 890 kcal at 1, 1360 kcal at 5 and 1759 kcal at 10 years old with 93 kcal/kg at 1, 73 kcal/kg at 5 and 52 kcal/kg at 10, respectively (p for trend <0.05). The percent of energy from fat increases (23 to 30%) and carbohydrate decreases (64 to 54%) with age until 10; however, the protein intake is constant around 13-14% throughout the 10 years. The plant sources of protein (soy products) and fat (seed oil) consumption increase with age until 10 years old and the vitamin C and calcium intake decrease with age until 6 years old. The average BMI is 16.8 at 1 and reaches the lowest value of 15.5 at 5 and 17.4 at 10 years old. Although the relative high birth weight group is still with the higher means for weight and height at 10 years old, the relative low birth weight group shows the highest energy intake per kg with the fast growth rate from birth to 2 years old and catches up growth with the relative normal birth weight group. The early adiposity rebound group has the higher energy and nutrient intakes than the late adiposity rebound group, especially for the boys. The protein intake at 2 years old is positively related to the early adiposity rebound (p<0.05). The calcium intake at 6 years old is positively related to height at 7 (p<0.05).

**Conclusions:** Our data demonstrate that the birth weight has time-varying latent effect on growth development in the first decade of childhood. The nutrition status including energy and protein intakes have impact on adiposity rebound indicated by BMI changes for children.

**Keywords:** dietary intakes, growth development, adiposity rebound, birth cohort, Taiwan

CHANGES IN BODY COMPOSITION AND CARDI-
OMETABOLIC RISK AMONG BLACK SOUTH AF-
RICAN ADULTS

(1)Kruger, Salome.; (2)Kruger, Iolande Marike.; (3)Schutte, Aletta Elizabeth.

(1)Ph D. Dietitian. Centre of Excellence for Nutrition. North-West University. Potchefstroom. South Africa.; (2)Ph D. Africa Unit for Transdisciplinary Health Research. North-West University. Potchefstroom. South Africa.; (3)Ph D. Hypertension in Africa Research Unit. North-West University. Potchefstroom. South Africa.

**Background and objectives:** Obesity-related health risk may differ by ethnicity at the same body mass index (BMI). The objectives of this study were too determine the predictive value of the World Health Organization (WHO) overweight cut-point of BMI of 25 kg.m2 in men and women, respectively, to identify 10-year cardiometabolic risk and to determine optimal male (M) and female (F) BMI cut-points to identify 10-year cardiometabolic risk.

**Methods:** In the longitudinal PURE study of healthy black South Africans (n=2010), aged 30-90 years in 2005, demographic, lifestyle and anthropometric measures were taken and blood pressure, fasting serum triglycerides, high-density lipoprotein (HDL)-cholesterol and blood glucose were measured. Three or more risk factors according to international metabolic syndrome (MetS) criteria (fasting plasma glucose >5.6 mmol/L /oral hypoglycemic drugs, systolic blood pressure (SBP) >130 and/or diastolic blood pressure (DBP) >85 /anti-hypertensive drugs, serum TG >1.7 mmol/L, HDL-cholesterol <1 mmol/L M /<1.3 mmol/L F) and waist circumference (WC) above sex-specific cut-points (>94cm M/ >80cm F) in 2015 were defined as elevated cardiometabolic risk.

**Results:** Participants with WC above sex-specific cut-points in 2005 had significantly higher odds of having the MetS in 2015 (odds ratio, OR = 6.99, 95% CI 5.01, 9.75). Participants with BMI in the overweight/obese range (BMI > 25 kg/m2) in 2005 had significantly higher odds of having the MetS in 2015 (OR = 6.38, 95% CI 4.55, 8.94). Receiver Operating Characteristic curves to identify a sex-specific optimal BMI cut-point associated with increased 10-year risk indicated a BMI cut-point of 23.3 kg/m2 in men and 24.6 kg/m2 in women. A BMI cut-point of 30 kg/m2 had poor diagnostic performance. WC cut-points to predict 10-year risk of MetS were 78.0 cm in women and 84.0 cm in men. All cut-points were lower than international proposed cut-points for adiposity.

**Conclusions:** Baseline BMI and WC were significantly associated with increased cardiometabolic risk after follow-up. The predictive value of the WHO overweight cut-point of body mass index (BMI > 25 kg/m2) was similar to the new sex-specific cut-points (23.3 kg/m2 for men, 24.6 kg/m2 for women), but a BMI of 30 kg/m2 had poor diagnostic ability.

**Keywords:** obesity, body mass index, waist circumference, cardiometabolic risk, Africa
# REDUCED CHILD STUNTING AND BETTER COGNITION: A CONTRIBUTION BY COMMUNITY HEALTH WORKERS IN A RURAL SETTING, KENYA

(1)Caroline, Sawe; (2)Grace Keverenge, Ettyang'; (3)Charles Obadiah, Kimamo; (4)Wambui, Kogi-Makau.

(1)MPH. Nutrition PhD student. Food Science, Nutrition and Technology. University of Nairobi. Kenya.; (2)PhD. Associate Professor. Human Nutrition. Moi University. Kenya.; (3)PhD. Psychologist. Psychology. University of Nairobi. Kenya.; (4)PhD. Professor. Food Science, Nutrition and Technology. University of Nairobi. Kenya.

**Background and objectives:** Globally an estimated 139 million children are stunted with a majority living in Low and Middle-Income countries. Stunting is an indicator of chronic malnutrition and after the second year of life, it becomes irreversible. It has been associated with infections, diminished survival and impaired cognitive development. Poor child cognition can be influenced by poor nutrition, health status, genetics and environmental factors. It has been linked to delayed school enrollment, performance and decreased economic activity in later years. Trained Community Health Workers have been proved effective in improving other health outcomes however, little research has been conducted if any of their contribution in stunting and cognitive development. This study assessed the impact of Community Health workers on stunting and cognition among children aged less than two years in a rural setting in Kenya.

**Methods:** A Comparative study design that recruited 192 children (101 intervention and 91 comparative arms). Community Health Workers provided key nutrition messages and counseling services to caregivers of children at specific times during child's growth. Stunting was computed based on WHO height-for-age Z-scores; and cognition determined by Bayleys Scale of Infant Development and composite scores.

**Results:** Child mean age was 11.84 (±6.90) months and height 70.86 (±8.82) cm. The prevalence of stunting was lower in intervention than in comparative arm (5.94% and 25.27% respectively; p<0.001) while poor cognition rates were higher in the comparative arm compared to intervention arm (34.07% and 14.85% respectively; p<0.001). After adjusting for confounders, children whose mother's had tertiary education had 0.03 times lower relative risks of being severely stunted compared to those whose mothers had primary education [RRR:0.033: 95% CI:0.001-0.891; p=0.042].

**Conclusions:** Community Health Workers have proved effective in reducing child stunting and improving child cognition. Mother's education showed to be critical in improving these outcomes. Further research on factors associated with the outcomes is recommended. Program interventions should target children aged below two years as it is the window period of opportunity

**Keywords:** Stunting, cognition, Community Health Workers, intervention

# EFFECT ON LEAN MASS, LINEAR GROWTH AND IRON STATUS OF IMPROVED ANIMAL SOURCE FOODS AND MICRONUTRIENTS FORTIFIED COMPLEMENTARY FOODS AMONG KENYAN YOUNG CHILDREN: A RANDOMIZED CONTROLLED TRIAL

(1)Konyole, Silvenus; (2)Ayoma, Selina; (3)Kinyuru, John; (4)Owuor, Bethwell; (5)Estambale, Benson; (6)Wells, Jonathan; (7)Michaelsen, Kim F.; (7)Friis, Henrik; (8)Roos, Nanna; (9)Owino, Victor.

(1)Masinde Muliro University of Science and Technology. Kenya.;

(2)PhD. Nutritionist. Institute of Tropical and Infectious Diseases. University of Nairobi. Nairobi. Kenya.; (3)PhD. Nutritionist. Department of Food Science and Postharvest Technology. Jomo Kenyatta University. Juja. Kenya.; (4)PhD. Biologist. Department of Biology. Catholic University of East Africa. Nairobi. Kenya.;

(5)PhD. Parasitologist. Research Division. Jaramogi Oginga Odinga University. Bondo. Kenya.; (6)PhD. Nutritionist. Childhood Nutrition Research Centre. Institute of Child Health. London. UK.; (7)Department of Nutrition, Exercise and Sports. Faculty of Science. University of Copenhagen. Denmark.; (8)PhD. Nutritionist.

Department of Nutrition Exercise and Sports. University of Copenhagen. Copenhagen. Denmark.; (9)PhD. Nutritionist. Nutrition Section. International Atomic Energy Agency. Vienna. Austria.

**Background and objectives:** Malnutrition from early infancy in resource limited settings may result from among others low quality complementary foods with severe consequences later in life despite the rich food resources locally available, currently neglected but potentially useful as alternatives.

**Objective:** To evaluate the two developed WinFood products as replacement products for the standard corn-soy blend plus (CSB+) product meant for general distribution in food aid to combat moderate malnutrition. WinFood Classic (WFC) containing grain amaranth, maize, small fish(3%) and edible termites (10%) and WinFood Lite (WFL) with only grain amaranth, maize and fortified with minerals and vitamins as in CSB+ were tested against the existing purely plant based minerals and vitamins fortified CSB+.

**Methods:** Design: A randomized, double blind, controlled trial in 499 Kenyan children assigned aged 6 mo. To receive one of study foods for 9 months viz WFC (energy density 423.6Kcal/100g and 12.2mg/100g Iron; n=165); WFL (energy density 407.2Kcal/100g and 12.5mg/100g Iron; n=167); CSB+ (fortified with vitamin-mineral premix; n=167). The study was designed primarily to assess increments in fat-free mass by a deuterium dilution technique, linear growth and change in plasma ferritin, body iron stores and plasma transferrin receptor (sTfR). Secondary outcomes were changes in anthropometric variables including skin folds. Data were analyzed by the intention-to-treat approach.

**Results:** No differences between the WinFoods(WFC and WFL) and the CSB+ with respect to changes in fat free mass(FFM), length and haemoglobin(P=0.536,0.52 and 0.078 respectively). The mean length increased by 10.0cm (95% CI: 9.6, 10.5cm) during the 9 mo. Mean weight increased by 2.2kg (95% CI: 2.0, 2.4kg). The
weight gain was due to increase in mean FFM by 2.27kg (95% CI: 2.06, 2.48kg) and loss of fat mass by -0.09kg (95% CI:-0.28, 0.10kg). There were differences in plasma ferritin and sTfR (P=0.005 and 0.008 respectively). No differences between the WinFoods and the CSB+ in the changes from secondary outcomes except for head circumference of 3.5cm (95% CI: 1.1, 5.9cm) (P=0.002).

**Conclusions:** Locally produced products did not differ from CSB+. The small fish and the edible termites can potentially improve the nutritional quality of locally processed complementary foods and food aid products thus need further investigation.

**Keywords:** body composition, iron status, fortification, edible winged termites, Kenya.

**Further collaborators**

Jutta KH Skau: MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa

Suzanne M Filteau: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom

sleep and wake up. The time spent sited in a week represented the sedentary behavior. More than 100 minutes sited/day was considered sedentary. The consumption of macronutrients was rated by two 24hours recalls. Linear regression models were used to assess the relationship between sleep duration with diet and sedentary behavior.

**Results:** The sample comprised 54% of girls, with a mean age of 11.9 years old. The prevalence of sedentary behavior was 76.2%, being sited, in mean, for 243 minutes/day. The average calorie intake was 2226.90 kcal and the macronutrients were on average within the recommended for the age group studied. There was a negative association between sleep duration and the consumption of saturated fats only for girls and negative between sleep duration and sedentary behavior in both sexes.

**Conclusion:** Sleep duration was negatively associated with the consumption of saturated fat in girls and sedentary behavior in both sexes.

**Keywords:** Sleep; Diet; Adolescents.

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SLEEP DURATION, DIETARY INTAKE AND SEDENTARY BEHAVIOUR IN BRAZILIAN TEENS: THE LONCAAFS STUDY

**Background and objectives:** Introduction. Studies suggest that the association between increased variability of hours of sleep and abdominal obesity can be explained by the energy intake, with special attention to carbohydrates and fats. Sedentary behavior linked to screen time has been strongly associated with sleep behavior disorders.

Objective. To describe the relationship between sleep duration, sedentary behavior and macronutrients dietary intake in adolescents aged 10 to 14 years old from João Pessoa, Paraíba, Brazil.

**Methods:** Design. Cross-sectional study developed with 1384. The data analyzed in this study are part of the first year (2014) collection of Longitudinal Study Sedentary Behavior, Physical Activity, Eating Habits and Health of Adolescents - The Loncaafs Study. Based on information of a whole week (week and weekend), sleep duration was measured as the mean difference between the time to

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RELATIONSHIPS BETWEEN CONSUMPTION OF ULTRA-PROCESSED FOODS. GESTATIONAL WEIGHT GAIN AND NEONATAL OUTCOMES IN A SAMPLE OF US PREGNANT WOMEN

**Background and objectives:** An increasingly large share of diet comes from ultra-processed foods (UPFs), which are assemblages of food substances designed to create durable, convenient and palatable ready-to-eat products. There is increasing evidence that high UPF consumption is indicative of poor diet and is associated with obesity and metabolic disorders. This study sought to examine the relationship between percent of energy intake from ultra-processed foods (PEI-UPF) during pregnancy and maternal gestational weight gain, maternal lipids and glycemia, and neonatal body composition. We also compared the PEI-UPF indicator against the US government's Healthy Eating Index-2010 (HEI-2010).

**Methods:** Data were used from a longitudinal study performed from 2013-2014 at the Women's Health Center and Obstetrics &

<footnote>(1)Costa Pereira De Arruda Neta, Adélia; (2)Emília Lima, Flávia;</footnote>

<footnote>(2)Valdna Oliveira dos Santos, Elaine; (2)Ferreira Leite Saldanha, Susana; (2)Costa da Silva, Celso; (3)Miguel de Souza Neto, João;</footnote>

<footnote>(2)Cabral Fernandes Vieira, Clara; (2)Francisca Rodrigues, Iara;</footnote>

<footnote>(4)Araújo Teixeira, Juliana; (5)Marchioni, Dirce.</footnote>

<footnote>(1)PhD. Department of Nutrition. School of Public Health. University of Sao Paulo. Sao Paulo. Brazil.; (2)Department of Nutrition. Federal University of Paraíba. University City. João Pessoa. Brazil.; (3)Department of Physical Education. Federal University of Paraíba. University City. João Pessoa. Brazil.; (4)PhD. Department of Nutrition. School of Public Health. University of Sao Paulo. Sao Paulo. Brazil.; (5)Department of Nutrition. School of Public Health. University of Sao Paulo. Sao Paulo, Brazil.</footnote>

<footnote>(1)Rohatgi, Karthik; (2)Tinius, Rachel; (3)Cade, W. Todd; (4)Martinez Steele, Euridice; (5)Cahill, Alison; (6)Parra, Diana C.</footnote>

<footnote>(1)Student. Program in Physical Therapy. Washington University School of Medicine. USA.; (2)PhD. Assistant Professor of Exercise Science. School of Kinesiology, Recreation, and Sport. Western Kentucky University. Bowling Green. United States.; (3)PT. PhD. Professor of Physical Therapy. Medicine Program in Physical Therapy. Washington University School of Medicine. Saint Louis. United States.; (4)MS. Researcher. Department of Nutrition. University of São Paulo. São Paulo. Brazil.; (5)MD. Associate Professor. Obstetrics and Gynecology. Division of Maternal Fetal Medicine. Washington University School of Medicine. Saint Louis. United States.; (6)PhD. Assistant Professor. Program in Physical Therapy. Washington University School of Medicine. Saint Louis. United States.</footnote>
Gynecology Clinic in St. Louis, MO, USA. Subjects were pregnant women in the normal and obese weight ranges, as well as their newborns (n=45). PEI-UPF and the Healthy Eating Index-2010 (HEI-2010) were calculated for each subject from a one-month food frequency questionnaire (FFQ). Multiple regression analysis was used to analyze the relationship between PEI-UPF or HEI-2010 and various clinical outcomes. The ability of these dietary indices to predict gestational weight gain was also compared with the predictive abilities of total energy intake and total fat intake.

**Results:** An average of 54.4 ± 13.2% of energy intake was derived from UPFs. A 1% point increase in PEI-UPF was associated with a 1.57 kg increase in gestational weight gain (p=0.0036). Similarly, a 1% point increase in PEI-UPF was associated with increases of 0.23 mm in thigh skinfold (p=0.030), 0.14 mm in subscapular skinfold (p=0.017), and 0.59 percentage points in total body adiposity (p=0.038) of the neonate.

**Conclusions:** PEI-UPF was associated with and might be a useful predictor of several maternal and neonatal clinical outcomes. PEI-UPF was a better predictor of gestational weight gain and infant body fat than either total energy or fat intake, and a better predictor of infant body fat than HEI-2010. Thus, maternal UPF consumption may also affect long-term health outcomes (such as obesity) of the child. UPF consumption should be limited during pregnancy and diet quality should be maximized in order to improve maternal and neonatal health.

**Keywords:** ultra-processed foods, gestational weight gain, birth outcomes, neonatal body composition, maternal nutrition

few caregivers (3.3%) had no schooling while majority had secondary education and higher. However, two thirds of caregivers were unemployed and depended on child support grant for income. Majority of children were given three meals or more per day with very few who were given less than three meals per day. Almost all children were introduced to complementary foods before the age of six months. More than half of the children stopped breastfed at the age of 13 to 18 months. Majority of children were given starchy foods and very few children were given vegetables and fruits. Few children were stunted, 16.7% were wasted while 13.3% underweight.

**Conclusions:** A significant number of children were stunted, wasted and underweight. In addition, poor infant feeding practices were also observed as most children were given complementary foods before the age of six months.

**Keywords:** Malnutrition, children, nutritional status, feeding practices

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NUTRITIONAL STATUS AND FEEDING PRACTICES OF CHILDREN AGED 2 TO 5 YEARS IN VHEMBE DISTRICT, LIMPOPO PROVINCE, SOUTH AFRICA

**Background and objectives:** Appropriate feeding practices are fundamental to child survival, growth and development. Poor infant feeding practices are associated with child death as well as poor growth.

To determine the nutritional status of children and feeding practices of children aged 2 to 5 years.

**Methods:** A cross-sectional study design was used. Five pre-schools were randomly selected from Vhembe District. 243 children aged 2 to 5 years were randomly selected from each pre-school. Caregivers were interviewed using the local language. The children's anthropometric measurements were also taken on the same day of interview by field workers. Data was analyzed using SPSS computer software version 23.

**Results:** More than half of children were females while 48% were males. The age of caregivers ranged from 20 to 36 years. Very

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PREVALENCE OF IRON, FOLIC ACID AND VITAMIN A DEFICIENCY IN COLOMBIAN SCHOOL-CHILDREN AND ADOLESCENTS AND POSSIBLE RISK FACTORS

**Background and objectives:** According to the National Survey of Nutrition Status in Colombia 2010, 1:4 children aged 6 to 59 months, 11% between 13 and 17 years old and 8% from 5 to 12 years old presented anemia; and 1:4 children aged 1 to 4 years have vitamin A deficiency. The objective is to determine the prevalence and possible risk factors of iron (Fe +), folic acid (FolAc) and vitamin A (vitA) daily intake by means of a reminder of 24 hours in Colombian children, according to the Program for the Evaluation of Diets and Management of Food (DIAL).

**Methods:** Study of prevalence among schoolchildren (n=1221) and adolescents (n=1650) between 8-18 years of age in the Andean zone (La Unión=476), atlantic (Cartagena=427), pacific (Cali=1220, Quilichao=356) and amazonic (Florencia=392) zone and public (n=2342) and private (n=529) school, to whom sociodemographic (age, sex), anthropometric variables (weight, height, circumference of waist) and were diagnosed of malnutrition by body mass index, low height by height/age and abdominal obesity by waist circumference. Normal daily Fe+= 9-18 mg, FolAc=300-400 µg and VitA=500-700 µg were considered according to age and sex.

**Results:** 2871 Colombian children were included; 52.1% male, 12.9±2.4 years old, with Fe+=81.8±77.1 mg/d, FolAc=322.9±243.7 µg/d and VitA=665.6±1252.7 µg/d. With malnutrition=28.9%, low height=5.9% and 4.4% abdominal obesity. They presented Fe+=66.3%, FolAc=77.1% and VitA=63.2% deficiency; being possible risk factors for the Atlantic zone, adolescents, malnutrition, female sex and school (p <0.05).

<footnote>(1)Mushaphi, Lindelani Fhumudzani; (2)Chauke, Tlangelani;</footnote>

<footnote>(2)Mulabisano, Tshavhuyo; (2)Munene, Helen; (2)Matloga, Lufuno.</footnote>

<footnote>(1)PhD. Nutritionist. Department of Nutrition. School of Health Science. University of Venda. South Africa.; (2)BSc. Nutritionist. Department of Nutrition. School of Health Sciences. University of Venda. South Africa.</footnote>

<footnote>(1)Ramirez, Carmen Rosy; (2)Velasco, Carlos.</footnote>

<footnote>(1)Hospital Regional María Inmaculada. Florencia, Colombia;</footnote>

<footnote>(2)Universidad del Valle. Cali, Colombia.</footnote>
**Conclusions:** More than 2/3 of these Colombian schoolchildren and adolescents presented deficiency of daily intake of Fe+, FolAc and VitA; being possible risk factors, geographical area, school, age group, sex and nutritional status.

**Keywords:** Iron deficiency, Folic acid deficiency, Vitamin A deficiency, Children

(1)Ramirez, Carmen Rosy; (2)Velasco, Carlos.

(1)Hospital Regional María Inmaculada. Florencia, Colombia;

(2)Universidad del Valle. Cali, Colombia.

**Background and objectives:** According to the National Survey of Nutrition Situation in Colombia 2010, 1:6 children and adolescents are overweight or obese; and 1:10 children and adolescents from 5 to 17 years of age present growth retardation. The objective is to determine the nutritional status in Colombian children, according to body mass index (BMI) and height for age (HA) using the WHO tables, and according to waist circumference (wc).

**Methods:** Prevalence study in schoolchildren (n=1235) and adolescents (n=1746) between 8-18 years of age in the Andean zone (La Unión=488), atlantic (Cartagena=489), pacific (Cali=1254, Quilichao=357) and socioeconomic variables (age, sex), anthropometric variables [weight (W), height (H), wc) and socio-demographic variables (age, sex), from public (n=2433) and private (n=548) schools. Were diagnosed by BMI in malnutrition (obesity, overweight, undernutrition and severe undernutrition), altered height (low height and severe low height) and abdominal obesity by wc (> p90%).

**Results:** 2981 Colombian children were included; 52.0% male, 12.9±2.3 years old, with W=48.0±13.3 kg, H=153.3±12.9 cm and wc=71.1±9.4 cm. They presented malnutrition=28.8%, altered heigth=6.0% and 4.2% abdominal obesity; being possible risk factors for malnutrition=the pacific zone, the private school and the adolescents (p<0.05), for the altered height=the public school, and for abdominal obesity=the pacific zone, the public school, the female sex, and the school children.

**Conclusions:** About 1/3 of these Colombian schoolchildren and adolescents presented malnutrition (undernutrition=2.3%, overweight and obesity=26.5%), and few had low height and abdominal obesity; being possible risk factors, the geographical area, the school, the age group and the sex.

**Keywords:** Overweight, Obesity, Undernutrition, Abdominal obesity, Children

(1)Arias, Katherine; (1)Velasco, Carlos; (2)Ramirez, Carmen Rosy.

(1)Universidad del Valle. Cali. Colombia.; (2)Hospital Regional María Inmaculada. Florencia. Colombia.

**Background and objectives:** In assessing the nutritional status of children, the daily consumption of ingested foods makes it possible to assess whether their diet is complete, balanced, adequate and adequate. The objective is to determine the prevalence and possible risk factors of the daily consumption of kilocalories (kcal), carbohydrates (CH), proteins (Prot), fats (Fat) and dietary fiber (Fib) in Colombians children, according to the Program for the Evaluation of Diets and Management of Food (DIAL).

**Methods:** Study of prevalence among schoolchildren (n=1221) and adolescents (n=1650) between 8-18 years of age in the Colombian andean (La Unión=476), atlantic (Cartagena=427), pacific (Cali=1220, Quilichao=356) and amazonic (Florencia=392) zone, from public (n=2342) and private (n=529) school, to whom socioeconomic (age, sex), anthropometric variables (weight, height, circumference of waist) and were diagnosed of malnutrition by body mass index, low height by height/age and abdominal obesity by waist circumference. Normal daily consumption of kcal=1750-2250 kcal/m2, CH=50-55% total caloric value (TCV), Prot=10-15% TCV, Fat=30-35% TCV and Fib=Age + 5 grams.

**Results:** 2871 Colombian children were included; 52.1% male, 12.9±2.4 years old, with kcal=1950.4±672.2 kcal/m2/d, CH=259.8±113.0 g/d, Prot=360.8±304.0 g/d, Fat=354.9±311.7 g/d and Fib=20.7±15.1 g/d, with malnutrition=28.9%, low height=5.9% and 4.4% abdominal obesity. They presented a hypocaloric daily consumption=75.0%, hypoglycemic=42.5%, hyperprotein=71.5%, hyperlipid=44.9% low in Fib=53.6%; being possible risk factors in the Atlantic and Andean zone, adolescents, malnutrition, female sex and private school (p <0.05).

**Conclusions:** The daily consumption of these Colombian schoolchildren and adolescents was hypocaloric, hypoglycemic, hyperprotein, hyperfat and low in fiber; being possible risk factors, geographical area, school, age group, sex and nutritional status.

**Keywords:** Daily consumption, Energy, Macronutrients, Dietary fiber, Children
# DIETARY DIVERSITY WAS NOT ASSOCIATED WITH SERUM CONCENTRATIONS OF VITAMIN B12, IRON AND FOLATE IN A COHORT OF PREGNANT GHANAIAN ADOLESCENT GIRLS

(1)Intiful, Freda; (2)Asante, Matilda; (3)Asare, George; (4)Wiredu, Edwin.

(1)School of Biomedical and Allied Health Sciences. Department of Nutrition and Dietetics. University of Ghana. Ghana.; (2)Senior Lecturer. Department of Nutrition and Dietetics. University of Ghana. Ghana; (3)Professor. Department of Medical Laboratory Sciences. University of Ghana. Ghana; (4)Professor. Department of Pathology. University of Ghana. Ghana.

**Background and objectives:** Previous studies have suggested that good dietary diversity in the diet has an impact on micronutrient intakes and could be used as reliable measures for assessing nutrient adequacy. The objective of this study was to assess dietary diversity and determine its association with serum concentrations of iron, folate and vitamin B12.

**Methods:** A cross sectional study involving 203 pregnant adolescent girls was carried out. The minimum women dietary diversity score tool was assessed based on a 3-day 24-hour recall. Serum concentrations of vitamin B12, folate and iron were also measured

**Results:** The mean minimum dietary diversity score was 5.26±1.37. Z-test for proportions showed significant differences between the proportion of women who had good and poor diversities (41.3% vs 58.7%; P=0.013). Serum concentrations of iron, vitamin B12 and folate were 20.62±13.09µmol/L; 552.09±348.43ng/L and 3.72±ng/L respectively. Minimum dietary diversity score did not show any correlations with serum indices

**Conclusions:** Minimum dietary diversity score did not show any association with serum concentrations of iron, vitamin B12 and folate.

**Keywords:** Pregnant. Dietary diversity. Iron. Folate. Vitamin B12.

meal which has all the nutrients available to grow. A well-balanced diet is important for adequate nutrition to address common nutrient deficiencies among pregnant women that include iodine, iron, vitamin A and zinc. In settings where the prevalence of anaemia among women of reproductive age is 20% or higher, intermittent iron and folic acid supplementation is recommended as a public health intervention in menstruating women, to improve haemoglobin concentrations, iron status and reduce anaemia.

**Methods:** Study methods:

The study adopted a phenomenological case study approach. Using this qualitative methodology, this study fills a gap in the literature on pregnant women's experience in what to eat and why to eat that kind of foods during pregnancy. The voices of pregnant women were used in a form of narratives in the selected town. The kind of foods these women eat, during pregnancy forms the basis of this study.

**Results:** The research findings revealed different foods eaten by these pregnant women during pregnancy. Almost 75 percent of women between the ages of 18 – 25 years were eating what they were able to buy in terms of affordability, whilst the remaining 25 percent were following the prescribed menu from the antenatal clinics. Other findings were the social-cultural practices.

**Conclusions:** Poverty plays an important role in food intake and that it is not that awareness is not created or pregnant women have not been educated during antenatal about the kind of foods to eat during pregnancy but it is because they lack what it takes to buy the food. Majority confirmed that, they didn't have access to affordable healthy foods.

**Keywords:** Life course, nutrition, food security and deficiency

# PREGNANT WOMEN'S FOOD IN TAKE DURING PREGNANCY - A CASE STUDY IN TESHIE, A SUB-URB OF ACCRA

Akita, Morkor C.

FAO Regional Office For Africa. Nutrition Unit. Ghana

**Background and objectives:** The “Life Course Perspective” proposes that environmental exposures, such as, social, physical, biological, and behavioral factors, as well as life experiences, throughout the entire life span, influence health outcomes in current and future generations. Nutrition, from preconception to adulthood, encompasses all of these factors and has the potential to positively or negatively shape the individual or population health trajectories and their intergenerational differences. It is not just about eating food but it is about eating a well-balanced

# DIETARY STUDY IN CUBAN ELDERLY WITH ALZHEIMER'S DISEASE (AD) OR MILD COGNITIVE IMPAIRMENT (MCI)

(1)Lanyau Domínguez, Yeneisy; (2)Macías Matos, Consuelo; (3)Llibre Rodríguez, Juan Jesús; (4)Rodríguez Suárez, Armando; (5)Quintero Alejo, María Eugenia; (5)Arocha Oriol, Caridad; (6)Díaz Domínguez, Maybe; (7)Suárez Medina, Ramón; (6)Herrera Javier, Dania.

(1)MSc. Nutritionist. Center of Nutrition and Food Hygiene. National Institute of Hygiene. Epidemiology and Microbiology. Cuba.; (2)PhD. Center of Nutrition and Food Hygiene. Institute of Hygiene. Epidemiology and Microbiology. Cuba.; (3)PhD. Physician specialized in internal medicine. Center of Alzheimer's Study. Cuba; (4)PhD. Nutriotinist. Center of Nutrition and Food Hygiene. Institute of Hygiene, Epidemiology and Microbiology. Cuba; (5)BcS. Center of Nutrition and Food Hygiene. Institute of Hygiene, Epidemiology and Microbiology. Cuba; (6)BS. Center of Nutrition and Food Hygiene. Institute of Hygiene, Epidemiology and Microbiology. Cuba; (7)MSc. Statistc. Epidemiology Center. Institute of Hygiene, Epidemiology and Microbiology. Cuba.

**Background and objectives:** Background: Alzheimer's Disease, the most common form of dementia, is increasing at a rhythm without precedents at worldwide. Some epidemiological
studies have explored the relation between the diet and AD, some
foods have been related with dementia, while others no.

Objectives: To evaluate the association between the food intake
with MCI and AD with in Cuban elderly.

**Methods:** Cross sectional study in 424 subjects older than 65 years; 43 with AD, 131 with Mild Cognitive Impairment (MCI) and 250 normal subjects from Havana City. Dementia was diagnosed using the 10/66 Dementia and DSM-IV criteria and MCI with the Petersen criteria. Diet was evaluated using a weekly food-frequency questionnaire. Pearson's Chi square and prevalence ratios were used for data analysis.

**Results:** Food intake was not different between studied groups, with exception that cereals and tubers, intake was lowest in AD group. Fish, grains+fruits, vegetables, fats intake was inadequate in 80%, 60%, 50%, 50 % respectively, in the subjects of the three groups. It was not found any association between inadequate intake of different foods with the prevalence MCI and AD, only the inadequate intake of cereals and tubers was associated significantly with the prevalence of AD.

**Conclusions:** High frequency of older adults of three groups had insufficient intake of fish, grains+fruits, vegetables and fats. Only the insufficient intake the cereals and tubers was associated significantly with the prevalence of AD.

**Keywords:** Diet, Alzheimer's Disease, Cognitive Impairment.

**Results:** 2871 Colombian children were included; 52.1% males; 12.9±2.4 years old; with kcal=1950.4±672.2 kcal/m2/d, Cholest=346.0±205.6 mg/d, SFA=149.6±129.7 mgr/d, MFA=165.5±145.0 mgr/d and PUFAs=144.4±142.8 mgr/d, with malnutrition=28.9%, low height=5.9% and 4.4% abdominal obesity. They presented a high daily consumption in Cholest=46.4%, SFA=49.3%, MFA=11.6% and PUFAs=43.7%; being possible risk factors for the consumption of Cholest, SFA and PUFAs, geographical area, school, sex and malnutrition (p <0.05)

**Conclusions:** The daily consumption of these Colombian schoolchildren and adolescents for Cholest, SFA and PUFAs is higher than 43.7%; being possible risk factors, geographical area, school, sex and nutritional status

**Keywords:** Cholesterol, Saturated fatty acids, Mono-unsaturated fatty acids, Polyunsaturated fatty acids, Children

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DAILY CONSUMPTION OF CHOLESTEROL, SATURATED, MONO-UNSATURATED AND POLYUNSATURATED FATTY ACIDS IN COLOMBIAN SCHOOLCHILDREN AND ADOLESCENTS

Tabares, Daniela; Arias, Katherine; Velasco, Carlos.

Universidad del Valle. Cali. Colombia.

**Background and objectives:** A diet that achieves a healthy lifestyle from the point of view of cardiovascular prevention corresponds to a prudent diet recommended for the whole pediatric healthy population. The objective is to determine the daily consumption of cholesterol (Cholest), saturated fatty acids (SFA), mono-unsaturated fatty acids (MFA) and polyunsaturated fatty acids (PUFAs) through a 24-hour reminder in Colombian children, according to the Program For the Evaluation of Diets and Food Data Management (DIAL)

**Methods:** Study of prevalence among schoolchildren (n=1221) and adolescents (n=1650) between 8-18 years of age in the Andean (La Unión=476), atlantic (Cartagena=427), pacific (Cali=1220, Quilichao=356) and amazonic (Florencia=392) zone, from public (n=2342) and private (n=529) school, to whom sociodemographic (age, sex) and anthropometric (weight, height, circumference of waist) variables and were diagnosed of malnutrition by body mass index, low height by height/age and abdominal obesity by waist circumference. Normal daily intake of Colest=300 mg/d, SAF≤10% total caloric value (TCV), MFA≤15% TCV and PUFAs<10% TCV were considered according to age and sex

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THE INFLUENCE OF BREASTFEEDING HOSPITAL INITIATIVE ON NUTRITION KNOWLEDGE OF MOTHERS AND FEEDING PRACTICES OF CHILDREN IN LIMPOPO PROVINCE, SOUTH AFRICA

(1)Mbhenyane, Xikombiso; (2)Mandiwana, Tshifhiwa; (3)Mushaphi, Lindelani Fhumudzani; (2)Mbhatsani, Vanessa; (4)Mabapa, Solomon;

(2)Motadi, Selekane; (2)Mabasa, Eric; (2)Masia, Tirhani.

(1)PhD. Dietitian. Division of Human Nutrition. Stellenbosch University. South Africa.; (2)Msc. Nutritionist. Department of Nutrition. University of Venda. South Africa.; (3)PhD. Dietitian. Department of Nutrition. University of Venda. South Africa;

(4)Msc. Scientist. Department of Nutrition. University of Venda. South Africa.

**Background and objectives:** Baby Friendly Hospital initiative (BFHI) provides a vital contribution to achieving and sustaining the behaviours and practices necessary to enable every mother to give every child the best start in life by creating sustainable change beyond the hospital (WHO, 2008). The main aim was to evaluate the influence of BFHI on nutrition knowledge of mothers, breast feeding and feeding practices for children under two.

**Methods:** Cross sectional and exploratory with an analytical component. The target population was mothers with a new baby following their delivery either at the BHFI or Non-BFHI hospital. Mothers were purposefully recruited from randomly selected primary health care clinics located in the district. Data was collected by nutritionists using a validated questionnaire which had four sections namely demographic and environment factors, Nutrition knowledge on infant feeding, infant feeding practices, eating habits of children and mothers and a section for anthropometric data recording. Data was analyzed using SPSS, version 24. Descriptive statistics will percentiles, chi-square and Pearson's correlation with a p-value of >0.005.

**Results:** The final sample was 169 mothers and 169 children under two years. Data was analysed for 157 mother-child pairs with full data sets. 36.7% of mothers were from a BFHI status
hospital while 56.2% were from a Non-BFHI hospital. Mothers (61.7%) were aged between 21 – 30 years while children were between 7 – 24 months (91.5%).

Knowledge: 18.5% from BFHI status and 27.2% from Non-BFHI were taught on nutrition during pregnancy; 14.8% from BFHI status and 40.8% from Non-BFHI (p= 0.000) were taught on nutrition during breastfeeding; 15.4% from BFHI status and 35.4% from Non-BFHI (p = 0.009) were taught on nutrition during lactation.

Practices: 8.8% from BFHI status and 17.0% Non-BFHI exclusively breastfed their babies up to six months. 35.5% of all had already been started on formula with 24.3% having done so by 2 months. Many of the children had already been introduced to complementary feeds by 6 months with maize meal porridge (65.1%) being the first food.

**Conclusions:** The level of knowledge was higher with mothers from the Non-BFHI hospitals and the feeding practices were also better.

**Keywords:** Breastfeeding hospital initiative; mothers; feeding practices of children

31.9% teach mothers to initiate breastfeeding within 30 minutes of delivery, 1.3% could mention two signs of good attachment, 80% inform the mothers to request their babies weight any time they come to infant welfare clinics, 48.1% agreed that exclusive breastfeeding plus ARV drugs (for babies and positive mothers) is allowed respectively.

**Conclusion:** There is need to improve health workers' knowledge and counseling skills on IYCF practices through training and supportive supervision so as to enhance the nutritional status of infants and young children.

**Keywords:** Knowledge, health workers, infant, young child, Delta state.

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## LEVEL OF KNOWLEDGE AND TEACHING OF INFANT AND YOUNG CHILD FEEDING (IYCF) PRACTICES AMONG HEALTH WORKERS IN DELTA STATE

(1)Chrysanthus Chukwuemeka, Odo; (2)James, Okpoto; (2)Benson, Etchie.

(1)BSc. Dietitian-Nutritionist. Department of Internal Medicine. Federal Medical Centre Asaba Delta State. Nigeria.; (2)Degree (Bsc). Nutritionist. Delta State Primary Health Care Development Agency (DSPHCDA). Delta State Ministry of Health. Nigeria.

**Background and objectives:** Background: Infant and young child nutrition can be improved if health workers (Nurses and Community Health Extension Workers) with adequate nutrition knowledge provide nutrition education to pregnant/lactating mothers who attend Ante-Natal/IYCF Welfare clinics.

**Objectives:** To determine the Level of knowledge and teaching of Infant and Young Child Feeding (IYCF) practices among Health Workers in Delta State.

**Methods:** 235 Primary Health Centres (PHCs) were randomly selected from 445 functioning PHCs in Delta State. The most senior health workers: 198 Nurses and 37 Community Health Extension Workers (CHEWs); one from each Centre were used for the study in May, 2015. The survey instrument was a structured and validated questionnaire. Data obtained were on the subjects' knowledge and teaching of early initiation, exclusive breastfeeding, complementary feeding, etc. The data was analyzed using Epi-info 7. Frequencies and percentages were the statistical methods adopted to separate and compare mean values.

**Results:** 98.7% of the subjects give nutrition education to pregnant/lactating mothers during Ante-Natal/IYCF welfare clinics.

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## EFFECT OF PERICONCEPTIONAL MULTI MICRO-NUTRIENT SUPPLEMENTATION ON THE LEVEL OF TOTAL ANTIOXIDANT STATUS

**Background and objectives:** Antioxidant plays pivotal role to prevent abnormal pregnancy outcome that have correlation with oxidatif stress. This research aims to evaluate the effect of multiple (MMN) micronutrient supplementation in periconception period on the level of total antioxidant status (TAS).

**Methods:** Research was conducted in four sub-districts of the city of Makassar from January 2013 to October 2014 using a double-blind, randomized, controlled trial design. A total of 240 preconception women were recruited; 32 of these women became pregnant. The participants were randomly assigned into an intervention group (n=18) and a control group (n=14). The intervention group received (MMN) capsules, while the control group received iron/folic acid (IFA) capsules. The groups were instructed to take the capsules every day until a urine pregnancy test showed positive results for pregnancy. TAS eximinized using colorimetric technique. Statistical analysis was performed using the Wilcoxon and Mann-Whitney U tests.

**Results:** The results showed that the average level of TAS decreased in both the intervention (-0.09 ± 0.1 mmol/l; p=0.009) and control groups (-0.09 ± 0.1 mmol/l; p=0.01). However, these changes were not significant. Furthermore, the mean difference between the two groups was also not significant (p=0.76).

**Conclusions:** These findings suggest that periconceptional MMN supplementation can't prevent reduction of TAS in preg-

<footnote>(1)Otoluwa, Anang Samudera; (2)Hadju, Veni; (3)As'ad, Suryani;</footnote>

<footnote>(4)monoarfa, yustiyanty; (5)Yatim, Herwin; (6)Thaha, Abdul Razak.</footnote>

<footnote>(1)MD, MPPM, Dr. Lecturer. Academy of Nursing Luwuk.Banggai. Indonesia.; (2)MD, MSc, PhD. Lecturer. Department of Nutrition. School of Public Health. Hasanuddin University. Indonesia.; (3)MD. MSc. Dr. Lecturer. Department of Nutrition. Faculty of Medicine. Hasanuddin University. Indonesia.; (4)Ir. MKes. PhD Student. Airlangga University. Indonesia.; (5)Ir. MM. PhD Student at Brawijaya Malang. Indonesia.; (6)MD. MSc. Dr. Lecturer. Department of Nutrition. School of Public Health. Hasanuddin University. Indonesia.</footnote>